• Resident Simulation

  • The Department of Anesthesiology Simulation Center services medical students, residents, fellows, advanced practice providers, nurses, and faculty. The UTSW Anesthesia Patient Safety Simulation team utilizes a state-of-the-art High Fidelity Simulation lab, trained confederates (actors), and seasoned simulation instructors to create a dynamic, interactive, and safe learning environment. Using a video-assisted debriefing model, our certified instructors enable the participant to self-reflect on their ability to navigate an emergent situation.

    PATIENT SAFETY FOCUS

    Our anesthesia simulation team is currently the driving force on the UTSW medical campus behind patient safety simulation. Over the 2012-2014 period, our simulation team’s focus has been on horizontal and vertical integration of simulation resources across the UTSW campus. We have sought to align the needs and resources of all groups currently conducting simulation at UTSW.

    Being the leaders in team training on campus, with special certification in the AHRQ TeamSTEPPS® curriculum, we hope to empower the various departments conducting simulation with “Train the trainer” sessions on the AHRQ TeamSTEPPS® crisis resource management training. Currently, we conduct team training with the departments of medicine, obstetrics and gynecology, as well as the emergency medicine department.

    Patient Safety Courses that we currently offer:

    1. Perioperative consultant and patient safety course (ABA approved)

    The Specific course objectives include:

    • Communication: We will discuss strategies for promoting effective communication in group settings such as SBAR, call outs, check backs, and closed-loop communication
    • Human Factors: Participants will appreciate the fundamentals of Human factors engineering and display an understanding of incorporating redundancies and checks and balances into systems. There will also be a focus on developing methods to standardize protocols
    • Epidemiology of Errors: Participants will learn the background of the national patient safety movement, as well as a discussion on differences between latent and active failures
    • Systems-Based Practices as they relate to Patient Safety: We will dissect the key components of the system-at-large, discuss each element’s role in the system, as well as discuss how a breakdown in one of these elements can affect patient safety
    • Methods and Tools to Evaluate Safety Events: We will discuss risk assessment, root cause analysis, and failure modes and effects analysis.

    2. Central Venous Access and Complications Course

    At the end of this course, the participant will be able to:

    • Obtain central venous access in the Internal Jugular and Subclavian Venous locations
    • Manage and Treat common central venous access related emergencies
    • Demonstrate an algorithmic approach to the diagnosis of unstable hemodynamics
    • Recognize and apply Crisis Resource Management principles in emergent settings
    • Demonstrate proper sterile technique for central venous access placement

    3. Sedation for the Non Anesthesiologist Course

    At the end of this course, the participant will be able to:

    • Understand the pharmacokinetics of fentanyl, midazolam, ketamine, and propofol
    • Demonstrate basic airway management skills, including bag mask ventilation, LMA placement, and tracheal intubation
    • Exhibit the ability to assess ventilation and oxygenation
    • Display knowledge of ASA standards for Monitoring and Sedation outside the OR

    4. AHRQ Team STEPPS Train the Trainer Course

    At the end of this course, the participant will be able to:

    • Demonstrate the necessary skills of an effective team approach to an emergent situation using CRM principles
    • Utilize enhanced communication techniques to optimize team dynamics
    • Implement brain-based learning strategies to facilitate alignment of a multi-disciplinary team to patient care

    SIMULATION METHODOLOGY

    Multi-disciplinary Approach to Simulation: We incorporate a multi-faceted approach to simulation designed to enhance patient safety in the peri-operative period. We aim to engage all types of adult learners—auditory, visual, kinesthetic, experiential--by including multi-media, high-fidelity and medium-fidelity simulation, didactics, and group dynamic problem-based learning discussions.

    • Realism: We take special measures to insure the “fidelity” or “realism” of the participant encounters in the simulation lab-- in everything from the yellow food coloring in the foley bag, to live on-demand media streaming projected on flat screens (TEE imaging, video laryngoscopy, etc.). We utilize live confederates with scripted roles, and on occasion, standardized patients to insure fidelity when needed
    • Hybrid Model Simulation: We define ourselves as a team by the novel use of a hybrid model simulation, whereby we integrate medium fidelity task trainers into the high fidelity environment. This unique blending of simulation modalities allows us to develop a unique opportunity for episodic memory to develop

    SIMULATION RESOURCES

    Equipment:

    • 2x Lardael SimMan 3G Manikins.
    • 3x Lardael Medium Fidelity Airway Manikins
    • 2x Phantom Blue Central Line Task Trainers

    Facility: 

    • Virtual Operating Room. This simulation lab is located at the UTSW Medical School in the Southwestern Center for Minimally Invasive Surgery (SCMIS). Measuring 18 feet by 20 feet, this is an exact replica of a modern-day operating room. It is equipped with live functional laparoscopic equipment needed for surgical-nursing-anesthesia team training
    • Multi-purpose Simulation Room: Adjacent to the virtual OR is a smaller simulation lab which can be outfitted to represent of variety of other healthcare environments.

     Break Out Space:

    • Teleconferencing classroom directly adjacent to the virtual OR, which can accommodate 55 individuals and is fully equipped for broadcast of training exercises internally from the virtual OR to the classroom or anywhere worldwide.
    • Skills lab equipped with tasks trainers for airway management and invasive line placement.
    • Debrief Room: conference room with live video feed seating 10-15 for video debriefing.


    SIMULATION COURSE OFFERINGS

    Here is just a short list of some of the various opportunities offered by the UTSW Department of Anesthesiology Simulation Team:

    MEDICAL STUDENTS

    • MS-1 Applied Physiology Clinical Correlate Simulation Lab: We have partnered with the physiology faculty at the UTSW medical school to establish a simulation-based clinical correlate curriculum for the first year physiology course
    • MS-3 & 4 Clerkship in Anesthesia: Medical students are then re-introduced to the simulation lab as third and fourth year anesthesia clerkship rotators, where their knowledge base of physiology in the context of disease is expanded upon to build their foundation in critical care medicine. The clerkship curriculum allows for medical student simulation on a weekly basis throughout the academic year

    INTERNS

    PGY-1 Vapor Camp: The month prior to entering the operating room environment, UTSW anesthesia interns are immersed over the course of a week to over 100 mini-simulations, that underscore many of the basic anesthetic principles they will encounter almost immediately upon the first days of entering the operating room as anesthesia residents. This curriculum serves as the resident’s first exposure to the foundations of safe anesthetic practice, upon which we build and expand throughout the residency.

    RESIDENTS

    • CA-1: The first year simulation curriculum in anesthesia is broad, with over 150 fully-integrated and validated scenarios, spanning the entire gamut of anesthetic practice. The goals of the first year curriculum are heavily weighted on crisis resource management training. There is also a particular focus on the core principles of critical care medicine central to perioperative medicine, as well as the unique knowledge base of the anesthesiologist as the definitive airway manager, resuscitation expert, and peri-operative pharmacologist
    • CA-2&3: As the resident matriculates to subspecialty rotations (obstetrics, cardiac, pediatric, acute regional, ICU), we incorporate advanced simulation scenarios into these subspecialty rotations. These simulation courses are designed to challenge a graduating anesthesiologist, and enable our residents to nurture their clinical judgment skills, and ultimately to develop their voice as a perioperative consultant
    • ACGME Milestone Metrics Evaluations: Medical knowledge and patient care metrics are evaluated by the simulation lab for the anesthesia residency. Specifically, residents matriculate through airway simulation and are evaluated against benchmarks deemed appropriate for their level of training

    TEAM TRAINING

    • High-Risk Obstetric Team Training: We have developed and implemented team-training exercises for horizontal integration of healthcare providers involved in the care of High-Risk Obstetric Patients. Participants include Obstetrics residents, Anesthesia residents, and Labor and Delivery nurses. Seasoned OB/GYN, Anesthesia, and Nursing faculty work together to implement scenarios centered around high-fidelity obstetric crises. These scenarios serve as a launching pad to discuss modifications of behavioral characteristics needed to optimize the management of a crisis using TeamSTEPPS principles
    • Code Response Team Training: In the Zale-Lipshy ICU, we have implemented mock codes to align the various members of the Code Response teams in this particular hospital system. Moreover, there is also a emphasis highlighting the importance of CRM and TeamSTEPPS® in effectively managing a code.

    GRANTS & RESEARCH

    • 2013 University of Texas Patient Safety Committee Grant. Critical Decisions: Improving Patient Safety and Healthcare Delivery Effectiveness through Serious Gaming Technology
    • 2013 Application of Simulation in Large Group Settings Integrating Automated Response Systems (Dr. Bhoja)
    • 2014 Biometric Validation of the AHRQ Team STEPPS Curriculum (Dr. Guttman)

    FUTURE DIRECTION

    MOCA CERTIFICATION
    We have currently submitted our application to the American Society of Anesthesiology (ASA) for endorsement as a national simulation center that administers the Part IV Maintenance of Certification in Anesthesiology. The ASA has recognized the invaluable benefits behind simulation in medical education, and has now mandated simulation for re-credentialing of all board-certified anesthesiologists. We anticipate approval by January 2014.

    UTSW Texas Clinical Safety and Effectiveness integration of the AHRQ TeamSTEPPS® Curriculum
    Dr. Guttman is in the process of integrating the AHRQ TeamSTEPPS® curriculum into the UTSW CS&E Course.

    Acute and Chronic Pain Symposium
    A high-fidelity simulation course, by Dr. Humair Rana and Dr. Brian Adams, is being developed, focusing on acute and chronic pain emergencies. This course will be expanded into a full day seminar, incorporating ultrasound and regional block techniques, offered to the Dallas Anesthesia Community.

    UTSW 2018 West Campus Simulation Patient Safety Center

    Both Dr. Guttman and Dr. Bhoja sit on the UTSW Simulation Steering Committee. They have offered their vision and simulation experience to the committee on resource allocation and specifically, on Vertical Integration—the alignment and collaboration of needs and resources within the bodies of UME, GME, CME, and Quality, with a unifying vision for the future of simulation and immersive learning here on campus.