Simulation Training

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.Since the initiation of our simulation lab, 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.
• CLICK HERE TO VIEW THE FACILITY!

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.

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. Ambardekar)

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. Ambardekar 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. Ambardekar 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.