development of a cost-effective in-situ thoracic surgery
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• Across surgical specialties, simulation training is becoming a
mandatory part of the curriculum as it offers experiential learning
opportunities. (1)
• In thoracic surgery programs, there are some high fidelity technical
skill-based simulations but there is a lack of “non-technical skill”
learning exercises which encompasses competent teamwork and
communication. Furthermore, most existing simulation programs
involve expensive mannequin, animal models and dedicated
facilities.
• Non-technical skills have been identified as relevant factors
promoting a successful and meaningful career through appropriate
decision making, communication and interprofessional skills. (2)
Background
Development of a Cost-Effective In-Situ Thoracic Surgery Simulation Model
Joel Bierer1, Eustatiu Memu1, Robert Leeper2, Dalilah Fortin1, Eric Fréchette1,Richard I. Inculet1 and Richard A. Malthaner1
Divisions of 1Thoracic Surgery, 2General Surgery, London Health Sciences Centre, Western University, London, Canada
.
Figure 1. NOTTS Scores: Consultant and Resident.
• Our goal was to develop a simulation training program with the
following qualities:
• Low cost
• Readily reproducible scenarios
• High fidelity scenarios
• In-situ (in functional operating rooms)
• Focused on non-technical skills
• Feature components which also require technical skills
Figure 3. MMMO Fidelity Scores.
Objective
Methods
Results Summary
• Three thoracic surgery experts and three thoracic surgery residents
were evaluated by four Thoracic Surgery Consultants through the
NOTTS and TeamSTEPPS2 criteria.
• All simulation participants completed MMMO questionnaire.
• A number of latent safety threats were identified within our
institution.
Figure 2. TeamSTEPPS2 Scores: Consultant and Resident.
• The simulation was trialed with thoracic surgery consultants and
residents with great effectiveness.
• NOTTS and TEAMSTEPPS2 scores proved the simulations validity
as it was able to differentiate trainee from consultant.
• There was a very positive response to this simulation training as
evident in the MMMO scores.
• In addition to trainee learning, this simulation program was able to
identify latent safety threats which can be addressed to improve
patient safety at our own institution.
• This is a unique simulation, in terms of learning objectives and in-
situ nature, and is a Canadian first.
• A novel and inexpensive Canadian in-situ Thoracic Surgery crisis
simulation model was developed and used to identify latent safety
threats and reinforce team training behaviors in a high risk clinical
setting.
Future Direction • This simulation model will be featured as part of the 2016 Canadian
Thoracic Surgery Boot Camp.
References (1) Envisioning simulation in the future of thoracic surgical education. J. Thorac. Cardiovas.
Surg. 135:477
(2) Yule 2., et al. 2009. Experience matters: comparing novice and expert ratings of non-
technical skills using the NOTSS system. Anz. J. Surg. 79:154
(3) TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety. 2015.
Agency for Healthcare Research and Quality. Available at:
www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html.
(4) Tong B., et al. 2012. Validation of a thoracoscopic lobectomy simulator. Eur. J.
Cardiothorac. Surg. 42:364
Development Method
• This first scenario featured a post-pneumonectomy airway obstruction by
residual tumor.
• Thoracic surgery expert opinion design the simulation algorithm.
• The physical model featured a functioning operating room and a modified
Laerdal airway mannequin.
Simulation Model
• Laerdal Vital Sign SimulatorTM program was projected to OR screens to
drives the simulation as the patient’s vitals are changed in real time to
reflect the team’s progression through the crisis scenario.
• Each simulation features a thoracic surgeon, confederate anesthesiologist
and three surgical nurses.
• Laerdal airway mannequin was easily and reversibly modified to resemble
the patient by clamping the right bronchus and positioning a fixed tumor
replica to block the left airway.
• Real-time flexible bronchoscopy was available to visualize the obstruction.
• Rigid bronchoscopy kit was available upon request.
• Anesthesia cart and intubation equipment was present.
Simulation Training
• Non-technical skill curricula was previously sent out to participants to
identify learning objectives.
• All simulations were recorded and all participants were subsequently
evaluated through the NOTSS and TeamSTEPPS2 criteria. (2,3)
• Each participant had a 15 minute performance debrief to solidify learning.
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