Defining and Addressing Anesthesiology Needs in Simulation-based Medical Education

Abstract

Background: This study's primary aim was to determine how training programs use simulation-based medical education (SBME), because SBME is linked to superior clinical performance.

Methods: An anonymous 10-question survey was distributed to anesthesiology residency program directors across the United States. The survey aimed to assess where and how SBME takes place, which resources are available, frequency of and barriers to its use, and perceived utility of a dedicated departmental education laboratory.

Results: The survey response rate was 30.4% (45/148). SBME typically occurred at shared on-campus laboratories, with residents typically participating in SBME 1 to 4 times per year. Frequently practiced skills included airway management, trauma scenarios, nontechnical skills, and ultrasound techniques (all ≥ 77.8%). Frequently cited logistical barriers to simulation laboratory use included COVID-19 precautions (75.6%), scheduling (57.8%), and lack of trainers (48.9%). Several respondents also acknowledged financial barriers. Most respondents believed a dedicated departmental education laboratory would be a useful or very useful resource (77.8%).

Conclusion: SBME is a widely incorporated activity but may be impeded by barriers that our survey helped identify. Barriers can be addressed by departmental education laboratories. We discuss how such laboratories increase capabilities to support structured SBME events and how costs can be offset. Other academic departments may also benefit from establishing such laboratories.

Keywords: Simulation; anesthesia; education; milestones; residency; survey.

Figure 1.

Primary simulation space for programs. The pie chart in Figure 1 depicts the distribution of respondents’ answers for question 5 of our survey (n = 45): “In which location does the majority of simulation-based training take place at your program?” Respondents were only able to select 1 answer. Other responses to this question consisted of 1 of each of the following responses: an off campus, affiliated, shared lab; empty operating rooms; and a central shared laboratory that is on campus for the medical school but off campus for the center’s department.

Figure 2.

Skills and activities at primary simulation spaces. The bar chart in Figure 2 depicts the distribution of respondents’ answers for question 6 of our survey (n = 45): “Which skills are practiced/which activities occur in the place you listed above [i.e., at the primary simulation space],” in descending order by percentage of respondents who selected each skill. This question allowed respondents to select multiple options simultaneously, as applicable; thus, percentages for the answers total to over 100%. Other responses to question 6 consisted of 1 of each of the following responses: introduction to pediatrics rotation; clinical scenarios, OSCE [Objective Structured Clinical Examination] preparations, and cadaver lab; specific anesthesia complications; point-of-care ultrasound; and crisis resource management. One respondent did not provide details for their selection of other for this question.

Figure 3.

Resources at primary simulation spaces. The bar chart in Figure 3 depicts the distribution of respondents’ answers for question 7 of our survey (n = 45): “What resources are available at the primary center for simulation-based training,” in descending order by percentage of respondents who selected each resource. This question allowed respondents to select multiple options simultaneously, as applicable; thus, percentages for the answers total to over 100%. Other responses to question 7 consisted of 1 of each of the following responses: video and standardized patients.

Figure 4.

Barriers to simulation. The bar chart in Figure 4 depicts the distribution of respondents’ answers for question 8 of our survey (n = 45): “What kinds of barriers exist that prevent/hamper the use of simulation-based training at your center, if any,” in descending order by percentage of respondents who selected each resource. This question allowed respondents to select multiple options simultaneously, as applicable, or select N/A - I am not aware of any such barriers; thus, percentages for the answers total to over 100%. Other responses to question 8 consisted of 1 of each of the following responses: faculty time availability, time away from clinical duties, and clinical schedule and clinical work demands.

Supplemental Figure 1.

Anesthesia Education Laboratory photograph. The photograph shows the Anesthesia Education Laboratory (AEL) at Beth Israel Deaconess Medical Center (BIDMC). The photograph was taken by the entrance to the AEL.

Supplemental Figure 2.

Anesthesia Education Laboratory concept image. The figure is the actual concept image of the Anesthesia Education Laboratory (AEL) at Beth Israel Deaconess Medical Center from the planning phase for establishing this space. Note that only the areas in the center of this figure represent the AEL (including the huddle room depicted on the bottom left corner) and that the cabinets depicted toward the upper right were ultimately omitted to accommodate computer screens.

Supplemental Figure 3.

Anesthesia Education Laboratory blueprint. The blueprint of the Anesthesia Education Laboratory (AEL) at Beth Israel Deaconess Medical Center is not drawn to scale. The dimensions of the entire space are 18 ft 6 in × 29 ft (540 sq ft), whereas the huddle room depicted in the top left is 8 ft 3 in × 8 ft 9 in. A photograph of the AEL can be seen in Supplemental Figure 1; concept art for the AEL can be seen in Supplemental Figure 2.