Unanticipated Difficult Airway in Obstetric Patients

Background The objective of this study was to develop a consensus-based algorithm for the management of the unanticipated difficult airway in obstetrics, and to use this algorithm for the assessment of anesthesia residents' performance during high-fidelity simulation. Methods An algorithm for unanticipated difficult airway in obstetrics, outlining the management of six generic clinical situations of "can and cannot ventilate" possibilities in three clinical contexts: elective cesarean section, emergency cesarean section for fetal distress, and emergency cesarean section for maternal distress, was used to create a critical skills checklist. The authors used four of these scenarios for high-fidelity simulation for residents. Their critical and crisis resource management skills were assessed independently by three raters using their checklist and the Ottawa Global rating scale. Results Sixteen residents participated. The checklist scores ranged from 64-80% and improved from scenario 1 to 4. Overall Global rating scale scores were marginal and not significantly different between scenarios. The intraclass correlation coefficient of 0.69 (95% CI: 0.58, 0.78) represents a good interrater reliability for the checklist. Multiple critical errors were identified, the most common being not calling for help or a difficult airway cart. Conclusions Aside from identifying common critical errors, the authors noted that the residents' performance was poorest in two of our scenarios: "fetal distress and cannot intubate, cannot ventilate" and "maternal distress and cannot intubate, but can ventilate." More teaching emphasis may be warranted to avoid commonly identified critical errors and to improve overall management. Our study also suggests a potential for experiential learning with successive simulations.

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P.181 High-Fidelity Simulation-Based Microsurgical Training for Neurosurgical Residents

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.457 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S72-S72

Author(s):

B Santyr ◽

M Abbass ◽

A Chalil ◽

D Krivosheya ◽

LM Denning ◽

...

Keyword(s):

Rating Scale ◽

Global Rating Scale ◽

High Fidelity ◽

Global Rating ◽

High Fidelity Simulation ◽

Femoral Vessel ◽

Simulation Based ◽

Microsurgical Techniques ◽

One Year ◽

Training Modules

Background: Microsurgical techniques remain a cornerstone of neurosurgical training. Despite this, neurosurgical microvascular case volumes are decreasing as endovascular and minimally invasive options expand. As such, educators are looking towards simulation to supplement operative exposure. We review a single institution’s experience with a comprehensive, longitudinal microsurgical simulation training program, and evaluate its effectiveness. Methods: Consecutive postgraduate year 2 (PGY-2) neurosurgery residents completed a one-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat femoral vessel training modules were used. Trainee performance was video recorded and blindly graded using the Objective Structured Assessment of Technical Skills Global Rating Scale. Results: Eighteen participants completed 107 microvascular anastomoses during the study. There was significant improvement in six measurable skills during the curriculum. Mean overall score was significantly higher on the fifth attempt compared to the first attempt for all 3 live anastomotic modules (p<0.001). Each module had a different improvement profile across the skills assessed. The greatest improvement was observed during artery-to-artery anastomosis. Conclusions: This high-fidelity microsurgical simulation curriculum demonstrated a significant improvement in the six microneurosurgical skills assessed, supporting its use as an effective teaching model. Transferability to the operative environment is actively being investigated.

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A CanMEDS Competency-Based Assessment Tool for High-Fidelity Simulation in Internal Medicine: The Montreal Internal Medicine Evaluation Scale (MIMES)

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v13i4.280 ◽

2018 ◽

Vol 13 (4) ◽

pp. e10-e16

Author(s):

Patrice Chrétien Raymer ◽

Jean-Paul Makhzoum ◽

Robert Gagnon ◽

Arielle Levy ◽

Jean-Pascal Costa

Keyword(s):

Internal Medicine ◽

Rating Scale ◽

Assessment Tool ◽

Teaching Method ◽

Global Rating Scale ◽

High Fidelity ◽

Global Rating ◽

High Fidelity Simulation ◽

Holistic Teaching ◽

Competency Based

Introduction: High-fidelity simulation is an efficient and holistic teaching method. However, assessing simulation performances remains a challenge. We aimed to develop a CanMEDS competency-based global rating scale for internal medicine trainees during simulated acute care scenarios. Methods: Our scale was developed using a formal Delphi process. Validity was tested using six videotaped scenarios of two residents managing unstable atrial fibrillation, rated by 6 experts. Psychometric properties were determined using a G-study and a satisfaction questionnaire.Results: Most evaluators favorably rated the usability of our scale, and attested that the tool fully covered CanMEDS competencies. The scale showed low to intermediate generalization validity.Conclusions: This study demonstrated some validity arguments for our scale. The best assessed aspect of performance was communication; further studies are planned to gather further validity arguments for our scale and to compare assessment of teamwork and communication during scenarios with multiple versus single residents.

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Effect of Simulation Training on Compliance with Difficult Airway Management Algorithms, Technical Ability, and Skills Retention for Emergency Cricothyrotomy

Anesthesiology ◽

10.1097/aln.0000000000000138 ◽

2014 ◽

Vol 120 (4) ◽

pp. 999-1008 ◽

Cited By ~ 50

Author(s):

Vincent Hubert ◽

Antoine Duwat ◽

Romain Deransy ◽

Yazine Mahjoub ◽

Hervé Dupont

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Rating Scale ◽

Global Rating Scale ◽

Global Rating ◽

Difficult Airway Management ◽

Management Guidelines ◽

Checklist Score ◽

Skills Retention ◽

The Impact

Abstract Background: The effectiveness of simulation is rarely evaluated. The aim of this study was to assess the impact of a short training course on the ability of anesthesiology residents to comply with current difficult airway management guidelines. Methods: Twenty-seven third-year anesthesiology residents were assessed on a simulator in a “can’t intubate, can’t ventilate” scenario before the training (the pretest) and then randomly 3, 6, or 12 months after training (the posttest). The scenario was built so that the resident was prompted to perform a cricothyrotomy. Compliance with airway management guidelines and the cricothyrotomy’s duration and technical quality were assessed as a checklist score [0 to 10] and a global rating scale [7 to 35]. Results: After training, all 27 residents (100%) complied with the airway management guidelines, compared with 17 (63%) in the pretest (P < 0.005). In the pretest and the 3-, 6-, and 12-month posttests, the median [range] duration of cricothyrotomy was respectively 117 s [70 to 184], 69 s [43 to 97], 52 s [43 to 76], and 62 s [43 to 74] (P < 0.0001 vs. in the pretest), the median [range] checklist score was 3 [0 to 7], 10 [8 to 10], 9 [6 to 10], and 9 [4 to 10] (P < 0.0001 vs. in the pretest) and the median [range] global rating scale was 12 [7 to 22], 30 [20 to 35], 33 [23 to 35], and 31 [18 to 33] (P < 0.0001 vs. in the pretest). There were no significant differences between performance levels achieved in the 3-, 6-, and 12-month posttests. Conclusion: The training session significantly improved the residents’ compliance with guidelines and their performance of cricothyrotomy.

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Fiberoptic Oral Intubation

Anesthesiology ◽

10.1097/aln.0b013e31818d6c3c ◽

2008 ◽

Vol 109 (6) ◽

pp. 1007-1013 ◽

Cited By ~ 77

Author(s):

Deven B. Chandra ◽

Georges L. Savoldelli ◽

Hwan S. Joo ◽

Israel D. Weiss ◽

Viren N. Naik

Keyword(s):

Virtual Reality ◽

Operating Room ◽

Rating Scale ◽

Training Model ◽

Educational Interventions ◽

Global Rating Scale ◽

High Fidelity ◽

Global Rating ◽

Significant Difference ◽

Better Than

Background Previous studies have indicated that fiberoptic orotracheal intubation (FOI) skills can be learned outside the operating room. The purpose of this study was to determine which of two educational interventions allows learners to gain greater capacity for performing the procedure. Methods Respiratory therapists were randomly assigned to a low-fidelity or high-fidelity training model group. The low-fidelity group was guided by experts, on a nonanatomic model designed to refine fiberoptic manipulation skills. The high-fidelity group practiced their skills on a computerized virtual reality bronchoscopy simulator. After training, subjects performed two consecutive FOIs on healthy, anesthetized patients with predicted "easy" intubations. Each subject's FOI was evaluated by blinded examiners, using a validated global rating scale and checklist. Success and time were also measured. Results Data were analyzed using a two-way mixed design analysis of variance. There was no significant difference between the low-fidelity (n = 14) and high-fidelity (n = 14) model groups when compared with the global rating scale, checklist, time, and success at achieving tracheal intubation (all P = not significant). Second attempts in both groups were significantly better than first attempts (P < 0.001), and there was no interaction between "fidelity of training model" and "first versus second attempt" scores. Conclusions There was no added benefit from training on a costly virtual reality model with respect to transfer of FOI skills to intraoperative patient care. Second attempts in both groups were significantly better than first attempts. Low-fidelity models for FOI training outside the operating room are an alternative for programs with budgetary constraints.

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Non-technical skills of medical students in the course of pediatric emergency simulations are associated with their mindfulness: an observational cohort study

10.21203/rs.2.11230/v1 ◽

2019 ◽

Author(s):

Jacek Chmielewski ◽

Włodzimierz Łuczyński ◽

Jakub Dobroch ◽

Grzegorz Cebula ◽

Tomasz Bielecki ◽

...

Keyword(s):

Medical Students ◽

Rating Scale ◽

Technical Skills ◽

Pediatric Emergency ◽

Global Rating Scale ◽

Attention And Memory ◽

High Fidelity ◽

Global Rating ◽

Extreme Stress ◽

Fixation Error

Abstract Background High fidelity medical simulations allow for teaching medical skills in safe and realistic conditions. Pediatric teams of emergency departments work under extreme stress, which affects high-level cognitive functions, specifically attention and memory, and increases the already high stakes for young doctors. Lapses in attention increase the risk of serious consequences such as medical errors, failure to recognize life-threatening signs and symptoms, and other essential patient safety issues. Mindfulness as a process of intentionally paying attention to each moment with curiosity, openness and acceptance of each experience without judgment can potentially contribute to improving the performance of medical teams in conditions of pediatric emergency. The aim of the study was to determine whether the actions of medical students in the course of pediatric high fidelity simulations are related to their mindfulness. Participants and methods A total of 166 standardized simulations were conducted among students of medicine in three simulation centers of medical universities, assessing: stress sensation, technical skills (checklists), non-technical skills (Ottawa Crisis Resource Management Global Rating Scale) and mindfulness using Five Facet Mindfulness Questionnaire. Results The perception of stress among students was lower and more motivating if they were more mindful. Mindfulness of students correlated positively with avoiding fixation error, but negatively with listening to and managing the team. The lowest scores among non-technical skills were noted in the area of situational awareness (fixation error). In subsequent simulations of the same team, students' non-technical skills improved, although no change was noted in their technical skills. Conclusions The results of our research indicate the relationship between the mindfulness of medical students and their non-technical skills and the perception of stress in pediatric emergency simulations. Further research is needed to show whether mindfulness training leads to any changes in this field. Trial registration ClinicalTrials.gov, NCT03761355).

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Otoskills training during covid-19 pandemic: a before-after study

BMC Medical Education ◽

10.1186/s12909-021-02706-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maxime Fieux ◽

Antoine Gavoille ◽

Fabien Subtil ◽

Sophie Bartier ◽

Stéphane Tringali

Keyword(s):

Surgical Training ◽

Rating Scale ◽

Surgical Simulation ◽

Global Rating Scale ◽

Middle Ear Surgery ◽

Global Rating ◽

Training Requirements ◽

Significant Difference ◽

Before And After ◽

Total Performance

Abstract Background The ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator. Methods In this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively. Results Six out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40–0.64], p < 0.001), without a significant difference between novice and intermediate residents. Conclusions This preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

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The ASSET Global Rating Scale is a Valid and Reliable Adjunct Measure of Performance on a Virtual Reality Simulator for Hip Arthroscopy.

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.01.046 ◽

2021 ◽

Author(s):

Meghan E. Bishop ◽

Gabriella E. Ode ◽

Daniel Hurwit ◽

Stephan Zmugg ◽

Ryan Rauck ◽

...

Keyword(s):

Virtual Reality ◽

Hip Arthroscopy ◽

Rating Scale ◽

Global Rating Scale ◽

Global Rating ◽

Virtual Reality Simulator ◽

Measure Of Performance

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Objective structured assessment of technical skill in temporal bone dissection: validation of a novel tool

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001201 ◽

2021 ◽

pp. 1-11

Author(s):

M Stavrakas ◽

G Menexes ◽

S Triaridis ◽

P Bamidis ◽

J Constantinidis ◽

...

Keyword(s):

Temporal Bone ◽

Rating Scale ◽

Assessment Tool ◽

Three Dimensional ◽

Technical Skills ◽

Technical Skill ◽

Global Rating Scale ◽

Global Rating ◽

Validity And Reliability ◽

Cortical Mastoidectomy

Abstract Objective This study developed an assessment tool that was based on the objective structured assessment for technical skills principles, to be used for evaluation of surgical skills in cortical mastoidectomy. The objective structured assessment of technical skill is a well-established tool for evaluation of surgical ability. This study also aimed to identify the best material and printing method to make a three-dimensional printed temporal bone model. Methods Twenty-four otolaryngologists in training were asked to perform a cortical mastoidectomy on a three-dimensional printed temporal bone (selective laser sintering resin). They were scored according to the objective structured assessment of technical skill in temporal bone dissection tool developed in this study and an already validated global rating scale. Results Two external assessors scored the candidates, and it was concluded that the objective structured assessment of technical skill in temporal bone dissection tool demonstrated some main aspects of validity and reliability that can be used in training and performance evaluation of technical skills in mastoid surgery. Conclusion Apart from validating the new tool for temporal bone dissection training, the study showed that evolving three-dimensional printing technologies is of high value in simulation training with several advantages over traditional teaching methods.

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