A national collaborative simulation project: paediatric anaesthetic emergencies

Abstract

In collaboration with nine simulation centres in the United Kingdom, we are developing a national core skills paediatric simulation course for specialist registrars (SpRs) during their paediatric anaesthetic training module. The Royal College of Anaesthetists (RCA) states: '(trainees should have) strategies and practice for the management of anaesthetic emergencies in children: loss of airway, laryngospasm, failed venous access, suxamethonium apnoea and anaphylaxis including latex allergy' (1). This is unlikely due to the limited time SpRs spend in paediatric anaesthesia, the time constraints of the European working time directive and the centralisation of paediatric services. Paediatric simulators may provide this exposure in a short time frame. High fidelity patient simulators are computer driven mannequins that mimic the anatomy, physiology and pharmacology of a vast number of different patients and pathological states. Any intervention by the learner, leads to real-time interactive changes in the patient/simulator condition. This includes airway manipulation, airway instrumentation, ventilation strategies, delivery of anaesthetic gases and delivery of intravenous fluids and drugs. In the aviation industry simulator training has enhancedsafety (2); whether simulator training in medicine improves clinical performance or patient safety has yet to be proven. What is known is that simulator training improves confidence and performance when dealing with a simulated scenario for the second time and healthcare workers find simulator training both useful and enjoyable (3-6). After ethical approval the first stage of this project involved development of five evidence based peer reviewed scenarios. An extensive literature review for each scenario was completed. Evidence based management guidelines for each of the emergencies were drawn up. After some iteration the scenarios and guidelines were endorsed by the participating centres. The next stage involves programming the simulators and planning the content and structure of the course. A pilot course will be run at one simulation centre to assess validity of the emergency scenarios. Conclusions: This is the first time a national collaborative simulator project has been undertaken in the UK. It may be extremely useful in training for emergencies in paediatric anaesthesia. It is a model that could be adapted for simulator training in other specialities in medicine. Morgan PJ. Experimental learning in anaesthesia simulation centre: analysis of students' comments. Med Teach 2002; 24: 23-26. 6 Chopra V et al. Does training on an anaesthesia simulator lead to an improvement in performance? Br

Ten years of simulation‐based training in pediatric anesthesia: The inception, evolution, and dissemination of the Managing Emergencies in Pediatric Anesthesia (MEPA) course

“…The MEPA course was piloted in Bristol in 2006 and shortly thereafter in pediatric hospitals around the UK (the home institutions of the committee members) . From the outset it was specified that the faculty providing the course should include at least one full‐time tertiary level pediatric anesthetist (so as to confer content expertise/credibility) and one accredited simulation educator (so as to adhere to best practices in adult learning).…”

“…In 2006, a group of medical educators in Bristol, UK sought to tackle a challenge intrinsic to the modular rotation of anesthetics training. Pediatric anesthesia attachments could be as brief as 3 months and yet the expected competencies specified by the Royal College of Anaesthetists (UK) included management of some exceedingly rare events . In a competency‐based framework based in part on observed patient encounters, it was unlikely that the trainee could be “signed‐off” on real‐life events during their short period in pediatric anesthesia.…”

“…Pediatric anesthesia attachments could be as brief as 3 months and yet the expected competencies specified by the Royal Accepted: 26 July 2017 DOI: 10.1111/pan.13224 College of Anaesthetists (UK) included management of some exceedingly rare events. 2 In a competency-based framework based in part on observed patient encounters, it was unlikely that the trainee could be "signed-off" on real-life events during their short period in pediatric anesthesia. It followed that a logical solution would be to use simulation as an educational modality.…”

Simulation in pediatric anesthesiology

“…An evidence‐based approach would provide the broadest utility for simulation, both nationally and internationally. Such an approach has been developing in the United Kingdom and now in Canada with the MEPA program for registrars . The combination of an evidence‐based set of scenarios that are combined with an expert consensus about effective management would provide a curriculum that benefits subspecialty practice in pediatric anesthesiology.…”

Board 152 - Program Innovations Abstract Transcontinental Telesimulation

“…1 Initially, a collaboration comprising a few simulation centres with a core faculty of paediatric anesthesiology educators, the spirit of collaboration has been maintained as the group has grown to include MEPA centres delivering a standardized curriculum in multiple centres on four continents. 1 Initially, a collaboration comprising a few simulation centres with a core faculty of paediatric anesthesiology educators, the spirit of collaboration has been maintained as the group has grown to include MEPA centres delivering a standardized curriculum in multiple centres on four continents.…”