Evaluating training for a simulated team in complex whole procedure simulations in the endovascular suite

Abstract

Introduction: Simulators supporting the development of technical skills for complex procedures are gaining prominence. Safe performance of complex procedures requires effective team interactions. Our research group creates 'whole' procedure simulations to produce the psychological fidelity of clinical settings. Recruitment of real interventional team (IT) members has proved challenging. Actors as a simulated team are expensive. We hypothesised that medical students and trainees in a vascular unit could authentically portray members of the endovascular suite for carotid stenting. Methods: This paper describes the evaluation of a training programme for a simulated IT. Participants rated the extent to which programmes objectives were met and realism of simulations. Researchers' field notes provided insight into strengths and weaknesses of the programme. Results: Seven members from the vascular unit undertook training. Learning objectives were largely met. Nineteen simulations with 13 interventionalists were performed. Realism levels were at least moderate. Simulated IT members reported increased understanding of teamwork and roles in the endovascular suite. Discussion: A simulated IT proved feasible. Authentic psychological fidelity complemented the physical fidelity of the simulated suite. Although there were areas for development in training, this approach might contribute considerably to interventionalist training and increase knowledge and skills of vascular trainees and medical students.

Effectiveness of systems changes suggested by simulation of adverse surgical outcomes

“…The second breakdown was not in the new system but in the knowledge base of the individual responding to the crisis. This breakdown highlights the importance of standardised team training, both for simulated teams and in real life—a concept which been elaborated on by Nestel et al ,15 who described the use of medical students and trainees in a vascular unit to portray members of a simulated endovascular suite for carotid stenting and reported that a simulated interventional team proved feasible with these resources, and that authentic psychological fidelity complemented the physical fidelity of the simulated suite. While the test subject nurse did react and call for assistance, the confederate playing the role of the anaesthesiologist did not identify the problem in a timely manner leading to the adverse event occurring.…”

“…Patient actors were medical students who volunteered their time and were trained with a standardised script during a training session held prior to the simulated exercise. Similar to the work described by Nestel et al ,15 the standardised trained students as patient actors in these simulated exercises served to preserve the fidelity of the scenario.…”

Deficiencies Persist in the Experience of UK Vascular Trainees

“…18 In comparison to open surgery, endovascular skills are particularly suited to this since stent graft planning, use of imaging workstations, ultrasound skills, and catheter skills do not have to be practised in the operating theater. There is evidence that clinically relevant outcomes can be improved through cognitive training and complex simulation for endovascular procedures, 19 –21 and competence assessment in vascular surgery can also be reliably performed in the simulated environment. 22,23…”

Using simulation for interventional radiology training

“…This includes mentored training in patients within an interventional apprenticeship, a process that is unlikely to ever be entirely replaced by simulation [41]. Indeed, simulation is not a substitute for curriculum-based training, or for participating in the actual care of real patients -it should be used in support of both [34][35][36][37][38][39][40][41][42].…”

“…Focusing on known strengths, such as training procedural sequencing, cognitive and communication skills, gross motor behaviours and teamwork within context, represent opportunities to use simulation as a component of a recognised IR curriculum [30,[34][35][36].…”