Simulation-based Assessment and Retraining for the Anesthesiologist Seeking Reentry to Clinical Practice

DeMaría, Samuel; Samuelson, Stefan T.; Schwartz, Andrew D.; Sim, Alan; Levine, Adam I.

doi:10.1097/aln.0b013e31829761c8

Cited by 33 publications

(10 citation statements)

References 23 publications

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“…While simulation assessment for physicians remains controversial,42 it is currently the only way to “show how”, especially for management of unpredictable rare clinical crises. Simulation might be an effective tool to assess competency and (re)train anesthesiologists who are seeking active clinical status 43. These physicians are a heterogeneous group and not always elderly.…”

Section: Assessment Of Physicians For Age-related Decline In Competencementioning

confidence: 99%

The aging anesthesiologist: a narrative review and suggested strategies

Baxter

Boet

Reid

et al. 2014

Can J Anesth/J Can Anesth

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PurposeTo address an aging anesthesia workforce, we review the relevant changes and implications associated with age in order to stimulate discussion at the individual, local, and national levels regarding appropriate changes in practice aimed at protecting patient safety.Principal findingsIn a 2013 survey of Canadian Anesthesiologists, 22% were aged 55-64 yr, 7% were aged 65-74 yr, and 3% were older than 74 yr. Clinical abilities decline with age, making older anesthesiologists more likely than their younger colleagues to be associated with adverse patient events. Anesthesiologists older than 65 yr in Ontario, Quebec, and British Columbia had 50% more cases involving litigation and almost twice the number of cases involving severe patient injury compared with anesthesiologists younger than 51 yr of age. In the absence of overt deterioration in skills, decisions about reducing activities and retirement are left largely to individuals despite their limited ability to self-assess competence. This state of affairs may contribute to the increased incidence of adverse events and poor patient outcomes.ConclusionsProvincial regulatory bodies have peer assessment programs to evaluate physicians at random, following a complaint, and at certain ages, but all have limitations. Simulation has been used widely for training and assessment in the aviation industry as well as in automobile driving exams. Simulation can assess crisis recognition and management, which is crucial in anesthesiology and not well assessed by other methods, and could assist elderly anesthesiologists during the pre-retirement phase of their careers. A standardized schedule for winding down would have advantages for physicians, their department, and their patients. A suggested schedule might include no further on-call duties for those aged 60 yr and older, no further high-acuity cases for those aged 65 yr and older, and retirement from operating room (OR) clinical practice (with possible continuation of non-OR clinical or other non-clinical activities, if desired) at age 70 yr. These timelines could be extended with satisfactory performance in annual simulation sessions involving assessment and practice in crisis management.

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Section: Assessment Of Physicians For Age-related Decline In Competencementioning

confidence: 99%

The aging anesthesiologist: a narrative review and suggested strategies

Baxter

Boet

Reid

et al. 2014

Can J Anesth/J Can Anesth

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show abstract

“…For example, the American Heart Association currently uses simulated experiences for nurse anesthetists, as well as other health care workers, in the high-stakes certification process for Advanced Cardiac Life Support, Basic Life Support, and Pediatric Advanced Life Support (American Heart Association, 2017). Additionally, high-fidelity simulation has been found to provide an effective means to evaluate competency and retrain anesthesiologists seeking reentry to practice (DeMaria, Samuelson, Schwartz, Sim, & Levine, 2013). The panel's unanimous agreement on question 14, noting the simulation's ability to provide an acceptable substitute to clinical practice for assessing provider competency, certainly favors the use of high-fidelity patient simulation for high-stakes assessment.…”

Section: Aim 2: the Use Of Simulation For High-stakes Assessmentmentioning

confidence: 99%

Recertification and Reentry to Practice for Nurse Anesthetists: Determining Core Competencies and Evaluating Performance via High-Fidelity Simulation Technology

Heyes

Schnitzen²,

Starr³

et al. 2018

Journal of Nursing Regulation

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The National Board of Certification and Recertification for Nurse Anesthetists addressed a barrier to return to practice of uncertified practitioners by replacing required direct patient care experiences with high-fidelity simulation. Objectives The aims of this study were to: (a) validate a set of clinical activities for their relevance to reentry and determine if they could be replicated using simulation, (b) evaluate the content validity of an existing simulation scenario containing the proposed clinical activities and determine its substitutability for a clinical practicum, and (c) evaluate the validity of two methods to assess simulation performance. Methods A modified Delphi method incorporating an autonomous, anonymous, three-round online survey process using three unique expert certified registered nurse anesthetists groups was used to address each study aim. Results Twenty-seven clinical activities gained consensus as necessary to be assessed in the simulation. All 14 survey questions used to determine simulation content validity exceeded the minimum content validity index (CVI) value of 0.78, with a mean CVI of 0.99. The global rating scale CVI and the competency checklist CVI were 0.83 and 1.0, respectively. Conclusion The findings add to the existing literature supporting the utility of simulation for high-stakes provider assessment and certification.

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“…23 For example, Demaria and colleagues found that a program, aimed at anesthesiologists returning to work, consisting of a two-day simulation-based session provided an effective assessment and retraining tool. 24 Simulation has also been proven as a technique for improving technical skills and reducing cost in a variety of medical areas, including bedside procedures, and can be employed to retrain attendings. 2,25 Retraining opportunities may be organized among faculty only, in conjunction with residents, or in conjunction with other interprofessional team members learning similar skills.…”

Section: Future Directionsmentioning

confidence: 99%

Procedural Competence Among Faculty in Academic Health Centers: Challenges and Future Directions

Vaisman

Cram

2017

Academic Medicine

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Increasingly, faculty are taking on more direct responsibilities in patient care due to reductions in resident work hours, increasing admissions, and an endless push for efficiency. Furthermore, the rise of different career tracks in academia (i.e., patient care, research, education, or administration) and a drive for efficiency and subspecialization have placed additional strains on academic health centers. Combined, these factors have led to faculty increasingly being placed in the position of supervising bedside procedures that they may have not performed in years or with tools they have never trained with at all. Despite these challenges, procedural retraining for faculty remains non-standardized across most academic health centers. The resulting lack of procedural competence among faculty creates a number of challenges for the different parties involved. In this Perspective, the authors discuss the nature of the current problem of faculty procedural competence and the challenges it poses for faculty and academic health centers, medicolegal ramifications, and the challenges it poses to the faculty-trainee relationship. The authors then suggest several strategies to delineate and resolve this problem. To delineate the problem, they suggest single-center surveys to address the current paucity of data. To resolve the problem, they suggest the consideration of some modest, low-cost interventions such as having backup systems in place for procedure supervision (e.g., procedural service teams or interventional radiologists) and providing faculty with opportunities to retrain.

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Simulation-based Assessment and Retraining for the Anesthesiologist Seeking Reentry to Clinical Practice

Abstract: Anesthesiologists seeking to return to active clinical status are a heterogeneous group. The simulated environment provides an effective means by which to assess baseline competency and also a way to retrain physicians.

Cited by 33 publications

References 23 publications

The aging anesthesiologist: a narrative review and suggested strategies

The aging anesthesiologist: a narrative review and suggested strategies

Recertification and Reentry to Practice for Nurse Anesthetists: Determining Core Competencies and Evaluating Performance via High-Fidelity Simulation Technology

Procedural Competence Among Faculty in Academic Health Centers: Challenges and Future Directions

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