Use of High Fidelity Simulation in Cardiac-specific Anesthesia Scenarios for Resident Education and Assessment
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 14
- 主要终点
- Use of NASA Task Load Index Scale in the Evaluation of Neuro-Cognitive Workload during Cardiac Anesthesia Based Simulation Scenarios
研究概览
简要总结
High fidelity simulations provide a unique opportunity for teaching and evaluation of knowledge, clinical reasoning, decision making and teamwork. We have developed a series of novel cardiac based simulations that review difficult learning objectives of cardiac anesthesiology rotation. We hypothesized that residents who have completed a rotation in cardiac anesthesiology will perceive these simulations to be both mentally challenging and a useful tool in preparing them for their subsequent clinical experience and for their anesthesiology board. For the first time, we have used the NASA Task Load Index Scale in evaluating Neuro Cognitive Workload during Cardiac Anesthesia Based simulation scenarios .Residents who have completed the cardiac rotation at least once would be assigned the task in small groups either a group of 2 or group of 3.The module consists of 3 different scenarios. The scenarios include, weaning the patient off of cardio pulmonary bypass, management of severe protamine drug reaction and acute hypotension from malfunction of the coronary graft in a simulated operating room in real time.
- Setting up a Simulation Lab,almost similar to real cardiac operating rooms would have cardio-pulmonary bypass machine,transesophageal echocardiography images upon request,all emergency medications with various infusions pumps,defibrillator,real time monitors include EKG,SpO2,invasive arterial line,CVP,PAP,ETCO2,operating room surgical equipment,anesthesia machine with ventilator.
- Tasks Assigned to the residents
- Feed-back and Teaching Session
- At the end of each session residents are encouraged to reflect upon how they performed and learning gaps that they perceived and areas that they felt needed to improve upon.
- Feedback session would be followed by interactive teaching to reinforce the knowledge.
- Evaluation of Hypothesis using NASA TLX Scale. Immediately following the Simulation based training, residents would be given the paper based NASA TLX scale to assess the neurocognitive workload
详细描述
The Ohio State University CSEAC Scenarios Content expert: Sujatha Bhandary MD The Ohio State University CSEAC 1st Scenario Development Form Scenario Name: Weaning from Cardiopulmonary Bypass Content expert: Sujatha Bhandary MD Date of Development: 8/29/14 Targeted Audience: CA-2, CA-3 anesthesia residents Simulation Platform: HPS
Synopsis of Scenario:
The purpose of this scenario is for the participant to take a thoughtful, systematic approach to weaning a patient off of cardiopulmonary bypass (CPB). Separation from cardiopulmonary bypass is a task which requires attention to multiple organ systems, communication with other members of the patient care team (i.e. surgeon, perfusionist), and a firm grasp of cardiopulmonary physiology. A small randomized controlled study of residents has previously demonstrated that simulation-based training in weaning from CPB has translated to improved clinical performance in the OR. While this task can at first be overwhelming for the trainee, high fidelity simulation provides an opportunity to practice this complex task in a safe environment.
The scenario will begin with the patient under general anesthesia and on cardiopulmonary bypass. The surgeon will have just completed an uncomplicated triple vessel CABG on a 57 year old male with 45 minutes of bypass time. When the participant takes over the case the patient will have a junctional bradycardia (rate 40) with a MAP of 50 mmHg, a temperature of 35 degrees celcius, and a SpO2 of 100%. The surgeon will announce that he is planning to remove the aortic cross clamp at which time the resident should call for their attending. The participant will be informed that their attending will not arrive and they will need to complete the task on their own. After removal of the cross clamp the patient will go into ventricular fibrillation. The participant will be responsible for recognizing the arrhythmia and treating the condition with lidocaine and defibrillation. After defibrillation the patient will go back into a junctional bradycardia which the participant will need to treat by pacing. At this point the participant will also need to begin ventilating the patient and treating underlying hyperkalemia (which will become evident upon obtaining an ABG). Failure to treat the hyperkalemia will result in refractory ventricular fibrillation. An echocardiogram (if requested) will reveal a normal appearing heart with good contractility. After pacing the patient, ventilating, and treating the underlying metabolic disturbances the patient can be successfully weaned off of CPB with a low dose epinephrine drip. At this point the scenario will end.
Learning Objectives:
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Resident physicians who have completed at least one month of cardiac rotation are included.This high fidelity simulation lab course if offerred to every resident that meets the criteria.This is a part of their educational activity.At the beginning of the course they are given the option to participate in the survey.If they do not wish to participate in the survey it will not affect their education.Participitaion in the survey is purely voluntary.
排除标准
- •Resident physicians that did not wish to participate in filling out the survey or not able to fill out the survey.
结局指标
主要结局
Use of NASA Task Load Index Scale in the Evaluation of Neuro-Cognitive Workload during Cardiac Anesthesia Based Simulation Scenarios
时间窗: 2 years
The NASA-TLX Scale is a multi-dimensional tool used to evaluate subjective workload in subjects performing a task. The scale uses six factors to evaluate the magnitude and source of the workload in human subjects with both high reliability and sensitivity. The scale has been one of the gold standards for cognitive workload measure for over thirty years.
次要结局
未报告次要终点