Simulation in Anaesthesiaat the Royal Adelaide Hospital

Dr Graham Lowry FANZCA

The Royal Adelaide Hospital Adult Tertiary Teaching Hospital

∞ Affiliated with the University of Adelaide

∞ 680 beds

∞ 23 operating theatres

∞ 24 ICU / 10 HDU/ICU beds

Major trauma referral centre for Sth Australia

∞ Receives 800 retrievals/year

Department of Anaesthesia

Branch of Critical CareAnaesthesia/Pain/Hyperbaric medicine52 FTE Consultants32 Registrars

Simulation Unit Operational since 2003

Teaching/education role

∞ Interns

∞ Registrars/trainees

∞ Consultant anaesthetists

∞ Technical and non-technical skills

Relatively low budget

Specialty of Anaesthesia Five years of postgraduate training

∞ Major focus of training on developing technical skills

Conflict of decreased working hours versus need for clinical experience

∞ Aging population

∞ More complex surgery

Increased emphasis from ANZCA for training in non-technical skills.

Why Consultant Anaesthetists?Historically, a lack of training in this areaOften seen as leaders during a crisis in theatre BUT:∞No leadership training∞Often poor followers

Crisis Resource Management training is not mandatory

The Scenarios Clearly defined goals important

Simple clinical scenarios

∞ Diagnostic uncertainty useful for teaching human factors

∞ Team dynamics create complexity

∞ Level of fidelity always a challenge

Self reflection and evaluation important learning component

Challenges……1 Changing the culture

Stressful for

∞ for participants

∞ facilitators

Labour intensive

∞ maintaining service commitment versus patient safety and quality of care.

Challenges……2

Availability of relevant, validated outcome measures.

Adequate funding and resource allocationManaging participants’ expectations and comfort

levels

Advantages ……1

Allows training/experience in rare (but catastrophic) events

Breaks down the “silos”Work as a team, train as a team even if the “team”

is constantly changing

Advantages ……2

Training/practicing in contextIssues of access to facilitiesMoving beyond the operating theatre…