Practical Updates in Anesthesiology

1. Practical Updates in Anesthesiology Dr. Mark Wigginton MB,BS FRCA

2. How to Teach A Brainiac:Educational theories in medical simulation

3. Content • Why is simulation not straight forward • Theories of learning • Types of simulation • How educational theory is relevant to medical simulation • Fidelity • Effective debrief

4. Adult Learners • Highly motivated • Attend courses because they want to learn • Self directed educational objectives • Teaching adult learners can be difficult • Defensive reasoning

6. Dangers of simulation • Stress inducing • Under performance in company of peers • Long term self esteem and emotional issues

7. Theories of learning • Behaviourism • Conditioning • Cognitivism • Humanism • Transformative learning • Constructivism • Taxonomies of intelligence • Howard Gardner 1983 Frames of Mind

8. Taxonomies of intelligence • Linguistic intelligence • Logical-mathematical intelligence  • Musical intelligence  • Bodily-kinesthetic intelligence  • Spatial intelligence  • Interpersonal intelligence  • Intrapersonal intelligence  • Moral / Naturalist /Spiritual / Existential

9. Types of Simulation • Simulation for assessment • Simulation for research • Simulation for systems appraisal • Task training • Application of knowledge scenarios (High signal) • Human factors – CRM scenario (High noise)

11. Types of simulation vs educational objectives • Task training • Application of knowledge scenarios (High signal) • Human factors – CRM scenario (High noise)

12. Example • Educational objectives: • Increased knowledge of anaphylaxis algorithm • Increased awareness of how to facilitate effective teamwork • Increased ability to perform emergency cricothyroidotomy

13. Freidman et al. Clinical Impact of Epidural Anesthesia Simulation on Short- and Long-term Learning Curve. RegAnesth Pain Med 2009;34: 229-232

14. Integration of learning theory

15. CONCRETE EXPERIENCE: Once the simulation has run the decisions made and the effects they had can be viewed in entirety. They become concrete experience. Kolb’s learning cycle related to a simulation scenario REFLECTIVE OBSERVATION: This part of the learning cycle relates to the debrief phase of simulation. If candidates are not able to critically evaluate the results of their actions they will not learn from them. ACTIVE EXPERIMENTATION: The process of doing the simulation during which the candidate will make decisions and potentially need to alter these decisions depending on response. ABSTRACT CONCEPTUALIZATION: Thinking about the task and using conceptual knowledge in planning strategy. In simulation this may relate to pre-course material or pre-scenario briefing.

20. Suspension of disbelief

21. Techniques for improving fidelity • High fidelity mannequin • Well programmed scenario • Experienced controller • Reduced scenario leader input • Candidates adopt their normal role • Faculty adopt their normal role • Ambient sound • Realistic setting • Point-of-care simulation

22. Considerations for point-of-care simulation • Safety • Interruption of normal activity • Mixing of simulation equipment with real equipment

23. CONCRETE EXPERIENCE: Once the simulation has run the decisions made and the effects they had can be viewed in entirety. They become concrete experience. Kolb’s learning cycle related to a simulation scenario REFLECTIVE OBSERVATION: This part of the learning cycle relates to the debrief phase of simulation. If candidates are not able to critically evaluate the results of their actions they will not learn from them. ACTIVE EXPERIMENTATION: The process of doing the simulation during which the candidate will make decisions and potentially need to alter these decisions depending on response. ABSTRACT CONCEPTUALIZATION: Thinking about the task and using conceptual knowledge in planning strategy. In simulation this may relate to pre-course material or pre-scenario briefing.

24. Debrief • Duration at least as long as the simulation • In a different area • Video debrief • There’s no such thing as non-judgmental debrief • Espoused theory • Theory-in-use

25. Summary • Why is simulation not straight forward • Theories of learning • Types of simulation • How educational theory is relevant to medical simulation • Fidelity • Effective debrief

26. References • Argyris C. Teaching Smart People How to Learn. Harvard Business Review 1991; 4(2) • Pavlov I. P., (1927). Conditioned reflexes. London: Routledge and Kegan Paul. • Kang SG, Yang KS, Ko YH, Kang SH, Park HS, Lee JG, Kim JJ, Cheon J. A study on the learning curve of the robotic virtual reality simulator. J Laparoendosc Adv Surg Tech A. 2012 Jun;22(5):438-42. • Friedman Z., Siddiqui N., Katznelson R., Devito I., Bould M.D., Naik V. Clinical Impact of Epidural Anesthesia Simulation on Short- and Long-term Learning Curve High- Versus Low-fidelity Model Training. RegAnesth Pain Med 2009; 34(3):229-232 • Gaba D.M., Crisis resource management and teamwork training in anaesthesia. British Journal of Anaesthesia 105 (1): 3–6 (2010) • Kolb D., (1984) Experiential Learning: Experience as the Source of Learning and Development. Prentice-Hall, Inc., Englewood Cliffs, N.J. • Coffield F., Moseley D., Hall E., Ecclestone K. (2004) Learning styles and pedagogy in post-16 learning. A systematic and critical review. London: Learning and Skills Research Centre. • Maslow A. A theory of human motivation. Psychological Review 1943; 50(4): 370-96 • Hamann S. Cognitive and neural mechanisms of emotional memory. Trends in Cognitive Sciences 2001; 5(9): 394-400 • Russell J. A Circumplex Model of Affect. Journal of Personality and Social Psychology 1980; 39(6): 1161-1178 • Argyris C., Schön D. Theory in practice: increasing professional effectiveness (1974) Jossey-Bass San Francisco • Rudolph J., Simon R., Dufresne R., Raemer D. There’s No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment. Simulation in Healthcare 2006; 1(1): 49-55