Research Activities, July 2013
Challenges remain when using simulation–based training in pediatric anesthesiology
Health Information Technology
Since 1969, computer-controlled patient simulators have evolved into high-tech ways to train medical professionals on a variety of techniques and procedures. Unfortunately, child and infant simulators have lagged behind their adult mannequin counterparts because of the technical difficulties in translating mechanical features of an adult mannequin to the scale of a neonate or infant. A new review article looks at the ways that simulations are being used in pediatric anesthesiology, research into the use of simulation, and current and future challenges in its use.
Simulation has been used for developing new skills specific to pediatric anesthesia. These task-training skills include emergency airway management in children, ventilator management, central line placement, and regional anesthetic techniques. Simulation also uses scenarios to assess performance, demonstrate clinical and teamwork competencies, and expose trainees to the vast domain of potential conditions. Effective scenarios are also being created that optimize team interactions. As such, there is a trend towards in situ simulation, where participants engage in a simulation run in their actual clinical environment, such as an operating room.
Some simulations currently being used at pediatric hospitals include identifying latent system errors, evaluating provider workloads, and trauma team responses to mock codes. According to the authors, the future of simulation in pediatric anesthesiology will depend on improved educational outcomes, patient outcomes, and clinical care delivery. At present, the costs of simulation are high. In addition, there is no direct evidence that it improves patient outcomes.
The researchers suggest that areas for future scenario development should draw from identified untoward events or near-misses; and the management approach should reflect evidence-based research and expert consensus opinion. The study was supported by AHRQ (HS18734).
See "Simulation in pediatric anesthesiology," by James J. Fehr, M.D., Anita Honkanen, M.D., and David J. Murray, M.D., in Pediatric Anesthesia 22, pp. 988-994, 2012.