The simulation program for anesthesia residents at Queen’s University has been up and running with regular sessions occurring since May 2006. We are committed to using this new technology to provide excellent educational sessions for our residents in a fun, safe & protected learning environment. Sessions are designed specifically for our residents to practice identifying and responding to crises, to develop team and communication skills, and to handle challenging scenarios and practice decision-making. Each simulation is followed by a group debriefing to maximize the learning from each session. It is in this way that the simulation program offers the residents a unique opportunity to apply & practice implementing their knowledge in a safe environment without compromising patient care.
Introduction to the Simulation Lab
The high fidelity simulator is located at the new Medical School Building, 15 Arch Street, just across from Kingston General Hospital. The mannequin is set up on a simulated OR suite with a functioning anesthesia machine including ventilator and monitoring capabilities. With the drapes up and the monitor beeping in the background we have had many people believing that a real patient was in the room. There is a separate observation room for the operator of the computer that runs the simulator, as well as for the video equipment. The observation room also allows students to watch and hear what is happening in the imulator room in real time, and video allows review of the session, for debriefing purposes. Our anesthesia supplies include a difficult airway equipment, a resuscitation cart, and multiple part-task trainers.
Our simulator is a state of the art high fidelity simulator (Sim Man model), made by the company General Electric, specifically for the purpose of medical education. The simulator is driven by sophisticated modelsof human physiology and pharmacology that automatically determine the ‘patient’s’ response to the students’ actions and interventions. We have an adult and a pediatric mannequin that can be used at the site and may also have access to an infant in the future. The clinical features of the mannequins include heart and breath sounds, palpable pulses and chest excursion with generated end tidal CO2, cardiac rhythm & oxygen saturation; all of which correlate with the clinical conditions of the patient. Invasive and noninvasive monitoring is possible. The airway is anatomically realistic and allows for various methods of intubation, as well as simulation of the difficult airway through tongue swelling, airway swelling and laryngospasm. A simulated cricothyroid membrane can allow for emergency surgical airway access. The pulmonary system allows for spontaneous or mechanical ventilation and multiple physiologic parameters can be altered to reproduce the patient with atelectasis, pneumothorax, asthma or COPD. Similarly the cardiac system generates appropriate heart sounds, an appropriate ECG for the scenario as well abnormalities such as ischemia or arrhythmias. Trauma features include the ability to do pericardiocentesis and decompression of a tension pneumothorax via needle or chest tube. The drug recognition system identifies drugs given by the students through a barcode reader and has pharmacokinetic and dynamic modeling for 50 intravenous drugs. Although the mannequin for our simulator often looks the same, the simulator can act like almost any patient – from the frail elderly hypovolemic granny to the robust healthy teenager. Almost any scenario can occur from common problems such as hypotension from hypovolemia or sympathectomy, high airway pressures and desaturation to full-blown anaphylaxis and MH. There is the potential for designing a scenario to meet almost any educational goals that you may have.
Residents experience a ½-day simulator session, including debriefing, approximately 5 times a year as part of their Core Teaching schedule. These sessions are on topics coordinated with the didactic curriculum the residents are working on at the time. Additionally, residents visit the simulation lab several other times during their training for specific sessions, such as airway training days, ultrasound guided regional anesthesia training, ACLS/ATLS/PALS training, and a “Boot Camp” designed to aid in the transition to independent call duties. The program is in constant evolution, with new sessions being added all the time.
We welcome you to the anesthesia simulator program and look forward to your participation.
Dr. Jessica E. Burjorjee
Dr. Louie Wang