Simulation-Based Training Prepares Practitioners for High-Risk Events

Pamela J. Chambers, DNP, EJD, MSN, CRNA, CPPS, FAANA, Assistant Professor, Nurse Anesthesia Program, Rosalind Franklin University; Recent Two-Term Member, Board of Directors, National Board of Certification and Recertification for Nurse Anesthetists; Member, TDC Group APC Advisory Board

As an educator teaching future Certified Registered Nurse Anesthetists (CRNAs), I see firsthand students’ eagerness to participate in simulation-based (SIM-based) education, where we create scenarios that they’re going to encounter as practitioners. Right from the start, they actively seek to discover where they might have shortcomings, so that they can safely address them prior to delivering patient care.

SIM-based training can enhance clinical skills and competencies while helping students and midcareer professionals prepare for various scenarios, including emergencies.

SIM-based learning benefits clinicians in a variety of specialties, but it is especially important for those who work in high-acuity, high-risk areas like anesthesia.

SIM for Expected Emergencies

SIM-based learning can only be as strong as the foundation of knowledge it’s built upon. Most students complete their coursework in anatomy, physiology, and pathophysiology for various conditions across the lifespan before undertaking SIM-based learning. Thereafter, SIM training sessions focus on clinical events that students and practitioners will encounter, either on a daily basis or as low-frequency, high-risk events.

While many opportunities for simulation exist, organizations may choose to prioritize SIM-based training for high-risk events, such as cardiac arrest, that practitioners may encounter. This is why many healthcare providers from a variety of specialties undergo Advanced Cardiac Life Support (ACLS) training.

SIM for Specialized Skills

A SIM-based education curriculum commonly follows intense didactic foundational instruction related to anesthesia knowledge and skills such as fiber-optic intubation or regional anesthesia. Students master foundational knowledge first, and then instructors incorporate simulation into learning scenarios so that students can operationalize their learning. This allows faculty members to assess students’ competency relative to where they are in their studies.

SIM for Unexpected Emergencies

A common area to which organizations may devote resources for SIM-based training is high-risk, low-frequency events. For CRNAs, these include malignant hyperthermia and local anesthetic systemic toxicity (LAST). While such emergencies do not occur often, treatment guidelines exist and are incorporated into SIM scenarios. We can create realistic scenarios for learners to exercise decision-making processes to intervene before these events are encountered in patient-facing care.

Granted, not all practitioners feel an urgency to prepare for rare clinical events, but we live in a very mobile society, so clinicians may wish to be prepared for less common occurrences.

SIM for Teamwork

The megacode, which simulates a cardiovascular emergency following ACLS education, is by definition a team event. Facilitators may take different approaches to teamwork training: Participants may be asked to rotate or exchange roles, so that all participants understand each role’s contribution, or they may be asked to fulfill one role, so that they focus on the most applicable competencies.

Either way, the delegation of roles is a vital part of many SIM-based training sessions, because delegation is vital to speed of response. For instance, a patient with LAST may experience a seizure, but not all members of the care team will know why—so the CRNA may delegate roles to the care team. CRNAs and CRNA students practice delegating roles as part of providing the swiftest and most effective possible intervention.

SIM for Skills Assessment

SIM-based education can help a practitioner practice responding to a potentially catastrophic event before it happens. Therefore, to maximize the benefits to patient safety, SIM learners need the opportunity to demonstrate competencies, and to learn from mistakes in a nonpunitive environment. An environment of psychological safety helps clinicians learn to mitigate risks, improve patient safety, and provide higher-quality overall care.

Various methods of assessment are used to measure the performance of learners and learning outcomes. These include:

• Debriefing: Discuss what each learner observed, considering critical steps that were missed and ways to perform important skills and actions in the next iteration.
• Feedback: Inform learners of the actions that evaluators observed and how those actions demonstrate learning and retention of material.
• Competency Testing: Assess the learners’ knowledge, skills, and abilities related to clinical scenarios and management of various situations that may be encountered in patient care.

SIM-Based Training Selection

Many healthcare systems and professional organizations recognize the value of SIM-based training, but may not know where or how to get the training. Some universities have dedicated SIM centers used for providing SIM-based education. For instance, Rosalind Franklin University of Medicine and Science provides an array of simulation-based curricula led by faculty who are certified by the Society for Simulation in healthcare.

SIM-based education providers don’t have to be certified in simulation education. However, before signing up for any SIM-based activity, it is important to ensure that the host organization possesses the proper facilities and qualifications. For instance, an organization hosting SIM-based training for ACLS should have a training electrocardiogram and an automated external defibrillator (AED), two examples of scenario-specific equipment.

SIM for Patient Safety and Risk Management

This is an exciting time in the development of SIM-based education for healthcare professionals, in which we are discovering many new things about how to craft effective training sessions, both in person and through remote learning.

SIM-based education gives participants, whether students or practicing clinicians, an opportunity to put learning into action, while giving healthcare organizations a means of assessing competency without risk to patients. Of course, competency is not the ceiling of healthcare practice—it is a floor measure, and many practitioners aim higher. Yet in a highly precise field like anesthesiology, achieving the floor (competency) is already both difficult and well worth measuring.

Creating teachable scenarios for SIM-based learning while carefully assessing learner performance is a powerful tool for improving patient safety while mitigating liability for clinicians and healthcare systems.