- Harvard Medical School, Anesthesiology, Faculty Memberadd
This letter expands upon the three tenets of the Healthcare Simulation Manifesto—comprehensive safety, collaborative advocacy, and ethical leadership. To do this, we will discuss two key terms: ‘essential’ and ‘autonomy’ in relation to... more
This letter expands upon the three tenets of the Healthcare Simulation Manifesto—comprehensive safety, collaborative advocacy, and ethical leadership. To do this, we will discuss two key terms: ‘essential’ and ‘autonomy’ in relation to safety for standardized/simulated patients (SPs). In this time of crisis, simulationists must move the boundary of skills training previously accepted as safe for human beings, and leverage technology to ensure the highest level of safety achievable for our SPs.
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BACKGROUND A formative hepato-pancreato-biliary (HPB) ultrasound (US) skills practicum is offered annually to graduating HPB fellows, using entrustment assessments for open (IOUS) and laparoscopic (LAPUS) US. It is hypothesized that... more
BACKGROUND A formative hepato-pancreato-biliary (HPB) ultrasound (US) skills practicum is offered annually to graduating HPB fellows, using entrustment assessments for open (IOUS) and laparoscopic (LAPUS) US. It is hypothesized that validity evidence will support the use of these assessments to determine if graduating fellows are well prepared to perform HPB US independently. METHODS Expert faculty were surveyed to set Mastery Entrustment standards for fellow performance. Standards were applied to fellow performances during two annual US skills practicums. RESULTS 11 faculty questionnaires were included. Mean Entrustment cut scores across all items were 4.9/5.0 and 4.8/5.0 and Global Entrustment cut scores were 5.0/5.0 and 4.8/5.0 for IOUS and LAPUS, respectively. 78.5% (29/37) fellows agreed to have their de-identified data evaluated. Mean fellow Entrustments (across all skills) were 4.1 (SD 0.6; 2.6-4.9) and 3.9 (SD 0.7; 2.7-5), while the Global Entrustments were 3.6 (SD 0.8; 2-5) and 3.5 (SD 1.0; 2-5) for IOUS and LAPUS, respectively. CONCLUSIONS Two cohorts of graduating HPB fellows are not meeting Mastery Standards for HPB US performance determined by a panel of expert faculty.
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A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousands of lives have already been tragically lost. The global crisis has been disruptive, even a threat, to healthcare simulation, affecting all... more
A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousands of lives have already been tragically lost. The global crisis has been disruptive, even a threat, to healthcare simulation, affecting all aspects of operations from education to employment. While simulationists around the world have responded to this crisis, it has also provided a stimulus for the continued evolution of simulation. We have crafted a manifesto for action, incorporating a more comprehensive understanding of healthcare simulation, beyond tool, technique or experience, to understanding it now as a professional practice. Healthcare simulation as a practice forms the foundation for the three tenets comprising the manifesto: safety, advocacy and leadership. Using these three tenets, we can powerfully shape the resilience of healthcare simulation practice for now and for the future. Our call to action for all simulationists is to adopt a commitment to comprehensive safety, to ...
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Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events,... more
Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.Methods: Standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioural and technical performance measures. Analysis using Generalisability and Decision studies were completed for the two scenarios with two raters.Results: The behavioural score was not more re...
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We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish... more
We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to ni...
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Training-induced cognitive bias may affect performance. Using a simulation-based emergency airway curriculum, we tested the hypothesis that curriculum design would induce bias and affect decision making. Twenty-three novice anesthesiology... more
Training-induced cognitive bias may affect performance. Using a simulation-based emergency airway curriculum, we tested the hypothesis that curriculum design would induce bias and affect decision making. Twenty-three novice anesthesiology residents were randomized into 2 groups. The primary outcome measure was the initiation of supraglottic airway and cricothyroidotomy techniques in a simulated cannot-ventilate, cannot-intubate scenario during 3 evaluation sessions. Secondary outcomes were response times for device initiation. After a baseline evaluation and didactic lecture, residents received an initial practical training in either surgical cricothyroidotomy (CRIC group) or supraglottic airway (SGA group). After the midtest, the groups switched to receive the alternate training. From baseline to midtest, the SGA group increased initiation of supraglottic airway but not cricothyroidotomy. The CRIC group increased initiation of cricothyroidotomy but not supraglottic airway. After co...
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ABSTRACT Advances in histopathology and immunohistochemistry have allowed for precise microanatomic detail of tissues. Two Photon Confocal Microscopy (TPCM) is a new technology useful in non-destructive analysis of tissue. Laser light... more
ABSTRACT Advances in histopathology and immunohistochemistry have allowed for precise microanatomic detail of tissues. Two Photon Confocal Microscopy (TPCM) is a new technology useful in non-destructive analysis of tissue. Laser light excites the natural florophores, NAD(P)H and NADP+ and the scattering patterns of the emitted light are analyzed to reconstruct microanatomic features. Guinea pig skin was studied using TPCM and skin preparation methods including chemical depilation and tape striping. Results of TPCM were compared with conventional hematoxylin and eosin microscopy. Two-dimensional images were rendered from the three dimensional reconstructions. Images of deeper layers including basal cells and the dermo-epidermal junction improved after removing the stratum corneum with chemical depilation or tape stripping. TCPM allows good resolution of corneocytes, basal cells and collagen fibers and shows promise as a non-destructive method to study wound healing.
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OBJECT Microsurgical skills remain an integral component of neurosurgical education. There is a need for an objective scale to assess microsurgical skills. The objective of this study was to assess the face and construct validity of a... more
OBJECT Microsurgical skills remain an integral component of neurosurgical education. There is a need for an objective scale to assess microsurgical skills. The objective of this study was to assess the face and construct validity of a benchtraining microanastomosis module and an objective assessment scale, i.e., the Northwestern Objective Microanastomosis Assessment Tool (NOMAT). METHODS Medical students, neurosurgical residents, and postdoctoral research fellows at Northwestern University were enrolled in the study. Trainees were divided into 3 groups based on microsurgical experience: 1) experienced, 2) exposed, and 3) novices. Each trainee completed two end-to-end microanastomoses using a 1-mm and a 3-mm synthetic vessel. Two cameras were installed to capture procedural footage. One neurosurgeon blindly graded the performance of trainees using both objective and subjective methods to assess construct validity. Two neurosurgeons reviewed the contents of the simulation module to as...
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To develop and implement a team-training curriculum. We hypothesized that better interactions between personnel would lead to improved patient safety, increased efficiency, and better staff satisfaction. Prospective assessment of a... more
To develop and implement a team-training curriculum. We hypothesized that better interactions between personnel would lead to improved patient safety, increased efficiency, and better staff satisfaction. Prospective assessment of a team-training program. University-affiliated hospital. Operating room physicians, nurses, technicians, and other personnel. Four-hour classroom curriculum, intraoperative coaching on team-related behaviors, and follow-up feedback sessions. Baseline metrics and observational data were collected for 3 months before implementing the team-training program and 6 months after a designated implementation date. A questionnaire regarding perceptions of teamwork was completed at the beginning of and 6 weeks following the team-training classroom session. Six months after implementation of team training, compliance with preoperative briefings was 66%. No changes in hospital metrics were observed. An improved perception of teamwork among the participants was demonstrated in pretraining and posttraining surveys. Perceptions of teamwork and the utility of a preoperative briefing differed among nurses, surgeons, and anesthesiologists. Our team-training program resulted in moderate compliance with behaviors taught in the curriculum. Even with only moderate compliance, we demonstrated improved perceptions of teamwork.
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Tissue engineering of oral mucosa could allow improved reconstructive options for intraoral tissue defects. Porous collagen-glycosaminoglycan (CG) matrices coated with a silicone elastomer were seeded by centrifugation with cultured human... more
Tissue engineering of oral mucosa could allow improved reconstructive options for intraoral tissue defects. Porous collagen-glycosaminoglycan (CG) matrices coated with a silicone elastomer were seeded by centrifugation with cultured human oral mucosal epithelial cells (strain OKG4 gingival keratinocytes) at a density of 250,000 cells per square centimeter. Full-thickness dorsal wounds (1.5 x 1.5 cm) were created surgically on each athymic mouse and were treated with either a seeded matrix or an unseeded matrix, or they were left open as a control. The CG matrices reduced the degree of wound contraction at day 14 compared with open wounds. The epithelial thickness of seeded matrices at day 14 was significantly greater (p = 0.0001) than that of unseeded matrices. Seeded matrices had more rapid degradation at 14 days compared with unseeded matrices. Human oral mucosal cells seeded into CG matrices contribute to form a stratified and differentiated epithelial layer during revascularization, cellular infiltration, and degradation of the CG matrix.
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Two-photon confocal microscopy is a new technology useful in nondestructive analysis of tissue. The pattern generated from laser-excited autofluorescence and second harmonic signals can be analyzed to construct a three-dimensional,... more
Two-photon confocal microscopy is a new technology useful in nondestructive analysis of tissue. The pattern generated from laser-excited autofluorescence and second harmonic signals can be analyzed to construct a three-dimensional, microanatomical, structural image. The healing of full-thickness guinea pig skin wounds was studied over a period of 28 days using two-photon confocal microscopy. Three-dimensional data were rendered from two-dimensional images and compared with conventional, en face, histologic sections. Two-photon confocal microscopy images show resolution of muscle, fascia fibers, collagen fibers, inflammatory cells, blood vessels, and hair. Although these images do not currently have the resolution of standard histology, the ability to noninvasively acquire three-dimensional images of skin promises to be an important tool in wound-healing studies.