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Simulation

UT Southwestern Anesthesiology - Simulation Center

Residency Simulation

The Anesthesia Resident Simulation Program relies on a team-based approach comprised of residents of varying CA-levels and embeds them in peri-operative emergency scenarios. These scenarios are designed to teach our residents the strengths of team training and crisis management in accordance with clinical emergencies they are likely to encounter in practice. The lead role is assigned to the senior residents in the group to allow them the opportunity to function as attending anesthesiologists in the simulated crisis.

Our program conducts simulations in a 49,000-square-foot, state-of-the-art simulation facility. The simulations consist of scenarios incorporating advanced clinical simulators, high-fidelity training environments (operating rooms, PACU, ICU, L&D suites, trauma bays), embedded participants (actors), simulation technicians, and simulation instructors to help foster a dynamic, interactive clinical learning environment for the participant.

Residents receive protected time for simulation, which takes place every Tuesday. The day is split in half, with three residents participating in the morning, and three residents in the afternoon. Two anesthesia faculty facilitate the scenarios over the course of the day, providing a faculty-to-resident ratio of 2:3. On average, every resident participates in simulation four times a year.

One of the core elements of simulation is to maintain a safe learning environment. As such, the residents are debriefed after each session using a video-assisted debriefing model with experienced anesthesia faculty who have been formally trained as simulation instructors. During this debrief, we discuss the clinical concepts underlying the simulated situation, and highlight the importance of TeamSTEPPS®, an AHRQ team training framework. Achieving a faculty-to-resident ratio of 2:3 allows instructors to focus closely on the individual resident, while identifying areas for improvement in the team dynamics.

The Department of Anesthesiology Simulation Center services medical students, residents, fellows, advanced practice providers, nurses, and faculty. The UTSW Anesthesia Patient Safety Simulation team utilizes a state-of-the-art High Fidelity Simulation lab, trained confederates (actors), and seasoned simulation instructors to create a dynamic, interactive, and safe learning environment. Using a video-assisted debriefing model, our certified instructors enable the participant to self-reflect on their ability to navigate an emergent situation.

Patient Safety Focus

Our anesthesia simulation team is currently the driving force on the UTSW medical campus behind patient safety simulation. Since the initiation of our simulation lab, our simulation team’s focus has been on horizontal and vertical integration of simulation resources across the UTSW campus. We have sought to align the needs and resources of all groups currently conducting simulation at UTSW.

Being the leaders in team training on campus, with special certification in the AHRQ TeamSTEPPS® curriculum, we hope to empower the various departments conducting simulation with “Train the trainer” sessions on the AHRQ TeamSTEPPS® crisis resource management training. Currently, we conduct team training with the departments of medicine, obstetrics and gynecology, as well as the emergency medicine department.

Patient Safety Courses that we currently offer:

  • Perioperative consultant and patient safety course (ABA approved)

    The Specific course objectives include:

    • Communication: We will discuss strategies for promoting effective communication in group settings such as SBAR, call outs, check backs, and closed-loop communication
    • Human Factors: Participants will appreciate the fundamentals of Human factors engineering and display an understanding of incorporating redundancies and checks and balances into systems. There will also be a focus on developing methods to standardize protocols
    • Epidemiology of Errors: Participants will learn the background of the national patient safety movement, as well as a discussion on differences between latent and active failures
    • Systems-Based Practices as they relate to Patient Safety: We will dissect the key components of the system-at-large, discuss each element’s role in the system, as well as discuss how a breakdown in one of these elements can affect patient safety
    • Methods and Tools to Evaluate Safety Events: We will discuss risk assessment, root cause analysis, and failure modes and effects analysis.
  • Central Venous Access and Complications Course

    At the end of this course, the participant will be able to:

    • Obtain central venous access in the Internal Jugular and Subclavian Venous locations
    • Manage and Treat common central venous access related emergencies
    • Demonstrate an algorithmic approach to the diagnosis of unstable hemodynamics
    • Recognize and apply Crisis Resource Management principles in emergent settings
    • Demonstrate proper sterile technique for central venous access placement
  • Sedation for the Non Anesthesiologist Course

    At the end of this course, the participant will be able to:

    • Understand the pharmacokinetics of fentanyl, midazolam, ketamine, and propofol
    • Demonstrate basic airway management skills, including bag mask ventilation, LMA placement, and tracheal intubation
    • Exhibit the ability to assess ventilation and oxygenation
    • Display knowledge of ASA standards for Monitoring and Sedation outside the OR
  • AHRQ Team STEPPS Train the Trainer Course

    At the end of this course, the participant will be able to:

    • Demonstrate the necessary skills of an effective team approach to an emergent situation using CRM principles
    • Utilize enhanced communication techniques to optimize team dynamics
    • Implement brain-based learning strategies to facilitate alignment of a multi-disciplinary team to patient care ent

Simulation Methodology

Multi-disciplinary Approach to Simulation: We incorporate a multi-faceted approach to simulation designed to enhance patient safety in the peri-operative period. We aim to engage all types of adult learners – auditory, visual, kinesthetic, experiential – by including multi-media, high-fidelity and medium-fidelity simulation, didactics, and group dynamic problem-based learning discussions.​

  • Realism: We take special measures to insure the “fidelity” or “realism” of the participant encounters in the simulation lab in everything from the yellow food coloring in the foley bag, to live on-demand media streaming projected on flat screens (TEE imaging, video laryngoscopy, etc.). We utilize live confederates with scripted roles, and on occasion, standardized patients to insure fidelity when needed.
  • Hybrid Model Simulation: We define ourselves as a team by the novel use of a hybrid model simulation, whereby we integrate medium fidelity task trainers into the high fidelity environment. This unique blending of simulation modalities allows us to develop a unique opportunity for episodic memory to develop. 

Grants & Research

  • 2013 University of Texas Patient Safety Committee Grant. Critical Decisions: Improving Patient Safety and Healthcare Delivery Effectiveness through Serious Gaming Technology
  • 2013 Application of Simulation in Large Group Settings Integrating Automated Response Systems (Dr. Bhoja)
  • 2014 Biometric Validation of the AHRQ Team STEPPS Curriculum (Dr. Ambardekar)
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