About

Welcome! At Stanford, we integrate many different simulation courses throughout residency, ranging from mannequin-based full team scenarios with debriefings to procedural skills training for hands-on practice, both anesthesia-only and with interprofessional teams. The main courses are described below. When patients are unstable, the principles of Crisis Resource Management (CRM) often affect care as much as medical knowledge does. Therefore, many courses include aspects of CRM key points (Leadership, Call for Help early, Establish Role Clarity, Distribute the Workload, Communicate Effectively, Mobilize available Resources, Anticipate and Plan, Know your Environment, Use All Available Information, Allocate Attention Wisely). We are privileged to have at Stanford the leadership of Dr. David Gaba, Associate Dean for Immersive & Simulation-based Learning and Dr. Steve Howard, Professor of Anesthesia, who first adapted CRM principles from aviation to simulation-based training in anesthesia in 1990 and authored the book “Crisis Management in Anesthesiology” published in 1994, with revised second edition 2015. In 2010, Stanford University School of Medicine opened a new state of the art facility for simulated and immersive learning at the Li KaShing Center (LKSC) for Learning and Knowledge. The LKSC has allowed us to further expand simulation education. The facility, with 28,000 square feet dedicated to immersive learning, encourages Stanford residents to not only fine tune their own skills, but also to help educatemedical students in the simulated environment.

Beginning in 2012, all Stanford operating rooms have an Emergency Manual, designed and tested by simulation and AIM lab faculty, as a resource that is used before, during, and after critical events locally and at multiple institutions around the world and shared cost-free. See http://emergencymanual.stanford.edu to download latest version and for Crisis Resource Management key points handout.

For more information on simulation at Stanford in general, see http://cisl.stanford.edu and for specific questions, please contact any of listed course directors. This document provides a summary of most of the current simulation courses for Stanford Anesthesia residents, which Dr. Ron Pearl, Dr. Alex Macario and the department strongly support for resident education.

For any simulation questions, feel free to contact me or any of the faculty listed with each course

Dr. Sara Goldhaber-Fiebert, saragf@stanford.edu

Course Offerings

Anesthesia Newbie Course

CA-1 July, 1 full day

  • Faculty: Dr Steve Howard, Dr. Kyle Harrison, Dr. Sara Goldhaber-Fiebert
  • Contact: Dr. Steve Howard, showard@stanford.edu
  • Program Description: This course provides exposure to the basics of anesthesia and familiarity with Stanford equipment before caring for real patients as an anesthesia resident. Small groups go through a half day simulation session where they set up the room and perform an anesthesia machine check. They are then presented with two types of general anesthetic inductions (e.g., non-full stomach and full stomach) as well as common physiologic perturbations. This gives new residents the opportunity to "slow the process down,” ask questions, and discuss with faculty. The other half of the day is spent practicing key procedural skills on mannequinmodels.
  • Quote from resident: The "newbie course" was a great introduction to feeling like an anesthesiologist since I had not been in an OR for more than 10 months. Being able to be hands-on with everything in the room was very helpful for the upcoming weeks of anesthesia residency.

Anesthesia Crisis Resource Management Series

Includes 1 full day each year of residency in groups of 4- 5: ACRM 1, ACRM 2, ACRM3

  • Faculty: Dr Steve Howard, Dr. David Gaba, Dr. Kyle Harrison, Dr. Ruth Fanning, Dr. Sara Goldhaber-Fiebert, Dr. Naola Austin, Dr. Calvin Kuan, Dr. Jennifer Basarab-Tung
  • Contact: Dr. Steve Howard, showard@stanford.edu
  • Program Description: In a realistic-feeling operating room setting with mannequin patients, anesthesia residents are given the opportunity to be “it” -- leader and decision maker -- as the attending anesthesiologist. For each ACRM course, 4-5 residents spend the entire day (about 8 hours) participating in intensive simulation scenarios, each followed by an in-depth debriefing, and are taught by 2-4 faculty members. Residents rotate through different roles in the simulation scenarios (primary anesthesiologist, responding anesthesiologist, scrub tech, real-time observer in debriefing room) but all debrief together. These challenging cases get everyone’s adrenaline flowing in a safe and fun learning environment.While reviewingmedical concepts and technical skills, the debriefings also focus on principles of Crisis Resource Management as outlined in the overview above. This course was developed by Dr. David Gaba and Dr. Steve Howard in 1990. Stanford ACRM was the first of its kind and has since spread around the world and to most other medical specialties.
  • Quotes from residents: “The ACRM1 course was one of the best educational aspects of my residency training to this point. Working in a team model to respond to crises is not common in the OR on a daily basis, so seeing how you react in simulation is an eye-opening experience. I'm proud to say, within the next week I was met by a real situation in the OR in which I was able to draw on what I had learned in simulation to help guide me (and my patient) through safely.” “Terrific scenarios. They are a wonderful opportunity to experience intense situations and to learn from our mistakes in a safe way”. “The only thing I would add is ACRM 4, 5, 6, 7!”

EVOLVE: A multi-year simulation-based immersive learning curriculum for anesthesia residents preparing for independent practice

Half-day per resident each year, groups of 6

  • Faculty: Dr. Ruth Fanning, Dr. Naola Austin, Dr. Jennifer Basarab-Tung, Dr. Sara Goldhaber-Fiebert
  • Contact: Dr. Ruth Fanning, rfanning@stanford.edu
  • Program Description: Evolve is a multi-year, simulation-based immersive curriculum for anesthesia residents focusing on the role of anesthesiologists as perioperative physicians. The curriculum is centered around the core competencies of professionalism; systems based practice, practice-based learning and improvement, and interpersonal communication. The concepts of multi-disciplinary teams, transitions of care, supervision and leadership are highlighted. Curricular development has concentrated on perceived gaps in training cited locally and nationally, paying particular attention to suggestions made by current and past residents at Stanford. This immersive curriculum uses multimodal techniques including high fidelity mannequin based simulation, part-task trainers and standardized patient actors in a variety of settings. Simulation scenarios are developed to incorporate learning objectives pertinent to attending anesthesiologists’ multiple roles such as; 1) dealing with diagnostic dilemmas and critical thinking concepts, while supervising multiple inter-disciplinary teams, 2) challenging end of life conversations with families while managing acutely critical medical events, 3) when and how to balance the roles of patient care and teaching. The course structure and scenarios are designed to include residents at different levels of training. Senior residents are given the opportunity to act as “attendings”, supervising, giving feedback, supporting junior residents and team members, while ensuring patient care is optimal at all times. Residents in the ‘junior” role give feedback to residents playing the “attending” role. Debriefing sessions following the scenarios take a 360-degree approach featuring peer-to-peer reflection and feedback, standardized patient actor feedback and instructor facilitation to ensure learning objectives are achieved.
  • Quotes from residents: “Playing attending today sometimes felt like twister… it's easy to want to do everything or to delegate everything. Being an excellent attending probably requires a balance of helping with tasks as well as delegating.” “It’s good to see how the senior residents handle situations. It is great to see how different people who are at different levels of learning think through difficult situations.” ”The attending role today was challenging. Learning to multi-task, let residents have sufficient autonomy, yet provide safe, fast efficient patient care is hard. It was great to get an opportunity to practice these skills.” “ It gave me an understanding of the multiple pulls on attendings’ time and thoughts. Helped me improve my communication and prioritization skills.”

START Plus (Successful Transition to Anesthesia Residency Training)

PGY-1 Bay area residents, monthly, 4-hour sessions

  • Faculty: Dr. Kyle Harrison, Dr. Larry Chu
  • Contact: Dr. Kyle Harrison, kharriso@stanford.edu; Dr. Larry Chu, lchu@stanford.edu
  • Program Description: Monthly sessions for PGY-1 residentsmatriculating into Stanford anesthesia to prepare them to excel during internship year with a focus on the skills and critical thinking skills utilized as an anesthesiologist. This course “flips the classroom” and uses a combination of educational modalities that are coordinated with the Stanford START program (http://start.stanford.edu), which include online lectures, group discussion, part-task trainers and high fidelity simulations to cover common clinical crisis scenarios encountered during internship and prepare participants for a successful transition to anesthesia residency. Exercises focus on team building, physician wellness and introducing interns to Stanford's anesthesia faculty and senior residents.
  • Quotes from residents: “This course is definitely one of the highlights of my intern experience!”

OR InterCEPT: An operating room interprofessional communication education program for teamwork.

  • Faculty: Dr. Sara Goldhaber-Fiebert, Dr. Ruth Fanning, Dr. Naola Austin
  • Contact: Dr. Sara Goldhaber-Fiebert, saragf@stanford.edu
  • Program Description: InterCEPT is an interdisciplinary collaboration between the Departments of General Surgery, Anesthesiology, Nursing, and Allied Perioperative Health Professionals, created to improve interdisciplinary communication and teamwork in the Operating Room through in-situ simulation and debriefing. It initially started as an offsite simulation-based training program, progressively involved more participants from each profession, and in 2017 transitioned to the ORs at Stanford Hospital. Simulation training sessions occur once a month, with participants from multiple disciplines together. Anesthesiology residents and faculty play an active role in these interprofessional simulation scenarios and the debriefings that follow each session.

Stanford Advanced Airway Management and Fiberoptic Course

CA-1, two full days every year

  • Faculty: Dr. Vladimir Nekhendzy
  • Contact: Dr. Vladimir Nekhendzy, nek@stanford.edu
  • Program Description: This is a highly popular CME airway course, which is usually given in September. The CA-1 attendance is required and is sponsored by the department. Please visit https://med.stanford.edu/cme/courses/2017/saamp17/advancedairway17.html for the most recent, 2017 airway course information. The course will provide you with essential evidence-based knowledge and solid technical skills necessary to effectively manage anticipated and unanticipated difficult airway in the operating room, emergency department, intensive care unit, and in adult and pediatric patient populations. The course includes 12 state-of-the art difficult airway stations and a comprehensive, integrated 6 station fiberoptic course on basic and advanced techniques of the flexible fiberoptic intubation.
  • Quotes from residents: “Stanford residents…they can just intubate anybody!”

OBSim

Residents attend at least one of these 2-4hour sessions during residency

  • Faculty: Dr. Gillian Abir & Dr. Naola Austin
  • Contact: Dr. Gillian Abir, gabir@stanford.edu
  • Program description: Developed at CAPE (Center for Advanced Pediatric & Perinatal Education) in 2005, OBSim course sessions are conducted on the Labor & Delivery Unit in order to recreate the operational reality of an actual patient event. The drills involve the complete multidisciplinary obstetrics teams, which includes anesthesiologists (attendings, fellows and residents), obstetricians (attendings, fellows and residents),neonatologists, nurses, and technicians. The drill topics are changed on an annual basis ( and so far, we have never repeated the same exact scenario). We focus strongly on the identification of occult system issues and the development of institutional-specific best practices. Current anesthesia faculty includes Gillian Abir MBChB (who coordinates OBSim & NeoSim for our residents) and Naola Austin MD. We have recently conducted drills involving Family Centered Care and the NICU, the ED and Trauma Service, studied the use of checklists, and conducted disaster drills with the Office of Emergency Management. Scenarios have included: stat cesarean delivery; eclamptic seizure; massive hemorrhage and use of the MTG protocol; perimortem cesarean delivery; magnesium overdose; twin delivery, and trauma in a pregnant patient.
  • Quote from resident: “I was able to participate in the on-site OB simulation that coordinated a simulation between labor and delivery nurses, anesthesia techs, scrub techs, OB residents/attending, and anesthesia resident/attending. It was a real life scenario and conducted in real time. I learned the logistics of treating ‘while on the go’, meaning pushing drugs, developing an anesthetic plan, and hemodynamic treatment while transporting from the delivery room to the operating room. Just recently I was on my second OB rotation in which a real life case was very similar to the one we had in OBSim. After all was said and done, the OB resident looked up at me and said ‘this was just like the sim’. We were better prepared, had decreased transport times, and shorter delays due to our training in simulation.”

NeoSim

Residents attend one, 4-5hour session during residency and earn Neonatal Resuscitation Provider [NRP] certification which is valid for two years

  • Faculty: Dr. Gillian Abir
  • Contact: Dr. Gillian Abir, gabir@stanford.edu
  • Program description: NeoSim is an immersive, simulation-based version of the basic NRP course offered by the American Academy of Pediatrics (AAP). NeoSim was created by Dr Lou Halamek, a Neonatologist at Lucile Packard Children’s Hospital who serves on the board of AAP. Approximately 10% of newborns will require some degree of resuscitation immediately after delivery; as a result our residents have been attending the course since 2003. The course is fun, very educational, and relevant for every anesthesiologist. As of 2012, the majority of NeoSim courses are combined with an OBLS course (Obstetric Life Support).
  • Quote from resident: “I learned a lot during the simulation courses, it's like having really scary life-or- death experiences that I'll never forget, without consequences.”

Ultrasound-Guided Central LineWorkshop

CA-1 summer, annually, 3-hour session

  • Faculty: Dr. Fred Mihm
  • Contact: Dr. Fred Mihm, fmihm@stanford.edu
  • Program description:This course exposes new CA1 residents to the use of ultrasound in placing central venous lines, with an emphasis on the safest, line via the internal jugular vein. The training is designed to introduce residents to the ultrasound machine (buttons/knobs), acquiring optimal images, central line kits/components (triple lumen introducer lines, RIC lines, dialysis, PA catheters, Continuous ScvO2 catheters). Particular attention is placed on using the ultrasound probe with needle guide in order to actually visualize vessel puncture and to minimize complications. 

iCRM

Crisis Management in the ICU(2-hour session for anesthesia residents on VA ICU rotation

  • Faculty: Dr. Geoff Lighthall
  • Contact: Dr. Geoff Lighthall, geoffl@stanford.edu
  • Program Description: iCRM provides team simulation training focusing on caring for critically ill ICU patients. Debriefings of scenarios focus onmedical knowledge and implementation of best practices, as well as the impact of CRM principles on patient care. Given the many different caregivers who practice in the ICU, this multidisciplinary team training includes not only anesthesia residents, but also ICU fellows, residents from medicine and surgery, nurses, respiratory therapists, and pharmacists.
  • Quote from resident: "High point of ICU rotation"

Regional Anesthesia Workshop Series

CA-1, CA-2 and CA-3, a total of 9, 1 ½ hour sessions

  • Faculty: Cynthia Khoo MD, PhD
  • Contact: Cynthia Khoo MD, PhD, cynthiak@stanford.edu
  • Program description: The workshop series is composed of 9 annual hands-on sessions for our CA-1, CA-2, and CA-3 residents. The first session is an introduction to ultrasound-guided regional anesthesia to familiarize the trainee with the handling of an ultrasound machine and image acquisition, with ultrasound scanning in live models and real-time needling in phantom models. Each year the residents will have a cadaver prosection session in the anatomy lab. There will also be a series of model scanning sessions, with each focused on a specific area for regional anesthesia techniques, including upper extremity, lower extremity, and truncal blocks. The last session is a regional anesthesia review to prepare residents for independent practice.

Pain Medicine Simulation

Open to all resident classes, occurs during chronic pain rotation or on voluntary basis, 1-hour session with 30 minute debriefing

  • Faculty: Dr. Jordan L. Newmark
  • Contact: Dr. Jordan L. Newmark, jnewmark@stanford.edu
  • Brief description: Pain medicine fellows and anesthesia residents during their chronic pain rotation (or during resident academic time) may, depending on scheduling, participate in challenging patient encounters relevant for the practice of pain medicine in the peri-operative or outpatient clinic setting. Patient safety, communication skills, clinical documentation, and coordinating interdisciplinary care are included in the relevant learning and discussion points for this curriculum.

Additional Simulation Courses and Resources

  • There are many additional Simulation Courses and Resources at VA Palo Alto:
  • Led by Dr. Geoff Lighthall, geoffl@stanford.edu and Dr. Kyle Harrison, kharriso@stanford.edu
  • Procedural Skills trainers – VA ICU rotation
  • Mock Code and mock emergency team simulations -- hospital wide, all VA anesthesia and ICU rotations
  • In situ simulations in operating rooms and PACU
  • SOS: Interdisciplinary advanced life support – medicine students primarily
  • SCARED: leadership and critical event management – medicine residents