Simulation at Stanford Anesthesiology

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, Dr. Ellile Sultan
Contact: Dr. Ruth Fanning, rfanning@stanford.edu and Dr. Naola Austin, naola@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 reviewing medical 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.

Faculty: Dr. Ruth Fanning, Dr. Naola Austin, Dr. Jennifer Basarab-Tung, Dr. Ellile Sultan, Dr. Sara Goldhaber-Fiebert
Contact: Dr. Ruth Fanning, rfanning@stanford.edu or Dr. Sara Goldhaber-Fiebert, saragf@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 multiple 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.

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 residents matriculating 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, 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.

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/advancedairwayent/advanced_airway_course/index.html for the most recent 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.

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 obstetric team, 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. In the past we have 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.

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 on medical 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.

Faculty: Dr. Jordan L. Newmark
Contact: Dr. Jordan L. Newmark, jnewmark@stanford.edu

Program 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.

Faculty: Dr. Calvin Kuan & Dr.Tammy Wang
Contact: Dr. Calvin Kuan ckuan@stanford.edu

Program Description: This interdisciplinary course was created to provide our pediatric anesthesia and pediatric critical care medicine fellows the opportunity to be the “pre-tending” (i.e. team leader and primary decision maker) in charge of managing pediatric focused crises.  The clinical scenarios are inspired by rare but real events to give the fellows a chance to think through high acuity and complex crises that they might not otherwise get to experience before they are on their own as attendings.  The cases are designed not to be straightforward.  The diagnoses are not necessarily singular or easy to deduce, and the scenarios are devised to induce critical thinking and reasoning, and to elicit cognitive biases and errors.  Active participants not only include the learners in the hotseat (pediatric anesthesia and pediatric critical care fellows), but also other members of the multidisciplinary health care team that they work with including nurses from the OR, ER and ICU, nurse practitioners, physician assistants, respiratory therapists, and pharmacists.  The fellows learn how to be an effective team leader, how to be an effective team follower/helper, how to communicate effectively, and how to combat cognitive biases.  The participants benefit immensely from interactions with members of other specialties and health care team.