The Anesthesia Patient Safety Foundation (APSF) is pleased to announce the funding of 2 Safety Scientist Career Development Awards (SSCDA) starting July 1, 2016. The recipients of the awards are Amanda R. Burden, MD, and Ankeet D. Udani, MD, MSEd. Their projects both involve a topic that is of increasing importance to the APSF—emergency manuals. This is evidenced by the September 2015 APSF experts’ workshop titled: Implementing and Using Emergency Manuals and Checklists to Improve Patient Safety.
The chair of the review committee was APSF President Robert K. Stoelting, MD. Other members consisted of members of the APSF Executive Committee and a subset of members from the APSF Scientific Evaluation Committee. The SSCDA application requires that the investigator develop both a research plan and a mentoring/career development plan with the goal of developing the next generation of safety scientists. The award is $75,000 per year for a period of 2 years ($150,000 total).
A brief description of the SSCDA proposed projects and mentoring plans follows.
Amanda R. Burden, MD
Associate Professor of Anesthesiology
Director Clinical Skills and Simulation
Cooper Medical School of Rowan University
Cooper University Hospital
Dr. Burden’s educational submission is entitled: “Emergency Manual Use: A Training Program for the Reader.”
Omission of crucial steps in the treatment of patients during critical events is a threat to patient safety. Despite evidence that when Emergency Manuals (EMs) are used, teams more consistently adhere to guidelines and appropriately perform critical tasks, introduction and use of EMs and crisis resource management (CRM) education in health care remains inconsistent. While intense CRM education, training, and implementation processes have been adopted by other high hazard fields to assure that EMs are used effectively, no standardized process exists in health care. In our prior work, we found that effective EM use is enhanced when a dedicated “reader” reads the EM to the team during critical events. Creation of a standardized program to educate, assess, and deploy trained “readers” stands to strengthen the implementation of the “reader” role and increase frequency of “reader deployment” in critical events.
The primary aim of this project is to develop and evaluate a standardized EM Reader training program. The proposed project will use mixed methods to create, assess, and implement a standardized process of EM Reader and crisis management education to achieve accurate and consistent EM use by health care teams treating patients during critical events. The first phase includes an in-depth evaluation of current EM use and EM Reader needs in real and simulated perioperative emergencies to elicit key safety areas that will inform development of the course. Phase two includes creation of an educational program compatible with clinician needs and workflow elucidated in the initial evaluation phase and adapted from previously published implementation, assertiveness, and educational tools. Phase three involves implementation of the course and assessment of the process, and Phase four includes pilot deployment of trained “readers” to the clinical environment.
This work has the potential to improve the safety of critically ill patients in the perioperative arena by helping assure that guidelines are followed through the use of EMs and by improving crisis management and teamwork skills to help health care teams work together more effectively.
Mentoring/Career Development Plan:
Dr. Burden will be mentored by David M. Gaba, MD (primary mentor); Steven K. Howard, MD; and Jeffrey B. Cooper, PhD (secondary mentors). Each brings significant expertise and unique abilities to assist Dr. Burden with the project and help her with the use of simulation to train interprofessional teams. She will pursue Masters level education in human factors, qualitative research methods, and medical education theory to assist in her efforts to create, implement, and assess this program. To gain additional education in human factors of EMs and CRM education, she will intern with Barbara Burian, PhD, Senior Research Scientist, NASA Ames Research Center and consultant to the Royal Aeronautical Society Flight Operations Group.
Ankeet D. Udani, MD, MSEd
Assistant Professor of Anesthesiology
Department of Anesthesiology
Dr. Udani’s educational research submission is entitled “A comparison of two learning theories on emergency manual use: Classroom-based experiential learning versus electronic-based self-directed learning.”
Humans perform poorly on cognitive and motor tasks during high-stress situations. The operating room can be loud, stressful, and present unexpected clinical surprises. In these crisis situations, emergency manuals can help anesthesia providers reduce reliance on memory, retrieve critical information, prioritize key actions, and avoid missing important steps. Similar manuals are used by other high-risk, high-reliability organizations to optimize safety. It is unknown how to teach anesthesia providers to effectively use emergency manuals in the operating room. We propose a comparative effectiveness study of classroom-based experiential learning versus electronic-based self-directed learning (E-learning) on anesthesia provider emergency manual use.
The utility of emergency manuals is diminished when providers are unfamiliar with manual content. There is a need to study and optimize the process of teaching initial familiarity and use of emergency manuals. We will design, implement, and assess the impact of 2 exclusive, educational curricula. Our primary aim is to compare the impact of self-directed E-learning versus experiential learning methods on anesthesia residents’ use of emergency manuals during simulated intraoperative crises. Our secondary aims are to determine the impact of the 2 distinct educational curricula on residents’ knowledge, attitudes, and use of emergency manuals before, during, or after real intraoperative crises.
Our analysis will compare self-directed E-learning versus experiential learning. We will discover whether an innovative, self-directed E-curriculum is more effective in teaching emergency manual use than the current method of simulation-based, experiential learning. We will also assess the impact of the 2 curricula on emergency manual use by anesthesia trainees in the operating rooms. In line with the APSF’s mission, this project will allow us to systematically implement a new patient safety initiative, starting with effective training and education.
The findings from our proposed project will add important knowledge to the nascent field of emergency manual training, use, and implementation. Our efforts will focus next on how to train all operating room personnel (surgeons, nurses, technicians, etc.) efficiently and effectively to manage critical events best by using emergency manuals. And then, how to maintain best practices in perioperative crisis resource management. We will design, test, and implement effective training methods to eliminate error and optimize perioperative patient safety.
Based on results from this project, we will deliver the most effective curriculum’s educational resources to anesthesiology residency programs and the anesthesiology community at large. We will continue to assess the curricula for implementation success and long-term improvements in patient safety and trainee education.
Mentoring/Career Development Plan:
As part of this APSF award to train young safety scientists, Ankeet D. Udani, MD, MSEd, will be mentored by Jeffrey Taekman, MD. Dr. Udani has previously designed and studied the impact of educational strategies in anesthesiology. With this career development award, Dr. Udani will develop skills in implementation science to complement his knowledge in anesthesia education, simulation, and patient safety. Dr. Udani’s development through this award will give him the skills necessary to gain experience in translational research design in medical education. Dr. Udani aims to be a leader in thematic and systematic design of educational interventions to best impact perioperative patient safety at the level of clinical care and population outcomes.