Simulation in healthcare : journal of the Society for Simulation in Healthcare
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We attempted to adapt a METI Emergency Care Simulator to support anesthesia scenarios but faced two challenges: the CO2 gas exhaled by the mannequin does not represent the simulated patient's physical status, and the METI Waveform Display software does not support capnography monitoring. ⋯ We were able to substantially increase the realism of our anesthetic scenarios for research studies and training participants with only a small increase in the fidelity of our capnography monitoring.
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Residents train in a historically hierarchical system. They may be compelled to question their teachers if they do not understand or disagree with a clinical decision, have a patient safety concern, or when treatment plans are unclear. We sought to determine whether a debriefing intervention that emphasizes (1) joint responsibility for safety and (2) the "two-challenge rule" (a rubric for challenging others) using a conversational technique that is assertive and collaborative (advocacy-inquiry) can improve the frequency and effectiveness with which residents "speak up" to superiors. ⋯ This instructional intervention improves "speaking up" by residents to other physicians during simulated obstetric cases. Providing increased opportunities for resident learning, sharing responsibility for patient safety, and overcoming communication barriers within the medical hierarchy may improve teamwork and patient safety.
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This study was performed to assess perioperative reevaluation of Do-Not-Resuscitate (DNR) orders by practicing anesthesiologists. ⋯ Inadequacies in perioperative reevaluation of DNR orders existed at all stages. Simulation of perioperative DNR orders is a useful way to elicit anesthesiologist's actions in the heat of the moment, which may bring us closer to understanding the actions of anesthesiologists during clinical practice.