Essay
About simulation and airway safety
De la simulación a la seguridad en vía aérea
José Andrés Calvachea,b,
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jacalvache@gmail.com
Correspondence to: C/6 10N-142 Hospital Universitario San Jose, Popayan, Colombia.
Correspondence to: C/6 10N-142 Hospital Universitario San Jose, Popayan, Colombia.
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Exposure to real life patients is essential and necessary for the development of clinical skills; however, to accomplish high-quality performance and safety, there may be some risks inherent to the training process itself and the learning curves and skills. These risks can be minimized with the use of simulated models that mimic real life scenarios and its conditions. Consequently, simulation results in a safe environment where researchers and trainees may test and improve their personal and team skills. Furthermore, the use of simulation in research provides considerable benefits. It allows for exploring and describing the attitude of the various healthcare professionals or trainees and for evaluating the various technologies or devices under diverse scenarios and situations, free of risk for actual patients and with fewer ethical implications.<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">By definition, simulation “is a technique, not a technology, that reflects or amplifies actual clinical experiences under participative guidance with an interactive approach”.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p></span></p><p id="par0015" class="elsevierStylePara elsevierViewall">Simulation-based training may potentially improve safety through a broad range of mechanisms, including: (1) routine training under emergency situations; (2) team training; (3) development of a sound environment to discuss mistakes without fear of recrimination; (4) safety and feasibility evaluation of new procedures; (5) evaluation of skills; (6) evaluation of the use of new devices; (7) human performance assessment; (8) acquisition of skills beyond the clinical context.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The literature reports the positive impact of simulation on the participant's knowledge, confidence during the procedures, teamwork performance, and process improvement within the simulation environment (simulated environment or <span class="elsevierStyleItalic">T1</span>). However, presently the data to support that simulation-based interventions resulting in safe outcomes for the individual patient or the population as a whole are scarce (actual patient scenario or <span class="elsevierStyleItalic">T2</span>; population or <span class="elsevierStyleItalic">T3</span>).<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> McGaghie WC et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> present a classification of the outcomes to consider under each particular scenario described (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In the last few years there has been increasing evidence to support that simulation-based learning really improves the abilities of the staff trained, and the acquisition and retention of new skills.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However, there are still few studies evaluating the process transition from <span class="elsevierStyleItalic">T1</span> to <span class="elsevierStyleItalic">T2</span>.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Crabtree et al. studied the correlation between a simulated scenario of fibrobronchoscopy intubation (<span class="elsevierStyleItalic">T1</span>) and the clinical skills in a real life situation (<span class="elsevierStyleItalic">T2</span>). Although no correlation was identified, the group concluded that the outcome used for the comparison (time to intubation) was not sensitive enough to detect improved performance during the procedure.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Consequently, the outcomes where a simulation scenario may influence a trainee may be quite different, difficult to assess and quantify, and go beyond the usual outcomes analyzed by researchers. They may be summarized into technical and non-technical “attitudes and skills”, that require complex and validated measurement methods that are not yet widely available.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> For instance, some authors consider that attitudes and professionalism should be outcomes considered in the <span class="elsevierStyleItalic">T1</span> scenarios.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> To approach simulation as a mere “transfer” of certain skills (measured for instance as the time to intubation) may be underestimating its value.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the past issue of the Colombian Journal of Anesthesiology, Uribe et al. present a study that shows the efficacy to secure the airway (tracheal intubation) using the SALT supraglottic device (Supraglottic Airway Laryngopharyngeal tube). Ninety naïve participants were highly competent during their first intubation attempt (90%).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In addition to their interesting findings and of the feasibility evidenced, this trial carried out under a simulated environment provided the participants with a wide range of abilities, different from those that the researchers studied as outcomes and classified as skills in scenario <span class="elsevierStyleItalic">T1</span>. Most of them were students that faced an intubation situation and their learning experience ranged from where to stand, the respect for a situation when the airway must be secured, to the performance of an expert during the teaching phase. There is no doubt that this experience (recreated within a research environment) was much more valuable for the participants. This is but one of the many advantages of simulation.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Simulation has been widely used throughout the airway training process and despite the heterogeneity of the populations, the scenarios, and the interventions included in the study, the evidence as a whole supports the use of this tool for most of the outcomes studied.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> The benefits of acquiring skills for managing the airway far exceed its limitations. In a recent systematic review, Kennedy et al. document that simulation is superior to non-simulation teaching scenarios, including videos, conferences, or personal study and show the considerable impact of using simulation for learning and developing skills associated to airway management. Nevertheless, the authors fail to report the effect on future behaviors and on the patient's outcomes (though there is still a shortage of outcome data).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Some authors defend the hypothesis that the impact on patient outcomes (considered the patient scenario or <span class="elsevierStyleItalic">T2</span>) may be appreciated in this context when structural changes are brought about in the education curricula rather than in individual procedures.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Some research recently published in the Colombian Journal of Anesthesiology shows the boom of the research process within simulation scenarios for the airway and other teaching-learning environments.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> Certainly they become a national reference and a broad area for future investigation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">For further information and details about the advantages and disadvantages of simulation, Gómez LM published in the Colombian Journal of Anesthesiology an extensive review on simulation-based training and its implications for teaching and learning.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Its impact on patient safety is further elaborated in the recent review by Naik VN et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "xres371161" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec350327" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres371160" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec350328" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-07-08" "fechaAceptado" => "2014-07-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec350327" "palabras" => array:5 [ 0 => "Airway Management" 1 => "Patient Safety" 2 => "Simulation" 3 => "Education Medical" 4 => "Anesthesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec350328" "palabras" => array:5 [ 0 => "Manejo de la vía aérea" 1 => "Seguridad del Paciente" 2 => "Simulacion" 3 => "Educación Médica" 4 => "Anestesia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Simulation is a valuable tool in health research, medical education and training of health personnel. Research and simulation-based education can focus on technical and non-technical skills needed to improve patient safety. This article comments on the effect of simulation on several outcomes, including those related to patient-safety during airway management.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La simulación es una valiosa herramienta en los procesos de investigación, educación médica y entrenamiento del personal de la salud. La investigación y la educación basa-das en la simulación pueden enfocarse en las habilidades técnicas y no técnicas necesarias para mejorar la seguridad del paciente. Este artículo de reflexión comenta aspectos relacionados al efecto de la simulación en diversos desenlaces, entre ellos los relacionados con la seguridad en el manejo de la vía aérea.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Calvache JA. De la simulación a la seguridad en vía aérea. Rev Colomb Anestesiol. 2014;42:309–311.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Simulation-based learning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">T3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Improvement or increase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Confidence, knowledge, skill, attitude and professionalism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient care safe practices (care process) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient safety outcomes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Object \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Individuals and work teams \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Individuals, equipment and systems \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Individuals, equipment and public health processes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scenario \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Simulation Lab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Actual patients and suppliers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systems and populations \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab560243.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">Source</span>: Adapted from McGaghie et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Classification of outcomes based on simulation-based learning.<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The future vision of simulation in health care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.M. 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| 2021 March | 6 | 2 | 8 |
| 2021 February | 8 | 9 | 17 |
| 2021 January | 7 | 9 | 16 |
| 2020 December | 4 | 6 | 10 |
| 2020 November | 6 | 8 | 14 |
| 2020 October | 2 | 3 | 5 |
| 2020 September | 8 | 8 | 16 |
| 2020 August | 6 | 9 | 15 |
| 2020 July | 5 | 6 | 11 |
| 2020 June | 6 | 3 | 9 |
| 2020 May | 3 | 2 | 5 |
| 2020 April | 5 | 3 | 8 |
| 2020 March | 1 | 3 | 4 |
| 2020 February | 4 | 5 | 9 |
| 2020 January | 2 | 2 | 4 |
| 2019 December | 6 | 4 | 10 |
| 2019 November | 3 | 4 | 7 |
| 2019 October | 1 | 0 | 1 |
| 2019 September | 2 | 2 | 4 |
| 2019 August | 2 | 0 | 2 |
| 2019 July | 9 | 8 | 17 |
| 2019 June | 4 | 3 | 7 |
| 2019 May | 1 | 7 | 8 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 13 | 1 | 14 |
| 2018 May | 36 | 8 | 44 |
| 2018 April | 54 | 8 | 62 |
| 2018 March | 54 | 10 | 64 |
| 2018 February | 40 | 10 | 50 |
| 2018 January | 80 | 8 | 88 |
| 2017 December | 38 | 9 | 47 |
| 2017 November | 29 | 6 | 35 |
| 2017 October | 23 | 12 | 35 |
| 2017 September | 31 | 9 | 40 |
| 2017 August | 47 | 10 | 57 |
| 2017 July | 47 | 7 | 54 |
| 2017 June | 38 | 23 | 61 |
| 2017 May | 42 | 15 | 57 |
| 2017 April | 48 | 18 | 66 |
| 2017 March | 26 | 62 | 88 |
| 2017 February | 14 | 9 | 23 |
| 2017 January | 11 | 7 | 18 |
| 2016 December | 29 | 25 | 54 |
| 2016 November | 22 | 15 | 37 |
| 2016 October | 30 | 13 | 43 |
| 2016 September | 34 | 9 | 43 |
| 2016 August | 40 | 7 | 47 |
| 2016 July | 14 | 0 | 14 |
| 2016 June | 0 | 12 | 12 |
| 2016 May | 2 | 30 | 32 |
| 2016 April | 0 | 19 | 19 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 0 | 19 | 19 |
| 2015 December | 15 | 8 | 23 |
| 2015 November | 32 | 14 | 46 |
| 2015 October | 42 | 12 | 54 |
| 2015 September | 38 | 10 | 48 |
| 2015 August | 40 | 8 | 48 |
| 2015 July | 29 | 7 | 36 |
| 2015 June | 22 | 4 | 26 |
| 2015 May | 23 | 8 | 31 |
| 2015 April | 26 | 20 | 46 |
| 2015 March | 35 | 13 | 48 |
| 2015 February | 33 | 14 | 47 |
| 2015 January | 34 | 11 | 45 |
| 2014 December | 62 | 14 | 76 |
| 2014 November | 39 | 8 | 47 |
| 2014 October | 50 | 19 | 69 |
| 2014 September | 18 | 8 | 26 |
Show all