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European simulation-based education and training in anaesthesiology and intensive care: still a long way to go?

De Hert, Stefan

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European Journal of Anaesthesiology: June 2022 - Volume 39 - Issue 6 - p 487-488
doi: 10.1097/EJA.0000000000001687
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Simulation is an interactive learning method where one can apply, learn and train knowledge and skills in specific situations. It also allows for training of nontechnical competencies, which are the social and cognitive skills, such as communication, collaboration, leadership, situational awareness and decision-making. Of note, anaesthesiologists have been pioneers in the use of high-fidelity mannequins to study human factors and improve crisis resources management skills for critical situations.1

For decades, simulation has been a key player in the portfolio of education and training for professionals involved in aviation, navigation and many other industries. In medical education, however, transfer of knowledge and skills is still largely based on the formats from the past and it is not unusual for medical students and healthcare professionals to be taught almost in the same way as they were decades ago.2,3 Although the place of simulation in education and training of healthcare professionals, especially anaesthesiologists and intensive care medical staff, is increasingly recognised, there is still a long way to go.4

In the current issue of the journal, Savoldelli and Østergaard report on the current place of simulation-based education and training (SBET) in teaching in anaesthesiology and intensive care throughout Europe. On the basis of the results of a survey developed, reviewed and pretested by the ESAIC (European Society of Anaesthesiology and Intensive Care) Simulation Committee, the authors were able to get a good insight in the current place of SBET in our profession. The results are straightforward and a source for reflection and action. Their findings indicate that there are significant differences and disparities with regard to implementation of and accessibility to SBET. These discrepancies are not only observed between countries but also amongst individual national training centres within some countries. The data further suggest that only five of the responding countries have reached an adequate and widespread implementation of high-fidelity simulation training. Of note, this educational method seems restricted to large centres in approximately one-third of the responding countries and is only marginal or very limited in the remaining majority of centres. Overall, the use of procedural simulation seems to be slightly more widespread than high-fidelity simulation. Finally, important differences are observed between countries in terms of duration, regulations and organisational aspects of residency training.5

In view of the currently growing evidence supporting the use of simulation for education and patient safety in healthcare in general,6 and in anaesthesiology and intensive care in particular,7–10 the situation portrayed by the results of this survey is somehow disappointing. Interestingly, almost all countries report several similar barriers that currently prevent SBET from being more extensively implemented in education and training in anaesthesiology and intensive care. The most frequently reported barriers are issues related to cost, lack of protected time, lack of regulatory and executive support, and lack of equipment or human resources. Yet, a few Europeans countries, Denmark, Ireland, Malta, The Netherlands, and also Iceland (for their local 2 years programme) have managed to implement mandatory simulation training into their curriculum. This is indicative of the fact that a strong national regulatory and executive support, including adequate funding, are essential to get SBET programs implemented in the curricula. In addition, the introduction of such programs gives the possibility to exchange a format of formal lectures for an active hands-on simulation program.

Is there a role for international professional and scientific societies in implementing SBET programmes? ESAIC has indeed developed such programmes with a dedicated ESAIC Simulation Committee actively involved in structural organisation of SBET for its members. The Simulation Committee is very active in promoting SBET by organising and running simulation masterclasses in cooperation with the Patient Safety and Quality Committee. In addition, several simulation-based learning activities are proposed to the delegates attending ESAIC annual meetings. However, traditional on-site simulation activities have been threatened recently by the COVID-19 pandemic. There is a strong need to help our community to adapt and find alternative training solutions, such as telesimulation activities,11,12 where international professional societies could be in a key position to facilitate such changes.

Likewise, regarding hurdles identified by the different national representatives in implementing local SBET programs, there is a role for international professional societies, such as ESAIC. A main concern is related to the costs and lack of equipment and human resources. The ESAIC Simulation Committee is developing actions targeting instructors and future leaders. These include master courses on how to develop a simulation curriculum based on sound educational principles, such as the Kerns's 6-step,9,13,14 courses to facilitate SBET with limited resources,15 initiatives to promote the implementation of interprofessional team training, and coordination of fellowships in the field. In addition, as indicated by a majority of the survey respondents, the ESAIC could also take a clear position by establishing standards and recommendations in the field. A first step in this direction might be the provision of a detailed curriculum for high-fidelity simulation training.

The availability of human resources is key to the successful development of SBET programs. Too often still, national institutes rely on the voluntary initiatives of professionals to develop SBET programs. There is an urgent need for regulatory bodies to consider the time devoted to education and especially SBET as ‘on duty’ time. Therefore, when planning an institutional healthcare workforce, dedicated time for training and education should be taken into account. Here is a potential role for the national societies and such efforts can be coordinated by the NASC (National Anaesthesiologist Societies Committee), one of ESAIC's bodies.

In conclusion, the report by Savoldelli and Østergaard5 provides a first inventory of the use of SBET during residency training across Europe. The results of this survey indicate that SBET is highly heterogenous with important differences and disparities regarding implementation and accessibility among different European countries with only a few countries reaching an adequate level of implementation. Beyond residency, future challenges include not only the use of SBET programs in the continuous education and training of staff members but also as a tool for recertification processes. In addition, the introduction of new forms of distant simulation training with new learning methods, such as serious gaming, online distant multiplayer immersive simulation followed by debriefing, and so forth, will need to be further developed and blended in SBET programs. ESAIC is committed to face these challenges in order to facilitate the development of national and institutional SBET programs for our members and also for the national and international anaesthesiology and intensive care communities.

Acknowledgements relating to this article

Assistance with the Editorial: none.

Financial support and sponsorship: none.

Conflicts of interest: SDH is chair of the Education and Training Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC).

Comment from the Editor: this article was checked and accepted by the Editors, but was not sent for external peer-review.


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