Elective rotation in simulation-based medical education during anesthesia residency.

Anesthesia has changed rapidly in the last 50 years, but medical training has not kept up with its current needs. Clinical decision making frequently involves elderly patients with severe diseases who undergo a wide range of diagnostic and therapeutic procedures. These are performed by an interprofessional workforce in a complex, and constantly dynamic system. Furthermore, managers are demanding high standards and cost effectiveness together with containment measures. In this context, emphasis on knowledge management is still the centerpiece of many clinical education programs. But with the enormous volume of information available, the constant evolution of clinical processes and management plans, the acquisition of more knowledge does not necessarily ensure greater predictability and control. To address this situation, some programs are teaching not just how to diagnose and treat patients, but also are helping to understand how the whole system works, and prepare doctors for the inevitable constant changes they will face during their professional lives. An alternative approach is not trying to predict how the healthcare system is going to be like, but trying to give the residents the tools to be adaptable, to be resilient to change, to accept and maintain some practices and to adopt new ones, so they can face problem solving more efficiently. A growing body of evidence is showing that if we want providers to work together with administrators to plan, implement, and evaluate quality and effective projects, it is not enough for specialty programs to focus exclusively on academics. They also have to develop core social and emotional skills, and reflective attitudes and behaviors. Traditionally, residency programs have followed a Flexnerian model in which trainees spend part of their time studying, attending seminars and grand rounds trying to memorize facts, and then shadowing doctors in order to be able to practice the procedures observed. A recent vision is to complement this approach with communication, leadership, and teamwork skills, and to use simulation as a teaching tool. But many struggle to integrate this kind of learning in their programs. Our hospital is working to promote this change allowing residents to choose an elective rotation in the use of simulation-based medical education to better align educational results with the changing needs of our health care system. Research is supporting that clinical skills, attitudes, and professionalism learnt after simulation interventions are transferred to the work setting, and are associated with improved clinical outcomes. The objective of the rotation is to help acquire the fundamental knowledge, skills, and abilities necessary to deliver quality healthcare simulation activities. Competencies include: creating learning environments in which professionals feel both stimulated and psychologically safe to cope with change; promoting the development of reflective practitioners, and enhancing the understanding of feelings and perspectives of others; expanding formative and summative assessment processes and tools, including debriefing to improve performance; facilitating the transformation of individual expert clinicians, into expert teams; and including system dynamics analysis and process re-engineering. Residents may apply for a 1--3 months elective rotation to develop an educational project. It is funded by the Anaesthesia Department at which the Resident is enrolled. Resources available include an Accredited simulation-based Education Institute, certified simulation-based educators, and daily clinical team training activities.