The use of simulated clinical experiences to improve competency in the novice anesthesia provider.

摘要

Original definitions and attributes of competency have undergone a paradigm shift resulting in new definitions that are formulated by outcomes and performance skills. This shift to outcomes-based competencies has been demonstrated in nursing education and practice in such specialties as orthopedics, nephrology, and in medicine for critical care skills, surgical skills and for graduate medical education.; Simulation use to advance an individual's psychomotor skills has long been grounded in aviation (Atlantic Coast Airlines, 1995; Kellner, 2001). Healthcare professions are beginning to adopt this method to evaluate or develop competencies in real-time simulated clinical environments. This forum with standardized criteria avoids the uncertainty and unpredictability of the actual clinical environment, provides greater reliability and validity when evaluating competency skills.; A quasi-experimental, one group, time series design on a sample of 15 graduate registered nurse anesthesia students without prior clinical anesthesia experience were used to evaluate the effects of simulated clinical experience on three core competencies of the novice anesthesia provider. This study was based upon the conceptual framework of Benner's Levels of Proficiency in Nursing Model (Benner, 2001).; Chi Square statistical analysis for quantitative evaluation on three core competencies was performed at three prescribed time intervals. These core competencies were: (1) Oral laryngoscopy with tracheal intubation demonstrated by auscultation of bilateral breath sounds, tracheal intubation in 30 seconds or less, and symmetrical rise and fall of chest wall, (2) Assignment of anesthetic risk category from hypothetical patient scenarios, and (3) Ventilatory mask fit with effective ventilation as evidenced by bilateral breath sounds, end-tidal carbon dioxide concentration and symmetrical rise and fall of chest wall.; Post simulation and clinical evaluation of endotracheal intubation and oral laryngoscopy demonstrated success on the first attempt by anesthesia providers. All novice anesthesia providers demonstrated this improvement in skill when time was used as a measure of successful intubation (less than 30 seconds).; Competency-based eduction allows healthcare professionals to satisfy societal and organizational expectations of clinical competence through evidence based instruction rather than on certification or licensure. The use of a human patient simulator provides a forum for the incorporation of knowledge, cognitive and psychomotor skills.