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Innovation and the Future in Continuing Medical Education

Michael A. Olympio, M.D., Chair
Workgroup on Simulation Education
Daniel J. Cole, M.D., Chair
Committee on Outreach Education

The Committee on Outreach Education has an important educational charge: to investigate the needs of the membership for future educational offerings. With the ASA Annual Meeting as its continuing medical education (CME) cornerstone, our Society has a rich heritage of excellence in CME. We have a commitment, though, to be proactive and innovative regarding future CME needs.

The market for traditional CME offerings is saturated with few content gaps. In the recent past, we have had variable success with our Regional Refresher Courses and Workshops. Over the past several years, however, a mandate for CME in transesophageal echocardiography has been met with the excellent workshops organized by Robert M. Savage, M.D.

As we are well-established in the electronic era, we have two innovative initiatives that should play an important role in meeting the future CME needs of anesthesiologists. The first initiative is an electronic “ASA Grand Rounds.” Under the leadership of Audree A. Bendo, M.D., a plan will be proposed whereby live CME sessions would be presented on a regular basis. The second initiative regards simulation education, presented below in more detail.

A 19-member Workgroup on Simulation Education, led by Michael A. Olympio, M.D., convened in December 2004 to organize a national network of simulation education offerings to meet the expanding needs of anesthesiologists. For example, researchers at the 2004 and 2005 International Meeting on Medical Simulation reported high-stakes, validated testing in simulation for the Israeli oral board certification process1 and a formal nationwide introduction of simulation training into the German medical school curriculum.2 The Centre for Anaesthesia Skills and Medical Simulation at the University of Western Australia offers 170 courses to both fellowship and consultant anaesthetists throughout Australasia.3 These new and global achievements follow a successful, although small-scale, 15-year history of simulation CME in the United States. In fact, anesthesiology was the pioneering discipline in medical simulation. Rapid expansion is inevitable, particularly following the Institute of Medicine’s Quality of Healthcare in America Project. In their report, To Err Is Human,4 the authors suggest the widespread application of simulation training to reduce human error in three of their five recommendations for designing safety systems in health care organizations.

David M. Gaba, M.D., Associate Dean for Immersive and Simulation-Based Learning at Stanford University, explains that “simulation is a technique, and not a technology, to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.”5 While describing the dimensions of the experience, he predicts that medicine will rapidly imitate the simulated training standards of commercial aviation, nuclear power production and military interventions. Dr. Gaba further suggests that, after certification, clinicians rarely undergo continual systematic training, rehearsal, performance assessment and refinement in their practice.

Clearly we are challenged to expand our use of simulation into the broader community of anesthesiologists and beyond, as described recently by Cooper and Taqueti.6 The historical development of simulation training suggests a lack of interdisciplinary collaboration that could be “hampering broader discovery, innovation, and dissemination.” Jeffrey B. Cooper, Ph.D., from the Massachusetts General Hospital Department of Anesthesia and Critical Care in Boston, recommends integration of procedural and mannequin technologies to achieve the broadest potential in training. For example, the Food and Drug Administration requires that vascular surgeons must first use simulation for carotid stent device training prior to clinical performance,7 but their simulation training does not yet include other members of the team who would be expected to work harmoniously in a crisis situation.

Furthermore, the American Board of Anesthesiology recognizes simulation as one tool in shifting the focus from initial certification with periodic voluntary recertification to the concept of time-limited certification and maintenance of certification.8 Maintenance of Certification in Anesthesiology (MOCA) is driven by public demands for stricter self-regulation and includes periodic self-assessment and evidence of practice performance and improvement. Obviously the provision of organized simulation facilities and programs will enhance the opportunities for MOCA.

ASA provides support for the Workgroup on Simulation Education to accomplish its mission. Already the group has outlined the content and organization of a new Simulation Registry Web site to be located within the ASA Web site . This site will offer a comprehensive listing of simulation educational opportunities. ASA members will receive an important survey requesting their opinions on simulation education while voluntary accreditation programs for simulation facilities and their instructors are being developed. These efforts should measurably enhance the quality of your instruction.

To introduce the concept of simulation education, we first plan to conduct a “Simulation Saturday” in centers across the nation. ASA members will voluntarily attend an introductory session to explore this exciting technology. The ASA workgroup will further develop standardized simulation curricula to be offered later at accredited centers. At the 2006 ASA Annual Meeting, we plan to present “Simulation Expo,” featuring a live, interactive, onscreen, teleconferenced simulation in anesthesia crisis resource management. Meanwhile, ASA members will have the opportunity to explore and attend simulation CME programs by searching the registry. Learning through performance and the immediate provision of feedback will be two of the most valuable aspects of this program. Watch the ASA Web site for continuing updates.

Overall, the Committee on Outreach Education and its activities play an important role in meeting the CME needs of ASA members. The above tools are just two innovative methods by which future CME needs for ASA members will be met by your ASA.


References:
1. Berkenstadt H. Simulation at the Board Exam Level. 5th Annual International Meeting on Medical Simulation. Society for Medical Simulation. 2005, Miami, Florida.
2. Moenk S. Development of the German Simulation Program. 4th Annual International Meeting on Medical Simulation. Society for Technology in Anesthesia. 2004, Albuquerque/Santa Fe, New Mexico.
3. Riley RH, Grauze AM, et al. Three years of “CASMS”: The world’s busiest medical simulation centre. Med J Australia. 2003; 179:626-630.
4. Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human. Washington, DC: National Academy Press. 1999:173-182.
5. Gaba DM. The future vision of simulation in health care. Qual Saf Health Care. 2004; 13:i2-i10.
6. Cooper JB, Taqueti VR. A brief history of the development of mannequin simulators for clinical education and training. Qual Saf Health Care. 2004; 13:i11-i18.
7. Emory Heart Center. Emory Cardiologist Christopher Cates Says Virtual Reality Training Key to Reducing Medical Errors. Available online. Accessed on July 29, 2005.
8. Tuman KJ. Report from the president. ABA News. 2005; 18:1-3.