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February 1, 2013 Volume 77, Number 2
What's New In... ASA Simulation Education Network Offering Simulation Courses for MOCA® Part IV Update from the ASA Editorial Board for Simulation-Based Training (Formerly the ASA Committee on Simulation Education) Amanda R. Burden, M.D.

Manuel Pardo, Jr., M.D.

Ken B. Johnson, M.D.

Randolph H. Steadman, M.D., M.S.

The ASA Committee on Simulation Education was formed in 2006, and converted to an Editorial Board in 2012. The group’s mission is to foster access to high-quality simulation-based training for ASA members. To accomplish this, they developed endorsement criteria for simulation programs and, since 2007, have endorsed 33 programs that comprise the ASA Simulation Educational Network (SEN). Links to endorsed programs can be found on the ASA Simulation webpage: starting at the For Members header on the ASA home page,, select Education and Events, then Simulation Education.

The American Board of Anesthesiology (ABA) recognizes simulation training as an innovative approach for physicians to assess their clinical and teamwork skills in managing critical events. In January 2010 the ABA incorporated simulation as a requirement in the Practice Performance Assessment and Improvement (PPAI) portion of the Maintenance of Certification in Anesthesiology (MOCA®). This change responded to the American Board of Medical Specialties requirement that specialists assess the quality of the care they provide and apply consensus recommendations to improve that care. This use of simulation training by ABA and ABMS is, in part, recognition that experiential learning is expected to have more substantial impact on practice improvement, clinical competency and patient safety than can be achieved by traditional learning methods.

The ABA charged the ASA Committee on Simulation Education with the task of developing simulation-based courses to be offered by the network of endorsed programs as a means to satisfy the simulation component of MOCA® PPAI. As part of the simulation courses, participants generate and implement a practice improvement plan tailored to their practice environment. As of October 2012, over 1100 ABA diplomates have attended simulation courses at SEN programs. Course evaluations have been overwhelmingly positive with greater than 98 percent reporting that the course was relevant to their practice, while 96 percent would recommend the course to colleagues, and 94 percent anticipated changing their practice based upon what they learned. A publication outlining the first two years’ experience using simulation for MOCA® will appear in an upcoming issue of The Journal of Continuing Education in the Health Professions.

Programs that offer courses to meet the MOCA simulation requirement are endorsed for a two-year period. As this MOCA requirement approaches its third year of implementation, all 18 of the original endorsed programs have applied for and received re-endorsement. The application and re-endorsement process are peer-reviewed and consider participant evaluations, course content, quality and volume, as well as program infrastructure. Course content and scenarios are evaluated to ensure quality, as are program instructors and leadership. Members of the Simulation Education Editorial Board conduct the peer review with the intent of ensuring that simulation requirements for MOCA® are met and that there is consistency among programs.

New this year is the introduction of subspecialty MOCA® simulation courses. The aim of this effort is to ensure that courses are relevant to diplomates’ practice. The Simulation Education Editorial Board has recently begun endorsing programs to offer subspecialty MOCA® simulation courses to include Critical Care (CCM) and Pain Medicine (PM). The number of endorsed programs offering MOCA®-SUBS programs is expected to grow as demand for subspecialty courses increases.

For ABA diplomates considering simulation training, MOCA® course criteria include: a minimum of six hours of course instruction; active participation in challenging, simulated events; interactive, instructor-facilitated post-scenario debriefing; and a self-assessment leading to strategies to improve practice. At least one course instructor must be an ABA diplomate and the student-to-instructor ratio must be no greater than 5:1.

Courses are designed to present challenging perioperative events that require clinically relevant problem solving. Courses meeting the criteria emphasize teamwork and communication. The events included in the course are typical of those encountered in the general practice of anesthesia. Because of their impact on patient safety, three topics are addressed in every course: principles and practice of teamwork and communication, management of significant hypoxemia from any cause (including difficult airway), and management of significant hemodynamic instability. These three topics are addressed through the use of a variety of scenarios unique to each program.

Each participant is the primary anesthesiologist during at least one scenario. At the conclusion of the scenario, an instructor-facilitated peer debriefing ensues. The debriefing is designed to encourage participants to review and reflect on the simulated clinical events and develop a practice improvement plan. Practice improvement may include expanding personal clinical knowledge or skill and/or improving patient safety through improvements in anesthesia group practices or hospital policy regarding perioperative care.

The MOCA® program requirements are specific to board certified anesthesiologists who are enrolled in the ABA MOCA® program, but post-residency anesthesiologists who are not enrolled in the MOCA program are welcome to participate as well. These courses are designed as experiential learning opportunities that stimulate practice improvement.

Regardless of whether they are seeking MOCA credit, participants may find managing challenging scenarios in front of others to be intimidating. Performance anxiety is a normal reaction that course instructors minimize by focusing on improvement opportunities and emphasizing the absence of individual testing. Participants do not receive a formal, written evaluation of their performance. Rather, after a review of the challenges faced during the various scenarios, participants reflect on how they would overcome these challenges during actual cases, and develop an improvement plan suitable for the challenges in their practice. Course participants seeking MOCA® credit are given up to 90 days after the course to implement their improvement plan and provide ASA with a follow-up assessment of the status of their improvement plan.

More information is available at the For Members section of the ASA website at including FAQs and a list of SEN centers that offer simulation-based training. This list contains links to the websites for each program that describe specific course details and how to enroll. This site also has information and an application for simulation programs that would like to apply to join the SEN. The ASA Calendar link on the ASA home page also links to courses offered by SEN programs.

MOCA® is a registered certification mark of The American Board of Anesthesiology, Inc.

Drs. Burden, Pardo, Johnson and Steadman are members of the ASA Editorial Board for Simulation-Based Training.

Amanda R. Burden, M.D. is Assistant Professor of Anesthesiology; Director, Simulation Program, Cooper Medical School of Rowan University and Cooper University Hospital, Camden, New Jersey.

Manuel Pardo, Jr., M.D. is Professor; Vice Chair for Education; Residency Program Director; Sol Shnider Endowed Chair for Anesthesia Education, University of California, San Francisco.

Ken B. Johnson, M.D. is a Professor and Director, Center for Patient Simulation, Carter M. Ballinger Presidential Chair in Anesthesiology, and Adjunct Professor, Department of Biomedical Engineering, University of Utah, Salt Lake City.

Randolph H. Steadman, M.D., M.S. is Professor and Vice Chair, Department of Anesthesiology, David Geffen School of Medicine at the University of California, Los Angeles.

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