Continuing Medical Education
Most simulation centers offer continuing medical education (CME)
for experienced practitioners, and nearly all aspects of simulation training for
residents (except novice training) can be expanded for this purpose.
Several studies have shown that experienced anesthetists also
have deficiencies in the management of critical patient situations and make severe
errors comparable to those of anesthesia residents.[22]
[58]
[65]
[68]
[98]
[100]
[129]
A study performed by Jacobsen and associates in Denmark[23]
involving 42 specialist anesthetists demonstrated major deficiencies in the diagnosis
and treatment of anaphylactic shock, as well as in application of the ACRM principles,
when a score adopted from Gaba and Howard was used.[38]
[92]
Because crisis situations are a rare occurrence
during routine clinical work, these results are not unexpected.
In addition, experience in terms of years on the job probably does not correspond
to expertise and excellence, nor does hierarchy. Therefore, it cannot be overemphasized
that crisis management training with simulators should be started early in education
and training and applied recurrently during practice.
An interesting aspect of CME training in the United States is
that it is regulated separately by each of the states and it is nearly uniformly
based only on the number of hours spent in the activity. Reading a short article
and answering a handful of questions can generate 1 hour of credit, as can sitting
through a lecture. Yet simulation training is, in general, much more interactive
and much more intensive than other activities. In Australia and Germany, for example,
CME requirements are expressed in terms of "points" to be accrued. Simulation training
counts for a large number of points per hour spent, commensurate with its intensity,
which might make simulation-based CME financially competitive relative to simpler
methods. At the Harvard hospitals, the captive insurer, Harvard Risk Management
Foundation, has taken unprecedented steps to link simulation-based CME training to
discounts for medical malpractice insurance rates for experienced clinicians, both
in anesthesia and in obstetrics (personal communication, Jeff Cooper, Ph.D., Partners
Healthcare).
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