Simulation in Anaesthesia
at the Royal Adelaide Hospital
Dr Graham Lowry FANZCA
The Royal Adelaide Hospital
 Adult Tertiary Teaching Hospital
∞ Affiliated with the University of Adelaide
∞ 680 beds
∞ 23 operating theatres
∞ 24 ICU / 10 HDU/ICU beds
 Major trauma referral centre for Sth Australia
∞ Receives 800 retrievals/year
Department of Anaesthesia
Branch of Critical Care
Anaesthesia/Pain/Hyperbaric medicine
52 FTE Consultants
32 Registrars
Simulation Unit
 Operational since 2003
 Teaching/education role
∞ Interns
∞ Registrars/trainees
∞ Consultant anaesthetists
∞ Technical and non-technical skills
 Relatively low budget
Specialty of Anaesthesia
 Five years of postgraduate training
∞ Major focus of training on developing technical skills
 Conflict of decreased working hours versus need for clinical
experience
∞ Aging population
∞ More complex surgery
 Increased emphasis from ANZCA for training in nontechnical skills.
Why Consultant Anaesthetists?
Historically, a lack of training in this area
Often seen as leaders during a crisis in theatre
BUT:
∞ No leadership training
∞ Often poor followers
Crisis Resource Management training is not
mandatory
The Scenarios
 Clearly defined goals important
 Simple clinical scenarios
∞ Diagnostic uncertainty useful for teaching human
factors
∞ Team dynamics create complexity
∞ Level of fidelity always a challenge
 Self reflection and evaluation important learning
component
Challenges……1
 Changing the culture
 Stressful for
∞ for participants
∞ facilitators
 Labour intensive
∞ maintaining service commitment versus patient safety
and quality of care.
Challenges……2
Availability of relevant, validated outcome
measures.
Adequate funding and resource allocation
Managing participants’ expectations and comfort
levels
Advantages ……1
Allows training/experience in rare (but
catastrophic) events
Breaks down the “silos”
Work as a team, train as a team even if the “team”
is constantly changing
Advantages ……2
Training/practicing in context
Issues of access to facilities
Moving beyond the operating theatre…