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Published in CenterView on May 29, 2012
Pamela Womack
Pamela Womack

School of Nursing helps to provide in situ training for anesthesiology, OB residents

By Matt Westerfield

The patient fighting a postpartum hemorrhage was in the operating room, ventilated and ready for emergency surgery, when anesthesiology resident Dr. Lillian Zamora realized her CO2 monitor wasn’t working, meaning she couldn’t evaluate the patient’s breathing.

Fortunately, the patient was only a simulation manikin, but employing that manikin in a Winfred L. Wiser Hospital for Women and Infants OR taught a valuable lesson: how to communicate effectively in a high-stress real-world environment.

The joint service, in situ training exercise, a first of its kind at the University of Mississippi Medical Center, was a collaboration between the School of Medicine and the School of Nursing that provided medical residents with simulation experience in a real hospital setting.

“It’s about as good a blend of reality that we can get with the opportunity to put the residents in the same situation where they can be evaluated fairly,” said Dr. Jan Cooper, associate professor of nursing and director of the SON’s simulation center. “This is our first experience of doing in-situ training — actually bringing the simulators into the work environment, which makes the whole fidelity of the situation higher.”

“The reason that we’re doing this between anesthesiology and OB together in Wiser with the high-fidelity manikin is that this is the best way to work on one of the most elusive parts of medical care, which is teamwork in the setting that it occurs,” said Dr. John Bethea, assistant professor of anesthesiology.

The May 9-10 training exercise involved nursing faculty and staff who presented a labor-and-delivery scenario with the school’s Sim Mom simulator. After delivering the baby, the residents were required to diagnose a post-delivery emergency and transport the mother to the OR along with the help of actual OB nurses.

Zamora, who graduated from UMMC in 2009, was one of six anesthesiology and nine obstetrics residents to participate in the exercise. She said the simulation reinforced the importance of asking for feedback and giving direct commands.

“You need to be aware that you have to tell individuals what to do so that things get done,” she said. “What I learn during the simulations are non-technical skills that we overlook at times when we are taking care of patients during critical times, such as communicating clearly to the team.”

Zamora said she feels simulation is worthwhile if it helps health-care professionals evaluate what they are doing on a daily basis.

“Yes, people laugh and, yes, it’s a little awkward, because it’s not really how it goes down. But it helps you picture that scenario,” she said.

Simulation is becoming part of the certification and recertification process for physicians, Bethea explained.

“And one of the things that the residents commented to me on is that it’s not like being in the simulation center. That’s what throws off the residents, because when they know it’s all simulation, it’s easy to treat it as all simulation. Doing this type of simulation in clinical areas makes the residents ready for patient care and certification simulations.”

One of the goals of the scenario is to reinforce what Bethea calls closed-loop communication with respect to crisis resource management. A key part of that is assigning direct commands to a specific team member and having that team member acknowledge what he or she is responsible for in order to ensure follow-through and prevent errors.

Bethea first discussed the idea with Dr. Sheila Bouldin, associate professor of obstetrics and gynecology, and they agreed it would be best to conduct the simulation in Wiser to make it as authentic as possible.

“Dr. Cooper is well-known to be heavily involved with the maternal/fetal simulation, so I reached out and talked to her, and she was very enthusiastic about joining,” he said.

The School of Medicine and the School of Nursing have been working together more and more, Bethea said, adding that the SON deserves special credit for devoting its time and resources when nursing students weren't even involved.

“This is them helping out because they are good people and they are willing to share their resources with the university,” he said. “To me, that’s a sign of what we really want: people genuinely trying to help each other out. (The School of Nursing) really wants to help doctors and nurses work together better. They want to see better teamwork.”

An added benefit of the exercise is teaching professionalism and respect, Bethea said.
“Everybody deserves respect,” he said. “It’s not just teaching people technical things. It’s role-modeling how to treat other people.”

“What it’s allowed me to do is to make more connections with the nurses up here,” Cooper said. “We could get together and determine if there’s a way to use simulation for the orientation of OB nurses and also for the training of nursing students. So it’s beginning to open those doors.”

Obgyn sim 2
From left, Dr.KathrynMallette, Christy Purviance and Dr. Sarah Mitchell