1. Simulation in Anaesthesia at the Royal Adelaide Hospital
Dr Graham Lowry FANZCA

2. 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

3. Department of Anaesthesia
Branch of Critical Care
Anaesthesia/Pain/Hyperbaric medicine
52 FTE Consultants
32 Registrars

4. Simulation Unit Operational since 2003 Teaching/education role Interns
Registrars/trainees
Consultant anaesthetists
Technical and non-technical skills
Relatively low budget

5. 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 non- technical skills.

6. 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

7. 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

8. Challenges……1 Changing the culture Stressful for for participants
facilitators
Labour intensive
maintaining service commitment versus patient safety and quality of care.

9. Challenges……2 Availability of relevant, validated outcome measures.
Adequate funding and resource allocation
Managing participants’ expectations and comfort levels

10. 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

11. Advantages ……2 Training/practicing in context
Issues of access to facilities
Moving beyond the operating theatre…