Hypothyroidism - A Causal Approach to Testing Assumptions against Empirical Results.

There is a controversy in the diagnosis and treatment of hypothyroidism. We propose the disagreement is fueled by statistical paradoxes, and sampling biases that provide different perspectives depending upon the sample selection criteria. The statistical inconsistencies become more apparent when viewed using a causal lens.

Non-Technical Skills Bingo-a game to facilitate the learning of complex concepts.

Acquiring the concepts of non-technical skills (NTS) beyond a superficial level is a challenge for healthcare professionals and simulation faculty. Current simulation-based approaches to teach NTS are challenged when learners have to master NTS concepts, clinically challenging situations, and simulation as a complex technique. The combination of all three aspects might overwhelm learners.

Lessons for simulation-based education from social psychology.

Effective practice is informed by underlying theoretical models. Better awareness and understanding of such models can enhance reflection by practitioners on their current educational activities and so help drive the cycle of continuing improvement. In this article the author reflects on in which a better understanding of social psychology gave insights into why some practices appeared to be more effective than others and some ways in which future practice could be altered.

Review article: the influence of psychology and human factors on education in anesthesiology.

Purpose: We look at the changing nature of medical education in the developed world with particular reference to those areas of the new curriculum frameworks which have introduced topics from the psychosocial realm.

Principle Findings: Research in the branch of psychology dealing with human factors has developed a useful body of working knowledge which applies to other industries where humans interact with the complex systems in which they function. Some findings are already being applied to facets of anesthesia performance, including situation awareness, effective teamwork, countermeasures against active errors and latent pathogens, and limitations of human performance.

Literature review: instructional design and pedagogy science in healthcare simulation.

This article is a review of the literature focused on simulation as an educational intervention in healthcare. The authors examined the literature based on four key levels: (1) the validity and reliability of the simulator, (2) the validity and reliability of the performance evaluation tool, (3) the study design, and (4) the translational impact. The authors found that the majority of research literature in healthcare simulation does not address the validity and reliability of the simulator or the performance evaluation tool.

Human performance limitations (communication, stress, prospective memory and fatigue).

A key role in anaesthetic practice is gathering and assimilating information from a variety of sources to construct and maintain an accurate mental model of what is happening to the patient, a model that will influence subsequent decisions made by the anaesthetist on the patient's behalf, as part of a larger team. Effective performance of this role requires a set of mental functions that place great demands upon the physiology and psychology of anaesthetists, functions that are vulnerable to a wide range of factors including those affecting team performance and those affecting the anaesthetist specifically. The number of tasks, their complexity, the physical and mental demands of the job, the underlying health and well-being of the anaesthetist and the environment and context within which the team attempt to meet the demands placed on them will influence the outcome of patient care.

When things do not go as expected: scenario life savers.

In this paper we discuss scenario life savers - interventions before and during simulation scenarios that allow to create and use relevant learning opportunities, even if unexpected events happen during the conduction of the scenario. Scenario life savers are needed, when the comprehension or acceptance of the scenario by the participants is at stake, thus compromising learning opportunities. Scenario life savers can principally work by bringing participants back on track of the planned scenario or by adapting the conduction to their actions on the fly.

Defining excellence in anaesthesia: the role of personal qualities and practice environment.

Background: Calls for reform to postgraduate medical training structures in the UK have included suggestions that training should foster excellence and not simply ensure competence.

Methods: We conducted a modified Delphi-type survey starting with an e-mail request to specialist anaesthetists involved in education, asking them to identify the attributes of an excellent anaesthetist. In focused group interviews, their coded and categorized responses were ranked, and suggestions were made for incorporation into anaesthesia education.

Beyond monitoring: distributed situation awareness in anaesthesia.

Situation awareness (SA) is one of the essential non-technical skills for effective and safe practice in high-risk industries, such as healthcare; yet, there is limited research of its significance in anaesthetic practice. In this paper, we review this scant research that focuses on SA as patient monitoring alone and advocate for a more comprehensive view of SA in anaesthetic practice and training that extends beyond monitoring, namely, a distributed cognition approach. We identify further factors influencing anaesthetists' SA and provide a case that resulted in an anaesthetic fatality to illustrate the application of an alternative view of SA in anaesthesia.

Anaesthetists' non-technical skills.

This review presents the background to the development of the anaesthetists' non-technical skills (ANTS) taxonomy and behaviour rating tool, which is the first non-technical skills framework specifically designed for anaesthetists. We share the experience of the anaesthetists who designed ANTS in relation to applying it in a department of anaesthesia, using it in a simulation centre, and the process of introducing it to the profession on a national basis. We also consider how ANTS is being applied in relation to training and research in other countries and finally, we discuss emerging issues in relation to the introduction of a non-technical skills approach in anaesthesia.

Drug errors: consequences, mechanisms, and avoidance.

Medication errors are common throughout healthcare and result in significant human and financial cost. Prospective studies suggest that the error rate in anaesthesia is around one error in every 133 anaesthetics. There are several categories of medication error ranging from slips and lapses to fixation errors and deliberate violations.

No simple fix for fixation errors: cognitive processes and their clinical applications.

Fixation errors occur when the practitioner concentrates solely upon a single aspect of a case to the detriment of other more relevant aspects. These are well recognised in anaesthetic practice and can contribute significantly to morbidity and mortality. Improvement in patient safety may be assisted by development and application of countermeasures to fixation errors.

Accident and emergency training perspectives in Scotland.

Objective: To determine the perspectives of Scottish accident and emergency (A&E) trainees and trainers on current training in the speciality, in order to help develop a simulator based training programme to complement existing training.

Methods: Questionnaires were sent to all Scottish A&E trainees and consultants responsible for training. They were presented with various clinical challenges.

The use of an anaesthetic simulator to assess single-use laryngoscopy equipment.

Objective: To compare the view at simulated direct laryngoscopy obtained with a standard laryngoscope, with and without a disposable cover and a disposable laryngoscope blade.

Design: Randomized non-blinded comparison.

Setting: The high-fidelity human patient simulator at the Scottish Clinical Simulation Centre.

Integrating human factors into the medical curriculum.

Background: The study of human factors is a scientific discipline that deals with the interactions between human beings and the elements of a system. This is important because shortcomings in these areas, if unchecked, can result in adverse outcomes. Research into human factors in industries where safety is paramount has provided the basis of countermeasures against human error.

Low- to high-fidelity simulation - a continuum of medical education?

Context: Changes in medical training and culture have reduced the acceptability of the traditional apprenticeship style training in medicine and influenced the growth of clinical skills training. Simulation is an educational technique that allows interactive, and at times immersive, activity by recreating all or part of a clinical experience without exposing patients to the associated risks. The number and range of commercially available technologies used in simulation for education of health care professionals is growing exponentially.