Anne-Sophie Nyssen

A comparison of the training value of two types of anesthesia simulators: Computer screen-based and mannequin-based simulators

UNLABELLED In this study, we compared two different training simulators (the computer screen-based simulator versus the full-scale simulator) with respect to training effectiveness in anesthesia residents. Participants were evaluated in the management of a simulated preprogrammed scenario of anaphylactic shock using two variables: treatment score and diagnosis time. Our results showed that simulators can contribute significantly to the improvement of performance but that learning in treating simulated crisis situations such as anaphylactic shock did not significantly vary between full-scale and computer screen-based simulators. Consequently, the initial decision on whether to use a full-scale or computer screen-based training simulator should be made on the basis of cost and learning objectives rather than on the basis of technical or fidelity criteria. Our results support the contention that screen-based simulators are good devices to acquire technical skills of crisis management. Mannequin-based simulators would probably provide better training for behavioral aspects of crisis management, such as communication, leadership, and interpersonal conflicts, but this was not tested in the current study. IMPLICATIONS We compared two different training simulators (computer screen-based versus full-scale) for training anesthesia residents to better document the effectiveness of such devices as training tools. This is an important issue, given the extensive use and the high cost of mannequin-based simulators in anesthesiology.

Stress and burnout in anaesthesia.

Purpose of review Recently, many researchers have been studying stress and burnout in anaesthesia. Some researchers have examined the effects of stress in the workplace. Others have identified some job characteristics that have an impact on anaesthetists well-being. Yet, few studies use the same measure of stress and/or define the concept of stress in the same way, making comparison and aggregation of results difficult, and therefore minimizing the general impact of these research findings. Recent findings The following review focuses on the increasing recent research on stress and burnout in anaesthesia regarding the existing stress models and shows where the progress has been made, and where difference of opinion and divergence of approach remain. Summary From the referred studies, the review challenges the more practical problems of prevention of stress and burnout and provides some avenues for future investigations.

Impact of 2D and 3D vision on performance of novice subjects using da Vinci robotic system.

Abstract Purpose of the study: The aim of this study was to evaluate the impact of 3D and 2D vision on performance of novice subjects using da Vinci robotic system. Methods: 224 nurses without any surgical experience were divided into two groups and executed a motor task with the robotic system in 2D for one group and with the robotic system in 3D for the other group. Time to perform the task was recorded. Results: Our data showed significant better time performance in 3D view (24.67 ± 11.2) than in 2D view (40.26 ± 17.49, P < 0.001). Conclusions: Our findings emphasized the advantage of 3D vision over 2D view in performing surgical task, encouraging the development of efficient and less expensive 3D systems in order to improve the accuracy of surgical gesture, the resident training and the operating time.

Error detection: A study in anaesthesia

Although error has been shown as the main cause of accidents in complex systems, little attention has been paid to error detection. However, reducing the consequences of error depends largely on error detection. The goal of this paper is to synthesize the existing scientific knowledge on error detection, mostly based on studies conducted in laboratory or self reporting and to further knowledge through the analysis of a corpus of cases collected in a complex system, anaesthesia. By doing this, this paper is better able to describe how this knowledge can be used to improve understanding of error detection modes. An anaesthesia accident reporting system developed and organized at two Belgian University Hospitals was used in order to collect information about the error detection patterns. Results show that detection of errors principally occurred through the standard check (routine monitoring of the environment). Significant relationships were found between the type of error and the error detection mode, and between the type of error and the training level of the anaesthetist who committed the error.

Prospective issues for Error Detection

From the literature on error detection, the authors select several concepts relating error detection mechanisms and prospective memory features. They emphasize the central role of intention in the classification of the errors into slips/lapses/mistakes, in the error handling process and in the usual distinction between action-based and outcome-based detection. Intention is again a core concept in their investigation of prospective memory theory, where they point out the contribution of intention retrievals, intention persistence and output monitoring in the individuals possibilities for detecting their errors. The involvement of the frontal lobes in prospective memory and in error detection is also analysed. From the chronology of a prospective memory task, the authors finally suggest a model for error detection also accounting for neural mechanisms highlighted by studies on error-related brain activity.

Coordination in hospitals: organized or emergent process?

Hospitals have become more and more complex organizations that require increasing degrees of vertical, lateral and longitudinal coordination among their staff. As organizations, hospitals positively organize the coordination between the activities of its different agents, as well as the associated communication between them. The overall goal is to construct a “common ground” between the agents about the work process. In order to achieve this, a series of management tools are called upon. However these coordination mechanisms may fail. In the case analyzed, the agents seem to organize their behavior through direct and local individual interactions with their work environment, rather than through a global representation of the work. The case study demonstrates that intentionally organized coordination mechanisms interact with, and may be superseded by, the “emergence-through use” of coordination mechanisms in real time. These two mechanisms are clearly embedded at work, and can both be beneficial in promoting coordination in large scale systems.

Analysis of synchronization constraints and associated errors in collective work environments

This paper presents a framework of analysis of the requirements of synchronization and the associated errors in collective work environments. It proposes a formalism for describing the temporal relations that synchronization constraints take on in a work situation, giving special attention to the temporal information strategies used by the operators. A relational conception of time helps in understanding how the operators perceive, retain and utilize information to temporally co-ordinate their behaviours. An example application of the framework of analysis is developed for a situation of concrete work -anaesthesia- in the final section which concludes with the analysis of two cases of errors related to synchronization.

Perceptual and instrumental impacts of robotic laparoscopy on surgical performance

New technologies in surgery are in constant and considerable evolution; they transform the surgeon s activity and practice. In laparoscopic surgery, new systems allow the use of two(2D) or three-dimensional (3D) vision. However, the literature reports contradictory results concerning the benefits of 3D vision: some studies show that better motor performances are obtained with 3D vision [1, 8, 19, 25, 26] while others fail to reveal any difference in performance between 2D and 3D vision [5, 6, 12, 20]. In some studies [5], only complex tasks were performed faster and more easily with a 3D view whereas no difference between the use of 2D and 3D views appeared when performing the easiest tasks. The divergence in these results is partially due to the fact that first-generation 3D systems, with their lower resolution, were compared with standard 2D systems [10]. Nowadays, new 3D systems allow a natural bidimensional view and thus suppress the bias observed in previous studies. In this paper, we used a new-generation 3D system, the da Vinci robotic system. This robotic system allows a 3D visualization of the operative field to be gained, restores the degrees of freedom (DOFs) lost in classical laparoscopy, and improves the dexterity of the surgeon s hand and wrist. Only one published study [13] has compared the performance obtained using classical laparoscopic techniques and those using this robotic system. This study revealed advantages of the da Vinci robotic system, particularly when it was used with the 3D view option. However, only six subjects participated in this study and the chosen tasks were very specific to the robotic system training. Our objective was therefore to study, with more participants, the impact of the da Vinci robotic system on standard and ecological surgical tasks of increasing complexity (ecological in the sense that our tasks were similar to the gestures made by the surgeon in a real situation, for which we used bench models developed and validated in several studies [7, 22, 23]). To analyse the nature of the benefits brought about by these expensive new technologies precisely, we independently differentiated and studied the influence of the 3D view (afferent component), comparing 2D and 3D view, and the influence of movement freedom restauration (DOFs, efferent component), comparing the classical laparoscopy with the robotic system. We also studied the impact of the use of the robotic technology on the subject s self-confidence, satisfaction and facility, knowing that these three factors influence both the performance and acceptance of new technology in the operating room [16, 17]. To avoid any bias from earlier laparoscopic experience in our comparison between classical and robotic laparoscopic techniques, we only selected medical students without any prior experience in open, minimally invasive or robotically assisted surgery.

Influence of 2D and 3D view on performance and time estimation in minimal invasive surgery

This study aimed to evaluate the impact of two-dimensional (2D) and three-dimensional (3D) images on time performance and time estimation during a surgical motor task. A total of 60 subjects without any surgical experience (nurses) and 20 expert surgeons performed a fine surgical task with a new laparoscopic technology (da Vinci robotic system). The 80 subjects were divided into two groups, one using 3D view option and the other using 2D view option. We measured time performance and asked subjects to verbally estimate their time performance. Our results showed faster performance in 3D than in 2D view for novice subjects while the performance in 2D and 3D was similar in the expert group. We obtained a significant interaction between time performance and time evaluation: in 2D condition, all subjects accurately estimated their time performance while they overestimated it in the 3D condition. Our results emphasise the role of 3D in improving performance and the contradictory feeling about time evaluation in 2D and 3D. This finding is discussed in regard with the retrospective paradigm and suggests that 2D and 3D images are differently processed and memorised.

Reporting systems in healthcare from a case-by-case experience to a general framework: an example in anaesthesia

Reporting systems are becoming more widespread in healthcare. Since they may become mandatory under the pressure of insurance companies and administrative organizations, it is important to begin to go beyond a case-by-case approach and to move to a system where there is a general reflection on the best conditions of development and setting up of such systems in medicine. In this paper, we review existing reporting systems, break down their components, examine how they are constructed and propose some ideas on how to articulate them in a dynamic process in order to improve the validity of the tool as mediator of safety, quality and well-being at work.