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Simulation Exercise Improved Family Understanding and Support of Anesthesia Providers

Learn how the University of North Carolina School of Medicine used a simulation-based experiential learning event to help the families and friends of anesthesia care team members understand their loved one's work, thus improving support at home and enhancing clinician well-being.

What Was the Problem?

The prevalence of physician burnout is high, while satisfaction with work-life balance is low. Understanding the importance of communication and social support in wellness, the University of North Carolina developed “The Family Anesthesia Experience Day” as an initiative for anesthesia care team members and their loved ones.1 The program promotes a better understanding of the day-to-day work of an anesthesia care provider in order to help foster better communication and empathy with their support persons outside of work, resulting in improved well-being.

What Was the Intervention?

“The Family Anesthesia Experience Day” is a simulation-based experiential learning event developed to provide an opportunity for significant others, parents, close friends, and children to learn more about the anesthesia work environment. The program is designed to increase knowledge and improve communication between anesthesia care providers and people who comprise their immediate support system. The event organizers hypothesized that this improved communication and understanding would enhance provider well-being.

At the start of the event, all attendees gather for a welcome and introduction. There are 2 tracks that run simultaneously:

  • Kids' track for attendees aged 3 to 11 years, and

  • Adult track for attendees 12 years of age and up.

Kids Track

The kids' track attendees participate in multiple stations that introduce them to the medical field of anesthesiology. It is set up with a carnival-like atmosphere, where the children can freely move between stations and spend as much time as they desire at each one.

In this track, there are multiple activities including:

  • A basic airway management station (bag mask ventilation and intubation),

  • An ultrasound scanning station,

  • A syringe challenge (moving arterial and venous “blood” to different cannisters),

  • “Teddy bear hospital” where children bring their stuffed animals needing “stitches,”

  • An arts and crafts station with medical-themed coloring pages,

  • Anesthesia face mask decorating,

  • Story time where participants read a book about a child receiving anesthesia, and

  • A tour of a procedural suite in the children's hospital.

The event organizers asked parents to send in pictures of their children ahead of time to make “official”

ID badges for children to wear throughout the event and take home as a souvenir.

Adult Track

The adult track attendees are divided into groups and each group rotates through three stations.

Station 1—High-Fidelity Perioperative Simulation Experience

Station 1 consists of a simulated clinical experience with patient actors, real anesthesia clinicians, and a high-fidelity patient simulator. In this station, participants watch a live preoperative patient assessment with informed consent, a preoperative briefing with a simulated surgeon and operating room nurse, induction of anesthesia, an intraoperative code with resolution, and a verbal patient hand-off to the ICU team using SBAR techniques (Situation, Background, Assessment, Recommendation).

After the simulated clinical events, the faculty anesthesiologist in the simulation leads observers through a debriefing. The debriefing serves to engage the participants in a discussion regarding the roles, range of responsibilities, and stressors of an anesthesia provider.

Station 2—Hands-on Airway Skills

Using airway mannequins, small groups of participants practice tasks frequently performed by anesthesiologists, such as:

  • Bag mask ventilation,

  • Endotracheal intubation,

  • Laryngeal mask airway (LMA) placement,

  • Fiberoptic bronchoscopy, and

  • Video laryngoscopy on airway mannequins.

Station 3—Hands-on Procedural Task Trainers

Participants are divided into small groups where they are educated about and practice placing spinals and epidurals, central lines with ultrasound guidance, and peripheral nerve blocks with ultrasound guidance, all using procedural task trainers.

Overall, the initiative demonstrated that this type of simulation event could be successfully carried out from a logistical standpoint. Planning for the inaugural event took two months and involved many members of the Department including physicians, CRNAs, residents, and administrative staff. Financial costs associated with the event included facility fees for use of the simulation center, compensation for standardized patient actors, and purchase of materials used in the varying stations (such as procedural task trainers for the adult track and art supplies for the kids' track). In order to run the event, multiple faculty, residents, and CRNAs volunteered their time to facilitate teaching at the various stations.

Results

After the inaugural event, the event organizers surveyed the anesthesia providers and their adult support persons who participated in the event. All respondents indicated that they enjoyed participating and would recommend this event to others.

The anesthesia providers were also surveyed on their perception of the benefits of the event. The survey results showed an improved perception on the effectiveness of future communication regarding work-related issues with their social support team.

The support persons were surveyed on their understanding of the duties involved in delivering anesthesia care. There was an increase in knowledge of the role of an anesthesia provider. After the event, the supporting individuals indicated that they would be more capable of supporting their loved one with regards to the stresses of balancing a demanding career with their personal life.

Some of the comments from the family members attending the event included, “No wonder you need to de-stress when you get home,” and, “I had no idea,” in response to the different types of procedures anesthesia providers perform. In another case, the mother of one of the physicians tearfully and earnestly said after observing the simulated cardiac arrest in the operating room, “It is amazing that my daughter does this for a living!”

The University of North Carolina was able to gather baseline data that demonstrated an increase in support persons' knowledge of the roles and responsibilities of an anesthesia provider. However, because the program used only pre- and immediate post-event surveys, the impact on the long-term effects of the program on clinician well-being is unknown.

This experience suggests that simulation can be useful for lay persons to better support the daily work of anesthesia care providers. This experience can use low- or high-fidelity simulation. The expenses are minimal. Buy-in for the event can come from all providers in the department to include physicians, CRNAs, AAs, residents, fellows, technicians, and support staff.

There is reason to believe that this experience is beneficial to the provider and to the support person in the home or community. This initiative is a low-risk, low-expense exercise that may yield substantial short-term and potentially long-term benefit.

UNC Anesthesiology is planning future initiatives in which longitudinal data will be obtained in order to examine the effects the Family Anesthesia Experience Day has on additional areas of the clinicians' well-being, such as stress, burnout, and resilience. The data will evaluate the anesthesia providers' perception of personal well-being with an improved understanding of their work by their support persons. Lastly, UNC is expanding the program to focus specifically on trainees starting residency and entering their clinical clerkships, as this period in their lives and careers can leave them particularly vulnerable to burnout.

About the Organization

The Department of Anesthesiology at the University of North Carolina School of Medicine employs nearly 400 anesthesia care team members, including faculty, residents, fellows, nurse anesthetists, research faculty, nurses, technicians, and support staff. The Department provides clinical services for over 70 000 patients a year across the full spectrum of surgeries and procedures.

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Article Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

References
1.
Martinelli  S, Chen  F, Hobbs  G,  et al.  The use of simulation to improve family understanding and support of anesthesia providers.  Cureus. 2018;10(3):e2262. doi: 10.7759/cureus.2262Google Scholar
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