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PHARM Podcast 73 Human factors with Martin Bromiley & Dr Nicholas Chrimes – Lessons from aviation and anaesthesia

Martin Bromiley, commercial airline pilot and founder of Clinical Human Factors Group

Dr Nicholas Chrimes, anaesthetist and co-inventor of VORTEX

Dr Nicholas Chrimes, anaesthetist and co-inventor of VORTEX

Tonight on the podcast we interview Martin Bromiley, an aviation pilot and human factors advocate since the tragic death of his wife during a routine operation as a result of a Cannot Intubate Cannot Ventilate complication of anaesthesia in 2005. I get his views on the role of aviation, commercial and military , in helping medicine become safer and more resilient when unexpected crises occur. Also we have our old friend of the show, Dr Nicholas Chrimes of VORTEX fame, provide insight and commentary from an anaesthesia viewpoint. He discusses the role of simulation training and cognitive aids in preparing ourselves for the “seconds from disaster” situations.

BE SURE TO FOLLOW THESE GUYS ON TWITTER!

@MARTINBROMILEY

@NICHOLASCHRIMES

Show note references:

  1. JUST A ROUTINE OPERATION
  2. CLINICAL HUMAN FACTORS GROUP WEBSITE
  3. Combat aviation paradigms for resuscitationists
  4. Aviate,navigate, communicate. Where medicine is going wrong
  5. NAP4

Now on to the AudioPodcast ( available here and on iTunes)

Right Click and Choose Save-as to Download the Podcast.

5 Comments Post a comment
  1. At the end of that podcast I say that the answer is not putting more resources into simulation. I should clarify that what I meant it is not JUST putting more resources into simulation. It is also using our existing educational resources more efficiently and effectively – but there is no doubt that additional resources for human factors & teamwork education are required to change the culture and implement the changes needed to make healthcare safe.

    June 11, 2013
  2. Newer kit makes sim affordable and accessible….the key is to incorporate into existing culture and make teamwork/crisis management part of every day

    Adding a sim case on to the end of a routine theatre list, or ICU/ED ward round encourages buy in, with flow on changes in staff attitude, equipment checking and knowledge of use and anticipation of problems

    June 12, 2013
    • Tim, I agree in situ sim training has many advantages in terms of environmental fidelity, engagement of the “actual team” & efficient use of time – but it also has many dangers.

      Quarantining of simulated equipment from real equipment is one concern. For example if simulations are using expired drugs or a deactivated defibrillator, etc there must be a mechanism to ensure this equipment does not get muddled up with real equipment – in practice this often becomes quite a complex issue. Conversely when real equipment is used this must not compromise its availability for management of real patients (ie. the only crash cart is being used in the scenario).

      Negative transfer (using the power of the simulation experience to imprint incorrect behaviours) is another risk that takes on additional significance with in situ training. For example if a “live” defibrillator is used the energies must be dialed down to safe levels (whereas if using a de-charged” defibrillator, as might be more practical in a dedicated Sim Centre, allows the real charge to be dialed up). Unless these deviations from actual practice are specifically pointed out you can end up inadvertently teaching staff the wrong thing. Similarly in a real environment it is usually not appropriate to hit the emergency buzzer – yet by omitting this step you don’t want to train them out of this practice.

      These are just a couple of examples. All these issues are surmountable but only if someone is experienced enough with simulation to recognise they exist & know how to address them. In the end it is instructor expertise, not equipment availability, that is the really limited resource in healthcare simulation – and this is the mistake many healthcare facilities make, thinking that they can buy the “toys” and then just teach with simulation. Whilst skills training is relatively easy to learn, effective use of scenario-based teaching takes years to become proficient at. This means that expensive scenario based learning can be wasted – or worse do harm. Taking teams of clinicians and getting them to perform under pressure at tasks at which they are expected to be competent in front of their peers (& juniors), makes them extremely psychologically vulnerable (this vulnerability is increased the more senior the participants are). If they fail to manage the situation adequately (potentially for reasons related to the “altered reality” of the simulation rather than their own competence) it can be very confronting leading to a loss of confidence, loss of face and potential undermining of team performance. Having someone with the skills to design scenarios appropriately, prepare participants adequately and debrief situations such as poor performance supportively, is vital to creating a safe & productive learning environment for scenario-based learning.

      Overall I agree that, for a host of reasons, an increase in the amount of in situ simulation is crucial to using our education resources more effectively – but more is required than just cheap access to simulation equipment. Sufficient resources are still required to ensure that staff can be made available to attend simulations (with adequate time available to debrief them afterwards, which is where the learning takes place) and to provide adequate training for simulation instructors to allow this teaching to be safe & effective for the participants.

      I actually think that a lot of the simulation-based teaching that goes on in healthcare (even at specialist sim centres) is relatively ineffective, raising people’s awareness of HF & teamwork issues – but not translating to a change in clinical practice. As I say to participants at the start of courses – if this course doesn’t ultimately influence your behaviour in the clinical environment to some extent, it’s a waste of time. It often is.

      June 18, 2013
  3. Graeme Dalziel. @scotty592 #

    Brilliant podcast Minh. Has really got me thinking about human factors in error. Many thanks.

    Graeme

    June 12, 2013
  4. DRMS #

    Excellent podcast, really enjoyed the discussion and the points raised.

    August 1, 2013

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