Integrating Team Training For Cardiac Surgery; Combining Multiple Simulators
Fahd A. Makhdom, SANJAY ASOPA, EIKI NAGAOKA, RICHARD CHERRY, GERARD SEIJTS, RAJNI PATEL, PETER ALLEN, MICHAEL CHU, BOB KIAII.
LHSC, Lonond, ON, Canada.
Background To develop a simulation module for team training in cardiac surgery that engage the entire cardiac surgical team. Integrate a simulated beating heart model with a high-fidelity patient simulator and with a cardiopulmonary bypass simulator to enhance the realism of the simulator and ensure active engagement of the cardiac surgery team members. Method A cardiac surgical team participated in one fixed clinical scenario. Each team included; a cardiac surgeon, an anesthetist, a perfusionist, a scrub nurse, and a circulating nurse. The clinical scenario was for a patient undergoing an off-pump triple vessel coronary artery bypass grafting. During the operation, the patient develops hemodynamic instability and ventricular fibrillation requiring placing the patient on cardiopulmonary bypass emergently. The evaluation was carried during the team performance by a team of expert include a cardiac surgeon, an anesthetist, a senior perfusionist, an operating room charge nurse, and a psychologist. The performance was videotaped and evaluated by a second psychologist separately. A revised NOn-TECHnical Skills (NOTECHS) scale was used to assess non-technical team skills. The evaluation form was filled by the team of expert, the participant and by the second psychologist after viewing the videotaped performance Following the scenario each participant filled realism questionnaire. The questionnaire had three components physical, semantic and phenomenal realism and finally aan overall global score to assess realism of the simulated scenario. Results The average over all degree of realism of the simulation was 4.8 ± 0.6 out of 6. The average score for different component was 5.1 ± 0.8 , 4.9 ± 0.8 , 4.9 ± 0.7 out of 6 for physical, semantic and phenomenal realism respectively. The NOTECH scores were plotted in a circular chart to visually assess each team performance. A high score will be more peripheral on the chart. Fig 1. Showed a comprehensive scoring for all participants.
Conclusion This is a descriptive study that shows the feasibility of integrating multiple simulators. This model can be used to teach, improve, or evaluate a performance of the entire cardiac surgical team. This integration enhances the degree of realism and improve the active engagement of the participant. 
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