Bartmess Samuel, D'Ambrosio Martin, Obr Clark
Resident, University of Iowa Roy J. and Lucille A. Carver College of Medicine.
Clinical Associate Professor, Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine.
MedEdPORTAL. 2016 Sep 23;12:10461. doi: 10.15766/mep_2374-8265.10461.
This activity is designed for midlevel and senior anesthesia trainees to experience the complexities of one-lung ventilation in pediatrics in a high-fidelity simulated environment. With the use of video-assisted thoracoscopic surgery (VATS) becoming increasingly common in pediatrics, we identified this area as an opportunity for the development of a dedicated educational simulation activity.
Our simulated patient is a 3-year-old girl with empyema presenting for decortication via VATS who subsequently develops hypoxemia. The main challenges for the trainee include airway selection and insertion, lung isolation with fiber optic confirmation, and management of hypoxemia in the setting of one-lung ventilation. A pediatric medical simulator suitable for practicing resuscitation is required, and a tracheobronchial tree model is highly desirable. Basic knowledge of thoracic and pediatric anesthesia is required, but specific experience with pediatric lung isolation is not.
Learners who experienced the content of this simulation expressed a strong sentiment of value. All pilot trainees were surveyed and indicated they either agree or strongly agree (4 or 5, respectively, on a 5-point Likert scale) that "This simulation enhanced my understanding of how to select lung isolation devices for pediatric patients" and "This simulation enhanced my understanding of how to manage hypoxia in context in one-lung ventilation." Comments were overall positive, including "I am better prepared to manage pediatric one lung ventilation cases."
At the University of Iowa, this activity is part of a core curriculum of simulation training that resident physicians in anesthesiology experience during their training. It functions as a tool for education, evaluation, and self-identification of weaknesses in the learner's knowledge base as it relates to the perioperative management of pediatric one-lung ventilation, as well as for reinforcing material learned in the classroom and operating room. Numerous anesthesiology residents and faculty have pilot-tested this simulation, and necessary modifications have been made based on their feedback.
本活动旨在让中级和高级麻醉学员在高保真模拟环境中体验小儿单肺通气的复杂性。随着电视辅助胸腔镜手术（VATS）在儿科中的应用越来越普遍，我们将这一领域视为开展专门教育模拟活动的契机。
我们的模拟患者是一名3岁患有脓胸的女孩，拟通过VATS进行纤维板剥脱术，随后出现低氧血症。学员面临的主要挑战包括气道选择与插入、通过纤维支气管镜确认肺隔离以及在单肺通气情况下处理低氧血症。需要一个适合进行复苏练习的儿科医学模拟器，并且非常希望有气管支气管树模型。学员需要具备胸科和儿科麻醉的基础知识，但无需有小儿肺隔离的具体经验。
体验过该模拟内容的学习者表达了强烈的价值感。对所有试点学员进行了调查，结果显示他们要么同意（在5分制李克特量表上为4分），要么强烈同意（5分）“该模拟增强了我对如何为儿科患者选择肺隔离装置的理解”以及“该模拟增强了我对如何在单肺通气情况下处理低氧血症的理解”。总体评论是积极的，包括“我对处理小儿单肺通气病例有了更好的准备”。
在爱荷华大学，此活动是麻醉科住院医师培训期间所经历的模拟培训核心课程的一部分。它作为一种教育、评估工具，用于识别学习者在小儿单肺通气围手术期管理相关知识库中的弱点，同时也用于强化在课堂和手术室所学的知识。众多麻醉科住院医师和教员对该模拟进行了预测试，并根据他们的反馈进行了必要的修改。
