Simulated patient and learner for consultant workshop

Today the department organised a meeting for consultants, they joined together for a review for teaching methods, from an inspiration from another colleague, how to give a good feedback to the trainees, how to supervise your trainees during a procedure and finally what a good reflection from our learners should be.

The sample of what happened during the day is available in the following link, it started with a volunteer to supervise a simulated doctor trainee to perform a simple procedure, but it went out a nightmare because of a simulated patient. Enjoy the show.

Supervision

Feedback from MD graduates 1

What did new MD graduates, Class 2007 tell us? 1. The thing that we won't change...

1. The size of MS5 per group, 3-4 MS5 a group is too big, better to have MS5 : Consultant at 1:1
2. Handouts of lecture, no standard, not harmonised across the academic year
3. Practice more in Paediatrics and Emergency patients
4. Would love to experience the Surgical ICU and Pain Clinic

Response: 

Dear our Med Students, Imagine or Ideas sometimes is not practical in real life, working 1:1 with consultant doesn't mean education, it usually means training (depends on what you 'd like to have Brain's or Hands' skills). You can apply for elective period for extern, we now have SICU, Pain management and the newest "Clinical Anaesthesia" elective. Please don't even think of practising anaesthesia in children or emergent patients, if there is anything bad happening, you will never ever forget that event, dear.

Anaesthesia and Critical Care with Technology

Fluid management is the centre of shock management, but only in the early phase of shock, your patient will finally not respond to your additive fluid by the end, at that time point, you will have to find more ways to augment your patient's haemodynamics.

Will the application of ultrasonography, the TOE, transoesophageal echocardiograph, will be another helpful equipment to help and guide your making decision. It will help you to differentiate your patient's CVS status. The diameter of great vein either Superior vena cava or Inferior vena cava is an index to demonstrate the dynamic haemodynamics monitoring parameter. If both vessels can be collapsed or compressible, SVC by the breathing from mandate breath by IPPV or IVC from abdominal pressure linked closely to intrathoracic pressure, it would mean that your patient will be improved after you give him/her more fluid. This is shown in the condition 1 and 2 where the SVC is difficult to orientate during inspiration phase, and the diameter is significantly smaller than the expired time. The SVC collapsibility and IVC collapsibility are essential dynamic haemodynamic parameter that will be helpful in the situation that you have to decide whether or not to give more fluid to your patient. If your patient has the condition 3, you give more fluid in, you are endangering your patient, because at this point, your patient does not need fluid loading any more, and he/she would not have fluid responsiveness either.

 

Yesteryear Once More!

During working at the department office we discussed a lot about Competency Based Learning, so we wandered around and I can find some photo I took in Last May (2011/2554) during I attended the Asia Pacific Conference about Simulation in Health Care.

From the Speaker of National University of Singapore, he mentioned about the Competency the new 1st year Anaesthesia Residents should be able to perform after a period of one month can be shown here. The baby MO = Medical Officers.

If you are looking for the previous post about the meeting click here.

Compare to Simulation the traditional way of teaching is....

Student Feedback from SBL.

Debriefing period, and the things that our students should get with them out of the class is indeed the new way of thinking.

What's Simulation? This question was the response from my Department Chair, She really did ask me when I submitted her an article about the way of teaching medical students with this means.

Practical Aspect of Perioperative Mechanical Ventilation: A workshop for Professor Vorakitpokatorn Retirement

That is the full workshop name, and today is quite a good and funny day, because the two guest speakers from Mayo Clinic, Rochester MN have arranged an interactive educational sessions. We really think that lectures in our department should follow this pattern of the interactive activities, so that the participants have their times to analyse as well as think what next to make up their minds before the time is running out.

There are some photographs of the staffs working behind the scene, as well as the slide of the conference, and as promised some interactive sessions of the lecture by two Drs Daniel, Dr Daniel R Brown, and Dr Daniel Diedrich.

Thailand Quality Award

Actually, Thailand Quality Award has nothing to do with medical education, but many institutions not only in business adopt the process endorsed by the TQA to facilitate and improve the quality in many ways. Therefore, higher education cannot be shielded away from this, and the Ministry of Education has passed a law to ensure that every course has to follow a guideline to improve quality in every programme in all universiies across the Kingdom.

On April 26th, we the undergraduate anaesthesia education team had met and tried to draft our first version for the SIAS501 subject for MS anaesthesia education. It may not be perfect yet, and we have many more to do when we follow the guideline throughoutly, and that is the way ahead to ensure that our students achieve the best quality education.

Teaching skills to med students; Venepuncture

On Monday and Tuesday, there was a class arranged for new 4th year medical students, after finishing their third year they had to learn some basic skills before starting their clinical education.



The department of Anesthesiology was asked to help teach the skills as well as staffs from other department, we participated in teaching venepuncture skill on those two days. Some of them were excited, afraid, or even terrified when they knew that they would have to practise real human venepuncture with their colleagues. Indeed, there were some students getting syncope!


The main mistakes during venepuncture practice were not tight touniquet, the needle puncture was not deep enough to penetrate the wall of forearm veins, and they forgot to release the touniquet before they drew back the needle, so there was always blood leaking out and felt syncope.




Although it was a painful experience, however, they had to know and learn that otherwise they would not concern when they have to do or perform with the real humans. For me, it was a really enjoyable experience teaching this skill.

Department Education Conference

We, the staffs of our beloved department, gathered together to share and discuss about the education for medical students and our residents. It is a must for the department to follow according to quality assurance of education (Thai Qualifications Framework for Higher Education; TQF: HEd), that every single year 80% of the staffs must attend a conference to plan, follow and review for every course. Although it may not be able to achieve a goal of 80%, but the attmosphere inside the deparment conference room is great. Creative ideas are suggested, listened and get a review.

From the undergraduate team, the theme was "What can we give to medical students?". We have to focus on the main subject, SIAS 501; that we have to teach our students, we change the topics of lectures, and case studies. We hoped that simulation will start real soon so that we can use this type of education to teach the crisis management especially anaesthesia related complications. We have checklists for medical students for bedside teaching so that every staff can have an idea what we can discuss and talk to our students.

In an era of modern technology and internet, we will definitely apply the internet, and paperless for education for the medical students, lectures and powerpoint files will be added in the the e-learning platform by the hospital database.

For the residents, we discuss about rotation change, types of education that may work well with adult education.

Anaesthesia Education (Initiatives & Action plan; after SWOT)

Today our department had organised second meeting (after the previous one a month ago) and discussion for the next four years, what we are going to do after we finalised the list of things or outcomes we would like to see it happens. Some presentatives of nurse anaesthetists and technicians are also invited to participate the meeting.

In the undergraduate anaesthesia education team; we, the whole participants at the meeting, agreed to improve the way we teach our beloved medical students. The problem is we need to change our ways of thinking, we have only two weeks to teach them, but we cannot teach all aspects of our specialty, we do not have time to teach them to become a new anaesthetist, so we must change ourselves as well, just remember to teach them only the main objectives we have written before; such as preoperative evaluation and preparation, basic airway management skill, acute postoperative pain control, oxgen therapy. The way we communicate among ourselves should follow the principles of Medical education, we have to look back to OLE; objectives, learning process and evaluation.

Not only we have to change ourselves, we do have to emphasise these aforementioned objectives to our students as well, endotracheal intubation is not the only thing they should learn from us, they should seek their ways to gain more experience elsewhere during their time in other departments, endotracheal intubation is just the beginning part of anaesthetics administration; our medical students have to be well informed about this.

Our action plans include the emphasis of medical education among our consultants by either send newcomers to educate or invite education experts to our departments for fresh up our middle or senior consultants. Extend the medical student study time by the use of new media especially the electronic learning, so that we can assess the access and follow our students whether or not they log in and the process they have logged in. While the assessment of learning outcomes should be the self-assessment after they finish their time with us, especially three main skills; preoperative evaluation and preparation, open patient airway by mask and endotracheal intubations, also we have to see how they evaluate our department when they have graduate the medical school as well, how they judge us and think about competency in some skills such as CPR, lumbar puncture, and endotracheal intubation.

Time is running, the wind of change is coming.

Ventiltor setting: Perioperative ventilator workshop

Although it is a long weekend nationwide, but our department has arranged a conference about the perioperative ventilator setting. Today Aug-14 is the beginning day of the 2-day workshop, the topics started with basic and advance modes of mechanical ventilation. Patient care and monitoring of the patients who require ventilator support, the problems of ventilator-patient dyssynchrony, and special patient groups: neurologic, traumatic chest, transportation, and perioperative ventilator setting and complications.

When it was nearly the end of the day, we discussed about perioperative care by anaesthetists, because we can attenuate perioperative respiratory complications by using the lower oxygen concentration during the induction time, we can use FiO2 of 0.8 instead of 100% oxygen. We talked about within the next five years ventilator setting in the OR would catch up the ITU/ICU, actually, there are papers about ASV (adaptive support ventilation) using in the OR, and recent paper was published in European J of Anaesthesiology about this mode in 2009.

We will pose some photo of the workshop, as well as some slides later on, don't forget to update and tune in.

A very useful link for medical student

When I search the internet for more informations about how medical students will be taught in anaesthesia rotation, I learn that in the USA like our department, they are rotated to the department for two weeks.

While many departments show the curriculum and evaluation form, I ran across the department of anesthesiology at the University of Wisconsin which offers three case descriptions in the topics of acute pain management, paediatric anaesthesia, and emergency anaesthesia with the emphasis on haemodynamic monitoring and inotropes. Not only the case descriptions which you should have tried to learn, but the department also have two handouts for medical students in the topics of paediatric anaesthesia and local anaesthetics and regional anaesthesia.

Have a look at the link and try to figure out the cases by clink at the topic above.