Japanese Surgical Education Summit 2nd Annual Meeting

Instructional Design and the Use ofSimulation for Surgical Training:
Theory to PracticeAmin Madani
Department of Surgery, McGill University, Montreal, Canada

Disclosuresn

Nothing to Disclose

Surgical Training
Apprenticeship model:

Changing Surgical Paradigm
Changing surgical education paradigm*:
Limited work hoursn Decreased case volumesn Increased emphasis on safety and accountabilityn Cost control
n Emerging technologiesn* Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education:
theory to practice. Medical teacher. 2010;32(8):638-45.

What is Competence?
n“Expert surgeon”:
q
q
q

Technical skills
Judgment, decision-making
Teamwork

Deficiency in these aptitudes strongly contributeto surgicalerrorsSkillsKnowledge
Behaviorsn Current methods
for teaching/assessing are:
n

q
q
q
q

Subjective
BiasedRater/Instructor-dependent
Not standardized

What is Competence?
Minimum Standard

Proficient↑ Automaticity↑ Fluency↑ Consistency↓ Cognitive Load

Performance

Competent
Advanced
Beginner
NoviceExpertMinimum Training
Training

Dreyfus, H. L., & Dreyfus, S. E. (1986). Mind over machine: The power of human intuition and expertise in the era of thecomputer. New York: The Free Press.

What is Competence?
Student A

CompetentTraining

Student B

Student C

Instructional Design

Teaching

Assessment

MasteryInstructional Design
Pre-Test

Teaching
Post-Test
Performance Feedback
Practice
MasteryExample: FUSEØ

Fundamental Use of Surgical Energy™
(FUSE)Example: FUSE
ほとんどの外科的手技でエネルギーデバイスを使用

合併症
•
•
•

手術室火災
患者熱傷
他デバイスへの干渉

理解不十分

Example: FUSENBC	
  Today	
  Show:	
  November	
  2011	
  Example: FUSE

腹腔鏡下手術エネルギーデバイス関連医療事故
およそ1-2/10001
年間200万件（米国）2

Nduka CC et al. Cause and prevention of electrosurgical injuries in laparoscopy. 1994 J Am Coll Surg 179:161-170
2. Market engineering research for the U. S. market for general surgery laparoscopy access and closure instruments.
Medical and Healthcare Marketplace Guide. 1999. Frost and Sullivan, London, UK
1.

Example: FUSE
エネルギーデバイス	
  

合併症	
  

理解不十分	
  Surgeons	
  have	  knowledge	
  
gaps	
  in	
  the	  safe	  use	  of	
  energy-­‐based	
  devices	
  Objectivesn To outline the steps for designing a surgicalcurriculumn To perform a task analysisn To list the steps for developing a metricn To design a curriculum using best-practices in
educationn To describe the utility of simulation for surgicaltraining

Instructional Design
ADDIE Framework:n Analyzen Designn Developn Implementn Evaluate

Instructional Design
ADDIE Framework:n Analyzen Designn Developn Implementn Evaluate

Instructional Design – Analyze
Needs-Assessment:
1. Gap analysisn Define current and desired outcomes
Expertn Define “what you want Proficient
the learner to be able
to do at the conclusion of training”
Competentq Emphasis on performance vs. knowledge
Advanced
Beginner
NoviceGap

Instructional Design – Analyze
Needs-Assessment:
2. Task analysis

Instructional Design – Analyze
Needs-Assessment:
2. Task analysisn Evidence-based if possiblen If no evidence: expert consensus

Instructional Design – Analyze
Needs-Assessment:
2. Task analysisn Challenges:
Difficulty unpacking expert knowledge*q Lack of consensusq Lack of data/standardsq* Sullivan ME, et al. The use of cognitive task analysis to reveal the instructional limitations ofexperts in the teaching of procedural skills. Acad Med 2014; 89(5):811-6

Instructional Design – Analyze
Needs-Assessment:
2. Task analysisn Techniques:Interviews +/- videoq Focus groupsq In-vivo observationq Literature analysisq Think aloudqInstructional Design – Analyze
Needs-Assessment:
3. Specification of performancestandardsn What is successful performance?
n What defines expertise?
n What needs to be done, underwhat conditions?
n Standards will be used as basis
for assessment tools

Instructional Design – Analyze
Needs-Assessment:
4. Learner analysis
Who are the learners? What level are they?
q Are they motivated to learn a new skill?
qOrganizational analysis

5.

Barriers to successful performance?
q Available resources?
q Poor climate can hinder transfer of trainingq Timeline?
q How does this fit into the training curriculumqExample: FUSEØ

Fundamental Use of Surgical Energy™
(FUSE)Example: FUSE
Energy devices are poorly understood*n Pilot exam by experienced surgeons (N = 48)
Surg Endosc (2012) 26:2735–2739
DOI 10.1007/s00464-012-2263-y

and Other Interventional Techniques

Median score = 59% [55;73%]
Surgeons
don’t know what they don’t know about the safe useq 31% did not know how to correctly handle a fire;of energy in surgeryq 13% did not know that thermal injury can extend
Liane S. Feldman Pascal Fuchshuber
beyondtheStevenjaws
of a bipolar instrument;
Daniel B. Jones
Jessica Mischna
D. Schwaitzberg
the FUSE (Fundamental Use of Surgical Energy ) Task Forceq 10% thought a dispersive pad should be cut to fit
a child
q

•

•

•

•

•

TM

Received: 24 January 2012 / Accepted: 10 March 2012 / Published online: 27 April 2012

*FeldmanFuchshuber P,
Jones
DB,
Mischna J, Schwaitzberg SD; the FUSE (Fundamental Use of! SpringerLS,
Science+BusinessMedia,
LLC
2012
Surgical Energy™) Task Force. Surg Endosc. 2012 (10):2735-2739.

Abstract
Background Surgeons are not required to train on energybased devices or document their knowledge of safety issues
related to their use. Their understanding of how to safely
use the devices has never formally been tested. This study

multiple-choice examination (pretest) of critical knowledge. We administered it to members of the SAGES board;
Quality, Outcomes and Safety Committee; and FUSE Task
Force. Postgraduate course participants took the pretest,
and at the end of the course they took a 10-item post-test

Example: FUSE
10
academic
centers
Endosc5Surg
community
DOI 10.1007/s00464-015-4243-5 hospitals
145 participants

Overall: 58% (28-88%)
Surgeons: 60%
Trainees: 53%
and Other Interventional Techniques

Obihiro Kosei General
Hokkaido
University	
Surgeons haveknowledge
gapsHospitalin the	 safe use of energy devices:
KKR Tonan Hospital	

a multicenter cross-sectional study
Teine Keijinkai Hospital

Yusuke Watanabe1,2 • Yo Kurashima1 • Amin Madani2 • Liane S. Feldman2 •6 •Minoru Ishida3 • Akihiko Oshita4,5 • Takeshi Naitoh
Kazuhiro
Noma7 •
TohokuUniversity	
Okayama University	
Keigo Yasumasa8 • Hiroshi Nagata9 • Fumitaka Nakamura10 • Koichi Ono11 •Yoshinori Suzuki12 • Nobuhisa Matsuhashi13 • Toshiaki Shichinohe1 •JA
Hiroshima General Hospital	
Satoshi Hirano1
Kameta Memorial Center	
Received: 15 February 2015 / Accepted: 10 MayGifu
2015 University! Springer Science+Business Media New York 2015

JCHO Osaka Hospital	

completed a 35-item multipleAbstract Y, et al. Surgeons have knowledge gaps in the safe useMethods
Watanabeof energyParticipants
devices. SurgicalEndoscopy.
In Press.
choice question examination, testing critical knowledge of
Background2015.
Despitethe widespread use of surgical energy devices and the potential for rare but serious com-

ES. The examination was developed according to the ob-Example: FUSE
Needs-Assessment:
Gap analysis
ProficientCompetent
Advanced
Beginner
NoviceGap

ExpertExample: FUSE
Task Analysis:
SAGES – FUSE Task Force
n
n
n
n

Surgeons
Anesthesiologists
NursesEngineersInstructional Design – Design
ADDIE Framework:n Analyzen Designn Developn Implementn Evaluate

Instructional Design – Design
Design Training:
1. Develop instructional/learning objectivesn Objectives for achieving competencies
n Separate statement for each competencyn For surgical procedure, involves translatingprocedure into appropriately sized steps

Instructional Design – Design
Design Training:
1. Develop instructional/learning objectivesn

Bloom’s Taxonomy of learning:
Knowledge

SkillsAttitudes/
Behaviors

Learning Surgical Procedure “Competency”

Instructional Design – Design
Design Training:
1. Develop instructional/learning objectivesn

Bloom’s Taxonomy of learning:

Cognitive Domain

Creating
Evaluating
Analyzing
Applying
Understanding
RememberingInstructional Design – Design
Design Training:
1. Develop instructional/learning objectivesn Describes the outcome – measurablen Describes what the learner will be doing
when demonstrating achievement of theobjective - specificn Define important conditions, if anyn Define criterion for acceptable performanceExample: FUSESAGES – FUSE Task Force

63 Learning Objectives

FUSE Curriculum
Curricular	
  Domains	
  (10)	
  ObjecBves	
  (63)	
  1	
  エネルギーデバイスの基本

7

2	
  

有害事象のメカニズムとその予防

20

3	
  

モノポーラデバイス

4

4	
  

バイポーラデバイス5	
  アブレーション

6	
  軟性内視鏡デバイス

4

7	
  

超音波エネルギーデバイス

5

8	
  

マイクロウェーブエネルギーデバイス

2

9	
  

小児におけるエネルギーデバイス

310	
   他の医療機器との組み込み

者
患
の
で
室
術
手
安全性に重視5
4

9

FUSE Example: 学習目標
1.

高周波エネルギーが細胞／組織におよぼす影響

2.

高周波エネルギーデバイスに関わる用語

3.

エレクトロサージカルユニット（電気メス本体）の役割

4.

モノポーラとバイポーラの違い

5.

エネルギーデバイス関連有害事象の発生メカニズム6.

有害事象の回避する方法

7.

手術室火災を防ぎ、また手術室火災にどのように対処す
るかInstructional Design – Design
Design Training:
2. Develop performance standards for eachobjective (“metrics”)n Acceptable level of performance for“passing”n Metric for each learning objectiveor “competency” based on task analysisn Pass score determined empiricallyn Oriented towards individual or teamInstructional Design – Develop
ADDIE Framework:n Analyzen Designn Developn Implementn Evaluate

Instructional Design – Develop
Develop Instruction:n Establish prerequisitesn Develop didactic material (*keep to minimumfor performance-based training)n Develop computer/web-based componentsn Develop simulation scenarios, virtual patientsn Tie instruction back to learning objectives(“blueprints”)

Instructional Design – Develop
Develop Instruction:n Developing goodlearning strategies
Feedbackq Tailor practice toweaknesses(deliberate practice)q Integrate metrics into
teaching strategy

Teaching
Post-Testq

Performance Feedback
Practice
CompetenceExample: FUSE
63 FUSE
Objectives

OnlineModulesBook

Instructional Design – Implement
ADDIE Framework:n Analyzen Designn Developn Implementn Evaluate

Instructional Design – Implement
Implement Instruction:n Train instructors:
Cover curriculum and learning objectivesq Method of deliveryq Testing procedureqTrain learners on any new tools, registrationn Pilot (dry run) the coursen Ensure all equipment is ready/functionaln Teach the course!
n Collect data for feedbackn

Example: FUSEExample: FUSE
Beta-Test
N=227

Feedback*Feldman LS, Fuchshuber P, Jones DB, Mischna J, Schwaitzberg SDFundamental Use of Surgical
Energy (FUSE) Certification: Validation and Predictors of Success. Surg Endosc. 2015 In Press.

Instructional Design – Evaluate
ADDIE Framework:n Analyzen Designn Developn Implementn Evaluate

Instructional Design – Evaluate
Evaluate Training:n Development of surgical expertisen Levels of outcomes: Kirkpatrick framework

Results (patient outcomes)
Behavior (performance)
Learning (skills)
Reaction (self-reported)

Instructional Design – Evaluate
Evaluate Training:n Level 1: questionnaires

Results (patient outcomes)
Behavior (performance)
Learning (skills)
Reaction (self-reported)

Instructional Design – Evaluate
Evaluate Training:n Level 2: knowledge (examination), skills(time, accuracy, error in simulation)

Results (patient outcomes)
Behavior (performance)
Learning (skills)
Reaction (self-reported)

Instructional Design – Evaluate
Evaluate Training:n Level 3: performance on patients (errors, global
rating scales, checklists, time, accuracy)

Results (patient outcomes)
Behavior (performance)
Learning (skills)
Reaction (self-reported)

Instructional Design – Evaluate
Evaluate Training:n Level 4: patient outcomes (complications,mortality, patient-reported outcomes)

Results (patient outcomes)
Behavior (performance)
Learning (skills)
Reaction (self-reported)

Instructional Design – Evaluate
Evaluate Training:n Developing metrics and assessment tools:
Objectiveq Measurableq Specificq Validityq Evidence-basedq Task/skill dependentqInstructional Design – Evaluate
Evaluate Training:n Choosing metrics and assessment tools:
Appropriate learning domain (cognitive,
attitudes, psychomotor)q Depth of learningq Current proficiencyq Available resourcesq Fidelityq Psychometric propertiesq

GLOBAL

RATINGSCALE OF OPERATlVEPERFORMANCE

Instructional Design – Evaluate
PleaseBespeetcircle the number wrresponding to the candidate’s&ormance in each category.

irrespectiveof training

level.

for Tissue:

1

2

5

4

3

camiilly
appc+ldy

cueful~aftMoeadavlly-Z

Frrquartlydfactontkleacuued~
byiqpqridcwdi

Evaluate Training:bandied tissues
with minimal damage

Time and Motion:

1

Many umaruryn3
Etiicienl timddm
butlcmc~lmva

4

2

3
cm+mtwofi
butomsiau8y~
dilfar .wilwud

4

5
Fluid movea wth snsimmRlLr
and m mvkw4rdrlcnF

2

3
KnewNmesofnK6tmdudqncp-iuci

45
Obviously familiar with thelnNwnmLIandUw,,nvns

2

mova

5
Clur economy of movement
ad maximum e5kncy

Example – evaluating a how to dissect the hepato-cystic
triangle during laparoscopic cholecystectomyq Level 1: self-perceived confidence with performing
dissectionq Level 2: pig lab simulation + evaluating performanceusing checklist; or multiple-choice examination score
testing how to perform the procedureq Level 3: evaluating performance on patient using
checklistq Level 4: evaluating % bile duct injuries, pain score,
hospital length-of-stayInstrument

Handling:

1

Reputedly m&m tentative c.
wkwud nl0”~ wilb itlamxa
byiNppmpiWuwOfi

Knowledgeof Instruments:

1

Frqwntly asked fa
wmnginummentorused
inqqhteindnwnt

OVERALL

Figure2. The global

ON TEfS

rating

form

TASK,

SHOULDTEE CANDIDATE:

used

to assesstechnical

skill at eachFAILof the eightPASS
stationsin the Objective

Structured

AssessmentofInstructional Design – Evaluate
Evaluate Training:n How do you interpret scores?
High score = (?) Expertn

Validity evidence for metrics:
Contentq Response processq Internal structureq Relationship to variableq Consequencesq* Downing SM. Validity: on the meaningful interpretation of assessment data. Medical Education
2003; 37:830-7.

Instructional Design – Evaluate
Evaluate Training:n Providing feedback
Summativeq FormativeqInstructional Design – Evaluate
Evaluate Training:n Deliberate practice*“Individualized training activities to improve specificaspects of performance through repetition andsuccessive refinement”
1.
Repetition
2.
Focused feedback with active coaching by teacher
3.
Immediate performance repetition after feedback
4.
Stop/start – series of short performances
5.
Emphasis on difficult aspects and weaknesses
6.
Conscious focus (work vs. play)q* Ericsson, K., et al. (1993). "The Role of Deliberate Practice in the Acquisition of Expert
Performance " Psychol Rev 100(3): 363-406.

Instructional Design – Evaluate
Evaluate Training:n Deliberate practiceInstructional Design
ADDIE Framework:n Analyzen Designn Developn Implementn Evaluate

Instructional Design
Other Considerations:n Spacing effect:“Bolus” training vs. distributed trainingq Distributed training improves long-term performance*qn

Example1 session, 4 hours…orq 4 sessions over 1 months, 1 hour eachq*Moulton CA, et al (2006). Teaching Surgical Skills: what kind of practice makes perfect?
Annals of Surgery 244(3): 400-409.

Instructional Design
Other Considerations:n Mixed Practice:qnTraining multiple skills mixed together improves
performance, compared to teaching one skill at atime

Example: teaching skills a, b, c
aaaaa à bbbbb à ccccc…orq abc à abc à abc à abc à abcq

FUSE – free online modules(http://www.fuseprogram.org)n

–4059

Example: FUSE

evance, frequency) which weree value from 1 to 7.

4057

Table 3 Most highly rated objectives in the FUSE program(score [ 5.70)

SAGES – FUSE Task Force

Section
Score
Surg Endosc (2013) 27:4054–4059Objective
DOI 10.1007/s00464-013-3059-4
Identify various mechanisms whereby
2
6.38
electrosurgical injuries may occur
Identify general patient protection measures2
6.24
for setup and settings for the electrosurgicalunit
d surveys representing 49 % of the
Identify circumstances, mechanisms, and2
6.05
prevention of dispersive electrodes-related
wo percent of respondents were
injuryiced a subspecialty of general surIdentify the characteristics of monopolar and1
5.97
actice for more than 10 years. The
bipolar instruments and the differences
ergy-based devices, in addition to
betweenthem• L. Michael• Pascal Fuchshuber • Daniel B. Jones •Liane S. Feldman
Bruntical instruments,
were ultrasonic
Identify
circumstanceswhich• Jessica Mischna • Malcolm• Marc 2•
Stephanie
Jones
G. promote
MunroOR
A. Rozner5.90
anced bipolar
RF B.
vesselsealers
fires and identify prevention
strategies
TM
Steven D.toSchwaitzberg
the SAGES FUSE
Committee
dered themselves
have ‘‘expert’’ • forIdentify
circumstances, mechanisms, and
2
5.85
n
prevention of direct coupling-related injury
of energy-based devices. The mostmation about energy-based devices
Identify implanted devices and patients with10
5.84
implanted
devices
that
might
be
adverselyales representatives (Table 2).
affected by RF energy
Received: 25 February 2013 / Accepted:
10 June2013/ Published
17 July 2013
The scoreis theaveragerating online:
for importance,
relevance, and fre! Springer Science+Business Media
New
York
2013
quency (range = 1–7)

and Other Interventional Techniques(Task Analysis)

Rationale for the Fundamental Use of Surgical EnergyTM (FUSE)
curriculum assessment: focus on safety

63 Learning Objectives

Survey ranking each 63
objectives by importance

FUSE Blueprints

score was 5.09 and ranged from
Methods Psychometric experts led the test development
Abstract
Section weighting
objectives
with the highest scoresprocess. During a 2-day retreat, a multidisciplinary group
Almostall surgical procedures involve thee 3. FiveBackgroundof the seven mosthighly‘‘Mechanisms
and prevention
adversewith63 events
test objectives
assessing the knowledge anduse of2, devices
that apply
to tissue. Adverse
events ofdefinedrom section‘‘Mechanisms
and energy(section The2) was skills
most required
highly weighted,
to use energy-based surgical instruments
canelectrosurgery’’occur if the devices
are electrosurgery’’not used appropriately.
ents with.
TM
followed by ‘‘Fundamentals of electrosurgery’’ (section 1).

Example: FUSE
FUSEBlueprints

Beta-Test
N=227

Certification
Examination

Simulation for Surgical Education

Simulation for Surgical Education
What is simulation:n Technique to replace/amplify real-life patient
experiences with guided experiencesn Artificialn Evokes or replicates some aspects of the real
worldn Interactive

Simulation for Surgical Education
Types of simulation for surgical training:n Simulated patientsn Virtual patientsn Mannequin simulatorsn Task trainers (e.g. FLS)n Low-technology screen-based simulation (e.g.
serious games)n Virtual reality

Simulation for Surgical Education
Why simulation:
Immersive learning (“learning in context”)n Experiential learning (“learning by doing”)n Re-create rare scenariosn Re-create difficult scenariosn Re-create scenarios that allow learner to work on
weaknesses (i.e. focused training à deliberate practice)n Provides an environment to obtain formative feedback(e.g. replay video of performance) and immediately
practice aftern Reproducible for repetitionnSimulation for Surgical Education
Why simulation:
Improves trainingn Improves patient safety (free of adverse events)n Decreases long-term costs (i.e. reducing time andcosts for training)n Improves communication and team dynamicsn

Simulation for Surgical Education
Barriers to simulation for surgical training*:
Inadequate resources (personnel, equipment, costs)n Limited availability of faculty to teachn Limited incentives for faculty to teachn Inadequately trained facultyn Not tailoring the simulation-based curriculum for local
training needsn Does not replace “real” clinical experience - complimentaryn*Stefanidis D, et al (2015). Simulation in Surgery: What’s Next? Annals of Surgery 261(5):846-853.

Simulation for Surgical Education
FUSE Simulation Course for Surgeons:Simulation for Surgical Education
FUSE Simulation Course for Surgeons:1.

3.

Device Setup

Adverse Events (Open)2.

4.

Tissue EffectAdverse Events (Laparoscopy)

Simulation for Surgical Education
FUSE Simulation Course for Surgeons:n

20 courses; 4 countries; 500 surgeons/residents

Simulation for Surgical Education
FUSE Simulation Course for Surgeons:n

20 courses; 4 countries; 500 surgeons/residents

Surg Endosc
DOI 10.1007/s00464-015-4260-4

and Other Interventional Techniques

Structured simulation improves learning of the Fundamental Useof Surgical EnergyTM curriculum: a multicenter randomized
controlled trial
Amin Madani1 • Yusuke Watanabe1 • Nicole Townsend2 • Philip H. Pucher3 •Thomas N. Robinson2 • Patricia E. Egerszegi4 • Jaisa Olasky5 • Sharon L. Bachman6 •Chan W. Park7 • Nalin Amin8 • David T. Tang9 • Erika Haase10 • Davide Bardana11 •Daniel B. Jones5 • Melina Vassiliou1 • Gerald M. Fried1 • Liane S. Feldman1
Received: 14 February 2015 / Accepted: 24 April 2015
! Springer Science+Business Media New York 2015

学習目標	
  1.

高周波エネルギーが細胞／組織におよぼす影響

2.

高周波エネルギーデバイスに関わる用語

3.

エレクトロサージカルユニット（電気メス本体）の役割

4.

モノポーラとバイポーラの違い

5.

エネルギーデバイス関連有害事象の発生メカニズム6.

有害事象の回避する方法

7.

手術室火災を防ぎ、また手術室火災にどのように対処す
るか

Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  OR Fires – Fire Triangle

Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  OR Fires•	
  EsLmate:	
  550-­‐650/yr	
  (same	  as	
  wrong	  site	  surgery)	
  •	
  Most	  are	  minor	
  and	  result	
  in	
  no	
  injury	
  •	
  20-­‐30	
  serious	
  with	  disﬁguring	  or	
  disabling	
  injuries	  •	
  2-­‐5	
  deaths	
  per	
  year	  Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  手術室火災OR ﬁres

Fire Triangle ‒ Oxidizer (oxygen, nitrous
oxide)– マスク使用時は酸素流量を最小化– ラリンゲルマスクを考慮– 酸素濃度は30％以下に– 気管切開：実際に気管を切る際は、電気メスを使用しないようにする

Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  手術室火災OR ﬁresFire	
  Triangle	
  –	
  Oxidizer	
  (oxygen,	
  nitrous	
  oxide)	
  – 気道熱傷は特に危険	
  Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  手術室火災OR ﬁresFire	
  Triangle	
  –	
  Fuel	  (prepping	
  agent,	
  drapes)	
  	
  • アルコール系消毒薬による熱傷（4%）
乾いた後のドレーピング

Pooled	  Alcohol-­‐Based	
  Prep	  Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  手術室火災OR Fires

Fire Triangle ‒ Ignition Source• 70%はエレクトロサージャリーに起因• 10%はレーザー• 20%は光源機器関連、手術用ドリル、除細動器
ALWAYS•光源機器の電源は直前に入れる•光源を外す前に電源を切る使用
しない•使用しない時にケース（プラスチック）に収納High	
  Intensity	  Light	
  Source	  Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  OR Fires

Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  手術室火災 OR Fires
最良の対処は:	
  
	
  
予防	
  
(Minimize	
  all	
  risks)	
  Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  手術室火災 予防策• 頭頸部手術では使用する酸素をできるだけ減らす• ドレープの下で酸素が充満していることがある（ドレープをしっかりはる）• 消毒液が完全に乾くまでドレープをしない（余剰液の除去）• 光源の電源は使用する直前に入れる• できるかぎり低い出力設定で使用

Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  手術室火災 ‒ 対処
1. 酸素使用の中断§ 呼吸器回路からはずす§ Airway ﬁres: 抜管
2. 可燃物の除去 （ドレープ等）
3. 燃えている炎の消火
4. 患者ケア§ 必要があれば再抜管 (Airway ﬁres)§ 熱傷への処置

Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  OR Fires

Principles	
  of	
  Radiofrequency	
  Electrosurgery	
  Summary
Surgical performance is complex
Ø No “perfect” way for training experts
Ø A systematic process will help ensure effective
training is producedq Adhering to best-practices in educationØ Simulation can add significant value to training
and for assessment
ØExample: FUSE

Book

Certification
Examination

Simulation
CourseOnlineModules

THANK YOU