Cedrick Zouter, Stefano Mion, Gabriel Gurman, Thomas M Hemmerling
In many European countries, the anaesthesia community is experiencing a critical path, which faces an inversion of the age pyramid. Consequently, there is a decreasing replacement of senior staff by younger practitioners. In order to solve this shortage of anaesthetists, several countries are planning to postpone the age of retirement.1,2
Ageing may not necessarily be associated with a predictable pattern of decreased medical competence, but it leads towards ineluctable psychophysiological decline. In a recently published narrative review, we brought to light this serious issue, describing in detail the psychophysiological weakening caused by ageing.1 Such deterioration affects with certainty anaesthetists’ competence and could jeopardize patients’ care.3 The latter could be called meta-competence because it encompasses both technical skills (fine movements, proprioception, movement planning, etc.), as well as non-technical skills (memorisation, attention, cognitive function, etc.). Therefore, considering the current situation presenting an age pyramid downturned within the anaesthesia community worldwide, it seems reasonable to raise concerns regarding the health care quality and patients’ safety.
High-fidelity simulation could be a useful tool to detect and moderate anaesthetists’ psychophysiological decline that could impair senior anaesthetists’ meta-competence. In that respect, Weinger et al.4 recently conducted a trial evaluating consenting board-certified anaesthetists’ clinical practice via standardized simulation-based assessment. They found that anaesthetists with several years of clinical experience obtained a low score in non-technical skills scenarios designed to manage rare but life-threatening events (such as local anaesthetic systemic toxicity, haemorrhagic shock, or malignant hyperthermia). Interestingly, these authors also observed that lower-rated performances were associated with older age anaesthetists. Nevertheless, regular high-fidelity simulation sessions aiming to train clinicians to recognize and manage life-threatening events, using crisis resource management techniques, might lower the impact of ageing on non-technical skills. However, further trials should be performed to confirm this statement.
On the other hand, it is now clear that simulation could improve clinical performance and knowledge through practice.5 The main advantage is that simulation is a reliable and valid tool and, most importantly, a patient risk-free method. This advantage is of utmost importance for senior anaesthetists who want to learn new techniques requiring high dexterity level such as echo-guided procedure. In that respect, a good example is the insertion of a central line in the internal jugular vein, which is now strongly recommended by several medical societies.6 Therefore, high fidelity simulation could delay the gradual and continuous decline of the technical skills through repetition of unusual procedures on mannequins (central venous line insertion echo-guided, regional anaesthesia echo-guided, cricothyroidotomy, etc.). Moreover, it could offer the opportunity of becoming familiar with new technologies that have been proved to increase patients’ safety, such as ultrasound guidance for regional anaesthesia, which could in turn reduce the risk of local anaesthetic systemic toxicity by 65%.7
It could be advocated that the concerns raised above could be dealt with by offering senior anaesthetists the option to participate in simulation training sessions. Nonetheless, high fidelity simulation has mainly been studied and described as an instrument for residents training purposes and it has not been widely proposed as a tool to maintain high level of care within the practicing anaesthetist population.
A reason for this restricted access of the senior anaesthetist population to the simulation centre might be the fear of instructors’ judgments, and the stressful/intimidating environment present in simulation centres. However, self-debriefing after a simulation session may help to overcome this barrier.8 The same research group has identified ‘lack of free time’ as the main reason for absence of participation. Considering the shortage of anaesthetists, a reduction of the clinical time to allow anaesthetists to participate in simulation might be challenging. Nevertheless, this issue could be overcome, facilitating the access by building the simulation infrastructure within the institution or stimulating the participation by providing a certificate that reduces malpractice insurance premiums.
In conclusion, high fidelity simulation seems to be the solution to solve the irrepressible burden of ageing that our anaesthesia community is facing. However, how to incorporate regular simulation sessions in certified anaesthetists’ agenda remains to be elucidated.
Our anaesthesia community is ageing dramatically. The consequences of ageing on anaesthetists’ technical and non-technical skills have been well-described and could impact patient care. Thus, in order to improve patient care and outcome, we are conducting a survey to understand how the practicing anaesthesia community perceives simulation, how participation could be motivated, and finally, how participation barriers in simulation-based education could be solved.
The survey integrates 26 questions and will take approximately 5 minutes to complete.
Click on the link below to start the survey: https://fr.surveymonkey.com/r/JBYWGVX
We thank you in advance for your valuable help participating in this survey.
- Giacalone M, Zaouter C, Mion S, Hemmerling TM. Impact of age on anaesthesiologists’ competence. Eur J Anaesthesiol. 2016;33:787-93.
- Orkin FK, McGinnis SL, Forte GJ, et al. United States anesthesiologists over 50: retirement decision making and workforce implications. Anesthesiology. 2012;117:953-63.
- Baxter AD, Boet S, Reid D, Skidmore G. The aging anesthesiologist: a narrative review and suggested strategies/ Can J Anaesth. 2014;61:865-75.
- Weinger MB, Banerjee A, Burden AR, et al. Simulation-based assessment of the management of critical events by board-certified anesthesiologists. Anesthesiology. 2017;127:475-89.
- Green M, Tariq R, Green P. Improving patient safety through simulation training in anesthesiology. Anesthesiol Res Pract. 2016;2016,Article ID 4237523.
- Saugel B, Scheeren TWL, Teboul JL. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21:225.
- Neal JM. Ultrasound-guided regional anesthesia and patient safety: Update of an evidence-based analysis. Reg Anesth Pain Med. 2016;41:195-204.
- Savoldelli GL, Naik VN, Hamstra SJ, Morgan PJ. Barriers to use of simulation-based education. Can J Anesth. 2005;52:944.