Military Anaesthesia in contingencies: what skill sets are required and how will we prepare our trainees?

The Defence Medical Services are now in an established period of contingency operations. In 2008, the Royal College of Anaesthetists approved a Military Anaesthesia Higher Training Module which could be easily achieved by deploying to the field hospital in Camp Bastion, Afghanistan, for two months under the supervision of a consultant anaesthetist. This opportunity no longer exists but the need to assure quality training and to demonstrate military skill sets is still essential. This article discusses the revised Military Higher Module and how it will be implemented in the future either during deployment or during times of peace.

Human factors in contingency operations.

The UK Defence Medical Services are currently supporting contingency operations following a period of intensive activity in relatively mature trauma systems in Iraq and Afghanistan. Among the key lessons identified, human factors or non-technical skills played an important role in the improvement of patient care. This article describes the importance of human factors on Role 2 Afloat, one of the Royal Navy's maritime contingency capabilities, and illustrates how they are vital to ensuring that correct decisions are made for patient care in a timely manner. Teamwork and communication are particularly important to ensure that limited resources such as blood products and other consumables are best used and that patients are evacuated promptly, allowing the facility to accept further casualties and therefore maintain operational capability. These ideas may be transferred to any small specialist team given a particular role to perform.

Effect of expertise on diagnosis accuracy, non-technical skills and thought processes during simulated high-fidelity anaesthetist scenarios.

Background: The expert performance approach can be used to examine expertise during representative field-based tasks, while collecting process-tracing measures such as think-aloud verbal reports. Collecting think-aloud verbal reports provides an insight into the cognitive mechanisms that support performance during tasks. Method: We examined the thought processes and performance of anaesthetists during simulated environments. Verbal reports of thinking and the anaesthetists' non-technical skills (ANTS) were recorded to examine cognitive processes, non-technical behaviours and diagnosis accuracy during fully immersive, high-fidelity medical scenarios. Skilled (n=6) and less skilled (n=9) anaesthetists were instructed to respond to medical scenarios experienced in theatre. Results: Skilled participants demonstrated higher diagnosis accuracy and ANTS scores compared to less skilled participants. Furthermore, skilled participants engaged in deeper thinking and verbalised more evaluation, prediction and deep planning statements. Conclusions: The ability to employ an effective cognitive processing strategy, more efficient non-technical behaviours and superior diagnosis is associated with superior performance in skilled participants.

What should be included in a simulation course for anaesthetists? The Merseyside trainee perspective.

BACKGROUND AND OBJECTIVES: This study is the first attempt in the UK to establish the views of senior anaesthetic trainees in relation to acquiring the attributes of an 'ideal' anaesthetist, and how these could be met by a simulation course. METHODS: An electronic questionnaire consisting of open and closed questions was distributed to all 79 post-fellowship anaesthetic trainees in Merseyside, UK. Responses were anonymous and answers to open questions were independently coded into one of three themes: skills, knowledge and attributes/behaviour. RESULTS: The response rate was 81% (64 of 79). The most frequently mentioned attributes of the ideal anaesthetist were behavioural, rather than skills or knowledge elements. Respondents thought that a simulation course should concentrate on developing leadership, teamwork and communication skills. A total of 69% (40) felt that their current training had helped them to develop attributes of an ideal anaesthetist and half of this subset felt that simulation-based training had helped them acquire these qualities. Additional benefits of a simulation course are considered to be additional practice, exposure to rare events and a realistic environment. At least 25% of the respondents thought that simulation training should be a mandatory part of anaesthetic training. CONCLUSION: This study on the training needs of senior anaesthetic trainees, who have described the behavioural characteristics of an 'ideal anaesthetist'. Some of these attributes can be taught by simulation training. Our results should be used in the design of future simulation courses.