Neuro-critical care skills training using a human patient simulator.

BACKGROUND: Neurosurgical trainees regularly encounter critical care situations. Traditionally, education was accomplished through lecture and experience. Increasingly, human patient simulators (HPS) are employed, allowing trainees to sharpen skills in a safe and realistic environment. We describe our experience using HPS in neurosurgical training. METHODS: We developed a critical care training program for residents and medical students using HPS. We used a hi-fidelity, lifelike Human Patient Simulator™ (HPS™) produced by Medical Education Technologies, Inc.™ to simulate realistic scenarios for trainee education. Topics included spinal shock, closed head injury, and cerebral vasospasm. A three-way evaluation model was employed to test validity, including pre- and post-exercise testing, survey feedback, and videotaped replay. The simulation exercises were conducted by a neuro-critical care attending, a senior neurosurgical resident, and a HPS technician. RESULTS: We currently have 29 participants. On a 20-point critical care multiple-choice exam for these participants, average improvement has been 4.5 points or 25%. In subgroup analysis, average improvement was 4.75 points (24%) amongst neurosurgery residents, 3.07 points (18%) amongst neurology residents, 7 points (38%) amongst general surgery residents, and 7 points (38%) amongst senior medical students. Post-exercise evaluations were overwhelmingly positive. CONCLUSIONS: Neurosurgical critical care education is important for safe and effective care for patients. Clinical experience and didactic lectures help trainees obtain a solid knowledge base, but do not provide the benefit for learning in a fail-safe environment. Through the use of HPS, we have enhanced the critical care education of our trainees.

Unusual presentation of perioperative ischemic optic neuropathy following major spine surgery.

Perioperative visual loss following spinal surgery has become of increasing concern among anesthesiologists, surgeons, and patients alike. Perioperative ischemic optic neuropathy often occurs in patients greater than 50 years of age, in association with a number of presumed risk factors, including diabetes, hypertension, small cup-to-disc ratio, preoperative anemia, intraoperative hypotension, prolonged operative time in the prone position, and significant blood loss during surgery. The visual loss is notably devastating, and generally leads to permanent disability. A 44-year-old man whose central visual acuity was completely preserved is presented.

Education of trainees in the intensive care unit.

The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage in U.S. urban intensive care units. There is, therefore, a need for more novel approaches in educating trainees in critical care medicine to better prepare future physicians to manage acutely ill patients and improve patient safety. This article will review methods to improve educational designs in teaching critical care medicine to medical students, residents, and fellows, including the use of simulation technology to enhance cognition and procedural skills.