Entrenamiento en conciencia situacional para residentes de anestesia en entorno simulado

Se considera que los errores humanos son los mayores contribuyentes de eventos adversos en el cuidado de la salud Council for Safety and Quality in Health Care","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2006"]]},"page":"4","publisher-place":"Canberra, Australia","title":"Human Factors in Health Care","type":"article"},"uris":["http://www.mendeley.com/documents/?uuid=d338d3dc-0082-4633-8651-fca070306845"]}],"mendeley":{"formattedCitation":"(Australian Council for Safety and Quality in Health Care, 2006)","plainTextFormattedCitation":"(Australian Council for Safety and Quality in Health Care, 2006)","previouslyFormattedCitation":"(Australian Council for Safety and Quality in Health Care, 2006)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Australian Council for Safety and Quality in Health Care, 2006) y aunque estos errores se pueden atribuir a diferentes causas, uno de los factores más prevalentes es la pérdida o el déficit de conciencia situacional (SA por sus siglas en inglés) G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Endsley","given":"Mica R.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Aviation, space, and environmental medicine","id":"ITEM-1","issued":{"date-parts":[["1996"]]},"publisher":"Aerospace Medical Assn","title":"Sources of situation awareness errors in aviation.","type":"article-journal"},"uris":["http://www.mendeley.com/documents/?uuid=098e9d8d-b557-42cf-98b5-40f3051368d0"]}],"mendeley":{"formattedCitation":"(Jones & Endsley, 1996)","plainTextFormattedCitation":"(Jones & Endsley, 1996)","previouslyFormattedCitation":"(Jones & Endsley, 1996)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Jones & Endsley, 1996) . De hecho, se estima que ocasiona cerca del 82% de los incidentes en anestesia asociados con el error humano A loss of adequate Situation Awareness (SA) may play a major role in the genesis of critical incidents in anesthesia and critical care. This observational study aimed to determine the frequency of SA errors in cases of a critical incident reporting system (CIRS).\\n\\nMETHODS: Two experts independently reviewed 200 cases from the German Anesthesia CIRS. For inclusion, reports had to be related to anesthesia or critical care for an individual patient and take place in an in-hospital setting. Based on the SA framework, the frequency of SA errors was determined. Representative cases were analyzed qualitatively to illustrate the role of SA for decision-making.\\n\\nRESULTS: SA errors were identified in 81.5 %. Predominantly, errors occurred on the levels of perception (38.0 %) and comprehension (31.5 %). Errors on the level of projection played a minor role (12.0 %). The qualitative analysis of selected cases illustrates the crucial role of SA for decision-making and performance.\\n\\nCONCLUSIONS: SA errors are very frequent in critical incidents reported in a CIRS. The SA taxonomy was suitable to provide mechanistic insights into the central role of SA for decision-making and thus, patient safety.","author":[{"dropping-particle":"","family":"Schulz","given":"Christian M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Krautheim","given":"Veronika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hackemann","given":"Annika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kreuzer","given":"Matthias","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kochs","given":"Eberhard F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wagner","given":"Klaus J.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"BMC Anesthesiology","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2016","12","16"]]},"page":"1-10","publisher":"BMC Anesthesiology","title":"Situation awareness errors in anesthesia and critical care in 200 cases of a critical incident reporting system","type":"article-journal","volume":"16"},"uris":["http://www.mendeley.com/documents/?uuid=d951facc-3abc-4c35-a795-aeea34d0bf26"]}],"mendeley":{"formattedCitation":"(Schulz et al., 2016)","plainTextFormattedCitation":"(Schulz et al., 2016)","previouslyFormattedCitation":"(Schulz et al., 2016)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Schulz et al., 2016). Estudios previos en otros dominios, como la aviación, han demostrado cómo los programas de entrenamiento específico en SA han generado mejoras en comportamientos, actitudes y gestión de situaciones peligrosas, que redundan en la seguridad y la disminución de accidentes e incidentes R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Robertson","given":"Michelle M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Situation Awareness Analysis and Measurement","editor":[{"dropping-particle":"","family":"Endsley","given":"M. R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Garland","given":"D. J.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2000"]]},"publisher":"Lawrence Erlbaum Associates","title":"Training for Situation Awareness","type":"chapter"},"uris":["http://www.mendeley.com/documents/?uuid=ae830c3f-cacb-4d71-b946-10f850787fa9"]}],"mendeley":{"formattedCitation":"(Endsley & Robertson, 2000)","plainTextFormattedCitation":"(Endsley & Robertson, 2000)","previouslyFormattedCitation":"(Endsley & Robertson, 2000)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Endsley & Robertson, 2000). Sin embargo, no se han encontrado entrenamientos específicos para fortalecer la SA, en anestesia y por tanto, aún no es claro cómo se desarrollan las habilidades de SA en los anestesiólogos, ni qué tipo de entrenamiento puede contribuir a mejorar estas habilidades M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Endsley","given":"Mica R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kochs","given":"Eberhard F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gelb","given":"Adrian W.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wagner","given":"Klaus J.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Anesthesiology: The Journal of the American Society of Anesthesiologists","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2013"]]},"page":"729–742-729–742","title":"Situation Awareness in Anesthesia: Concept and Research","type":"article-journal","volume":"118"},"uris":["http://www.mendeley.com/documents/?uuid=0d1e3b56-07e9-41d7-8767-1545aaad7df2"]}],"mendeley":{"formattedCitation":"(Schulz et al., 2013)","plainTextFormattedCitation":"(Schulz et al., 2013)","previouslyFormattedCitation":"(Schulz et al., 2013)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Schulz et al., 2013). En cuanto a otros entrenamientos similares se encontraron un entrenamiento en Conciencia Situacional y Seguridad del Paciente para médicos y cirujanos R.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2011"]]},"number-of-pages":"287","publisher":"The Royal College of Physicians and Surgeons of Canada","publisher-place":"Ottawa, Ontario, K1S 5N8 Canada","title":"Situational Awareness and Patient Safety","type":"book"},"uris":["http://www.mendeley.com/documents/?uuid=8ba64bd6-5a91-49e4-8195-8afd8959e550"]}],"mendeley":{"formattedCitation":"(Parush et al., 2011)","plainTextFormattedCitation":"(Parush et al., 2011)","previouslyFormattedCitation":"(Parush et al., 2011)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Parush et al., 2011), que combina teoría, práctica y reflexión, iniciando con los conocimientos teóricos básicos sobre SA, y ejercicios de aplicación, en un entorno basado en el aula, ya ha mostrado resultados positivos When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes. Method: Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2. Results: Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist. Conclusions: This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs. Trial registration: This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.","author":[{"dropping-particle":"","family":"Jonsson","given":"Karin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brulin","given":"Christine","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Härgestam","given":"Maria","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lindkvist","given":"Marie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hultin","given":"Magnus","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2021"]]},"page":"1-11","publisher":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","title":"Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams","type":"article-journal","volume":"29"},"uris":["http://www.mendeley.com/documents/?uuid=3a698b78-6b51-4c0c-a6f6-d08735b6464b"]}],"mendeley":{"formattedCitation":"(Jonsson et al., 2021)","plainTextFormattedCitation":"(Jonsson et al., 2021)","previouslyFormattedCitation":"(Jonsson et al., 2021)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Jonsson et al., 2021). Algunos sobre Gestión de Recursos en Caso de Crisis de Anestesia (ACRM por sus siglas en inglés) Editio","id":"ITEM-1","issued":{"date-parts":[["2015"]]},"publisher":"Saunders Elsevier","title":"Crisis Management in Anesthesiology","type":"book"},"uris":["http://www.mendeley.com/documents/?uuid=609e35d3-59d3-4637-b2c4-8f65aa51657d"]}],"mendeley":{"formattedCitation":"(Gaba et al., 2015)","plainTextFormattedCitation":"(Gaba et al., 2015)","previouslyFormattedCitation":"(Gaba et al., 2015)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Gaba et al., 2015) que incluyen el uso de ‘videos de activación’ como disparador para el reconocimiento de los aspectos clave de la SA y el análisis de casos, la respuesta de los participantes a este entrenamiento ha sido positivo. Finalmente, entrenamientos en Habilidades No Técnicas para Anestesia (ANTS por sus siglas en inglés) Statement: We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I2 = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I2 = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes.","author":[{"dropping-particle":"","family":"Walshe","given":"Nuala C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Crowley","given":"Clare M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"O'Brien","given":"Sinéad","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Browne","given":"John P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hegarty","given":"Josephine M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Simulation in Healthcare","id":"ITEM-1","issue":"6","issued":{"date-parts":[["2019","12","1"]]},"page":"398-408","publisher":"NLM (Medline)","title":"Educational Interventions to Enhance Situation Awareness: A Systematic Review and Meta-Analysis","type":"article","volume":"14"},"uris":["http://www.mendeley.com/documents/?uuid=b9058998-45be-370d-9e10-be19d3b294fb"]}],"mendeley":{"formattedCitation":"(Walshe et al., 2019)","plainTextFormattedCitation":"(Walshe et al., 2019)","previouslyFormattedCitation":"(Walshe et al., 2019)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Walshe et al., 2019), en el que R., Maran, N., Glavin, R., & Patey","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2012"]]},"publisher-place":"Aberdeen, Scotland","title":"Framework for Observing and Rating Anaesthetists' Non-Technical Skills (ANTS) System Handbook v1.0","type":"report"},"uris":["http://www.mendeley.com/documents/?uuid=94409002-d005-3d80-a050-b998731fa167"]}],"mendeley":{"formattedCitation":"(Flin, R., Maran, N., Glavin, R., & Patey, 2012)","plainTextFormattedCitation":"(Flin, R., Maran, N., Glavin, R., & Patey, 2012)","previouslyFormattedCitation":"(Flin, R., Maran, N., Glavin, R., & Patey, 2012)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Flin, R., Maran, N., Glavin, R., & Patey, 2012) proporcionaron una escala y un formulario de calificación de marcadores de comportamientos observables, asociados con una buena práctica anestésica, por lo tanto, es más un sistema de evaluación que un entrenamiento. Durante el proceso de formación, los residentes de anestesia aún no han desarrollado estrategias que les permitan mantener una adecuada SA que garantice la seguridad del paciente. Una competencia más profunda sobre cómo lograr una buena SA podría mejorar el desempeño de los residentes disminuyendo su curva de aprendizaje y eventualmente mejorar la seguridad del paciente. Por lo anterior el objetivo de este estudio es desarrollar un sistema de entrenamiento y evaluación en SA, que prepare a los residentes de anestesiología para enfrentarse a las diferentes situaciones que puedan surgir en el entorno dinámico y complejo de las salas de cirugía. Para esta propuesta de investigación, se seleccionó como marco metodológico, el modelo ADDIE que caracteriza las fases de diseño instruccional: Análisis, Diseño, Desarrollo, Implementación y Evaluación (Branch, 2009; Cleland & Durning, 2015). En la fase de análisis que ya fue desarrollada se pudo determinar que los residentes de primer año, segundo año y tercer año, tienen diferentes necesidades de entrenamiento en SA y SA de equipo, por lo cual se plantea desarrollar un entrenamiento para cada año de residencia para un total de 3 entrenamientos diferentes con sus herramientas de evaluación correspondientes. Las fases de diseño, desarrollo, implementación y evaluación, serán desarrolladas por cada uno de los entrenamientos planteados de forma independiente. Para la fase de evaluación de cada entrenamiento se llevará a cabo un experimento en escenario simulado dentro del Centro de Simulación Clínica de la Pontificia Universidad Javeriana, en la que participarán los residentes de anestesia de la Facultad de Medicina de la misma Universidad. Se usará el marco de evaluación de Kirkpatrick D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kirkpatrick","given":"Wendy Kayser","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issued":{"date-parts":[["2016"]]},"publisher":"Association for Talent Development","title":"Kirkpatrick's four levels of training evaluation","type":"book"},"uris":["http://www.mendeley.com/documents/?uuid=54fb7044-d5c6-4578-84d8-aef34409e39c"]}],"mendeley":{"formattedCitation":"(Kirkpatrick & Kirkpatrick, 2016)","plainTextFormattedCitation":"(Kirkpatrick & Kirkpatrick, 2016)","previouslyFormattedCitation":"(Kirkpatrick & Kirkpatrick, 2016)"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}(Kirkpatrick & Kirkpatrick, 2016), donde se evaluarán: (1) las reacciones de los participantes (2) evaluación del aprendizaje obtenido; (3) evaluación cualitativa del cambio de comportamiento en las salas de cirugía después del entrenamiento; y (4) evaluación grupal de resultados luego de la capacitación. La población total es de 18 residentes, 6 residentes de primer año, 6 de segundo año y 6 de tercer año. Se espera contar con la totalidad de los residentes en la muestra. Los experimentos tendrán una estructura similar, en la que se llevará a cabo una nivelación de conocimientos técnicos, luego una evaluación previa al entrenamiento para evaluar los niveles de SA, se realizará el entrenamiento en SA de acuerdo a las necesidades detectadas para el año de residencia y finalmente, una evaluación posterior al entrenamiento. Las evaluaciones de SA estarán basadas en marcadores de comportamiento valoradas en escalas de Likert. Por lo tanto, se propone realizar el análisis usando el test no paramétrico, prueba de los rangos con signo de Wilcoxon, y calcular el tamaño del efecto con una correlación de rangos. Como resultados esperados del proyecto se plantea el sometimiento de un artículo en revista indexada y una ponencia en evento nacional. Además, se espera que resultados de este proyecto contribuyan principalmente al área de conocimiento de las ciencias naturales, ingeniería y tecnología desde el campo de la bioingeniería, los factores humanos y la ergonomía. De igual forma, se considera un aporte a las ciencias médicas y de la salud, en donde tendrá su aplicación en el entrenamiento de habilidades no técnicas en anestesia. Uno de los puntos a resaltar es que el proyecto incorpora procesos que pueden favorecer la apropiación social, dado que se ha mantenido dialogo permanente desde la formulación con directivos, profesores y estudiantes de la comunidad educativa que pertenecen al programa de la Especialización en Anestesiología de la Pontificia Universidad Javeriana. Por lo tanto, los resultados del proyecto serán divulgados en el Hospital Universitario San Ignacio y tendrán uso dentro de la Especialización en Anestesiología beneficiando a los residentes de anestesia. A largo plazo también puede tener impacto en la mejora de la calidad de la prestación de servicios que contribuyan a la seguridad del paciente. REFERENCIAS ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Australian Council for Safety and Quality in Health Care. (2006). Human Factors in Health Care (p. 4). Branch, R. M. (2009). Instructional Design: The ADDIE Approach. Springer Science Business Media. https://doi.org/10.1007/978-0-387-09506-6 Cleland, J., & Durning, S. J. (Eds.). (2015). Researching Medical Education (First Edit). Wiley Blackwell. Endsley, M. R., & Robertson, M. M. (2000). Training for Situation Awareness. In M. R. Endsley & D. J. Garland (Eds.), Situation Awareness Analysis and Measurement. Lawrence Erlbaum Associates. Flin, R., Maran, N., Glavin, R., & Patey, R. (2012). Framework for Observing and Rating Anaesthetists’ Non-Technical Skills (ANTS) System Handbook v1.0. www.abdn.ac.uk/iprc/ANTS Gaba, D., Fish, K., Howard, S., & Burden, A. (2015). Crisis Management in Anesthesiology (2nd Editio). Saunders Elsevier. Jones, D. G., & Endsley, M. R. (1996). Sources of situation awareness errors in aviation. Aviation, Space, and Environmental Medicine. Jonsson, K., Brulin, C., Härgestam, M., Lindkvist, M., & Hultin, M. (2021). Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), 1–11. https://doi.org/10.1186/s13049-021-00878-2 Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick’s four levels of training evaluation. Association for Talent Development. Parush, A., Campbell, C., Hunte, A., Ma, C., Calder, L., Worthington, J., Abbott, C., & Frank, J. R. (2011). Situational Awareness and Patient Safety. The Royal College of Physicians and Surgeons of Canada. Schulz, C. M., Endsley, M. R., Kochs, E. F., Gelb, A. W., & Wagner, K. J. (2013). Situation Awareness in Anesthesia: Concept and Research. Anesthesiology: The Journal of the American Society of Anesthesiologists, 118(3), 729–742-729–742. https://doi.org/10.1097/ALN.0b013e318280a40f Schulz, C. M., Krautheim, V., Hackemann, A., Kreuzer, M., Kochs, E. F., & Wagner, K. J. (2016). Situation awareness errors in anesthesia and critical care in 200 cases of a critical incident reporting system. BMC Anesthesiology, 16(1), 1–10. https://doi.org/10.1186/s12871-016-0172-7 Walshe, N. C., Crowley, C. M., O’Brien, S., Browne, J. P., & Hegarty, J. M. (2019). Educational Interventions to Enhance Situation Awareness: A Systematic Review and Meta-Analysis. In Simulation in Healthcare (Vol. 14, Issue 6, pp. 398–408). NLM (Medline). https://doi.org/10.1097/SIH.0000000000000376