High fidelity mannequin simulation of anaphylaxis: A gateway to treatment
Published Online: September 23, 2013
Physicians who specialize in Allergy and Immunology care for patients with potentially life threatening allergies, and provide treatments that can, rarely, trigger severe allergic reactions, including allergen immunotherapy and oral food challenges. While reactions in these situations could be life threatening, they are also exceedingly rare, making it difficult to educate physicians with regard to proper anaphylaxis management. Simulations using high-fidelity mannequins in combination with standardized patients (also known as hybrid simulation) is a new educational modality that provides “real-life” emergency situations for physicians to learn about management of uncommon but severe medical emergencies.
In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, Kennedy, et al, report the results of evaluating the effectiveness of hybrid simulation for allergic emergencies. The purpose of this study was to determine if team-training and preparation for office emergencies using hybrid scenarios would improve overall patient care and strengthen inter-office team performance. In addition, this group evaluated whether hybrid simulation training would result in the retention of knowledge and skills required for allergic emergencies.
Two allergy clinics participated in a one-day workshop focusing upon in-office allergic emergencies. During this workshop, various scenarios of allergic emergencies were simulated using both standardized patients and high-fidelity mannequins. All scenarios were videotaped, and the participants were graded by three objective evaluators using the Clinical Emergency Preparedness Team Evaluation (CEPTE). Data collected included the team’s performance in five areas: 1) role clarity, 2) communication, 3) teamwork, 4) situational awareness, and 5) scenario-specific skills. Furthermore, in order to evaluate the transfer of skills from the workshop to the separate clinics, unannounced simulations were performed in the participants’ own allergy clinics 10 -12 months after the workshop.
Personnel from both allergy clinics showed significant improvement in total team competency scores from baseline (scenario 1) to each subsequent scenario during the workshop day based upon CEPTE scoring. Evaluation of the individual markers of improvement in the CEPTE showed significant improvement in almost all areas. In the unannounced simulations that occurred 10-12 months after the initial workshop, both clinics showed significant improvement from the baseline simulation, suggesting retention of knowledge from the original workshop.
This study provides insights into the potential impact of simulation on patient outcomes. Most studies using simulation report on pre/post-test intervention data, but very few provide information on knowledge and skill retention over time. The unannounced in situ simulation provided the opportunity to observe teams in their own setting while using their own equipment and was an effective measure of retention of knowledge. The findings of this study are encouraging and illustrate the need to improve the learning environment by including hands-on instruction utilizing state of the art technology and structured feedback to students.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.