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Posts Tagged ‘anesthesia residency’

Behind the 2-Way Mirror with Dr. Crystal Tan

Dr Crystal Tan

Crystal Tan is a resident in Anesthesia at the Massachusetts General Hospital in Boston, MA. She spent the month of February at the Center for Medical Simulation on an elective rotation. The goal of the rotation program is to expose residents to the potential and operational use of simulation for education, clinical training and research. Over the course of the month, residents develop simulation scenarios including patient records, plot, setup, debriefing notes, and references.

“Have you ever wondered what happens behind the two-way mirror at a simulation center?

After spending a month at CMS, I can answer that question: wigs and fake blood, occasional burning smells, wonderful people dedicated to the art and theory of simulation, a willingness to roll with the punches and improvise, a philosophical approach to andragogy (a word I learned with Tony Dancel that means “adult education”), and a comically improbable amount of orange Tang.

I had a remarkable experience during my rotation. I learned about the technical ins and outs of staging simulations including setting up realistic scenarios, playing different operating room characters, and programming mannequins to have plummeting bradycardia or STEMIs. Through this supporting role, I watched (and sometimes helped) different groups of participants code a patient three times a day, three times a week. If repetition is the key to success, then I can’t think of a better way to practice ACLS protocols (not to mention the group dynamics intrinsic to crisis management).

A major component of the simulation experience is debriefing. After a simulation is completed, the team is given a chance to breathe, release their emotions, discuss the gritty details of the case, and perhaps learn something new. These sessions are run by debriefers trained to probe a participant’s thoughts with sincere interest and without judgment. I learned to set aside my preconceived notions as I observed and occasionally participated in these sessions. After each debriefing, I never doubted that each participant gave their full effort, and I believe each one walked away with at least one clinical or behavioral lesson they could incorporate into their practice.

The world of simulation is much larger than I realized; the depth of research, international collaboration, and even safety within simulation is incredible. Moreover, lessons from simulation are relevant not just in clinical practice but also in day-to-day life; if we could all set aside our assumptions and listen without judging, then we might all accomplish more.”

–Crystal Tan, MD

Matt Vanneman on CMS Residency

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Matthew Vanneman is a resident in Anesthesia at the Massachusetts General Hospital in Boston, MA. He spent the month of October at the Center for Medical Simulation on an elective rotation. The goal of the rotation program is to expose residents to the potential and operational use of simulation for education, clinical training and research. Over the course of the month, residents develop simulation scenarios including patient records, plot, setup, debriefing notes, and references.

“My stay at CMS was one of the most pivotal moments of my medical career. When I first showed up to CMS, I thought I would receive some instruction on how to organize and perform medical simulation better, but instead my entire world view of medical education was completed upended. CMS taught me that much of the “conventional” methods of teaching medical education that I had experienced during my training were actually missing so many of the key elements of adult learning theory, and as a result, leaving learners behind. Since the course, I have completely change my own methodology for teaching (which, I found out, takes a lot of practice!), and I am now so excited to further develop my skills as an educator. Through the course, I was extremely lucky to meet such an incredibly diverse group of people, coming from Qatar, Saudi Arabia, New Zealand, Pakistan, as well as all over the United States, and to learn from their experiences and perspectives about medical education. These conversations have deeply shaped me, not only as an educator, but also as a person. IMS has opened my eyes to an enormous new world and method of medical education, and has driven me to continue to improve my teaching to reach my goal of becoming an expert in medical education.”

-Matt Vanneman, MD

Reflections on Two Months at CMS

Albert CollageAlbert Chan, MD, is an anesthesiologist and a Visiting Scholar at the Center for Medical Simulation.

“As I meandered down the hallways of the Center for Medical Simulation at the Navy Yard saying my final goodbyes, I could not help but marvel at the amazing intellectual journey the past nine weeks has taken me. Not only have I learned about the intricacies of medical simulation and education, I have gained completely new insights into myself.

When I first arrived at the CMS, it was a bit daunting as I did not know what to expect. I was at the very center of the simulation world, surrounded by experts in medical education. What will they think of me with my limited simulation experience? Will I be accepted by the staff and faculty? My concerns were alleviated in no time – in true CMS fashion, everyone embraced and welcomed me into the family and established the “safe container.” I was ready to become a learner once again.

There were many things that were impressive at the CMS – the flattened hierarchy, the openness of communication, the constant reflection and feedback to each other, the demand for improvement and excellence, the creativity of the sim techs (yes, Johnny Tsunami), the wealth of knowledge, the constant supply of soda (yes, it’s amazing). But if I had to pick one thing I learned the most from, it would undoubtedly be the Comprehensive Instructor Course.

I was fortunate enough to be both a participant in the course, as well as faculty observing from behind the scenes. I learned so much about the application of educational theories, the complexities of debriefing, and more about the adult learners’ mind. Not being a reflective person naturally, be it due to my culture or personality – the course has made me look within myself and explore my own psyche. I came to realize the frequent inferences and assumptions I have made about others in the past, and the effect it has had on communication and relationships. Being curious has taken on a whole new meaning.

The most remarkable thing was how the faculty and staff embodied the principles that they taught, and how the course was so carefully crafted and choreographed to center around the learners’ needs, and to build a strong sense of community among the participants. If I were to be a medical educator, that is exactly what I aspire to be.

“How can you just do simulation for such nine weeks? Doesn’t it get boring?” one of my good friends asked me. This notion did cross my mind before I came to CMS, but I was proven wrong. Medical simulation is not simply using mannequins to unnerve clinicians – it is an experiential and reflective process – as was my fellowship at the CMS. At the same time, I was able to personally witness the power of conversation – not only through practicing debriefing with good judgment in the courses, but also by talking to CMS faculty, staff, techs – I have truly expanded my horizons.

Harkening back to what Mary Fey said in the Instructor Courses, I have attained “threshold knowledge” – I cannot unlearn the knowledge I have acquired here. WTF forever means “What’s Their Frame?”, I shall always teach from a stance of curiosity, and assumptions is the mother of all [mistakes].

Thanks to all the faculty at the CMS who have given me the opportunity to join in the debriefings and provided me with valuable feedback, and thanks for sparing me some of their valuable time despite busy schedules to chat about my project – especially Jenny, Roxane, Jeff, Dan, Robert and Kate. And thanks to the awesome staff who hung out with me in the back all the time and have taught me so much – Johnny, Tony, Jenn, Matt, Emily and fellow visiting scholars! Hopefully we can maintain our relationships in the years to come!

Most importantly, have to thank my dear wife Christina for supporting me on this trip and helping me take care of the babies while I am at CMS! I know it must have been tough!

Looking up at the wall of the back debriefing room one last time as I walked out, “The Basic Assumption” has taken a completely different importance and meaning from nine weeks ago, and I hope that I can bring all that I have learned back home.”

–Albert Chan, MD