Across the world, there is a need for standardized and accessible safe sedation training for nonanesthesiologists. Following ASA’s Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists, one program has implemented an innovative solution: a virtual preceptorship training experience that incorporates lectures, simulations, and a full sedation suite. Through the online modules within the Safe Sedation Training program, clinicians across specialties can establish a standardized, comprehensive knowledge base around ASA’s recommended best practices.
Safe Sedation Training, a spinoff of Applied Medical Visualizations, is an established partnership with the University of Utah, ASA, and Johnson & Johnson. In 2007, Applied Medical Visualizations received an NIH Small Business Innovation Research grant for the commercialization of online training protocols for moderate sedation education. The University of Utah facilitated a study in a high-fidelity simulated patient environment following the design and development of the first Safe Sedation Training learning module.
In 2010, the team received an Ethicon Endo-Surgery grant, providing the necessary funds to form a group of anesthesiologists, sedation nurses, designers, and software developers who worked to launch the first version of the SST learning platform. In just two years, that course was endorsed and positively reviewed by 28 anesthesiology department chairs, a nonprofit organization, and the International Society for Anaesthetic Pharmacology. Soon after, SST was endorsed by ASA. Moreover, the U.S. Food and Drug Administration approved the course as complementary training for computer-assisted personalized sedation systems.
Establishing a standardized training module
“As a junior professor decades ago, my charge as the chair of the sedation committee was to elevate the practice of sedation so it was a safe, quality practice across the hospital,” said Talmage D. Egan, MD. “With patient safety as our primary concern, it was clear there was a lot to do to become compliant with practice guidelines and get everyone in every department on the same page.” Dr. Egan is Professor and Chair, Department of Anesthesiology, Perioperative and Pain Medicine, Spencer Fox Eccles School of Medicine, University of Utah, and Founder and Clinical Lead of Safe Sedation Training (SST). The result of Dr. Egan’s work was a course that all physicians and nurses who practice sedation must complete to establish a more rigorous privileging mechanism among the hospital staff and to ensure that sedation practitioners had mastered a core set of fundamental knowledge.
At the time, the quandary Dr. Egan and his hospital faced was common across the nation. “Professional society organizations from numerous medical specialties generally agreed on what a safe sedation training curriculum should be composed of, but none were actually providing anything for learners to study. Many hospitals used some kind of short, rudimentary written quiz for privileging, which was obviously inadequate,” Dr. Egan said. “Most of the training was on-the-job, and though we all knew a solid, significant training experience with standardized elements was needed, it just hadn’t materialized at scale.”
Fulfilling an unmet need
For the developers of SST, the question became: How can we provide this training on a larger scale? “One challenging trend in education is that you can’t always bring all students to the teacher,” Dr. Egan said. “Small hospitals simply don’t have the economy of scale to put comprehensive training curricula together. With our program, we bring the curriculum directly to the students.” Nearly two decades since its launch, SST is realizing its goal of worldwide accessibility.
Since its inception in 2007, more than 35,000 students have completed the SST program across dozens of countries and scores of institutions. The moderate sedation training is standardized, comprehensive, scientifically grounded, mastery-assessed, consistent with ASA practice guidelines, and available to anyone from any specialty or clinical background, including nurses, pulmonologists, interventional radiologists, surgeons, and any medical proceduralist in between. It is the standard training for University of Utah students and has been adopted by many institutions in the U.S. and more than 300 institutions worldwide.
The global demand for sedation skills is huge, Dr. Egan said. “More than 50 million colonoscopies are performed worldwide, and that’s just one example of the kinds of procedures that are done with sedation that often don’t involve trained anesthesiologists.” It’s likely that most people will have sedation delivered by nonanesthesiology proceduralists once or twice in their lives, he added. “Sedation drugs are dangerous and can cause severe complications, including death – you need to know what you’re doing before you use them.”
Virtual preceptorship environment
The SST curriculum provides nine learning modules, including training on rescue, respiratory complications, patient safety monitoring, airway assessment and management, sedation pharmacology, and recovery. Modules are presented in a virtual preceptor environment, serving as a general model for a distance-based learning solution for clinical training challenges where accessibility is a key problem. “Our virtual preceptorship environment places the student in a virtual center of excellence,” Dr. Egan said. “We built the program around the concept of training students in a real-life environment and virtually recreating everything we would do in a clinical setting. It is meant to emulate a real-world experience in a way that’s accessible for all.”
The course is broken into three learning environments: a conference room for lectures and tests, a simulation center for workshop-type demonstrations, and a sedation suite where the student’s mastery of the material is assessed. A library of articles offers supplementary learning, such as how to write a nursing care plan for effective sedation care, key focus areas for pre-oxygenation before moderate sedation, and knowing the difference between rescue and resuscitation.
In the simulation center, students can enter a virtual environment where patients’ chests move with breathing, wristbands show patient history, a monitor updates patient physiological signals in real time, and a clock shows the minutes since sedation began. Moving into the sedation suite, students must apply clinical knowledge to pass modules wherein at various points they perform such things as auscultating the lungs, opening the airway, and feeling for expired gas, among many others. “It’s not enough to simply participate,” Dr. Egan said. “Students have to answer questions and complete tasks showing that the materials have been mastered. It’s a different – and better – approach than simply reading a textbook or listening to a lecture.”
Of course, Dr. Egan notes that there are important limitations to the program. Successful completion provides a thorough overview of safe sedation practices, but it does not include the hands-on training that should be supplemented with on-the-job experience. “We can talk about how you do bag mask ventilation when a patient isn’t breathing, but you still have to practice that in real life,” he said.
Dr. Egan also emphasized that a key goal of sedation training is to help practitioners recognize the difference between moderate sedation and deep sedation (and general anesthesia) so that they restrict their sedation practice to moderate sedation. “The practice of deep sedation and general anesthesia, of course, requires considerably more expertise and training,” Dr. Egan noted.
Despite the limitations, Dr. Egan is confident that the SST program offers real-world results. “I’m quite confident that Safe Sedation Training has saved lives, and that is what we are most proud of,” he said. “People are doing a better job in sedation practice in countries around the world. We’re conveying knowledge in a different way that is more engaging, more interesting, more widely available, and cheaper than alternatives like a traditional textbook or traveling to a conference.” With an increasingly far reach, SST is poised to positively impact the world of procedural sedation.
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