Attendance and Scheduling Issues

CHAPTER 5 Attendance and Scheduling Issues




“Half of life is showing up.”


Anonymous


Yea verily, hear these words, as they are the lament of simulator people from sea to shining sea. From Boston’s storied Ether Dome down to hurricane-battered Miami, across the fruited plain, up over the Rockies to LA’s smog, San Fran’s fog, and Seattle’s drizzle, the problem with simulators is always the same.


It’s not the scenarios—there are tons of them. They’re available on the Internet, they’re well described in articles, and the next great scenario is percolating in the imagination of an instructor somewhere in Chicago or Pittsburgh or Atlanta. Scenarios aren’t the problem.


It’s not the simulators themselves—the simulator “universe” has had years of experience with them. We know how to make them “do their thing.” Simulators are getting more and more clever, more and more user-friendly; and in the way of all things computeresque, they’re getting less expensive. Laerdal and METI honor their service agreements and keep their simulators humming pretty well. Simulators aren’t the problem.


It’s not the instructors—there are a lot of people who like to teach. Teach the teachers courses abound, but even without “official training” a good teacher put in a simulator can create a good learning experience.


So if it’s not the scenarios, if it’s not the simulators, and if it’s not the instructors, then what is the problem?


Moving the meat

Getting the residents in there

The lowest tech element in this high-tech world of computerized wizardry—scheduling the residents out of the OR and into the simulation lab

From the “Simulator guru’s” point of view, this is nothing short of maddening, but it is the biggest problem with simulator education. You can debate whether the simulator is a checklist or theater; you can argue whether simulators are valid teaching methods; you can hash and rehash the “Simulator as certification” question. But if you can’t get the residents to darken the doorstep of the simulation center, there is nothing to debate! The issue is decided. If no one ever goes to the Simulator center, then by definition simulation is a big, fat zero.


Simulator centers tend to open with great fanfare. Wow! Zowie! This is new, this is the latest, this is the way to go, now we’ve arrived, now we’re “keeping up with the Joneses” (who also have a Simulator). But the nitty gritty of making sure residents rotate through the simulator becomes a real headache, and it’s too easy to fall back into this response, “Oh, yeah, the simulator, um, we have one, but no one has gone there for the past year. We got a little short-staffed, and, you know, with the 80 hour rule it’s hard to, you know, make them go, and CRNA’s cost a pretty penny, and …”




BOX 5-1 Scheduling The Simulator



• Pull from OR?

• Evening?

• Weekend?

• Who pays?

• Voluntary?

So the Simulator sits there, becoming a cobweb magnet in a dark room. A hundred scenarios, a thousand lessons huddle within the Simulator’s latex chest, but there they sit and there they stay, waiting for someone to rediscover them.


The obstacles to scheduling are quite daunting, involving two nontrivial components—time and money!



MONEY HEADACHES WITH SIMULATION SCHEDULING



• Say your program has CRNAs. If, at 7:30 on a Wednesday you are going to pull three residents out of the OR and send them to the simulator, by mathematical analysis, fast Fourrier transformation, quantitative numerometricologic integrative triangulatory derivativations, you will have to send, just a second, let me count on my fingers.

Uh, you’ll have to send three CRNAs into the rooms to relieve your residents. So you must have three extra CRNAs that day. Three more than those needed for breaks, lunches, call-in-sicks, and having people to cover regular rooms and be ready for that ruptured aneurysm or stat C-section.


Three extra CRNAs? In today’s climate of CRNA shortages? Plus, what does a CRNA cost? I don’t have enough fingers to count that high.


• Say your program is an “all-resident” program. Let’s fire up that computer again and see what we’ll need to do if we pull three residents out of the OR at 7:30 on a Wednesday. Miracle of miracles, that same number keeps appearing—three!

So now your program needs to have three extra residents. And we still need to provide breaks—residents get a break every 2 hours, get a lunch break every 4 hours. (Ours is a vigilance

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May 31, 2016 | Posted by in ANESTHESIA | Comments Off on Attendance and Scheduling Issues

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