Introduction: This simulation on cardiopulmonary bypass (CPB) introduces learners to the relevant critical actions and concepts involved in going onto and off of CPB. It is intended that junior residents experience this simulation immediately prior to beginning their cardiac anesthesia rotation. Thus, this simulation serves to segue to the trainee's initial clinical experience with CPB. Methods: The case is fully presented for facilitators in the simulation case file, which includes a brief narrative description of the case, learning objectives to be covered by the simulation, and a summary of critical actions to be performed by the learner during the educational activity. It is optimal to run this simulation using a high-fidelity human patient simulator with anesthesia machine and relevant monitors. Results: The simulation was carried out by eight CA-1 or CA-2 residents during the 2016 academic year. Cardiac anesthesia faculties observed a significantly improved learning curve for trainees who had experienced this simulation prior to their first clinical case. Discussion: Overall, this simulation has been found to be a very effective learning tool at the University of Iowa. To that end, this simulation has been incorporated into the cardiac anesthesia curriculum, and all junior residents experience this simulation prior to beginning their rotation.

IntroductionThis simulation on cardiac tamponade and complete heart block in the context of severe aortic stenosis presents the learner with a rare (cardiac tamponade) and a common (complete heart block) complication in the intraoperative setting of transfemoral aortic valve implantation in a high-fidelity, low-risk simulation environment. Based on an amalgam of index cases, the simulation was developed to address a recognized area of need for cardiothoracic anesthesia scenarios in the simulation curriculum of our home institution.MethodsThe simulation case file covered the case narrative, learning objectives, a summary of critical actions performed, and supplemental figures needed to complete the educational activity. A high-fidelity patient simulator, an anesthesia machine, monitors, and a computer capable of displaying standard computer slide presentation software and movie files provided the optimal environment for simulation.ResultsFifteen anesthesia residents experienced the simulation over the 2016–2017 and 2017–2018 academic years. The trainees who experienced this simulation improved their understanding of tamponade hemodynamic pathophysiology and recognition of hemodynamically unstable bradycardia.DiscussionThis case has been an effective addition to the repertoire of simulation scenarios at the University of Iowa and has been incorporated into the general curriculum of simulation cases for mid-training junior and senior anesthesia residents.

Introduction: Providers at all levels should have some understanding of the pathophysiology and be able to manage such a patient in the operating room. In addition, any anesthetists providing pediatric care should be able to identify and understand the importance of other comorbid conditions in these patients. This simulation on posttonsillectomy and adenoidectomy hemorrhage in the pediatric patient presents a challenging case usually encountered in some form by most anesthesia residents during training. This simulation's objective is to challenge and further reinforce the knowledge of anesthesiology resident physicians who have completed 1 year of clinical anesthesia and at least 1 month of pediatric anesthesia. Methods: The simulation can be delivered in a single session of 1 hour or less. Materials in this simulation include a case template designed to provide facilitators with a general overview, a checklist of critical actions each learner should perform during the scenario, a brief summary to be provided to the learner to reinforce knowledge gained through the activity, and an evaluation form to assess the learner's view of the activity's educational value. Results: Learner comments were almost unanimously positive. All learners who returned surveys answered the questions "This simulation enhanced my understanding of how to manage critically ill patients in the perioperative period" and "The content was current and relevant to my practice" with either agree or strongly agree. Discussion: The module offers various points to practice troubleshooting skills in the management of difficult IV line placement as well as difficult airway management. In reality, this case could be modified in multiple ways, including management of a more severe hemorrhage with a much more hypovolemic patient.

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Introduction This activity is designed for midlevel and senior anesthesia trainees to experience the complexities of one-lung ventilation in pediatrics in a high-fidelity simulated environment. With the use of video-assisted thoracoscopic surgery (VATS) becoming increasingly common in pediatrics, we identified this area as an opportunity for the development of a dedicated educational simulation activity. Methods Our simulated patient is a 3-year-old girl with empyema presenting for decortication via VATS who subsequently develops hypoxemia. The main challenges for the trainee include airway selection and insertion, lung isolation with fiber optic confirmation, and management of hypoxemia in the setting of one-lung ventilation. A pediatric medical simulator suitable for practicing resuscitation is required, and a tracheobronchial tree model is highly desirable. Basic knowledge of thoracic and pediatric anesthesia is required, but specific experience with pediatric lung isolation is not. Results Learners who experienced the content of this simulation expressed a strong sentiment of value. All pilot trainees were surveyed and indicated they either agree or strongly agree (4 or 5, respectively, on a 5-point Likert scale) that “This simulation enhanced my understanding of how to select lung isolation devices for pediatric patients” and “This simulation enhanced my understanding of how to manage hypoxia in context in one-lung ventilation.” Comments were overall positive, including “I am better prepared to manage pediatric one lung ventilation cases.” Discussion At the University of Iowa, this activity is part of a core curriculum of simulation training that resident physicians in anesthesiology experience during their training. It functions as a tool for education, evaluation, and self-identification of weaknesses in the learner's knowledge base as it relates to the perioperative management of pediatric one-lung ventilation, as well as for reinforcing material learned in the classroom and operating room. Numerous anesthesiology residents and faculty have pilot-tested this simulation, and necessary modifications have been made based on their feedback.