State of the Art Simulation Center
The Frank J. Tornetta School of Anesthesia at Einstein Medical Center Montgomery in partnership with La Salle University School of Nursing and Health Sciences utilizes a state of the art simulation center located in the Karabots Professional Office Building, 1330 Powell Street in Norristown, PA. The dual simulation suite utilizes Gaumard HALS S3201®, Gaumard HAL S1000®, and Gaumard HAL S5 year old® interactive patient simulators. Also utilized are the Laerdal SimNewB® neonatal patient simulator and Laerdal’s Sim View® video recording system. A designated debriefing room provides a private area for faculty/student debriefing at the conclusion of simulation activities.
Sim Lab Orientation
Sim Lab Director Cindy Betron, CRNA, DNP provides a comprehensive didactic overview of simulation lab requirements followed by an orientation to the sim lab environment.
Student Immersion Experience
During the first week of the clinical residency portion of the program, students participate in a three day simulation immersion experience which exposes them to a variety of instrumentation, equipment and core concepts that will be encountered in the perioperative environment. Program faculty provide the newly enrolled nurse anesthesia student with an overview of operating room/anesthesia work area set up, GE and Draeger anesthesia workstation checkout procedures, mask ventilation, LMA/ETT insertion techniques, utilization of specialty airway devices (Glidescope, Ambu Fiberoptic aScope, Trucorp Airway Trainer, Ingmar RespiTrainer, Simbionix 3D Fiberoptic Trainer and regional anesthesia (spinal/epidural/peripheral nerve block) techniques.
First Year Simulation Experience
First year nurse anesthesia students participate in a comprehensive 9 month initial simulation experience which progresses in complexity. Initial instruction includes perioperative room set up, medication preparation, intubation techniques, and management of perioperative respiratory/cardiac events.
Laerdal Virtual IV Haptic Device
For those students requesting additional competency training on intravenous insertion techniques, program faculty provide an orientation to the ‘Laerdal Virtual I.V.’ system. Laerdal’s 3D virtual I.V. system is a comprehensive, fully interactive self-directed learning system for training intravenous catheterization. Powerful 3D graphics provide visual realism, while a state-of-the art force feedback device accurately simulates the sense of touch for a truly immersive experience.
Anesthesia Workstation Check Out Procedure(s)
After successfully completing didactic instruction on the proper function and management of the anesthesia workstation, students participate in simulation lab exercises requiring them to complete comprehensive checkout procedures on the GE and Drager anesthesia machine workstations. Students are required to demonstrate faculty observed competency assessment on the proper set up and function of the workstation prior to performing these tasks in the clinical area.
General Anesthesia Induction Sequence Competency Assessment
During the Fall semester, junior anesthesia students participate in a ‘general anesthesia induction sequence’ simulation experience. After comprehensive faculty instruction/demonstration coupled with faculty directed mandatory practice time, students are required to complete a general anesthesia induction in a simulated environment prior to anesthetizing patients in the operating room suites. This realistic experience utilizes supervising faculty and standardized patient actors during the induction sequence experience requiring students to utilize critical thinking skills to successfully achieve content specific learning objectives.
Basic Airway Workshop
Students participate in the ‘Basic Airway’ Workshop and demonstrate effective oral airway, nasal airway, laryngeal mask airway insertion techniques and mask ventilation techniques under direct faculty supervision. Endotracheal insertion techniques are introduced utilizing the MAC blade, Miller blade and Glidescope.
Students participate in small group CRNA instructed Fiberoptic Workshops utilizing a wide variety of bronchoscopy equipment incorporating basic and advanced bronchoscopy education techniques to master the art of double lumen tube insertion for thoracic anesthesia cases utilizing the following specialized instrumentation:
In the respiratory arena, Olympus has been a pioneer in developing innovative solutions to advance the art of bronchoscopy. The nurse anesthesia program utilizes an Olympus bronchoscope video system. Olympus bronchoscopes are encountered in the majority of all anesthetizing locations throughout the United States, therefore students are required to demonstrate competency in utilizing Olympus bronchoscopy in the simulation center.
Ambu Disposable aScopes
An alternative to Olympus bronchoscopy is the Ambu® aScope™ . The aScope is a single-use disposable flexible intubation scope that guides difficult airway intubations and is gaining popularity with many anesthesia departments.
Simbionix Bronch Express 3 D Virtual Reality Simulator
The Sim Bronch system was co-developed with CHEST (the American College of Chest Physicians). This virtual reality simulator provides a meaningful hands-on training solution for the growing demand for a realistic environment to effectively identify anatomical structures encountered during double lumen endotracheal intubation techniques.
Advanced Airway Workshop
Building on previous airway workshops, students participate in their Advanced Airway Workshop in the summer of their first year. Using a combination of mannequins, custom designed airway anatomic models and Laerdal simulators, participants explore a variety of advanced airway techniques, including invasive methods. This truly unique workshop allows for practice of emergent airway management skills in a realistic environment, and encourages familiarity with rarely-used devices and techniques.
Regional Anesthesia Workshop
During the latter part of their junior year, students participate in the Regional Anesthesia (Spinal/Epidural) simulation lab experience. Junior level students receive faculty supervised instruction and mandated repetitive practice in the Simulation Center prior to administering regional anesthesia in the perioperative environment.
Peripheral Nerve Block Workshop
Jeff Petrillo, CRNA, MS provides a hands on ultrasound guided regional anesthesia workshop experience to all students in small groups during their junior year and individually throughout their senior year. During the workshop each student identifies the anatomy, proper site identification and regional anesthesia administration technique for both upper and lower extremity blocks.
Invasive Lines Workshop
Students receive hands on instruction inserting central lines using SIMULAB Central Line Trainers, GAUMARD Pulsatile Arterial Line Trainers, and suturing techniques using SIMULAB Suturing Task Trainers from CRNA faculty members that insert invasive lines on a routine basis within their respective institutions.
Pediatric Boot Camp
First year anesthesia students participate in a full day simulation focused on pediatric room set up, pharmacologic preparation, clinical case management, intubation techniques, induction sequencing and neonatal resuscitative techniques. Featured pediatric faculty include Dawn Bent, DNP, CRNA, (Staff Anesthetist, St. Christopher’s Hospital for Children) Bob Grasso, CRNA, MS (Staff Nurse Anesthetist, St. Christopher’s Hospital for Children) Don Rank, CRNA, MSN (Chief CRNA, St. Christopher’s Hospital for Children) and Rob Simon, CRNA, MS (Staff Nurse Anesthetist, Children’s Hospital of Philadelphia).
Anesthesia Crisis Resource Management
Senior anesthesia students participate in the Anesthesia Crisis Resource Management (ACRM) course focusing on effective methodologies to manage a variety of perioperative emergencies facing the anesthesia provider. Key behavior principles featured in the ACRM include anticipation and planning, communication leadership and assertiveness, use of all available resources, utilization of cognitive aids, distribution of workload and mobilization of help, re-evaluation of situations, use of all available information and cross checking of redundant data. Perioperative emergencies featured during senior ACRM training include malignant hyperthermia, local anesthesia toxicity, pneumorthorax, airway fire, exsanguination protocols and many more.
Preanesthesia Patient Assessment Workshop
At the completion of their didactic preanesthesia assessment class, students participate in the preanesthesia assessment simulation exercise utilizing standardized patient actors to familiarize themselves with the preanesthesia patient assessment process, requirements for obtaining informed consent and formulation of an anesthesia plan of care.