Showing posts with label ASA. Show all posts
Showing posts with label ASA. Show all posts

Tuesday, November 19, 2019

Tips And Tricks For Anesthesia SimStat

Unless you like to humiliate yourself at a live simulation center in front of judgmental anesthesiologists you don't even know, the ASA's Anesthesia SimStat is for you. This is probably the easiest and least intimidating way to fulfill your MOCA Part 4 requirements. The ASA is currently selling five scenarios in SimStat. They represent everything from an appendectomy to trauma to labor and delivery, a pretty wide gamut of cases. After you complete all five, you'll be done with your Part 4 needs for half your MOCA cycle.

SimStat can be a bit tricky if you're an anesthesiologist who's been working in an outpatient ASC for a decade and don't remember the difference between dopamine and dobutamine. But have no fear, I'm here to give some tips and tricks to successfully complete SimStat as quickly and painlessly as possible. And here's my first hint--you don't need to know the difference between dopamine and dobutamine to do this.

Starting SimStat can be a bit tedious. You have to go through an orientation video with each scenario. The first time is helpful. By the fifth time, it's just a bore. The robotic voices in the simulations are also annoying. The voicing and graphics makes it obvious the ASA didn't spend Fallout level money to design this. But you can't get your credits unless you do the orientation.

Then you are dumped into a scene usually with a virtual colleague who suddenly has to leave in the middle of a case and you assume responsibility. All hell breaks loose in about five to ten minutes after your colleague leaves. You have to assume that you will go through each event at least four to five times before you pass it. The first time is just to understand exactly what they are looking for, either malignant hyperthermia, intravascular regional injection, or other life threatening complications. Once you realize what you're facing, each time you repeat it becomes progressively easier.

Now for some tips on how to successfully complete your games, er, anesthesia simulations. When you start the scenes, always remember to introduce yourself to the team and the patient through the dialogue box. You will get points taken off if you don't. This can be quite absurd as the patient could be in severe distress and you still have to take time to stop and do it. Then don't forget to read through any medical records available. Again points docked if you don't.

When each scenario begins, it moves relatively slowly before the complications pile up. This is the time to draw up any emergency resuscitation drugs you might need, just like in real life when preparing for cases. Once you've gone through the scene a couple of times, you'll know which drugs to get early on.

I like keeping the dialogue box open at all times and placed to the side of the screen. The dialogue box can give you clues about what you're supposed to do next, such as call a code or ask for a second anesthesiologist to assist.

Like any good role playing game, sometimes you have to search for clues and objects around you to get to the next level. There were a couple of times where what I needed was BEHIND me, which wasn't at all obvious. You have to use your arrow buttons to turn around to get what you need to keep the patient alive. So don't forget to look around you if you seem to come to a dead end (no pun intended).

I found that opening up the references box was very helpful in conducting a successful resuscitation. Maybe you forgot the treatment for MH. Or it's been awhile since you've renewed your ACLS certification. They are there in the references to help you save the patient.

You will need to score at least 70% to complete each scenario. Luckily they round up your score so one time I only scored a little over 69.5% and they let me pass anyway. Woohoo!. Most of the time the points just keep adding up for each virtual intervention you do. However they will also deduct points for doing something especially egregious, like if your patient dies.

One deduction I found particularly annoying was talking back to the surgeon. The virtual surgeon was being a real a**hole and we're not supposed to react to it. So don't fall for the talking back choice in the dialogue box. What is the ASA trying to teach anesthesiologists, just bend over and let surgeons abuse us?

So those are just some of the tricks that I hope will help you complete SimStat quickly and painlessly. Remember that you'll most likely need to take each one a few times before finishing so don't get frustrated. Each scene is good for five points towards MOCA Part 4. So when you finish all five, you're good to go until the next half of your MOCA cycle. Good luck.

Monday, November 18, 2019

Anesthesia SimSTAT. How The ASA Is Making Board Recertification As Painless As Possible

Yes I've ranted about the American Board of Anesthesiologists' Maintenance of Certification in Anesthesiology (MOCA) for quite some time. First of all, the doctors who really need to continue lifelong learning to maintain their medical knowledge are grandfathered out of MOCA's requirements. They get to keep their board certification for the rest of their lives without reading a single page of books or studying for any exams. Then there is the question of whether physicians who have to recertify through MOCA are really any more qualified than those who don't. I don't think you'll find many older anesthesiologists who think they are not as smart as their younger colleagues or more dangerous to their patients.


But since the ABA has to follow the rules set by the ABMS, MOCA is a fact of life for an increasingly large number of anesthesiologists. After all, lifetime board certificates for anesthesiologists ended nearly 20 years ago. The last anesthesiologists who received lifetime certificates are already more than halfway through their careers.

Since MOCA is here to stay, at least it's nice to see that the ABA has been receptive to the loud complaints about the complexity of keeping up with its onerous requirements. One of the most significant changes it made to maintain certification was the elimination of a single winner take all, make it or break it exam at the end of the MOCA cycle. This was extremely intimidating as your whole career could be derailed by one bad exam result. Now you just need to take short online quizzes called the MOCA Minute every year for ten years. The scoring system is a bit opaque despite the ABA's explanations on their website. But let's just say they're not in the business of kicking anybody out of their jobs.

The next hurdle the ABA tackled was the simulation requirement for MOCA Part 4. I know colleagues who were scared to death about Part 4. This was perhaps the most time consuming and expensive portion of MOCA. You needed to make a reservation at an ABA approved simulation center, which is usually in a big city academic facility possibly hundreds of miles away. The simulations are expensive, usually at least a couple of thousand dollars. This doesn't even count the time away from work, transportation costs, or hotel stays if you had to travel a long distance. Then just the thought of going through an oral board type exam, but this time in front of other anesthesiologists, was perhaps the worst part of the entire MOCA experience. Though there are other ways to complete Part 4, most of those involved starting research projects and how they would change their practice based on the results. Seriously, who has time to do that when you're in the OR ten hours a day?

Now the ASA has come to the rescue, assuming you're willing to part with some cold hard cash. The ASA has an online simulation called Anesthesia SimStat. For a cool $1125, if you're an ASA member (and I hope all my anesthesiologist readers are), you get to fulfill your Part 4 requirements from the comfort of your living room or office. Any gaffes you make will only be known to yourself. Nobody's judging your inability to think on your feet or make a critical differential diagnosis. It's all done in the privacy of your own place.

Anesthesia SimStat is truly an exam for the next generation. It is anesthesia through the sensibilities of a video game. I have taken all the scenarios and I've come away impressed, though I was never an avid gamer. It is private, relatively cheap, and meets a requirement to keep one's employment. I predict it will be a big boon for the ASA and anesthesiologists alike. Next I will give some insight in how to "win" at Anesthesia SimStat.