What I learnt this week: Should we simulate like Spacemen? #WILTW

This is the 83rd #WILTW

If you are fan of space travel, astronauts or Prof. Brian Cox this week’s Star Gazing Live may have had you in more of a frenzy than the opening of Star Wars: The Force Awakens. Live footage of British Astronaut Tim Peake taking off towards, and then docking with, the International Space Station was pretty difficult to avoid. It was an exciting spectacle but what really peaked my interest was the level of detail and intensity of training that Tim has undergone.

By no means I am trying to make a direct comparison between spaceflight and medicine. Analogies between the safety culture of airline industry and healthcare can become tired and the environment, risks and variables are different. However two particular facets of astronaut training I think have direct relevance to health care professionals.

Time: Not the total length of training but the length of their training missions. As part of his instruction Tim undertook a six hour underwater exercise.

Nasa_astronaut_training_at_NBL

This was to practice laying cables on the international space station in conditions similar to outer space. It is interesting that although junior doctors do very long shifts, and are technically in ‘training’, we don’t, to my knowledge, run long complex simulation exercises over hours which are similar to actual shifts. High fidelity simulation excels at 30-60minute scenarios but these are then commonly followed by a debrief and a cup of coffee. Should we run prolonged, and tiring scenarios, with medical students and junior doctors to examine the impact of fatigue on performance and communication? Do we owe it to patients to have done this?

Repeated Critical Event Training: Spaceflight is very checklist orientated.  System failures are rare but they are very well practiced with a clear plan for all participants should they occur. Having just this week taught on an Advanced Paediatric Life Support course I am very aware of the clear algorithms that exist for treating children (and adults) with critical illness and injury. The application of this guidance is variable, in part, because teams of health care professionals come together having never worked together before. Analogies here are challenging as the three astronauts who have just arrived at the international space centre practiced, again and again, knowing they will be working with each other, again and again, for the next six months. It begs the question though how much effort we should put into ensuring that teams work together repeatedly in simulations. In practice this would come with huge resource implications but is this not worth the potentially better outcomes? Locally we work extremely hard to run regular in-situ simulations but we’re not yet at a stage of having regular inter-specialty simulations that ensure all teams are comprised of members who have worked with each other before.

Flying into space is not the same a treating a two year old with severe meningococcal septicaemia. Yet our investment into the training of the professionals involved in both is vital to safe outcomes: whether you are on the moon or in the resuscitation room.

What have you learnt this week? #WILTW

(Do you have what it takes to be an astronaut – click here to find out!)

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