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Minutes of Meeting of Liverpool Society Of Anaesthetists
Wednesday October 8th 2014

‘Simulation - Toys for the Little Ones?’

Professor Aidan Byrne, Director of Graduate Studies, Cardiff Medical School

The meeting was opened by Dr Janice Fazackerley, the President of the Society for the last two years.  In her new role as Honorary Secretary to the Society, she said she wanted to pay tribute to her predecessor, Dr Ewen Forrest who has been in this post for the last nine years.  Following this, she handed over her duties as President to the new incumbent, Dr Ewen Forrest.   He then paid tribute to his predecessor for her role, not just within the Society but also in the wider region, over the last ten to twenty years and was pleased that she would continue to have influence on the Council of the Royal College of Anaesthetists. 

Dr Forrest then introduced the speaker, Professor Aidan Byrne. Professor Byrne opened his talk by asking the audience a question about who they would call to assist them if they had to deal with a sudden emergency in their operating theatre; a consultant colleague or a senior trainee? The response demonstrated a 50/50 split.  Professor Byrne then showed a slide demonstrating that performance during emergency scenarios was at its peak for senior trainees. Consultant performance then dropped off and became similar to middle grade anaesthetic trainees.  He then asked another question; does simulation work? The surprising answer was no, the reason being that a simulated environment was unlikely to faithfully replicate the complexities of a real situation and therefore, was difficult to be truly authentic which was important for learning.

Professor Byrne looked at a model of cognition. A sensation was perceived and processed, then compared to a previous experience from memory and leading to an action taken. The only aspect of this model that could be changed was memory which may then influence action.  He demonstrated this by showing three familiar dates and below, the same numbers jumbled up. He showed the ease with which these familiar numbers were recounted with no-one in the audience able to repeat the lower number. He spoke about both working memory which could only deal with approximately four items at once and mental capacity, the ability to process information. Despite both of these being limited, people can deal with complex situations without obvious overload. The reason for this is our ability to recognise patterns or schemata which we have learnt from previous experience.  These may be sensory schemata such as the recognition of a face or other visual pattern; motor schemata being the ability to do things without thinking about them, for example driving a car and abstract schemata, such as the expectation of what will happen next having had a similar experience in the past. These patterns may be consciously recognised producing motor responses or behaviours. However, Professor Byrne pointed out that much of our motor response or behaviour in a situation is the consequence of unconscious processing of which we are completely unaware.  He demonstrated this by showing a sentence and asked the audience to count how many F’s there were in it. The range of answers varied from seven to twelve when the actual number was ten. It showed how people missed the letters because they see the pattern but don’t always see the make-up of individual words.  He quoted J A Bargh and E Morsella from a paper entitled “The Unconscious Mind” in Perspectives on Psychological Science 2008 3, 73, which said “the role of consciousness is as gatekeeper and sense-maker after the fact”.  What this meant was that people distort the facts to fit in with what they believe.

Professor Byrne gave some definitions, firstly learning is the acquisition of schemata but effective learning means the acquisition of accurate schemata.  An expert is able to perform a task using little of their mental capacity and therefore, expertise lies in the unconscious areas of the brain. 

Professor Byrne discussed a study he had undertaken looking at the measurement of mental workload of anaesthetists during clinical practice (BJA 2010 105(6):767-771).  Anaesthetists wore a vibrator on their arm which they had to cancel every time it started vibrating.  The average response time was 1.35 seconds, however during times of high mental workload this time lengthened significantly, for example during induction and emergence from anaesthesia. It was also dependent on the experience of the anaesthetist being studied. It again showed that experienced trainees have the fastest response times although consultants were not far behind them. He then posed the question about whether sufficient experience can ultimately give everyone expertise? He said that the environment of learning was very important for the acquisition of experience. Therefore, knowledge learnt in the classroom, or indeed a simulator, may not be easily transferable into the normal working environment. Consequently, experience and practice in a real operating theatre was essential for the production of expertise in that area. However, not everyone is able to develop and demonstrate expertise despite having a similar amount of experience to a peer. 

Professor Byrne then looked at the consequences of ageing where in the case of consultant anaesthetists, there was often a narrowing of skills and experience.  This led to potential and actual holes in experience, with a reduced ability to cope with new situations. Therefore, simulation in this situation may be very helpful in refilling these holes. It may also produce feedback from others about performance.  Because learning degrades within months unless skills are maintained by regular practice, he thought that the role of simulation may be to integrate it into the clinical environment allowing regular practice of rare events so that performance can be maintained. 

Professor Byrne took some questions from the audience and Dr Simon Mercer gave the vote of thanks.


Ewen Forrest
Hon President
10th October 2014



Last updated: 26 October, 2014 LSA