Simulation and Research

Simulation Program and Educational Opportunities:

Simulation is the process of replicating real-life events or tasks for the purposes of rehearsal, reflection and learning. It encompasses a number of activities which are chosen according to the learning objectives of the program. Simulation can be computerized manikin-based where practitioners participate in a complete event (termed a scenario). This can be with faculty taking the role of other team members, and the learning is primarily focused on the anesthesiologist (uniprofessional simulation), or more than one discipline can be represented in the learner group (interprofessional simulation). Whereas the former is useful for consolidating knowledge of the medical management of events and rehearsing their conduct in real-time, the latter is useful for exploring non-technical skills related to working in a team (prioritization, resource utilization, decision-making, leadership, situational awareness, communication etc.). Manikin-based simulation can be located in an off-site sim center, or in-situ, when the manikins are set up in the real clinical environment. In-situ simulation allows the whole healthcare pathway to be experienced and tested and can often reveal latent safety threats that are in the background of many complex systems but are only exposed when the system is stressed. During their postgraduate training program Residents will have access to a number of scheduled simulation encounters  in each of these categories. Some of these are formally integrated into the curriculum and seek to cover those aspects of anesthesia training that are particularly suited to simulation based learning. Other simulation opportunities will be on an ad-hoc basis where simulation leaders at each site on the rotation provide just-in-time training which involves finding a moment in the immediate time leading up to task to simulate it first, thereby revealing any gaps in technique before undertaking the task on a real patient.

Simulation also encompasses task-training where only a part of a patient is replicated without the need for computer-controlled vital signs etc. Anesthesia is particularly amenable to task training with many technical components of our job having particular task-trainers associated (e.g. vascular access task trainers, airway trainers, difficult airway trainers, regional anesthesia task trainers, ultrasound phantoms etc.). At each site on the anesthesia rotation there are a number of task trainers available to Residents. These are accessible via the site lead for simulation. In many cases arrangements can be made to access these trainers out-of-hours or without immediate supervision enabling Residents to engage in deliberate practice and mastery learning. In other contexts, local faculty use the task trainers as vehicles for facilitated learning and provide real-time feedback on the conduct of a task, allowing the learner to be guided in-action, benefiting from the experience of the instructor.

Residents also have access to other types of simulation during their rotation: standardized patients; hybrid simulation; screen-based simulation; virtual interactive patients; case-based simulations; virtual reality and augmented reality. Some of the more specialized components of simulation will be available on request only – any interested resident can contact the department lead for simulation to discover current opportunities for involvement.

Residents are also able to engage in simulation as an instructor, to a variety of learner groups. There are recurring opportunities in this regard and also special projects that arise from time-to-time. Curious residents should declare their interest to their site coordinator who will be able to relay teaching opportunities or refer them to the simulation educator in need of assistant faculty. Residents undertaking Masters degrees in medical education will access a higher level of instructor opportunities, involving curriculum design, scenario design, program evaluation and performance metrics.

Residents will have the opportunity to participate in simulation-based research, both as a subject (only with their consent) and as an investigator. Simulation-based research can either be investigating simulation as an education modality and seeking to establish what configuration maximizes learning outcomes, or simulation can be the tool by which other components of healthcare are investigated (for example testing care pathways, new clinical areas or changes in management algorithms).

The usual construct of simulation for residents is to create a safe learning environment wherein residents can make mistakes and learn from them know they are not being evaluated or inferences made about their real-life clinical performance. The only context in which this is violated is where simulation is used for assessment purposes. This is the exception rather than the rule and it is made explicitly clear when a simulated event is being used for summative evaluation. As the College moves to Competence by Design, residents will encounter a number of simulation-based milestones. These are standardized "testing" scenarios that are run the same for all residents across Canada. The scenarios, their content and the nature of the rating of residents' performance is overseen by the Canadian National Anesthesia Simulation Curriculum (CanNASC) committee in close liaison with the Anesthesia Specialty committee at the College.

Simulation is a well-established component of medical education at all levels. The simulation-based learning available to Residents is rich and diverse. We are pleased to be able to offer a range of opportunities in each and every year of the program.

Research Opportunities:

There is a very large, productive research community in the department and areas of investigation include laboratory and clinical research. A number of internationally recognized researchers work with our department. Resident research experience is strongly encouraged and engagement in some form of scholarly activity is mandatory. The University of Toronto offers a rich environment for scientific enquiry. There are many active, highly successful investigators in basic and clinical sciences and we encourage the involvement of residents in research projects. Residents involved in research are expected to experience all phases of research projects including the design, conduct and analysis of data and the presentation and publication of results. Resident research is guided and mentored by our Research Committee to support resident success. For more information, please visit our Research Page

We also offer excellent opportunities for residents to pursue graduate degrees, not only in the basic and clinical sciences (MSc and PhD) but also in clinical epidemiology and medical education. A program in health administration is also available. Residents committing to at least a two-year experience in a Master's or PhD program can satisfy the requirement of the Royal College Clinician Investigator Program.  Please see our Anesthesia CIP site . Funding may be available through the department if extra time is required to complete a degree program.

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