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Course for minimal, moderate sedation providers garners praise

May be offered as pre-Annual Session course in 2012

The ADA is looking for ways to expand a continuing education course that’s tailored to the unique needs of dentists providing minimal and moderate sedation and make it more widely available to members.

IMAGE: Dr. Randall Crowell, Dr. Bryan Griffith and Dr. John McGaw rescue their patient
Teamwork: From left, Dr. Randall Crowell, Dr. Bryan Griffith and Dr. John McGaw rescue their patient.

The hands-on portion of Recognition and Management of Complications During Minimal and Moderate Sedation took place at ADA Headquarters Oct. 27-28. If feedback from participants is an indication of the course’s relevance, it’s a must for dentists who use minimal or moderate sedation in their practices.

“This is the best course I’ve had since dental school,” said Dr. Bryan Griffith, a Port Richey, Fla., general dentist who recently expanded the types of sedation he offers in his practice to include intravenous sedation. “It’s hands-on, so you’re pushing yourself to react from an emergency management standpoint. The manikins were incredible, and it was nice to be able to sit and talk about the scenarios and all the things that could happen in the office.”

Plans are in the works to offer the course as a presession course at the 2012 Annual Session in San Francisco. The resource-intensive course requires a number of faculty to facilitate the small groups of dentists who work in teams to “rescue” patients, which are high-fidelity simulators programmed to mimic what sedation providers might encounter, particularly during the first 10 minutes of an office emergency. The result is a fast-paced five-hour experience that often resembles an emergency room or M.A.S.H. unit instead of a dental office.

“What I saw was an unbelievable amount of interest and enthusiasm for this type of learning,” said faculty member Dr. Morton Rosenberg, professor of oral and maxillofacial surgery and associate professor of anesthesia at the Tufts University Schools of Medicine and Dental Medicine, and a member of the workgroup that developed the course.

The course emphasizes closed-loop communication, added faculty member Dr. James Phero, professor of clinical anesthesiology, pediatrics and surgery, University of Cincinnati Academic Health Center College of Medicine. Closed-loop communication means that if a practitioner says something, another person repeats it back to him or her.

“Everybody has access to emergency medical services in 10 minutes and less, but you can step up and use your office team and do a really good quality evaluation and management no matter what the situation may be,” said Dr. Phero. “They don’t happen very often so that’s why high fidelity and simulation courses are necessary. They give you the tools to do something that might never happen.”

IMAGE: Dr. Peter Tan
Faculty: Dr. Peter Tan called the course’s use of simulation “a quantum leap beyond the traditional forms of teaching.”

The course has been offered for the past two years, and some state dental boards have taken notice of it as a possible educational qualifier for moderate sedation providers.

“In concept it’s a great idea, but it would have to be available on a wide enough scale to make it a requirement,” said Dr. Bruce Whitcher, an oral surgeon and member of the Dental Board of California who attended the course at ADA Headquarters not in any official capacity but out of his own interest.

“It would be a long process before we could institute such a course as a requirement, but I think it’s a great idea,” said Dr. Whitcher. “This course focuses on airway management, where most sedation providers have the potential to run into complications. It tests the essential knowledge that they really need and the types of emergencies they might encounter.”

In addition to taking a didactic portion on ADA CE Online, participants attended Part 2 for hands-on activities that provided experience in task-training exercises (oxygen/ventilation, airway adjuncts, patient monitoring, drugs), followed by high fidelity activities using SimMan manikins programmed with hypoventilation/apnea and obstruction (allergy/asthma).

Simulation is a highly effective form of teaching, said faculty member Dr. Peter Tan, assistant professor at the University of Maryland. “The hands-on simulators and trainers are a quantum leap beyond the traditional forms of teaching,” said Dr. Tan. IngMar Medical donated RespiTrainers for the course, which gave participants an opportunity to ventilate a simulated healthy patient versus one with respiratory difficulty.

IMAGE: Dr. Juri Majul
Monitoring: Dr. Juri Majul (left) checks a manikin’s vital signs while Dr. Robert Watts Jr. focuses on ventilation.
“The way it was done in the past by putting a bag on Resusci Anne was not very lifelike,” said Dr. Tan. “With the RespiTrainers, students were able to feel and be monitored on what needs to be done to accomplish a good ventilation.”

“As a general dentist who is not doing IV sedation every day, you’re asking yourself, ‘Am I prepared to react the way I need to?’,” said Dr. Griffith. “Being able to visualize some of these emergency scenarios gives you an entirely different perspective.”

Many participants expressed a desire to have their entire team go through this training.

“Being able to think on your feet is an important component,” said Dr. Michael D. Edwards, chair of the Council on Dental Education and Licensure’s Committee on Anesthesiology and associate clinical professor at the University of Alabama School of Dentistry, who went through faculty training to be able to facilitate future sessions. “What’s often overlooked is management of the team in an emergency situation. With scenarios and simulators, you rotate being the team leader and being a part of the team so you understand what your staff might experience in an actual emergency. That’s so undervalued.”

“Task training and simulation is catching on throughout health care,” said Dr. Phero. “It’s such a powerful way to learn and retain information because you’re going through the process intellectually and thoroughly, and recognizing that this is what could happen in your office, and you’re much more prepared to deal with it.”

The ADA Foundation provided a grant for the development of Recognition and Management of Complications During Minimal and Moderate Sedation with the intention that the course would serve as a complement to Advanced Cardiac Life Support training. The Anesthesia Research Foundation of the American Dental Society of Anesthesiology received the grant to develop the course. The ADA Foundation has licensed the course to the ADA.

In addition to Drs. Edwards, Phero, Rosenberg and Tan, faculty included Dr. Ken Reed, Tucson, Ariz.; Dr. Robert Merin, Woodland Hills, Calif.; Dr. Steven Schimmele, Fort Wayne, Ind.; and Dr. James Tom, Los Angeles.

Details on the course’s availability as a pre-Annual Session CE course will be announced in 2012.