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Anaphylaxis training coming to simulation centre

Toronto, April 26, 2016

By Rebecca Goss

Dr. Christine Song shows how to give a patient epinephrine
Dr. Christine Song, an allergy and immunology specialist, shows how to give a patient epinephrine in the Simulation Centre. (Photo by Yuri Markarov)

Allergies are becoming more and more common, with as many as 600,000 Canadians thought to be at risk of anaphylaxis, a severe allergic reaction to food, drugs, insect venom or latex.

Yet medical students rarely – if ever – come across a patient having an anaphylactic reaction because most take place outside of a hospital and they last only a few minutes.

Proper training in how to treat anaphylaxis is vital at St. Michael’s, which has the largest combined adult and pediatric allergy and immunology residency program in Canada, in partnership with The Hospital for Sick Children. The hospital also has the largest adult cystic fibrosis program in North America and CF patients are more prone to adverse drug reactions than those without CF.

Researchers at St Michael’s have developed a first-of-its-kind simulation for allergy and immunology residents to practise treating anaphylaxis.

Dr. Stephen Betschel, program director for clinical immunology and allergy, came up with the idea for the simulation and received $6,000 for the project from the University of Toronto’s Department of Medicine Innovation Fund.

Residents will do the simulation four times (twice a year) during their rotation at St. Michael’s.

The simulation involves the student identifying and treating an anaphylactic reaction in a mock-hospital setting in the Allan Waters Family Simulation Centre. Students will deal primarily with medication allergies during the simulation, since they are the most common cause of anaphylactic reactions in hospitals. Working together as a medical team, timeliness in diagnosis and providing proper treatment are some things educators will be watching closely. The simulation relies heavily on peer feedback and debriefing afterward to retain more knowledge.

   
List of most common anaphylaxis triggers:
peanuts and tree nuts, fish and shellfish, eggs, dairy products, medications, insect bites and stings, latex

By analyzing and diagnosing an anaphylactic patient in the simulation, as opposed to simply treating the patient, students experience a much more accurate anaphylaxis situation, said Dr. Christine Song, an immunology and allergy specialist and lead educator on the project. Patients arrive at the hospital in various states of consciousness, so they may not be able to tell health-care workers about their allergies and may not be aware they have allergies.

“We were concerned there would be residents who go out and start practising without ever having hands-on experience dealing with an anaphylactic reaction,” said Dr. Song. “The repetition and practice is important for learners because the more times something is reinforced the more it becomes second-nature. For anaphylaxis, there are only seconds to minutes to react or your patient could die.”

The first simulation is scheduled for this summer with plans to expand the program pending more funding and interest. If the simulation is effective with allergy and immunology residents, Dr. Song and Dr. Betschel said they hoped to expand it to other students and staff.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.