Case study simulates operating room blackout for anesthesiology residents

Hope for the best; prepare for the worst. Virginia Commonwealth University medical student Luke Johnson is learning this principle firsthand as he explores his interest in anesthesiology and caring for patients in low-resource settings.

Now a third-year student in the VCU School of Medicine, Johnson sought research opportunities early in medical school, and he co-authored a study recently published in MedEdPORTAL that tackles one of the most precarious situations for an anesthesiologist—an operating room blackout. The goal, he said, is to make residency training more comprehensive, ensuring that trainees have prepared for and practiced worst-case scenarios.

"Research is a structured, evidence-driven way to find better ways to do things." Johnson said. "I want my research to have a positive impact on the field and larger society."

Expecting the unexpected

As a specialty, anesthesiology has long utilized simulation training for unexpected adverse reactions to anesthetic drugs. Operating room blackouts, however, are rare in the U.S., and Johnson said it's equally as rare to find an anesthesiology residency curriculum that covers what to do in the situation. He, however, is interested in working in international and low-resource areas, where blackouts are more common.

"I have a friend, Dr. Bokolo, who's a surgeon in West Africa, and he said that blackouts happen nearly every day in his ORs," Johnson said. "If I want to be an anesthesiologist that works in low-access areas, this is training that I'll need to have."

With his interest in global medicine in mind, Johnson reached out to Michael Kazior, M.D., an assistant professor in the Department of Anesthesiology, who has published multiple simulation studies with the goal of advancing anesthesiology training. Kazior, who described Johnson as a "real go-getter," introduced him to the power outage simulation study he had recently conducted in VCU's Human Simulation and Patient Safety Center.

In the simulation, two third- and fourth-year anesthesiology residents and an instructor were brought into a simulated routine hernia surgery, while two other residents watched via livestream in an observation room.

Sometime during the simulated surgery, facilitators in an observation room cut the electricity. They shut off all the participants' electronic equipment, including the anesthesia machine, which comprised a mechanical ventilator and inhalation anesthesia, lights and a patient-monitoring device that displayed the patient's vital signs.

The residents were then instructed on protocols to ensure the patient was as safe as possible, like converting to a total intravenous anesthetic, a bag valve mask in place of a mechanical ventilator and their own cellphone flashlights to illuminate the room.

Following the scenario, residents were debriefed by investigators and asked to reflect on their actions. They were also surveyed on their confidence levels before and after the simulation.

Johnson's main responsibility was to bring the study to the next phase by analyzing data from the simulation, running tests and creating tables, drafting the report manuscript and responding to editors' critiques—all of which earned him first authorship when the report was published in early May.

The data, Johnson said, showed that prior to the scenario, the participants felt unprepared for an operating room power outage. After going through the simulated scenario and debrief, the participants had an improved confidence in their abilities, signaling that simulation training for disaster situations can enhance anesthesiology training.

"Simulation research is extremely hard to publish, and Luke has already achieved a goal that most attendings are not able to attain," Kazior said. "He always wants to learn more, take the next step and progress in his academic goals."

Exploring opportunities

This was the first time Johnson had ever written a scientific report, an experience he described as "stressful, but rewarding."

Johnson credits his success to Kazior's guidance when it came to writing and editing the manuscript, along with his willingness to take Johnson under his wing. For Kazior, it was an opportunity to pay forward the mentorship he said he received throughout his medical education and residency training.

"The only reason I have the knowledge and ability to design and carry out these projects is because I had great mentors who taught me along the way," Kazior said. "I hope one day when Luke is an attending somewhere that he invites me to participate in a study that he has designed."

As he continues his clinical education over the next couple of years, Johnson said he is excited to explore anesthesiology and other specialties and use research as a means of combining his interests.

"Something I've seen in medical school is that my cohort has so many different interests and passions," Johnson said. "I think research is a way to explore how those interests intersect with what we're learning right now, and mentors really appreciate when you come to them with your own ideas and interests."

More information:
Luke Johnson et al, Power Outage: A Simulation Case for Anesthesiology Residents, MedEdPORTAL (2025). DOI: 10.15766/mep_2374-8265.11523

Provided by Virginia Commonwealth University