How do we enhance teaching using clinical skills?

How do we enhance teaching using clinical skills?

Literature

Issenberg B et al Medical Teacher, Vol. 27, No. 1, 2005, pp. 10–28

Spectrum of Simulation Technology

Part Task Trainers

Blended Simulation

Gaba

Simulation is a technique, not a technology

Gaba DM Qual Saf Health Care 2004;13:i2-i10

Constructive alignment

Learners

Activities

Learning

Emergent Outcomes

Unintended

Intended Outcomes

Assessment

Assessment criteria

What can we do with Simulation?

Knowledge Skills Drills Performance

Management of increased airway pressure- Look, Listen, Feel:

Adequate Oxygen Delivery

Adequate FGF

Check FiO2

Connections

Bag / Bellows Moving

FiO 2 1.0 Confirm

pPeak

Clear Airway

Airway position Capnograph trace

Airway noise LMA / ETT clear

Adjuncts Suction

Isolate equipment

Suction catheter

for patency

Attach AmbuBag

direct to ETT

Easy to ventilate =

EQUIPMENT PROBLEM

Check Breathing

Rate, Symmetry, SpO2

Exp tidal volume, EtCO2

Airway pressure

Patient problem:

Reconnect Equipment

Check muscle relaxation

Check Endobronchial

ETT

Neutral position

Release abdo gas

Broncho-dilators

Check Circulation

Rate, Rhythm

Perfusion

BP

Check Depth

Anaesthesia

Analgesia

Consider Surgical Problem

Call for HELP if problem not resolving quickly

What can we do with Simulation?

Knowledge Skills Drills Performance

Deliberate practice

Deliberate

Practice

Anders Ericsson

Florida State

Debriefing or real-time feedback

Dine et al CCM 2008, 36(10):2817-22

Mastery learning

Ass

ess

InstructionPart 1

IndividuaIised corrective activity

Ass

ess

InstructionPart 2

“Ability”

Number

Standard

Central Venous Catheter

Conventionally (27) Simulated Mastery (76)

Number of CVCs 31 114

Needle passes 1.61 (.67) 1.25(.71) ***

Arterial puncture 5/31 (16%) 1/114 (1%) ***

CVC adjustment 6/27(22%) 4/111 (4%) **

Success 27/31 (87%) 111/114 (97%) *

Pneumothorax 1/31 (3%) 1/114 (1%)

Barsuk J et al CCM 2009, 37(10): 2697-2701

Translation

Barsuk et al Academic Medicine, Vol. 86, No. 12, 2011: 1513-17

What can we do with Simulation?

Knowledge Skills Drills Performance

Simulator training works

Wayne D et al Teach Learn Med. 2005r;17(3):210-6.

Wayne et al Acad Med. 2006;81(10 Suppl):S9–S12

Transferability

Wayne D et al Chest 133(1): 56-61

What can we do with Simulation?

Knowledge Skills Drills Performance

Management of increased airway pressure- Look, Listen, Feel:

Adequate Oxygen Delivery

Adequate FGF

Check FiO2

Connections

Bag / Bellows Moving

FiO 2 1.0 Confirm

pPeak

Clear Airway

Airway position Capnograph trace

Airway noise LMA / ETT clear

Adjuncts Suction

Isolate equipment

Suction catheter

for patency

Attach AmbuBag

direct to ETT

Easy to ventilate =

EQUIPMENT PROBLEM

Check Breathing

Rate, Symmetry, SpO2

Exp tidal volume, EtCO2

Airway pressure

Patient problem:

Reconnect Equipment

Check muscle relaxation

Check Endobronchial

ETT

Neutral position

Release abdo gas

Broncho-dilators

Check Circulation

Rate, Rhythm

Perfusion

BP

Check Depth

Anaesthesia

Analgesia

Consider Surgical Problem

Call for HELP if problem not resolving quickly

Debriefing

Summary

Orientation

SCE

Briefing

Debriefing

Summary

Orientation

SCE

Briefing

Performance vs Learning

Theory adapted from: Guadagnoli, M. The application of the challenge

point framework in medical education. Medical Education 2012, 46:447-

453

Performanc

e

Potential benefit

Difficulty

“Outcome”

Performance vs Learning

Theory adapted from: Guadagnoli, M. The application of the challenge

point framework in medical education. Medical Education 2012, 46:447-

453

Optimal challenge point

Difficulty

“Outcome”Performanc

e

Potential benefit

Performance vs Learning

Theory adapted from: Guadagnoli, M. The application of the challenge

point framework in medical education. Medical Education 2012, 46:447-

453

Optimal challenge point

Difficulty

Novice

Expert

“Outcome”Performanc

e

Potential benefit

Challenge Point Framework

Concrete Experience

Reflective Observation

Abstract Conceptualisation

Active Experimentation

(Kolb 1984)

• Facilitated Debriefing

• Support

• Challenge

• Facilitated Debriefing

• Distillation

• THM’s

• Facilitated Debriefing

• Questions

• Video

• Simulation

• Objectives

• Safety

• Fidelity

• Engagement

Concrete Experience

Reflective Observation

Abstract Conceptualisation

Active Experimentation

• Facilitated Debriefing

• Support

• Challenge

• Facilitated Debriefing

• Distillation

• THM’s

• Facilitated Debriefing

• Questions

• Video

• Simulation

• Objectives

• Safety

• Fidelity

• Engagement

Concrete Experience

Reflective Observation

Abstract Conceptualisation

Active Experimentation

• Facilitated Debriefing

• Support

• Challenge

• Facilitated Debriefing

• Distillation

• THM’s

• Facilitated Debriefing

• Questions

• Video

• Simulation

• Objectives

• Safety

• Fidelity

• Engagement

Concrete Experience

Reflective Observation

Abstract Conceptualisation

Active Experimentation

Debriefing in a nutshell

Rudolph et al. Debriefing as formative assessment: closing performance gaps in medical education.

Academic Emergency Medicine (2008) vol. 15 (11) pp. 1010-6

Debriefing in a nutshell

Rudolph et al. Debriefing as formative assessment: closing performance gaps in medical education.

Academic Emergency Medicine (2008) vol. 15 (11) pp. 1010-6

Debriefing

• Supportive

• Acknowledging of emotion

• Descriptive

• Diagnostic

• Facilitated

• Supports implementation

SBME in Tayside

Quality output - MasteryImmersive simulation with appropriate outcomes

Faculty skilled at formative debriefing

Bridging the UG / PG boundaryLinking University and NHS activity

SBME in Tayside

We have…• Hardware

– AV Technology

– Manikins

– Part task trainers

– Space (including the Dow)

• Liveware– Staff

– Simulated patients

– Deanery / University / Health Board

SBME in Tayside

We need…

• You.

SBME in Tayside

We need…

• You.

(maybe a small bit of cash)

SBME in Tayside

You (might) need us…

about.me/benshippey

SBME in Tayside

Knowledge Skills Drills Performance

bjshippey@dundee.ac.uk 07899684427 ben_shippey about.me/benshippey @rallydoc