Post on 01-Dec-2018
Session T212Development & Implementationof Simulated Interactive Medicine
Michael Rota, MS, PA-C Nora Lowy, PhD, MPA, PA-C
Development & Implementation of Simulated Interactive Medicine
I. Introduction II. Development of “PA SIM” Project III. Curriculum Development IV. Insights Gained V. Simulation as an Educational Tool VI. Wrap-up and Q&A
Wagner College
• The Wagner Plan – “… personalized
education” – “… field-based learning
opportunities of NYC” – “… theory and practice”
• Mission – “… comprehensive
educational program” – “… experiential and co-
curricular learning” – “… interculturalism” – “… service to society”
Wagner College
• Vision Statement – “… engaged student
learning […] reflective and integrated, theoretical, and practical.”
– “… provide a transformative college experience”
• Strategic Plan – Enhancing and expanding
on… • Classroom experiences • Civic engagement • Experiential learning • Global education
Cunard Hall
• Built around 1852 by Edward Cunard, son and heir of Canadian shipping magnate Samuel Cunard
• Administrative building since the move to Grymes Hill in 1918
• PA program occupies the 3rd floor
Key Members of our “PA SIM” Project
• Nora Lowy, PhD, MPA, PA-C • Natalya Kusheleva, MS, PA-C • Shaun Beaulieu, MS, PA-C • Michael Rota, MS, PA-C • Robert Marchese, MS, PA-C • Austin Epstein, PA-C • Krystal Cromeyer, MBA
Goals
1. Share roadmap for development of our “PA SIM” lab
2. Provide guidelines for development of simulation curriculum
3. Discuss insights gained during the implementation of simulation into our curriculum
4. Facilitate discussions regarding use of simulation as an educational tool
Discovering Simulation• Numerous faculty meetings • Reflections on teaching
modalities • Discussions on advantages of
simulation • Inclusion of innovations in
teaching • Literature searches • Site visits
– Laerdal conference – NS-LIJ SIUH – NY SIM (NYU) – Wagner College School of
Nursing
Planning and Development• Meetings with consultant
–Natalya Kusheleva, MS, PA-C Director of Patient Safety Institute & Clinical Educational Programs at NS-LIJ SIUH
• Meetings with on-campus administration – Vice President for Finance and Business – Director of Operations – Chief Information Officer (CIO) – Media Director
Project Needs• Experiences we wanted to offer students…
– High-fidelity manikin-based experiences – Skill stations – Standardized patients – Virtual standardized patients – Debriefing sessions
• Equipment we needed to house… – Manikins – Task trainers – Portable exam tables and medical equipment – Computer stations – AV equipment for recording/viewing sessions
Project Needs
High-fidelity manikin-based experiences
Skill stations Standardized Patients (SPs)
Virtual Standarized
Patients
Debriefing Sessions
Experiences we wanted to offer students…
Project Needs
Manikins Task TrainersPortable Exam
Tables & Medical Equipment
Computer Stations
AV Equipment for Recording & Viewing Sessions
Equipment we needed to house…
Project Limitations
• Limited square footage • Building code
restrictions • Electrical system
limitations • Budgetary constraints • Groups of varying
sizes
Project DesignLimited Space • 4 Rooms
Equipment • Manikins • Task Trainers • Medical Supplies • AV Equipment
Project Design
• Floor plan – 3rd floor of Cunard Hall – 4 rooms, each
designated for a spectrum of learning experiences
• Equipment –Manikins – Task trainers –Medical supplies – AV equipment – Storage containers
Simulation Lab• 2 stations divided by a mobile hospital screen • 2 LCD screens for vital signs • 2 faculty viewing areas behind by
one-way mirrors • Digital video recording equipment including
microphones • 4 full sized manikins
– 2 male manikins – 1 female birthing manikin – 1 neonate manikin
• Dry-erase walls for student note taking
Clinical Skills Lab & Large Debriefing Room• Utilized as both a clinical skills lab and
a large debriefing room • Equipped with…
– Foldable exam tables – Movable desks – 80” flat screen television – Lectern with laptop
• Creative configurations – Physical exam practice – Skills training – Viewing live/recorded sessions – Debriefing – Lectures
Clinical Skills Lab & Large Debriefing Room
Activity Equipment CapacityPhysical exam practice Foldable exam tables 8Skills training Movable desks, task trainers 8Viewing live orrecorded sessions
Flatscreen TV, movable desks, chairs
16
Debriefing Movable desks 16Lectures Flatscreen TV, movable desks,
lecturn laptop, chairs32
Research & Debriefing Room• Utilized for virtual simulation experiences, evidence-based
research, thesis research meetings, debriefing, and group skills practice
• Equipped with… – Large conference table – 4 computer workstations – 70” flat screen television – Lectern with laptop
• Creative configurations – Virtual simulation experiences – PBL sessions – Research/statistics meetings – Skills training (e.g., suturing) – Viewing live/recorded sessions – Debriefing
Research & Debriefing RoomActivity Equipment Capacity
Virtual simulation experience Computer workstations 4Research and statistics meetings
Conference table, computer workstations
8
PBL sessions Conference table 16Skills training Conference table 16Viewing live/recorded sessions Flatscreen TV, conference
table16
Debriefing Conference table 16
Faculty & Administrative Viewing Room
• Utilized for simulation lab viewing and faculty conferences • Equipped with…
– 8-person conference table –Computer workstation – 60” flatscreen television –Breakout box to allows faculty/students to connect
their computers to the screen for utilization during conferences, workshops, and presentations
Faculty & Administrative Viewing Room
Activity Equipment CapacityAdvisement meeting Conference table 4Small group debriefing Conference table, viewing screen 8Research meeting Conference table, computer
workstation8
Faculty meeting Conference table, viewing screen 12
AV Capabilities• Wall-mounted HD PTZ cameras (2) and ceiling-
mounted directional microphones (2) • Recording equipment utilizing flash drives for
storage • Small flat-screen TVs (2) in the simulation lab for
viewing vital signs and diagnostic imaging • Large flat-screen TVs (3) for viewing live simulation
sessions in HD with audio, observing recorded simulation sessions during debriefing, and broadcasting presentations
Equipment: Manikins
• High-fidelity male manikin with tablet • High-fidelity female
birthing manikin with tablet and laptop • Additional male manikin • Neonate manikin
Equipment: Models
• Abdominal cavity model • Adult skull • Arterial wall layer model • Brain model • Breast model • Cardiac/pulmonary circulatory system • Complete hanging skeleton • Complete set of disarticulated bones • Complete spinal column • Complete upper and lower extremity
bone • Cross section model of ear
• Cross section stomach model • Female genitalia model • Heart model • Inflatable lung kit – includes smokers
lungs for comparison • Male genitalia model • Pregnancy hemi-pelvis model • Pregnancy stages model • Prostate model • Rectal model • Skin layer model • Stand-up human muscle model • Thoracic cavity model
Equipment: Procedure Trays• Arterial line tray • Bone marrow aspiration tray • Central mine tray • Cricothyrotomy tray • Dressing change kit • Foley insertion tray • Incision and drainage tray • Laceration tray • Lumbar puncture tray • Nosebleed tray • Paracentesis tray • Pericardiocentesis tray • Pneumothorax tray
Equipment: Task Trainers
• Arterial blood gas trainer • Breast exam trainer • Contraceptive methods trainer • CPR trainers • Female urinary catheter trainers • Intra-osseous injectable trainer • Intradermal injection trainer • Intramuscular injection trainer • Intravenous trainer • Intubation trainer
• Male urinary catheter trainers • Nasogastric tube trainer • Pap smear trainer • Pelvic exam trainer • Prostate exam trainer • Rectal exam trainer • Subcutaneous injection trainer • Tracheostomy site replacement
trainer • Venipuncture trainer
Curriculum Development: Assessment
Assessment
Students?
Diagnostic (Pre-test)
Formative
Summative
Curriculum?
Didactic Knowledge
Clinical Skills
Professionalism
Curriculum Development: Teaching
Teaching
Theory to Practice?
Application of knowledge
Clinical Skills?
Interview Skills
Physical Exam Skills
Procedural Skills
Laboratory / Diagnostic Interpretation Skills
Decision-Making Skills
Safety Skills
Professionalism?
Respect
Cultural Sensitivity
Adaptability
Communication / Counseling
Interaction in Multi-Disciplinary Teams
‘PA SIM’ Mission
To improve student learning outcomes through individual and team utilization of advanced technology.
‘PA SIM’ Mission & Goals
Mission: • To improve student learning outcomes through
individual and team utilization of advanced technology.
Goals:1. Strengthen Clinical Knowledge 2. Enhance Clinical Skills 3. Promote Culture of Safety
‘PA SIM’ Goals & Objectives1. Strengthen Clinical Knowledge
2. Enhance Clinical Skills3. Promote Culture of Safety
a) Supplement classroom learning with interactive experiences
b) Recognize strengths and address gaps in knowledge in debriefing process
‘PA SIM’ Goals & Objectives1. Strengthen Clinical Knowledge2. Enhance Clinical Skills
3. Promote Culture of Safety
a) Develop and reinforce procedural skills b) Practice clinical skills in a controlled environment c) Provide on-demand access to patient scenarios
‘PA SIM’ Goals & Objectives1. Strengthen Clinical Knowledge2. Enhance Clinical Skills3. Promote Culture of Safety
a) Improve patient safety b) Maintain compliance with hospital and professional
requirements
Teaching Skills
Skill Professional Year 1
Professional Year 2
Professional Year 3
Interview SkillsPhysical Exam SkillsProcedural SkillsLab/Diagnostic SkillsDecision-making SkillsSafety Skills
ModalitiesModalities
Low Fidelity Simulations
Manikins
Task Trainers
High Fidelity Simulations
Manikins
Task Trainers
Computer-based
Standardized Patients
Volunteers
Actors
Real Patients
Hybrid
Standardized Patients (SPs)
• Used in clinic-like settings where no interventions or treatments are provided
• Evoke many aspects of the real clinical world
• Respond with consistent and pre-defined accounts of their conditions
• Effective for early learners and advanced learners
Task Trainers
• Allow for practice of specific tasks • Reinforce key
elements of procedure or skill • Allow learners to
acquire basic procedural skills
Manikin-based Simulators
• Computerized manikin that stands in for patient
• Can replicate various functions of the human body
• Compatible with various medical equipment (e.g., ECG machine)
• Simulate life-threatening situations that require prompt recognition and treatment
• Effective for early learners and advanced learners
Computer-based Simulators
• Enables a full patient encounter as a ‘gaming experience’ • Patients are depicted as
3D animations or drawings • Allow learners to interact
by asking questions, viewing data, and selecting diagnostic or therapeutic actions
Insights Gained
Recognize Limitations
Cultivate Creativity
Develop Relevant Cases
Utilize Different Modalities
Create a Progressive Curricula
Recognize Limitations
• Accept the limitations of your facility • High tech equipment is
not a requirement • Start small and build
up • Additions can be
made as the need arises
Cultivate Creativity
• Use your imagination • Make your own task
trainers (e.g. using balloons and toothpaste to simulate incision & drainage of an abscess)
• Dress manikins with old clothing
• Print overlays for common medical conditions (e.g. rashes)
• Use food coloring to simulate body fluids
Develop Relevant Cases
• Standardize the learning process
• Create cases that meet objectives
• For each case, have no more than 3 or 4 objectives
• Tailor the degree of difficulty to the professional year
• Avoid complex or convoluted cases
• Focus on ‘teachable moments’
• Make your cases ‘fun’
Utilize Different Modalities
• Determine which cases are best run in the sim lab • Recognize the
limitations of the various modalities • Utilize the correct
modality for each case
Create Progressive Curricula
• Crawl, walk, run! • Develop a plan that
takes into account all phases of your program • Focus the objectives
to the phase of the program
Breakdown of SIM Activities by Phase
CrawlDidactic
• Skills training • Introduction to PBL
WalkClinical
• OSCE practice sessions
Run Graduate
• Advanced simulation cases • Advanced procedures
Development → Outcomes Analysis of Outcomes
Faculty Training
Practice Runs
Implementation
Research
Design
Blueprint
Products
Staging
Development
Implementation
Assessment
‘PA SIM’Goals & Objectives1. Strengthen Clinical Knowledge
a) Supplement classroom learning with interactive experiences
b) Recognize strengths and address gaps in knowledge in debriefing process
2. Enhance Clinical Skills a) Develop and reinforce procedural skills b) Practice clinical skills in a controlled environment c) Provide on-demand access to patient scenarios
3. Promote Culture of Safety a) Improve patient safety b) Maintain compliance with hospital and professional
requirements
1. Strengthen Clinical Knowledge
a) Supplement classroom learning with interactive experiences
1) Reinforce didactic knowledge through case scenarios
2) Participate in simulated cases utilizing a variety of modalities
3) Practice screening, education, and advocacy for common medical conditions
1. Strengthen Clinical Knowledge
b) Recognize strengths and address gaps in knowledge in debriefing process
1) Guide students through critical thinking and problem-solving processes
2) Reinforce unique characteristics of disease processes
3) Correct misunderstandings in assessment and managment of case scenarios
2. Enhance Clinical Skills
a) Develop and reinforce clinical skills
1) Observe clinical skills demonstrations 2) Perform skills in focused domains 3) Receive feedback and assessment of
performance 4) Develop proficiency through repeated practice
2. Enhance Clinical Skills
b) Practice in a controlled environment
1) Take advantage of teachable moments 2) Receive constructive feedback in a safe, non-
judgmental environment 3) Develop confidence needed for practice in a
clinical environment
2. Enhance Clinical Skills
c) Provide on-demand access to patient scenarios
1) Participate in standardized learning experiences
2) Encounter less common disease scenarios 3) Reinforce specific learning objectives on an as-
needed basis
3. Promote Culture of Safety
a) Improve patient safety
1) Develop procedural proficiency prior to performance on patients
2) Identify and correct patient care errors without adverse consequences
3) Recognize personal limitations and importance of inter-professional cooperation
3. Promote Culture of Safety
b) Maintain compliance with hospital and professional requirements
1) Obtain BCLS and ACLS certifications 2) Gain exposure to advanced procedures 3) Supplement program requirements for patient
encounters and performance of procedures
Before you build a sim lab, do your research, design your layout, prepare your blueprints, and determine the products you will need
Create a curricula that is progressively more difficult as students advance through the phases of your program