How to Effectively Incorporate Simulation as an ... · 7/17/2015 4 Zone 0- Pure Technical Skills...
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7/17/2015 1 How to Effectively Incorporate Simulation as an Educational Tool Debra Boyer, MD Boston Children’s Hospital Division of Respiratory Diseases Disclaimers I am not a simulation expert This is not a talk about traditional high fidelity simulation I have nothing to disclose
Transcript of How to Effectively Incorporate Simulation as an ... · 7/17/2015 4 Zone 0- Pure Technical Skills...
7/17/2015
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How to Effectively Incorporate Simulation as an Educational Tool
Debra Boyer, MD
Boston Children’s Hospital
Division of Respiratory Diseases
Disclaimers
I am not a simulation expert
This is not a talk about traditional high fidelity simulation
I have nothing to disclose
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Simulation
Something that is made to look, feel, or behave like something else especially so that it can be studied or used to train people
Merriam-Webster Dictionary
Objectives
Understand how medical educators use simulation
Explore some creative uses of simulation in graduate medical education
Consider how to include simulation as a component of a longitudinal curriculum
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Ways in which simulation can be used
Boot camps
Crisis resource management
Communication skills
Consultation skills (both calling and doing)
High-fidelity simulation for medical management skills
Teaching about resource poor environments
Skills training
………..
Zones of Learning in Simulation
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Zone 0- Pure Technical Skills
Teaching specific skills in a brief time frame
Independent practice at the “convenience” of busy participants
Side-by-side training with very heavy facilitator involvement
Courses are:– 1-2 hours
Zone 0- Pure Technical Skills-Examples
Orthopedic Surgical Skills Training– Beginning of rotation bootcamp (skills training in cast
applicaton, fracture reduction, etc. )
– Pracitice skills in main OR sim suite
– End of rotation “final assessment”
NICU Dialysis Skill Session
Cardiac ECHO simulation
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Zone 1- Clinical Competancy Training
Training participants in new/rarely used skills
Refreshing skills in high-risk, low-frequency events
Breaking down clinical decision making skills in a safe environment
Courses are– Short-practice opportunities (2-3 hours)
– Hands on
– Maximize limited time available
Zone 1- Clinical Competancy Training- Examples
CICU RN Orientation
Step down unit mock codes
ED Attending Faculty Sim– Supervised performance, feedback and instruction in
thoracotomy tube placement, securement, and troubleshooting
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Zone 2- Contextualized Skills Training
Multidisciplinary teams participate w/ focus on management and clinical decision-making
Deliberate practice opportunities
Courses are:– Mixed teaching approaches w/ both skill components
and team dynamics (2-3 hours)
– Scenarios (1 hour) and debriefing w/ more than one discipline and a range of learners
Zone 2- Contextualized Skills Training- Examples
Anesthesia Fellows Curriculum– Complex and rare high acuity clinical scenarios
– Frequent anesthesia/surgical emergencies where clinical judgment is required
– Simulated clinical scenarios, debriefing, didactics, training videos and performance enriching games
Pulmonary Fellows Boot Camp
ED Fellows Curriculum– Review approaches to patient presentations and key
critical diagnoses
– Medical management, procedural skills, effective communication, and team leadership techniques
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Zone 3- Team Training
Interdisciplinary from conception to implementation
Crisis management training
BCH has >34 team training programs in >26 divisions and departments
Courses are:– 4-6 hours
– Facilitators are trained in simulation and debriefing
Zone 3- Team Training- Examples
ORL Crisis Resource Management
CICU CRM– Review of Principles, Game Play, Trigger Tapes, 3
Scenarios combined with structured debriefing
– General CRM, ECMO team training, conflict resolution in the CICU
Ortho CRICO
Surgical Program CRM
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Zone 4- Live Event Debriefing
Under development
Debriefing of actual events
Piloting with CICU with ECMO
Other ways to utilize simulation…
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Pediatric Cardiology Fellowship Boot Camp
To teach skills and understand basic cardiac anatomy/physiology
Month long program prior to start of rotations
Checklist of items to accomplish
Pediatric Cardiology Fellowship Boot Camp
CICU
Electrophysiology
Exercise physiology
Catheterization
Echocardiography
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Pediatric Cardiology Fellowship Boot Camp
Basic lectures
Vascular access simulator
Obtaining consent for procedures
Code simulation/debriefing
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Pediatric Pulmonary Fellowship Boot Camp
Clinical exposure, teaching experiences and procedural training are variable
No formal training with simulation
No formal training in difficult conversations
Pediatric Pulmonary Fellowship Boot Camp
A series of three, four hour modules offered throughout the year in the simulation lab
Combination of simulation scenarios, short didactics and skills training on many topics identified in needs assessment
Includes discussions with families regarding the events
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Needs Assessment
Current Fellows (7/8)
BCH Faculty (14/18)
Former Fellows (15/23)
Pediatric Pulmonary Training Directors (33/49)
Nurses (4/6)
Chest tube placement
Absolutely essential
Nice, but not essential
Not necessary
BCH faculty 14% 71% 14%
National PD 0% 85% 15%
Former Fellows 27% 47% 27%
Current Fellows 0% 86% 14%
No sig differences btwn groups
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Summary- Usefulness of simulation
Absolutely essential– Complications of FB
– Management of hemoptysis
– Management of PTX
– End-of-life care
– New diagnosis of CF
Nice, but not essential– Thoracentesis
– Conscious sedation
How adequately trained are fellows in:
0
10
20
30
40
50
60
70
80
90
Chest Tubes Career Dev QI research
CHB facultyProgram DirectorsFormer FellowsCurrent Fellows
% superb/ adequately trained
p<0.05 p<0.05
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Structure of Session
High fidelity simulation– Bronchoscopy with transbronchial biopsies
Patient develops pneumothorax
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Structure of Session
High fidelity simulation– Bronchoscopy with transbronchial biopsies
Patient develops pneumothorax
Skills session- Chest tube placement
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Structure of Session
High fidelity simulation– Bronchoscopy with transbronchial biopsies
Patient develops pneumothorax
Skills session- Chest tube placement
Skills session- Pleurovac Jeopardy
Pleurovac Jeopardy
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Pediatric Pulmonary Fellows Boot Camp
Other new ways to use simulation?
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Milestone assessment and Simulation
Beeson et al. Simulation in Healthcare. 2014
Milestone assessment and Simulation
Beeson et al. Simulation in Healthcare. 2014
Controlled environment for evaluation
Efficient evaluation with minimal system-based interference
Reliable multi-evaluator feedback
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Milestone assessment and Simulation- Opportunities
Beeson et al. Simulation in Healthcare. 2014
Consider developing specialty-wide clinical simulations to assess some competancies
Develop procedural competancies programs for each specialty
Investigate other modalities aside from high fidelity sim– Standardized patients
– OSCE
– Task trainers
– Computer-based situation scenarios
Can’t I just use my current sim for Milestone assessment?
Beeson et al. Simulation in Healthcare. 2014
Not totally- scenarios must be mapped to specific milestone subcompetancies
Also, most simulations are set up for formative not summative assessment
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Summary
Think outside the box
Begin with a needs assessment
Simulation can be a brief experience, a block experience or longitudinal
Questions
