Simulation for Perfusion Procedures Tool for Education and Training of Professional Behaviours in Teams

Frank Merkle1, Ines Langemeyer2

1 Academy for Perfusion, Deutsches Herzzentrum Berlin, Germany

2 Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany

Carpenter JTCVS 2008

Human Factors in the CV Surgery OR

Bruppacher Anesthesiology 2010

Bruppacher Anesthesiology 2010

Bruppacher Anesthesiology 2010

Schmidt Ann Intern Med 2013

Schmidt Ann Intern Med 2013

Simulation in Medical Education

►Basic skills acquisition

►Clinical skills acquisition

►Examiniation and Certification

►Re-Certification

►Team-Training (Crisis Ressource Management)

Berlin Simulation Operation Room

Berlin Simulation Operation Room

Anesthesia

Anesthesia-Machine

• Oxygen

• Compressed air

Cardiovascular Monitoring

• ECG

• Blood pressures invasive

• Pulse oximetry

Beating Heart Trainer

Airway Management Trainer

• Intubation (oral, nasal)

• Ventilation

Connects to Anesthesia Machine

Beating Heart Trainer

• ECG-triggered beating heart

• CPB cannulae inserted

Connects to Orpheus Simulator

Beating Heart Trainer

Orpheus Simulator

Hydraulic circulatory model

with ECG Generator

Students‘ Introduction to Cardiac Surgery

First Interdisciplinary Workshop 2009

Designing a ScenarioDefining the Goal

Acquisition of new skills

Practice established skills

Testing for competency

Teamwork development

Stillsmoking 2008

Designing a Scenario

Designing a ScenarioLearning Objectives

Non-technical skills necessary for safe and effective performance in the operating room

►Cognitive or mental– Decision making

– Planning

– Situation awareness

►Social or interpersonal– Teamwork

– Communication

– Leadership

Matveesvskii 2008

Designing a ScenarioCompetence Levels

Novice

Advanced Beginner

Competent

Proficient

Expert

Benner 1984

Designing a ScenarioLearning Objectives

Sinz 2008

Development of Professional Behaviour

Concept 1: Work Process Knowledge

►Problem solving

►Supervising

►Regulating the work system

►Coping with critical situations on a decentralised level

►Proactive search for process quality

Fisher et al 2004

Development of Professional Behaviour

Concept 2: Scientification of Work

►Prevalence of science-generated knowledge in everyday life

►Psychic quality of scientific thinking

►Reorganisation of intellectual behaviour through scientifc

concepts

►Increased complexity of work process

Langemeyer 2012

Scientification of WorkTraditional concept:

►Incorporation of scientific knowledge into work knowledge / application of

knowledge to practice

►Replacement of practical/experience-based knowledge through scientific

knowledge

New concept:

►Intellectualized mode of monitoring objects and processes at work

►Transformation of spontaneous ways of thinking and behaviour to a different

form of mental activity „presence“ or „attentiveness“ at work

►Learning as an integral element of work

(Langemeyer, I.: Socio-technological changes of learning conditions, Encyclopedia of the Sciences of Learning,

2012)

Experimental Setting

►20 perfusion students (variable professional experience)

►4 groups with 5 participants each

►Each participant was assigned a role (i.e surgeon, surgeon

assistant, anesthesiologist, perfusionist, nurse)

►Each group performed standard scenario (cannulation and

starting of CPB, cardioplegia delivery)

Development of Professional Behaviour

►Video and audio recording of simulation session

►Video and audio recording of Feedback/Debriefing and group

discussions

►Analysis of video and audio recordings (scenario and

feedback sessions)

Development of Professional Behaviour

Simulation

Assistant surgeon (m): “What is the ACT?”

Perfusionist (m): “Where is this measured? 100 – could be?”

– Silence –

Anaesthetist (m): “Everything’s alright here. [Pause] Let’s continue.”

– No reaction of the perfusionist, no reaction of the team. –

Assistant surgeon [to the surgeon]: “Did you have a nice week-

end?”

Surgeon (m): “Yeah, not bad. A bit of biking [laughing].”

Assistant surgeon: “What’s the matter with the sucker?”

[Via loudspeakers, the trainer assigns the perfusionist how to

handle the touch screen module.]

Surgeon (m): “What’s the new ACT?”

– Perfusionist (m) is concentrating on the screen, touching on it

without corresponding to the surgeon. –

Surgeon: “O.-k. …”

Assistant surgeon: “We have an easy-going perfusionist, haven’t

we?”

– Laughter –

Anaesthetist (m): “An old machinist, isn’t he?”

– Laughter –

(Third group)

Scientificated ways of working :

►Incorporation of work process knowledge is not only an

individual psychological matter

►Distributed and situated cognition

►Capacity of the team to arrange and re-arrange relevant

information

Evaluation of Simulation - Key Findings

Role Play

►Participants took on roles of surgeons, perfusionists etc.

according to their own experience from the O.R., including ironic

or anecdotal comments

►In case of loss of awareness of work process, participants had

problems with leadership – unexpected situation

►Each team member should be capable to exert leadership with

respect to the problem to be solved

Evaluation of Simulation – Key Findings

Gender Relations

►Male students (male team) more inclined to compensate for lack

of competence with stereotyped role-play

►Female students (female team) more polite and less dominant

role-play

Evaluation of Simulation – Key Findings

Conclusion

►Simulation is a useful tool in Perfusion Education

►Simulation may be employed for

►skills training of individual team members

►(interdisciplinary) team training

►development of professional ethos and behaviour