The Role of Simulation in Medical Education

Transcription

1 The Role of Simulation in Medical Education September 6, 2015 Anita A. Thomas, MD

2 Disclosures None

3 Objectives 1. Understand the use of simulation as an educational tool for medical education. 2. Describe the utility of medical simulation to identify systems and safety issues as a quality improvement process. 3. Recognize the research/publication/cme potential from the use of medical simulation

4 Simulation

5 Background Just In Time originated at Toyota (1952) Manufacturing via Toyota Production System Translated to simulation training Simulated environment provides trainees competency via practice (Kneebone et al 2009) Atul Gawande s The Checklist Manifesto (2009) Use of mastery training checklists in simulation training

6 Context of Health Care Systems Processes Environment User Tool Team Task Cheng A, Grant V. (In Press) The Role of Simulation in Improving Pediatric Patient Safety. Comprehensive Textbook of Healthcare Simulation Pediatric Edition

7 Simulation in Medical Education See one, do one, teach one. Limited procedural/code opportunities for trainees Work hours Patient safety Alternative way to learn and assess in a uniform way

8 Medical Education, Simulation & Society Bradley P. Medical Education. 2006; 40::

9 Mock Code: Knowledge Simulation scenarios evaluated resident use of cognitive aids during cardiac arrests Most residents use cognitive aids 25% chose wrong algorithm PALS cards changed Team Nelson K et al. Simulation in Healthcare. 2008;3:

10 Resident Performance After Simulation Increasing number of simulation based mock codes resulted in a 50% increase in survival rate after pediatric cardiopulmonary arrest Benefit sustained over three years (Andreatta 2011) Procedural benefit for central venous catheter (CVC) insertion with simulation-based mastery learning Increased residents' skills in simulated CVC insertion Decreased the number of needle passes when performing actual procedures Increased resident self-confidence (Barsuk 2009)

11 In-Situ Simulation: Task Distribution Processes Environment Setting: New Pediatric ED with new staffing model User Team Tool Task Goal: Define optimal staff roles before facility opens Method: Iterative lab and in-situ simulations NASA Taskload Index

12 Building Hope Timeline Design/ Construction Simulation Testing Staff Training Clinical Opening ED Design Identified ~350 latent safety threats/unit Verified safety threats addressed Command center closed in 3 days

13 Building Hope Data 1844 Latent Safety Threats identified 207 critical/high priority threats 98% addressed before building opening

14 Simulation Publications: MedEdPortal Free open, online publication, academic resource Peer reviewed publications and educational modules publications downloaded weekly Educational scholarship

15 Simulation Education Resources Scenario overview Learning objectives Instructor guide Simulation technologist guide Equipment list Debriefing questions

16 Conclusions: Simulation in Medical Education Can be applied at all levels, settings Positive training environment and educational method Focus on low-frequency, high-risk tasks Assess existing system, implement new system Identify, mitigate latent safety threats before patient harm Potential for publication via MedEdPortal as a generalizable, comprehensive, stand alone curricula

17 Acknowledgements Special Thanks To: Neil Uspal, MD Ashley Keilman, MD Jennifer Reid, MD Kimberly Stone, MD, MS

18 Thank you!

19 References 1. Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Crit Care Med Jan; 12(1): Barsuk JH, McGaghie WC, Cohen ER, O Leary KJ, Wayne DB. Simulation-based mastery learning reduces complications during central venous catheter insetion in a medical intensive care unit. Crit Care Med 2009; 37(10): Geis GL, Pio BL, Pendergrass TL, Moyer MR, Patterson MD. Simulation to Assess the Safety of New Healthcare Teams and New Facilities. Simul Healthc Jun;6(3): Issenberg SB, McGaghie WC, Petrusa ER, Lee GD, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach Jan; 27(1): Johnson K, Geis G, Oehler J, Meinzen-Derr J, Bauer J, Myer C, Kerrey B. Simulation to implement a novel system of care for pediatric critical airway obstruction., Arch. Otolaryngol. Head Neck Surg Oct; 138(10): Kaufmann J, Laschat M, Wappler F. Medication errors in pediatric emergencies: A systematic analysis. Deutsches Arzteblatt Intl. 2012; 109(38): Kobayashi L, Shapiro MJ, Sucov A, Woolard R, Boss RM, Dunbar J, Sciamacco R, Karpik K, Jay G. Portable Advanced Medical Simulation for New Emergency Department Testing and Orientation. Academic Emergency Medicine. 2008; 13 (6): Patterson MD, Geis, GL, Falcone RA, LeMaster T, Wears R. In Situ Simulation: Detection of Safety Threats and Teamwork Training in a High Risk Emergency Department. BMJ Quality and Safety. bmjqs Published Online First: 20 December 2012 doi: /bmjqs Stone K, Reid J, Caglar D, Christenson A, Strelitz B, Zhou L, Quan L. Increasing pediatric resident simulated resuscitation performance: A standardized simulation-based curriculum. Resuscitation Journal Aug; 85(8),