enhancing medical education with simulation
TRANSCRIPT
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
[email protected] 07899684427 ben_shippey about.me/benshippey @rallydoc