use of simulation in moc
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Use of Simulation in MOC: NOT Ready for Prime TIME
Dr Kevin Lachapelle Adair Chair in Surgical Education
9th Annual Meeting of the ACS-AEI Consortium
High Stakes Simulation for MOC: Not Ready for Prime Time
• 1) What problem?
• 2) Little Data on Simulation for MOC
• 3) Simulation good for Formative Assessment, less for Summative Assessment
• 4) Needs to be aligned with Scope of practice/patient outcomes
• 5) Mandatory does not equal Buy in
• 6) Logistics and Cost
Problem?
STS Database
• 1 500 000 patients subjected to CABG 2000-2009
• predicted mortality 2.4%
• Observed mortality 2.4% to 1.9%
• Reduction in
• Stroke
• haemorrhage
• sternal wound infection
• 2000 complaints
• 200 physician interviews
• 3% of files result in disciplinary action
• communication
• sexual
Data on Simulation in MOC
• Association Between Licensure Examination Scores and Practice in Primary Care
R Tamblyn JAMA 288(23) 2002
• Association Between MOC Examination and Quality of Care for Medicare Beneficiaries
E Holmboe Archives Internal Medicine 168 (3) 2008
• American Association of Anesthesiology
• American Board of Internal Medicine
• Interventional Cardiology
Experience with Mandatory Simulation
• Learner outcome of Anesthesiologist SBE for MOC
• 8 studies
• Most Kirkpatrick 1, no comparison to other methodologies
“There is a paucity of empirical data that support the use of simulation for certification of trainees and practicing surgeons”
Simulation, Learning and Assessment
• What do we know ( we think)
JAMA. 2011;306(9):978-988
• Screen 10903 articles • 609 articles • Pre-test, intervention, post-test with a
comparison group • 35 000 participants. • Knowledge, skills, behaviour, ? Patient
outcome
Meta-analysis
• Majority in SimCentre • Majority Novice/beginner
• Students 27% • Residents 24.7% • Nursing 11.8% • Physicians 16.2%
• Technical skills 67%
17
FLS + FLS - Surgeon Age 38.2 50.4 Rate of BDI 0.47% 0.14%
• Simulator For Assessment
• Specifically validated for purposes of assessment
• Distinguish Beginner, Intermediate, Fully trained, Expert
• Correlate with actual clinical outcome
Impact of New Technologies ?
• Virtual reality
• 3D printing
• Live Tissue
Scope of Practice
• Changes during career
• Narrows, more specific
• Focus on Patient outcomes
• Work-based Assessment
• Shows competency, performance gaps
Tyranny of Mandatory
• Buy in equals success
• build on successful projects
Logistics and Cost
• 77 000 Canadian Physicians
• Impact? ( one sim activity /year)
• Capacity? ( Sim Centre across Canada)
• Cost $156 000 000!
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