Madigan Simulation Workshop for WWAMI

Fellows

Madigan Faculty Development Fellows

19 MAR 2013

Introductions

• Name, responsibility, experience with simulation

• Tell us why you chose to come to this course and what you hope to gain

• Tell us something personal about yourself

Administrative Matters

• Restrooms• Water fountains & snack shack• Lunch

Course Schedule

• Introduction to Simulation• Orientation to Simulation

Equipment• Lunch + Medical Apps • Scenario Development Exercise• Debriefing Exercise

Course Objectives

• At the end of this course, you will be able to—

• Prepare, build, conduct and debrief successful simulation scenarios

Engaging in Simulation

• We’ll do our best to create a simulated environment– equipment & actors

• We ask you to do your best to participate as if things were real

• You will do things differently than you would in a real setting

• If you’ve seen a scenario, hang back• Real event—This is not a simulation

The Basic Assumption

• We believe that everyone participating in simulation activities is intelligent, capable, cares about doing their best, and wants to improve

SCENARIO DEBRIEFING

BREAK

Why Sim?

Jay Baker, M.D.

Results

Outcomes # studiesPooled effect size

(95% CI)

Knowledge 118 1.20 (1.04-1.35)

Time skills 210 1.24 (1.03-1.25)

Process skills 426 1.09 (1.03-1.16)

Product skills 54 1.18 (0.98-1.37)

Time behaviors 20 0.79 (0.47-1.10)

Other behaviors 50 0.81 (0.66-0.96)

Direct patient effects 32 0.50 (0.34-0.66)

Technology Enhanced Simulation for Health Professions Education:

A Systematic Review and Meta-Analysis

Comfort Zone

Learning Zone

Sim is fun!

Set Up for Success

Jay Baker, M.D.

Provide for personal comfort and build trust

• Set up room beforehand• Greet participants• Introduce self & participants• Help participants understand the

context• Provide course learning objectives

Orient to Environment

• Introduce simulation• Discuss research protocols &

obtain permission• Formative versus summative

assessment? • Discuss care and comfort issues

Agree on Fiction Contract

• Be fair about simulation’s strengths and weaknesses

• Discuss why cases were selected• Ask for buy-in to the fiction contract• Recognize learners will probably

conduct themselves differently in simulation vs. clinical environment

Set Ground Rules

• Ask for confidentiality (Las Vegas principle)

• Appeal to participants to reflect on their actions and thinking during debriefing– Ask them to think deeply about their

practice, assumptions and knowledge– Insist that participants be polite, respectful

and curious about others’ actions and remarks

EQUIPMENT ORIENTATION

LUNCH

STAT Scenario Design

Jay Baker, M.D.

Scenario

Critical Actions

Debriefing

Learning Objectives

Scenario

Critical Actions

Debriefing

Learning Objectives

Determine Learning

Objectives

Write Critical Actions

Develop Case

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

First

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Then

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Finally

Milestones

• EM Milestones “Suggested Evaluation Methods” –

ACGME Core Competency Sim/Total

Patient Care 11/14

Medical Knowledge 0/1

Professionalism 2/2

Interpersonal Communication Skills 2/2

Problem-Based Learning Improvement 2/2

Systems-Based Practice 2/3

Total 19/24

CRITICAL ACTIONS MSME

NI

SUSTAIN IMPROVE

Place safety net—IV, O2, monitor & begin ABCs

PC1

ID afib with RVR & assess patient as stable.

PC3PC4

Take thorough history and ID time of onset

PC2PROF1

Consider rate control with diltiazem 0.25 mg/kg—defers to patient wishes

PC5 

Attempt pharmacologic cardioversion with procainamide 1 g IV/60 mins

PC9

Progress to synchronized cardioversion 120-200 J with sedation

PC10PC11SBP1

Choose appropriate sedation agents and doses

PC10PC11SBP1

Obs in ED x 1 hour then d/c home w/ f/u

PC6PC7

Demonstrate effective communication including closed loop feedback

ICS2

SCENARIO ALGORITHM

SET UP• Sim Man w/ live video feed & mic• Instructor will control Sim Man and

monitor case from video room• Resident will play role of RN• ECG available @ monitor

PRE ARRIVAL• 60 yo male with palpitations + mild

SOB x 30 mins. Tachy. Adenosine 6 mg given w/ no change.

• HR 125 BP 138/79 RR 24 Pox 97%

ARRIVAL• No change• PMH—Similar episode 4 y ago.

Txd w/ SCV in ED at that time.• Meds—None currently• All—None • SH—Tob x ½ ppd, etoh x1-2/day,

coffee x 4 cpd. Retail store owner, increased stress.

PRIMARY SURVEY• ABCs WNL except tachy as above

SECONDARY SURVEY• Pt remains stable throughout case

unless resident gives OD of sedation

LABS & IMAGES• CXR—WNL • Labs—All WNL including Troponin• ECG—Afib w/ RVR

DISPOSITION• Home

Simulation Training and Assessment Tool (STAT)– Stable Atrial Fibrillation with Rapid Ventricular Rate

Date: Instructor(s): Learner(s):

Learning Objectives:1. Assess patient as stable vs. unstable and diagnose atrial fibrillation2. Conduct appropriate work up of recent onset atrial fibrillation w/ rapid ventricular rate3. Appropriately treat and disposition

ME = Meets Expectations; NI = Needs Improvement

Milestones

Introduce the

SCENARIO ALGORITHMSET UP

Actor with bee stingO2 mask, Epipen

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1. Recognize anaphylaxis2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Exercise #1

Design scenario then rehearse x1

STAT Debriefing

Lower the learning barrier

• Introduce learners to sim environment• Acknowledge sim deficiencies• Contract– The Basic Assumption

“We believe that everyone participating in simulation activities is intelligent, capable, cares about doing their best, and wants to improve.”

Scenario

Critical Actions

Debriefing

Learning Objectives

DetermineLearning

Objectives

Identify Critical Actions

Develop Case

Reaction Phase

Teaching Phase

Summary Phase

Reaction Phase

• Elicit and recognize concerns

• Clarify facts of case

• Incorporate concerns into

teaching

Teaching Phase

Observe performance

of critical actions

Investigate reasons for

performance gaps

Close gaps through

discussion and

teaching

Generalize— Apply

lessons to home

context

Teaching Styles

Summary Phase

• “What did you do well?”

• “What did you learn?”

OR• “Take aways?”

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Observe performance

Run the scenario

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Assess gaps

Run the scenario

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Take notes

Run the scenario

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Debrief performance

Debrief the scenario

Exercise #2

• Introduce learner to environment• Run your scenario with a “learner”

– Identify performance gaps• Debrief the “learner”

–Close gaps through teaching• I will debrief your debriefing

Course Objectives

• At the end of this course, you will be able to—

• Prepare, build, conduct and debrief successful simulation scenarios

Questions?

simmingitup.blogspot.com

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement