presentation by michele nypaver
TRANSCRIPT
Michele M. Nypaver, MDAssociate Professor
William G. BarsanDept. of EM Research Forum
April 27, 2016
A Less Conventional Research Journey
We’re gonna be program directors!
Survival Guide for PD’s
Curriculum Development for Dummies
Learning 101
A girls guide to simulators
FINDING COLLABORATORS!
•AAP/Section on EM Program Directors Subcommittee•UM Educators (MERG),
Residents and PEM Fellow
Nypaver 101
• Clinical (Educator) Track•Associate Professor
•Scholarly Interests•Education
•Simulation•Assessment
•Quality Improvement•Children with Cancer & Fever
How do we evaluate (and measure) performance?Build your own or steal someone else’s tools!
What are we trying to assess?Formative?Summative?Cognitive?Technical?
What tools are available to measure the learner?
Are they valid?Are they reliable?Are the evaluators trained to use
the tool?Will the tool discriminate levels of learners?
OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILLS (OSATS)
GLOBAL RATING SCALE OF PERFORMANCE: Pediatric Emergency Endotracheal Intubation
Please circle the number corresponding to the candidate's performance in each category.
Time/Situational awareness
1 2 3 4 5 Does not know
Dependent on instruction Independent with
minor error(s) Independent and efficient
with no errors Preparation
1 2 3 4 5 Does not know
Dependent on instruction Independent with
minor error(s) Independent and efficient
with no errors
Medication 1 2 3 4 5 Does not know
Dependent on instruction Independent with
minor error(s) Independent and efficient
with no errors Pre- Intubation Processes 1 2 3 4 5 Does not know
Dependent on instruction Independent with
minor error(s) Independent and efficient
with no errors Intubation Technique 1 2 3 4 5 Does not know
Dependant on instruction Independent with
minor error(s) Independent and efficient
with no errors ETT Placement 1 2 3 4 5 Does not know
Dependent on instruction >90 seconds Between 60 and 90
seconds Between 60 and
30 seconds <30 seconds
Confirmation of Tube Place
1 2 3 4 5 Does not know
Dependent on instruction Independent with
minor error(s) Independent and efficient
with no errors
Recognizes Complication: Right main stem ☐ Not applicable
1 2 3 4 5 Does not know
Dependent on instruction Recognize and correct
>2 min Recognize and correct <2 min,
but >1 min
Recognize and correct <1 min
Would you let this Trainee perform this procedure on your next patient unsupervised?: YES NO
OVERALL PERFORMANCE
1 2 3 4 5 Very poor Competent Clearly superior
Assessment of learning (is hard)
Prospective comparison of live evaluation and video review in the evaluation of operator performance in a pediatric emergency airway simulation.House JB, Dooley-Hash S, Kowalenko T, Sikavitsas A, Seeyave DM, Younger JG, Hamstra SJ, Nypaver MM. J Grad Med Educ. 2012 Sep;4(3):312-6
Cloutier RL, Walthall JD, Mull CC, Nypaver MM, Baren JM: Best educational practices in pediatric emergency medicine during emergency medicine residency training: guiding principles and expert recommendations. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 17 Suppl 2: S104-13, 2010. PM21199076
House JB, Dooley-Hash S, Kowalenko T, Sikavitsas A, Seeyave DM, Younger JG, Hamstra SJ, NypaverMM: Prospective comparison of live evaluation and video review in the evaluation of operator performance in a pediatric emergency airway simulation. Journal of graduate medical education 4(3): 312-6, 2012.
Eppich WJ, Nypaver MM, Mahajan P, Denmark KT, Kennedy C, Joseph MM, Kim I: The Role of High-Fidelity Simulation in Training Pediatric Emergency Medicine Fellows in the United States and Canada. Pediatric emergency care 29(1): 1-7, 2013. PM23283253
Iyer MS, Santen SA, Nypaver M, Warrier K, Bradin S, Chapman R, McAllister J, Vredeveld J, House JB: Assessing the validity evidence of an objective structured assessment tool of technical skills for neonatal lumbar punctures. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 20(3): 321-4, 2013.
House J, Iyer M, Santen S, Warrier K, Bradin S, Chapman R, Vredeveld J, Nypaver, M: OSATS Assessment Instrument for Neonatal Lumbar Puncture. MedEdPortal www.mededportal.org/publication/9758, 2014.
House, J, Nypaver M, Dooley Hash S, Hamstra S.: OSATS Tool for Pediatric Rapid Sequence Intubation AAMC MedEdPORTAL Feb 2014
Doughty, Cara; Kessler, David; Zuckerbraun, Noel; Stone, Kimberly; Reid, Jennifer; Kennedy, Chris; Nypaver, Michele; Auerbach, Marc: Simulation in Pediatric Emergency Medicine Fellowships Pediatrics 136(1): 152-158, 2015. 26055850
House J, Santen SA, Carney M, Nypaver M, Fischer JP, Hopson LR.: Implementation of an Education Value Unit (EVU) System to Recognize Faculty Contributions Western Journal of Emergency Medicine16(6): 952-6, 2015. 26594298
Perry M, Hopson L, House JB, Fischer JP, Dooley-Hash S, Hauff S, Wolff MS, Sozener C, Nypaver M, Moll J, Losman ED, Carney M, Santen SA.: Model for Developing Educational Research Productivity Western Journal of Emergency Medicine 16(6): 457-451, 2015. 26594297
Hsu D, Nypaver M, Fein DM, McAneney C, Santen S, Nagler J, Zuckerbraun N, Roskind C, Reynolds S,Zaveri P, Stankovic C, House J, Langhan M, Titus MO, Dahl-Grove D, Klasner A, Ramirez J, Chang TP, Jacobs E, Chapman J, Lumba-Brown A, Thompson T, Mittiga M, Eldridge C, Heffner V, Herman B, Kennedy C, Madhok M, and Kou M on behalf of the PEM Fellowship Directors' Writing Group: Essentialsof PEM Fellowship Part 2: The Profession in EPAs Pediatric Emergency Care Journal accepted Feb 2016
The Pediatric Emergency Medicine Milestone Project
A Joint Initiative of The Accreditation Council for Graduate Medical Education,
The American Board of Pediatrics, and,
The American Board of Emergency Medicine
July 2015Emergency Medicine Advisory Group Wallace Carter, MD Deborah Hsu, MD, MEd Maybelle Kou, MD Michele Nypaver, MD Earl Reisdorff, MD
Thou Shalt:Learn & Teach Quality Improvement to residents & fellows
Thou Shalt:Participate in QI for Maintenance of Certification for your board.
ACGME
ABP
ABEM
2010Pediatric EmergencyMedicine LeadershipConferenceEnhancing Leadership to Improve Qualityof Care in Emergency Settings for ChildrenSponsored by the American Academy of Pediatricsand the AAP Section on Emergency Medicine
Benner C, Nypaver, M, Mora E, Mueller E, Seagull FJ, Walkovich K, Johnson K, Halverson S, Rothman E, Hucks G, Younger JG.: Making improvements in the ED: Does ED busyness affect time to antibiotics in febrile pediatric oncology patients presenting to the emergency department? Pediatric Emergency CareJournal (accepted for publication 11/2015).
Improving clinical processes (and publishing)
Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients.
Michele M. Nypaver MD1 , Sandra Spencer MD2, Katherine Hebert MD3, Christopher Benner MD4,5, Rachel Stanley MD, MHSA1,2, Daniel M. Cohen MD2, Alexander Rogers MD1, Jason Goldstick PhD, MA1, & Prashant Mahajan MD, MPH, MBA3
Center 1 Center 2 Center 3Education Interventions 1. Patient/Family information for ED experience during fever with neutropenia (FN) episodes
X X X
2. Staff/faculty on consensus guidelines for FN care (Time to Antibiotic goal < 60 minutes and Antibiotic type)
X X X
3. Staff/faculty initial education & update on project progress X X X
4. Standardized RN central line education/training X X Process Change 5. Topical anesthetic to central line site in triage X X X 6. Rapid rooming for all cancer patients with fever X X X 7. Ill appearing or severe triage category placed in resuscitation room X X X
8. Central line equipment more accessible X X X 9. Antibiotic delivery prior to absolute neutrophil count (ANC) result X X X
10. Rapid ANC testing X** 11. Electronic order entry modifications/order set development X X
12. Pharmacy assistance for antibiotic readiness/availability X X13. MD notified upon patient arrival X X 14.Direct phone communication (Oncology MD to Emergency MD) of incoming patient prior to arrival (when possible)
X
15. All febrile cancer pts triage level 1(highest acuity) X
TEAM Composition
Emergency Physicians X X X
Emergency Nurses X X X
Pharmacy Representative X X X
Oncology Physicians X X X
Computer Order Entry Representative X X
Infectious Disease Physician X X
Quality Improvement Representative X X
Table 2: Quality Improvement Project Interventions & Team Composition** Bold type = Interventions adopted at all sites**Rapid ANC testing at Site 2 was abandoned during the project period
ED Improvement is for kids too!Keith Kocher, MD Director
Michele Nypaver, MD Co Director Pediatrics
Joining general & pediatric ED provider data to improve pediatric emergency practice
Pediatric Initiatives:CT use in minor traumatic brain injury (adult & children)
CXR utilization in asthma, croup and bronchiolitisMEDIC-Program for alternatives to hospitalization (adult & children)