simulation for perfusion procedures tool for education and training of professional behaviours in...
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Simulation for Perfusion Procedures Tool for Education and Training of Professional Behaviours in Teams
Frank Merkle1, Ines Langemeyer2
1 Academy for Perfusion, Deutsches Herzzentrum Berlin, Germany
2 Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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Carpenter JTCVS 2008
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Human Factors in the CV Surgery OR
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Bruppacher Anesthesiology 2010
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Bruppacher Anesthesiology 2010
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Bruppacher Anesthesiology 2010
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Schmidt Ann Intern Med 2013
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Schmidt Ann Intern Med 2013
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Simulation in Medical Education
►Basic skills acquisition
►Clinical skills acquisition
►Examiniation and Certification
►Re-Certification
►Team-Training (Crisis Ressource Management)
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Berlin Simulation Operation Room
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Berlin Simulation Operation Room
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Anesthesia
Anesthesia-Machine
• Oxygen
• Compressed air
Cardiovascular Monitoring
• ECG
• Blood pressures invasive
• Pulse oximetry
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Beating Heart Trainer
Airway Management Trainer
• Intubation (oral, nasal)
• Ventilation
Connects to Anesthesia Machine
Beating Heart Trainer
• ECG-triggered beating heart
• CPB cannulae inserted
Connects to Orpheus Simulator
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Beating Heart Trainer
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Orpheus Simulator
Hydraulic circulatory model
with ECG Generator
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Students‘ Introduction to Cardiac Surgery
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First Interdisciplinary Workshop 2009
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Designing a ScenarioDefining the Goal
Acquisition of new skills
Practice established skills
Testing for competency
Teamwork development
Stillsmoking 2008
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Designing a Scenario
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Designing a ScenarioLearning Objectives
Non-technical skills necessary for safe and effective performance in the operating room
►Cognitive or mental– Decision making
– Planning
– Situation awareness
►Social or interpersonal– Teamwork
– Communication
– Leadership
Matveesvskii 2008
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Designing a ScenarioCompetence Levels
Novice
Advanced Beginner
Competent
Proficient
Expert
Benner 1984
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Designing a ScenarioLearning Objectives
Sinz 2008
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Development of Professional Behaviour
Concept 1: Work Process Knowledge
►Problem solving
►Supervising
►Regulating the work system
►Coping with critical situations on a decentralised level
►Proactive search for process quality
Fisher et al 2004
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Development of Professional Behaviour
Concept 2: Scientification of Work
►Prevalence of science-generated knowledge in everyday life
►Psychic quality of scientific thinking
►Reorganisation of intellectual behaviour through scientifc
concepts
►Increased complexity of work process
Langemeyer 2012
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Scientification of WorkTraditional concept:
►Incorporation of scientific knowledge into work knowledge / application of
knowledge to practice
►Replacement of practical/experience-based knowledge through scientific
knowledge
New concept:
►Intellectualized mode of monitoring objects and processes at work
►Transformation of spontaneous ways of thinking and behaviour to a different
form of mental activity „presence“ or „attentiveness“ at work
►Learning as an integral element of work
(Langemeyer, I.: Socio-technological changes of learning conditions, Encyclopedia of the Sciences of Learning,
2012)
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Experimental Setting
►20 perfusion students (variable professional experience)
►4 groups with 5 participants each
►Each participant was assigned a role (i.e surgeon, surgeon
assistant, anesthesiologist, perfusionist, nurse)
►Each group performed standard scenario (cannulation and
starting of CPB, cardioplegia delivery)
Development of Professional Behaviour
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►Video and audio recording of simulation session
►Video and audio recording of Feedback/Debriefing and group
discussions
►Analysis of video and audio recordings (scenario and
feedback sessions)
Development of Professional Behaviour
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Simulation
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Assistant surgeon (m): “What is the ACT?”
Perfusionist (m): “Where is this measured? 100 – could be?”
– Silence –
Anaesthetist (m): “Everything’s alright here. [Pause] Let’s continue.”
– No reaction of the perfusionist, no reaction of the team. –
Assistant surgeon [to the surgeon]: “Did you have a nice week-
end?”
Surgeon (m): “Yeah, not bad. A bit of biking [laughing].”
Assistant surgeon: “What’s the matter with the sucker?”
[Via loudspeakers, the trainer assigns the perfusionist how to
handle the touch screen module.]
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Surgeon (m): “What’s the new ACT?”
– Perfusionist (m) is concentrating on the screen, touching on it
without corresponding to the surgeon. –
Surgeon: “O.-k. …”
Assistant surgeon: “We have an easy-going perfusionist, haven’t
we?”
– Laughter –
Anaesthetist (m): “An old machinist, isn’t he?”
– Laughter –
(Third group)
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Scientificated ways of working :
►Incorporation of work process knowledge is not only an
individual psychological matter
►Distributed and situated cognition
►Capacity of the team to arrange and re-arrange relevant
information
Evaluation of Simulation - Key Findings
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Role Play
►Participants took on roles of surgeons, perfusionists etc.
according to their own experience from the O.R., including ironic
or anecdotal comments
►In case of loss of awareness of work process, participants had
problems with leadership – unexpected situation
►Each team member should be capable to exert leadership with
respect to the problem to be solved
Evaluation of Simulation – Key Findings
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Gender Relations
►Male students (male team) more inclined to compensate for lack
of competence with stereotyped role-play
►Female students (female team) more polite and less dominant
role-play
Evaluation of Simulation – Key Findings
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Conclusion
►Simulation is a useful tool in Perfusion Education
►Simulation may be employed for
►skills training of individual team members
►(interdisciplinary) team training
►development of professional ethos and behaviour
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