Bauman & White HPSN 2011

Simula'on-‐Based Resuscita'on: Team Leadership

Eric B. Bauman, PhD RN, Paramedic

Ka'e White, MD Copyright 2011 E. B. Bauman & K. White

All Rights Reserved

Ka'e White is a Staff Physician at Wm. S. Middleton Veterans' Memorial Hospital and a Clinical Instructor at the University of Wisconsin School of

Medicine and Public Health. Dr. White is also a Hospitalist at the Stoughton Hospital and hold the 'tle of associate with Clinical

Playground, LLC.

Disclosures & Affilia'ons

Disclosures & Affilia'ons

Eric B. Bauman is the founding and managing member of Clinical Playground, LLC. Dr. Bauman is a special event staff nurse for the University of Wisconsin Department of Athle'cs’ and a Paramedic/

Firefighter for the Town of Madison Fire Department and a Paramedic for the City of Middleton Department of EMS.

IRB Approval This study was granted an Exemp&on by the Health Sciences Internal Review Board at the

University of Wisconsin -‐ Madison

Needs Assessment

•  Leadership and Crisis Management Skills in VA Hospital related Cardiac Resuscita'on –  The PGY2 Medicine Residents from the University of Wisconsin School of Medicine & Public Health are responsible for leading a mul'-‐professional code-‐blue team

–  Residents have varied experience with cardiac resuscita'on

•  All have current ACLS Training •  Few if any have any Team Leadership experience or training

Iden'fying Cogni've and Behavioral Deficit

•  Anecdotally: Based on Ka'e’s experience as Chief Resident and when mentoring junior residents

•  Empirically: Based on the literature and our pretest ques'onnaire

Bauman, 2007

Medical Educa'on Literature In a study of Internal Medicine Residents (Hayes, et al, 2007)

•  49.3% felt inadequately trained to lead a cardiac arrest •  50.3% felt that standard ACLS training did not provide

necessary team leadership skills related to resuscita'on •  40% indicated they received no addi'onal training related to

resuscita'on beyond a standard ACLS course •  52.15% felt prepared to lead a cardiac resuscita'on -‐ 55.3%

worried they made errors •  Residents felt unsupervised -‐ No backup •  Post event debriefing/feedback was lacking

This was very consistent of the PGY2 Medicine Class working as Medical Officers of the Day

Hypothesis

Simula'on can be effec've for increasing resident comfort with ACLS algorithms and resuscita'on

leadership roles, while decreasing anxiety related to cardiac resuscita'on management.

Workshop Objec'ves •  Residents will demonstrate the ability to apply knowledge of ACLS

protocols in a high fidelity simulated case-‐based sehng with emphasis on the first 10 minutes of the event including diagnosis of the rhythm and underlying process, primary survey, and ini'al algorithm selec'on

•  Residents will demonstrate team leadership and team member skills and be able to describe the importance of delega'on of tasks, func'onal team dynamics, and role ownership

•  Residents will express improved confidence with code team leadership and decreased anxiety about managing code situa'ons

•  Residents will become aware of the strengths and weaknesses of simula'on as a learning tool.

Study Objec'ves

•  Increase comfort level related to using ACLS Algorithms

•  Use Simula'on-‐Based Educa'onal Interven'on to decrease anxiety associated with MOD Role

•  Increase perceived comfort level with code leadership

•  Increase par'cipant comfort level associated with simula'on-‐based learning environment

The theore'cal Framework Based Fink’s Taxonomy : Theore'cal Framework that was already in place to guide educa'onal interven'ons and

resident curricula in the Department of Medicine

Fink, D. L. ,2003

Learning How to Learn: • Becoming a beier Student

•  Inquiring about a subject •  Self-‐direc'ng learners

Founda'onal Knowledge: Understanding and remembering •  Informa'on •  Ideas

Applica'on •  Skills •  Thinking: Cri'cal, Crea've, & Prac'cal Thinking

•  Managing projects

Integra'on: Connec'ng •  Ideas • People • Realms of life

Caring: Developing new •  Feelings • Interests • Values

Fink’s Taxonomy

Human Dimension: Learning about •  Oneself •  Others

Our Pretest/ Pre-‐Interven'on Data n=24 1-‐5 Likert Scale

Mean Value is Reported

•  Comfort with ACLS Algorithms 2.8

•  Comfort with Leadership with Acute Ward Situa'on 2.68

•  Level of Anxiety in MOD Role 4.08 (High Anxiety Level)

•  Comfort with Simula'on as a Learning Tool 3.52

www.pamelaheath.com/Cartoons4.htm

Curriculum Development

•  Establish Objec'ves •  This goes beyond a desire to use the simulator

•  Iden'fy and target our learners •  Those rounding out their PGY1 Year

•  Storyboard Scenarios that meet interven'on objec'ves (Backfill and Narra've)

•  This is the way it would look in the VA •  Write/Repurpose and test scenarios

Timeline

Nov 2009 Project Incep'on Target Learners

Iden'fy Objec'ves

July 2009 Ka'e comes for tour of the Simlab

Dec. 29, 2009 Ka'e and Baby (Maggie) comes to Simlab

Storyboard Narra'ves & Backfill

Feb. 2010 Tested Scenarios

March 5, 2010 First of 4 Workshops

January, 2010 Planning con'nues

Outlined workshop Agenda

May 14, 2010 2nd of 4 Workshops

June 7th, 2010 3nd of 4 Workshops

June 14, 2010 4nd of 4 Workshops

Dec 1, 2009 Ka'e has Baby

Clovis Nov. 2009

Clovis June 2010

The Agenda •  7 Residents per workshop •  3 Facilitators per workshop

–  Educator, Aiending, Chief Resident •  2.5 Hours

–  Icebreaker Games focusing on team dynamics and leadership

–  Review of concepts of Crisis Resource Management (Gaba et al, 2001)

–  Scenarios with Debriefing (2 per Session) –  Wrap Up (Surveys and Feedback)

Environment

•  Icebreaker Games focusing on team dynamics and leadership Classroom

•  Review of concepts of Crisis Resource Management Wrap Up Classroom

•  Scenarios with Debriefing (2 per Session) Simula'on Laboratory

•  Wrap Up (Surveys and Feedback) Classroom


The Scenarios •  Based previous research focusing on resuscita'on and crisis management (Bauman, 2007) –  Two Scenarios: Pulseless VT and ACS

• Well known algorithms but s'll had cri'cal thinking components

– Learners “entered” authen'c designed experience scenarios without defined roles (Squire, 2006 )

Video Review of Sessions

•  Chief Resident, Department of Medicine Educators, Aiending Staff Physician

•  Provided Wriien feedback to all par'cipants

•  Opportunity for one-‐on-‐one mee'ng with Chief Resident and/or Aiending

What were they looking for?

•  Each evaluator was assigned to one or two residents to watch through each videotaped session

•  Evaluators observa'ons’ were compared and reconciled so that consistent feedback could be provided to each par'cipant

•  All par'cipants were provided with wriien feedback whether or not they self selected into a leadership or followership role.

Examples

•  Level of Par'cipa'on •  Communica'on Style: Closed Loop technique, asser'veness, appropriateness

•  Leadership orienta'on/posi'on in the room

•  Ability of leader to effec'vely delegate •  Decision Making ability Squire, Giovaneio, DeVane, & Durga, 2005

Gaba et al, 2001

Our Post-‐test/Post-‐Interven'on Data n=24 1-‐5 Likert Scale Mean Value is Reported

•  Comfort with ACLS Algorithms 3.38 •  Comfort with Leadership with Acute Ward Situa'on 3.44

•  Level of Anxiety in MOD Role 3.7 (Decrease in anxiety)

•  Comfort with Simula'on as a Learning Tool 4.26

*All results were sta's'cally significant

Comfort with ACLS Protocol

Comfort with code team leadership

Anxiety about code team leadership

Comfort with simula'on as a learning tool

Change in Survey Score 0.58 0.76 -‐0.38 0.88

-‐0.6

-‐0.4

-‐0.2

0

0.2

0.4

0.6

0.8

1

Chan

ge in Residen

t Survey Ra

;ngs

Resident Comfort Level Survey Results

Denotes a statistically significant change from pre- to post-workshop.

Limita'ons

•  Time Constraints –  Release from clinical responsibili'es –  Lab Scheduling – No everyone was able to play the role of leader

•  Primary feedback comment from par'cipants

•  Resident buy-‐in of the created environment –  Suspension of Disbelief – More orienta'on 'me – More Integra'on of Simula'on into Resident Training


Final Thoughts

•  Importance of theore'cal framework when designing curricula and research projects

•  Importance of objec've-‐based curriculum design

•  Knowing our learners program expecta'ons

•  Effec'vely targe'ng your audience

R. Kyle

References Bauman, E. (2007). High fidelity simula'on in healthcare. Ph.D. disserta'on, The

University of Wisconsin-‐Madison, United States. Disserta'ons & Thesis @ CIC Ins'tu'ons database. (Publica'on no. AAT 3294196)

Fink, D. L. (2003) Crea%ng Significant Learning Experiences. San Francisco Jossy-‐Bass Gaba, D. M., Howard, S. K., Fish, K., Smith, B., & Sowb, Y. (2001). Simula'on-‐based

training in anesthesia crisis resource management (ACRM): A decade of experience. Simula%on & Gaming, 32(2), 175-‐193.

Hayes, H.W., Rhee, A., Detsky, E., LeBlanc, V.R., and Wax, R.S. (2007). Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: A survey of internal medicine residents. Cri%cal Care Medicine 35(7), 1668-‐1672.

Squire, K. (2006). From content to context: Videogames as designed experience. Educa'onal Researcher. 35(8), 19-‐29.

Squire, K., Giovaneio, L., DeVane, B,. & Durga, S. (2005). From users to designers: Building a self-‐organizing game-‐based learning environment. Technology Trends, 49(5), 34-‐42.

Bauman & White HPSN 2011

Education

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