Implementation of Full Patient Simulation Training in Surgical Residency Gladys L. Fernandez, MD...
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Transcript of Implementation of Full Patient Simulation Training in Surgical Residency Gladys L. Fernandez, MD...
Implementation of Implementation of Full Patient Simulation Full Patient Simulation Training Training in Surgical Residencyin Surgical Residency
Gladys L. Fernandez, MDGladys L. Fernandez, MDBaystate Medical CenterBaystate Medical Center
Tufts University School of Medicine Tufts University School of Medicine
Baystate Simulation Center, ACS-accredited Level I Education Baystate Simulation Center, ACS-accredited Level I Education InstituteInstitute
2010 APDS Annual Meeting, San Antonio, Texas2010 APDS Annual Meeting, San Antonio, Texas
DisclosureDisclosure
Consultant for Medical Education Technologies, Consultant for Medical Education Technologies, Inc.Inc.
ObjectivesObjectives
Review course of Patient Simulation Review course of Patient Simulation implementation in our surgical implementation in our surgical residency residency
Discuss aims and methods of Patient Discuss aims and methods of Patient Simulation integration into Simulation integration into curriculumcurriculum
Describe our program experiencesDescribe our program experiences Explore future implementation plansExplore future implementation plans
Surgical Patient Surgical Patient SimulationSimulation
Clinical management performed in a high Clinical management performed in a high fidelity simulation environment using a fidelity simulation environment using a manikin simulatormanikin simulator
Specifically modeled experientialSpecifically modeled experiential
learninglearning KnowledgeKnowledge SkillsSkills BehaviorsBehaviors
Evolution of Surgical Patient Evolution of Surgical Patient Simulation at BMCSimulation at BMC
Phase III
2005 2007 2008 20092006
Team Training
1st PS use
ACS EI accreditation
1st Boot Camp
Center expansion
Curriculum integration
Curriculum development
QA/HCQ initiatives
Trauma Orientation
Curriculum DesignCurriculum Design
Needs assessment basedNeeds assessment based Critical management problemsCritical management problems
– Objectives-based Objectives-based – Patient management skillsPatient management skills– Clinical decision-makingClinical decision-making– Learner-specific needsLearner-specific needs– Assessment around core competenciesAssessment around core competencies
Curriculum ContentCurriculum Content
Introduction / orientationIntroduction / orientation Modeling Best PracticeModeling Best Practice Global initiativesGlobal initiatives Institutional M & M Institutional M & M Institutional QA / HCQ Institutional QA / HCQ RemediationRemediation
PreparationPreparation
Teaching Team PreparationTeaching Team Preparation– FacilitatorFacilitator– Embedded educatorEmbedded educator
Scene preparationScene preparation RehearsalRehearsal
– ““Flow”Flow”– Educational cuesEducational cues
Simulated Clinical Simulated Clinical ExperiencesExperiences
One hour sessionsOne hour sessions– Shock statesShock states– TraumaTrauma– Critical CareCritical Care– Preoperative processesPreoperative processes– Postoperative complicationsPostoperative complications
Multi-item assessmentMulti-item assessment
DebriefingDebriefing
StructuredStructured Objectives-basedObjectives-based AssessmentAssessment Learner-drivenLearner-driven Self-reflectiveSelf-reflective PositivesPositives ChallengesChallenges Video playbackVideo playback Take-home messagesTake-home messages Teaching Team DebriefTeaching Team Debrief
ResultsResults
July 2006—June 2009July 2006—June 2009 4.5 ± 1.4 sessions per academic 4.5 ± 1.4 sessions per academic
yearyear 39 PGY 1, 2, 3 residents39 PGY 1, 2, 3 residents
– 10 followed PGY 1 10 followed PGY 1 2 2– 4 followed PGY 1 4 followed PGY 1 2 2 3 3
ResultsResults
88
90
99
70
75
80
85
90
95
100
AY '06-'07 AY '07-'08 AY '08-'09
% A
tte
nd
an
ce
PS Compliance over Successive Years
ResultsResults
60
65
70
75
80
85
90
95
100
A B C D E F G H I J
Scor
e (%)
Resident
PS Performance Over 2 Years [n = 10]
PGY-1
PGY-2
60
65
70
75
80
85
90
95
100
A B C D
Scor
e (%)
Resident
PS Performance Over 3 Years [n=4]
PGY-1
PGY-2
PGY-3
81 ± 5 vs 86 ± 4
(p<0.01)
82 ± 4 vs 86 ± 2 vs 91 ± 1
(p<0.005)
ResultsResults
39 39 residentsresidents
88 > 2 SD
below mean
5 5 = clinical
ConclusionsConclusions
Patient simulation training was Patient simulation training was successfully implemented in our surgical successfully implemented in our surgical residency.residency.
Assessment instrument can detect Assessment instrument can detect predictable improvements across yearspredictable improvements across years
Challenges:Challenges:– Competition with other educational activitiesCompetition with other educational activities– Fidelity and realismFidelity and realism
Further work required to determine Further work required to determine effects on resident clinical competencyeffects on resident clinical competency
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