Medical Student Simulation Curriculum...implied, between any applicant, student or faculty member...

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S I M U L A T I O N C E N T E R

U T S O U T H W E S T E R N M E D I C A L C E N T E R

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H H H H H

Introduction

The 2017-2018 Medical Student Simulation Curriculum Catalog is your guide to the UT SouthwesternSimulation Center courses and offerings.

This Catalog is for informational purposes only. It is not intended to, nor does it, contain all regulationsthat relate to students. The catalog is revised periodically, but cannot always reflect up-to-the-minutechanges or developments in programs of the University of Texas Southwestern Medical Center and itsthree schools – UT Southwestern Medical School, UT Southwestern Graduate School of BiomedicalSciences, and UT Southwestern School of Health Professions. Contents of the catalog are, therefore,subject to revision without notice. Changes will become effective whenever the proper authority sodetermines and will apply to both prospective students and those already enrolled.

UT Southwestern reserves the right to withdraw courses at any time and change tuition or fees, rules,calendar, curriculum, degree programs, degree requirements, graduation procedures, and any otherrequirement affecting students. The provisions of this catalog do not constitute a contract, express orimplied, between any applicant, student or faculty member and The University of Texas System, UTSouthwestern Medical Center, or the three schools.

UT SOUTHWESTERN SIMULATION CENTERTable of Contents

Introduction

Course Overview …..……………………………………………………………………………………………………………………….Page 1

Pre-Test Evaluation Form ……………………………………………………………………………………………………………….Page 2

Post-Test Evaluation Form ……………………………………………………………………………………………………………..

Basic Life Support …………………………………………………………………………………………………………………………..Page 4

History Taking Skills ………………………………………………………………………………………………………………………..Page 7

Physical Examination Skills …………………………………………………………………………………………………………..Page 10

Entering Notes into the EMR ………………………………………………………………………………………………………. Page 13

Introduction to Female Pelvic Exam ……………………………………………………………………………………………. Page 16

Phlebotomy ………………………………………………………………………………………………………………………………….Page 19

Hematology High Fidelity Simulation …………………………………………………………………………………………….Page22

Peripheral IV …………………………………………………………………………………………………………………………………Page 25

Intramuscular Injections ……………………………………………………………………………………………………………….Page 28

Cardiovascular High Fidelity Simulation…………………………………………………………………………………………Page 31

Pulmonary High Fidelity Simulation ………………………………………………………………………………………………Page 34

Renal High Fidelity Simulation ………………………………………………………………………………………………………Page 37

Foley Placement …………………………………………………………………………………………………………………………..Page 40

Endocrine High Fidelity Simulation ……………………………………………………………………………………………….Page 43

Brain and Behavior High Fidelity Simulation …………………………………………………………………………………Page 46

Lumbar Puncture ………………………………………………………………………………………………………………………….Page 49

Advanced Cardiac Life Support …………………………………………………………………………………………………….Page 52

Introduction to Suturing and Knot Tying ………………………………………………………………………………………Page 55

Sterile Technique & Personal Protective Equipment …………………………………………………………………….Page 58

Basic Suturing and Knot Tying ………………………………………………………………………………………………………Page 62

OBGYN OSCE Pelvic and Breast Exams, Vaginal Deliver, Prescription Writing ……………………………….Page 66

Paracentesis …………………………………………………………………………………………………………………………………Page 72

Introduction to Ultrasound …………………………………………………………………………………………………………..Page 76

Recognizing the Sick Patient …………………………………………………………………………………………………………Page 79

Algorithmic Approach to Hypoxia …………………………………………………………………………………………………Page 82

Overview

Simulation CoursesCourse Title Time Line Course Number Course Director Course Co-director

1. BLS MS1 Orientation 1A.99.17.1.1 Angela Mihalic Jim Wagner

2. Colleges -History Taking Skills Colleges 1A.99.17.2.1 Jim Wagner Gary Reed

3. Colleges -Physical Exam Colleges 1A.99.17.3.1 Jim Wagner Gary Reed

4. Colleges-Entering Notes into EMR Colleges 1A.99.17.4.1 Jim Wagner Gary Reed

5. Introduction to Female Pelvic Exam Colleges 1A.99.17.5.1 MaryJane Pearson Carla Mosley

6. Phlebotomy Colleges/ Parkland 1A.99.17.6.1 Jim Wagner Joe Martinez

7. Hematology High Fidelity Simulation UME sim day 1A.99.17.7.1 Aditee Ambardekar Ravi Bhoja

8. IV Placement Hematology blockUME sim day

1A.99.17.8.1 Jim Wagner CUH Nurse Educator

9. Intramuscular Injections Hematology blockUME sim day

1A.99.17.9.1 Jim Wagner Joe Martinez

10. Cardiovascular High Fidelity Simulation UME sim day 1A.99.17.10.1 Aditee Ambardekar Ravi Bhoja

11. Pulmonary High Fidelity Simulation UME sim day 1A.99.17.11.1 Aditee Ambardekar Ravi Bhoja

12. Renal High Fidelity Simulation UME sim day 1A.99.17.12.1 Aditee Ambardekar Ravi Bhoja

13. Foley Placement Renal block UMEsim day

1A.99.17.13.1 Tolu Bakare Ryan Hutchinson

14. Endocrine High Fidelity Simulation UME sim day 1A.99.17.14.1 Aditee Ambardekar Ravi Bhoja

15. Brain and Behavior High Fidelity Simulation UME sim day 1A.99.17.15.1 Aditee Ambardekar Ravi Bhoja

16. Lumbar Puncture Brain and BehaviorUME sim day

1A.99.17.16.1 Jeff Vandermark Joe Martinez

17. ACLS Transitions 1B.99.17.17.1 Angela Mihalic Daniel Scott

18. Introduction to Suturing & Knot Tying Transitions 1B.99.17.18.1 Robert Rege Daniel Scott

19. Sterile Technique & Personal Protective Equipment Transitions 1B.99.17.19.1 Rohit Sharma MaryJane Pearson

20. Basic Suturing & Knot Tying Surgery Clerkship 1C.99.17.20.1 Rohit Sharma Alan Dackiw

21. OBGYN OSCE: Pelvic and Breast Exams, Vaginal Delivery, Prescription Writing OBGYN Clerkship 1C.99.17.21.1 MaryJane Pearson Tobi Fuller

22. Paracentesis IM Clerkship 1C.99.17.22.1 Neha Patel Anh Nguyen

23. Introduction to Ultrasound Transitions 1A.99.17.23.1 Jodi Jones Joe Martinez

24. Recognizing the Sick Patient EmergencyMedicine Selective

1A.99.17.24.1 Joe Martinez Kavita Joshi

25. Algorithmic Approach to Hypoxia AnesthesiaSelective

1A.99.17.25.1 Aditee Ambardekar Ravi Bhoja

Approved 8/30/17

Simulation - Pre Test EvaluationUniversal Evaluation Form Simulation Center

Name: Course Title: Insert title

Course #: Insert course numberID#:Date:

1. Experience None(1) (2)

Moderate(3) (4)

Extensive(5)

What is your prior experiencewith this skill?

2. ComfortNot

Comfortable(1) (2)

ModeratelyComfortable

(3) (4)

CompletelyComfortable

(5)How would you currently rateyour comfort in performing theskills being taught in this course?(See learning objectives)

3. Additional Comments_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

22

Approved 8/30/17

Simulation - Post EvaluationUniversal Evaluation Form Simulation Center

Name: Course Title: Insert text

Course #: Insert course numberID#:Date:

1. Total amount of time you spent on all parts of this course, including preparation, self-study, hands-on time, etc.

2. ComfortNot

Comfortable(1) (2)

ModeratelyComfortable

(3) (4)

CompletelyComfortable

(5)How would you currentlyrate your comfort inperforming the skills beingtaught in this course? (Seelearning objectives)

3. Quality Poor(1) (2)

Satisfactory(3) (4)

Excellent(5)

Please rate the overallquality of this course.

4. Difficulty Too Easy(1) (2)

Reasonable(3) (4)

Too Hard(5)

Please rate the difficultylevel of this course.

5. Training Resources Stronglydisagree (1)

Disagree(2)

Neutral(3)

Agree(4)

Strongly agree(5)

The resources (materials,videos, lecture, simulators,etc.) were adequate?

6. Facilitators Stronglydisagree (1)

Disagree(2)

Neutral(3)

Agree(4)

Strongly agree(5)

The facilitators (facultyand proctors) wereknowledgeable andhelpful.

7. Additional Comments______________________________________________________________________________________________________________________________________________________________

Time: ______Minutes ______Hours

33

Approved 8/30/17

UT SOUTHWESTERN SIMULATION CENTERAbbreviated Course Description

Course: Basic Life Support

Course Number: 1A.99.17.1.1

Course Version: 1.1

Version Start Date: August 9, 2017

Level: Pre-clerkship (MS1 Orientation)

Number of learners: 240 (all MS)

On Site Time Allocation per Learner: 4 hours

Course Layout: 2 groups of 120 students in 1 day, in TBL space

Location: TBL

Course Director: Angela Mihalic

Course Co-Director: Jim Wagner

Objectives

1. Describe new science and education from the 2015 AHA Guidelines Update for CPR and ECCincluding the AHA Chain of Survival for prehospital and in-faculty providers and the importanceof teams in multi-rescuer resuscitation.

2. Have hands-on instruction regarding high quality CPR for adults, children and infants3. Demonstrate skills for performing high quality CPR for adults, children and infants, effective

ventilations using a barrier device, use of the AED, and removal of foreign-body obstruction(choking) for adults and infants.

Summary:

As part of the MS1 Orientation course, students rotate for 4 hours in the TBL learning space to participatein the BLS course. The course director and other instructors provide information via videos and lecturesbased on the American Heart Association 2015 Guidelines for CPR and ECC. Students participate insimulated clinical scenarios with learning stations. Students work with the instructor to complete BLSskills practice and skills testing. Students also complete a written exam.

Assessment Protocol and Performance Expectation:

Direct observation of single and multi-rescuer CPR, high quality CPR for adults, infants, andchildren, proper use of an AED, and approach to removal of foreign-body.

Grading:

Needs more practice – if proficiency is not achieved on the task

44

Approved 8/30/17

Meets expectations – proficiency is achieved on the task

Successful completion is documented via provision of a BLS card.

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until this level of performance is achieved. Additional practice opportunities areavailable immediately.

Proctors: Provided by EMTS911

Materials required: Provided by EMTS911

55

Approved 8/30/17

Basic Life Support (BLS)

Simulation Scoresheet

Name:

Student ID#

*Scoresheet for BLS provided by American Heart Association.

66

Approved 8/30/17


Course: History Taking Skills


Course Version: 1.1


Level: Pre-clerkship



Course Layout:

Date Session ActivityMid August Individual, recorded interviews with standardized patients08/30/17 3 Skills Clinic I - Patient History & Basic Communication SkillsMid September Individual, recorded interviews with standardized patients10/04/17 8 Skills Clinic III - Advanced Communication SkillsEarly January Individual, recorded interviews with standardized patients01/17/18 20 Skills Clinic V - Challenging InterviewsEarly February Group, recorded interviews with standardized patients02/14/18 24 Skills Clinic VI - Disclosing Medical Error IP10/10/18 47 OSCE Preparation

Location: L3 OSCE rooms

Course Director: Jim Wagner

Course Co-Director: Carla Mosley

Objectives: Defined within the syllabi for each Colleges Course.

Summary: The communication skills curriculum becomes more complex and sophisticated over the fourskills clinics listed above. Beginning with basics (e.g. the “seven attributes of the chief complaint”),students add skills like redirection and following a patient’s lead in SC III, then managing patient’s withcomplicating factors (e.g. the angry patient or non-English speaking patient) in SC V, through learningabout disclosing errors and related team competencies in the team disclosure of an error in SC VI.


Competency in the history taking skills is assessed for each student at the end of Pre-clerkship OSCE.

77

Approved 8/30/17

Grading:

Needs more practice – if proficiency is not achieved on all tasks

Meets expectations – proficiency is achieved on all tasks

Exceeds Expectations – 2 or more exceeds expectations on scoresheet

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until this level of performance is achieved. Additional practice opportunities areavailable as needed on a separately scheduled basis.

Proctors: Standardized patients give immediate feedback, the students’ faculty mentors review thevideos and debrief the group in a meeting on the session dates listed above.

Materials required: Standardized patients, a simulation center with cameras and mics, and a system tomanage the recorded files.

88

Approved 8/30/17

History Taking Skills


Name:

Student ID#:

Task:

Document collected patient history data and its interpretation in a SOAP note

Description:

Students will interview standardized patients and record a note during a series of skills clinics during thePre-clerkship phase of medical school. These encounters will be captured in B-Line or EMS. Theencounters will then be scrutinized by trained standardized patients who use a rubric on the students'SOAP notes.

Errors:

· Not collecting and/or recording all seven attributes in the SOAP note· Not collecting and/or recording the "other" histories in the SOAP note· Not listing appropriate diagnoses· Not appropriately supporting the listed diagnoses with data from the history

Proficiency Score:

By the final Skills Clinic, students should receive a perfect score on the rubric

Proctored Post-test Score

ÿ Needs more practice – if proficiency is not achieved on the task

ÿ Meets expectations – proficiency is achieved on the task

ÿ Exceeds expectations – proficiency is achieved on the task and the student is able todemonstrate unusually superior performance (as determined by the proctor)

Proctor Name:

Date:

99

Approved 8/30/17


Course: Physical Examination Skills


Course Version: 1.1





Course Layout: Timeframe and duration of sessions: All students experience the following “PE Sessions”over a several week period, as below.

Date Session Activity08/23/17 2 General Appearance and Vital Signs & Skin09/27/17 7 HEENT Exam: Eye, Ear, Nose, Mouth, Throat10/25/17 11 Pulmonary Examination11/08/17 13 Cardiovascular Examination11/15/17 14 Abdominal Examination01/03/18 18 Musculoskeletal Examination - Upper & Lower Extremities, Back01/24/18 21 Dermatology Exam and Findings02/28/18 26 Practice Physical Exam I10/17/18 48 Neurological Exam10/10/18 47 OSCE Preparation





Summary: The physical examination is taught in a series of dedicated sessions, listed above, whichfeature standardized patients upon whom the students may practice. Note a “Practice” session isscheduled late in the year for students to put the examination together. The scope of these sessionshave been refined to “milestone 1”, which is clearly defined in the syllabi for each session. Also note thatthere are an additional series of Colleges sessions during which student’s interview and examineassigned, hospitalized patients, which is then critiqued by the students’ mentors.

1010

Approved 8/30/17


Competency in the physical examination skills is assessed for each student at the end of Pre-clerkshipOSCE.

Grading:





Proctors: The students’ faculty mentors demonstrates and then watches each student perform thefeatured examination component in a meeting on the session dates listed above.

Materials required: Standardized patients, physical examination tools, gowns, sheets, examinationtable.

1111

Approved 8/30/17

Physical Examination Skills


Name:

Student ID#:

Task:

Successfully demonstrate "milestone one" for each of the physical examination components

Description:

Students will examine standardized patients in front of their mentors, when they will demonstratemilestone one described in the session syllabus.

Errors:

Not satisfactorily demonstrating milestone one

Proficiency Score:

Given by mentor


ÿ Needs more practice – if proficiency is not achieved on the taskÿ Meets expectations – proficiency is achieved on the taskÿ Exceeds expectations – proficiency is achieved on the task and the student is able demonstrate

unusually superior performance (as determined by the proctor)

Proctor Name:

Date:

1212

Approved 8/30/17


Course: Entering Notes into the EMR


Course Version: 1.1





Course Layout: All students experience the “ACE4 Epic EMR” an EMR environment specifically created forthem, during following “Case Based Learning (CBL)” sessions over a several week period, as below.

Date Session Activity

03/21/18 29 CBL: Cardiovascular04/25/18 33 CBL: Respiratory05/23/18 37 CBL: Renal09/05/18 42 CBL: Gastrointestinal


Course Director: Jim Wagner, MD



Summary: Students are presented fictional patient data in the ACE4 environment, and students arecharged with creating differential diagnoses and management plans in the EMR in advance of theirsession scheduled above with their mentors.


During the session, the faculty mentor critiques the note the students have written as well as the ordersentered on their patients.

Grading:



1313

Approved 8/30/17



Proctors: The students’ faculty mentors demonstrates and then watches each student perform thefeatured examination component in a meeting on the session dates listed above.

Materials required: Standardized patients, physical examination tools, gowns, sheets, examinationtable.

1414

Approved 8/30/17

Entering Notes in the EMR


Name:

Student ID#:

Task:

Successfully pass a proficiency-based course within the Epic ACE4 environment.

Description:

After several practice sessions during the Colleges CBL Sessions, students will take a proficiency-basedcourse they must pass before given full privileges within the campus hospitals' Epic EMR.

Errors:

Not passing the proficiency-based course

Proficiency Score:

Given online, students must continue module until they pass.





Proctor Name:

Date:

1515

Approved 8/30/17


Course: Introduction to Female Pelvic Exam


Course Version: 1.1


Level: Pre-clerkship (MS2, August-September)



Course Layout: Occurs on 5 separate weekend mornings in August-September, with 24 studentscompleting the session on any one day. Each weekend session takes 3-4 hours and each studentparticipates for 2 hours. This course is part of the Colleges.

Location: Professional Office Building 2 OBGYN Clinical Suite on 5th floor

Course Director: Mary Jane Pearson M.D.

Course Co-Director: Tobi Fuller

Objectives:

1. Acquire the communication skills necessary to perform the female genital exam2. Demonstrate the female pelvic exam with a task trainer model3. Perform the female pelvic exam with a trained patient educator

Summary:

Students are expected to watch training videos prior to their scheduled session.

At the session, the students practice the pelvic exam with task trainers. They are supervised by MS4sand Dr. Pearson.

After demonstrating competence with the task trainers, the students perform the pelvic examindividually with the trained pelvic exam educator. In each exam room, there are three students, oneMS4 proctor and the trained pelvic exam educator. The students receive feedback from the MS4proctor and the patient educator at the conclusion of the exams.


Direct observation of the task trainer exam

Direct observation by MS4 supervisor

1616

Approved 8/30/17

Direct feedback given to student by patient educator

Grading:





Proctors:

4 trained patient educators (reimbursed by UTSW and Dept. of OBGYN)

4-6 MS4s

Faculty-Dr. Pearson

Materials required:

Specula/gloves/lubricant

Task trainers

1717

Approved 8/30/17

Introduction to Female Pelvic Exam


Name:

Student ID#:


1. Did the student demonstrate knowledge of the pelvic exam during the task trainer practice?

ÿ Exceeds expectationsÿ Meets expectationsÿ Does not meet expectations

2. Was the student able to perform the female pelvic exam in a compassionate manner?


3. Was the student attentive to feedback from the patient educator?


Proctor Name:

Date:

1818

Approved 8/30/17


Course: Phlebotomy


Course Version: 1.1



Number of learners: 240 medical students (full class)

On Site Time Allocation per Learner: All students experience a week-long phlebotomy course.

Course Layout: Each week, approximately 18 students take this course, so it takes about a year to processall the students.

Location: Within Parkland Hospital and Health System’s phlebotomy department.


Course Co-Director: Joe Martinez

Objectives

1. Become proficient in antiseptic technique2. Become proficient in venipuncture3. Become proficient in phlebotomy

Summary: Students are randomly scheduled for these clinics throughout the year in weekly rotations.Each shift is scheduled for approximately (3) hours. Students begin the week with a didactic session andone-on-one observation of their technique; the remainder of the week consists of drawing blood onpatients, gradually progressing to a point where they need minimal supervision. By the end of the week,students would have trained in a variety of phlebotomy techniques and must have successfullycompleted 80% of at least 16 attempts.


Direct phlebotomist observation, the student is expected to achieve proficiency according to timeand error metrics for the following tasks:

1. Tourniquet use2. Antiseptic technique3. Venipuncture4. Phlebotomy5. Sharps safety

1919

Approved 8/30/17

Grading:



Exceeds expectations – was able to complete significant additional blood draws

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until performance is achieved. Additional performance opportunities are availableduring weeks or on an as needed separately scheduled basis.

Proctors: Parkland Phlebotomy Team

Materials required: Phlebotomy kits with tourniquets, alcohol swipes, gauze, needles, vacuum vacutainerand blood collection tubes will be provided by Parkland Memorial Hospital.

2020

Approved 8/30/17

Phlebotomy Course


Name:

Student ID#:

Task:

Drawing blood from patients

Description:

All students experience a week-long phlebotomy course, which is provided under contract with ParklandHospital and Health System’s phlebotomy department. Each week, approximately 18 students take thiscourse, so it takes about a year to process all the students.

Errors:

· Not following proper technique· Not successfully collecting blood· Causing the patient too much discomfort· Not being comfortable with this skill

Proficiency Score:

Task completion with appropriate success rate


ÿ Needs more practice – if proficiency is not achieved on the taskÿ Meets expectations – proficiency is achieved on the taskÿ Exceeds expectations – proficiency is achieved on the task and the student is able to

demonstrate unusually superior performance (as determined by the proctor)

Proctor Name:

Date:

2121

Approved 8/30/17


Course: Hematology High Fidelity Simulation


Course Version: 2.0


Level: Pre-clerkship (Integrated Medicine)



Course Layout: 6-8 students x 4 simulators for 1.25 hours x 7 groups

Location: E6 Simulation Lab

Course Director: Aditee Ambardekar

Course Co-Director: Ravi Bhoja

Objectives

1. List and differentiate the physiologic signs of chronic and acute anemia.2. Place basic monitors on a patient in a clinical setting including electrocardiogram leads, pulse

oximeter, and blood pressure cuff.3. Explain the arterial oxygen content and oxygen delivery formulas in a clinical context.4. Enumerate the resources and steps necessary for the safe administration of fluids and blood products.5. List behaviors that enhance team function.

Summary:

The Integrated Medicine curriculum takes an organ-system approach to anatomy, histology, pathology,physiology, pathophysiology, and management. As part of this curriculum, there are 2-hour high-fidelitysimulation sessions whose overarching goals include 1) to demonstrate the clinical relevance of didacticmaterial the students are learning, 2) to develop a small-group, experiential activity in which the studentsdemonstrate knowledge and skill acquisition as it relates to the organ system, and 3) to instill and engagethe students in team-based practices that are crucial to the safe care of patients when on the wards.Students manage acute and sub-acute clinical situations in small groups of 6-8 students all the whileutilizing their acquired knowledge in the organ system, clinical care, and team-based practice.


Observation, debriefing, and feedback by experienced simulation educators to achieve the above learningobjectives. Ensuring student engagement, professional interaction and communication with patient andpeers, and task-based skill of placing basic monitors

2222

Approved 8/30/17

Grading:





Proctors: 4-5 simulation educators and 4 simulation staff for manikin management.

Materials required: Manikins x 4, 10 task trainers and monitor modules for learning how to place basicmonitors, cooler with simulated blood, suction, basic monitors, IV access with fluid hanging, simulatedpatient chart with history and lab values.

2323

Approved 8/30/17

Hematology High Fidelity


Name:

Student ID#:

Task Needs MorePractice

MeetsExpectations

ExceedsExpectations

Professionalism:Did the student engage professionallywith patient, peers, and educationstaff?

Engagement:Was the student involved in the care ofthe patient and the debrief?

Places Basic Monitors:

Proctor Name:

Date:

2424

Approved 8/30/17


Course: Peripheral IV Placement


Course Version: 1.1


Level: Pre-Clerkship, Hematology Block Simulation Day

Number of learners: 240 (all MS); cohorts of 15 to 20 students


Course Layout: Student groups will attend a half-day session on peripheral IV (PIV) placement. Sessionincludes pre-course material, which will include an online module prior to the beginning of this simulation,followed by practice then testing of PIV placement on trainers.

Location: TBL (12 stations)

Course Director: James Wagner

Course Co-Director: Joseph Martinez

Objectives

1. Become proficient in antiseptic technique2. Demonstrate the placement of a PIV on a task trainer that satisfies a standardized checklist

Summary:

Students are expected to watch an online training video prior to the PIV placement session, as pre-coursestudy materials. During the session, students will perform PIV placement observed and scored by aproctor. The tasks include proper tourniquet use, antiseptic technique, handling of angiocatheter,venipuncture technique, venous catheter insertion, securing of catheter, and sharps safety. Students areexpected to satisfy a standardized checklist.


Direct proctor observation, the student is expected to achieve proficiency according to time anderror metrics for the following tasks:

1. Tourniquet use2. Antiseptic technique3. Venipuncture4. PIV catheter insertion5. Securing of PIV catheter6. Sharps safety

2525

Approved 8/30/17

Grading:


Meets expectations – proficiency is achieved on the tasks

Exceeds expectations – was able to insert PIV proficiently and fast (50% of expected time)

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until performance is achieved. Additional performance opportunities are available oron an as needed separately scheduled basis.

Proctors: CUH Nurse Educators (8 nurses) and simulation personnel (4 education coordinators).

Materials required: 24 PIV insertion arm task trainers (2 per station), PIV insertion kits (includestourniquet, alcohol swipes, gauze, tegaderm) and angiocatheters.

2626

Approved 8/30/17

Peripheral IV Catheter Insertion; Pre-clerkship


Name:

Student ID#:

Task:

PIV Insertion

Description:

Utilizing a PIV insertion kit (tourniquet, alcohol swipes, gauze, tegaderm) an angiocatheter, and a tasktrainer students will place a tourniquet, select an appropriate vein, prepare site with proper antiseptictechnique, demonstrate proper venipuncture technique, successfully insert a PIV (3 insertions total),and secure catheter.

Errors:

· Improper use of tourniquet (improper site, placed too tight, placed not tight enough, not removed after blood draw· Improper antiseptic technique· Holding angiocatheter incorrectly· Recurrent venipuncture mistake (unable to access vein)· Recurrent catheter advancement mistake· Improper securing of angiocatheter

· Improper "Sharps Safety" (touch needle with hand, used needles not secured in sharps container after procedure)

Proficiency Score:

Task completion with no protocol violations




Proctor Name:

Date:

2727

Approved 8/30/17


Course: Intramuscular Injection


Course Version: 1.1


Level: Pre-Clerkship, Hematology Block Simulation Day



Course Layout: During Pre-Clerkship period, student groups will attend a one-hour session onintramuscular (IM) injection. Session will include a lecture at the beginning of the course, followed bypractice then testing IM trainer on injection task trainers.

Location: TBL

Course Director: Joseph Martinez

Course Co-Director: James Wagner

Objectives

1. Become proficient in antiseptic technique2. Become proficient in intramuscular injection

Summary:

During this session, students will attend an IM injection lecture, and then perform 3 repetitionsobserved and scored by a proctor. The tasks include selection of appropriate injection site (largemuscle), antiseptic technique, handling of syringe and needle, intramuscular injection technique(including safety check for inadvertent insertion of needle into vascular structure), and sharps safety.Students are expected to achieve 3 successful IM injections on a task trainer.


Direct proctor observation, the student is expected to achieve proficiency according to time anderror metrics for the following tasks:

1. Appropriate injection site selection2. Antiseptic technique3. Intramuscular injection technique4. Safety check for inadvertent insertion of needle into vascular structure before injection5. Sharps safety

2828

Approved 8/30/17

Grading:


Meets expectations – proficiency is achieved on the tasks

Exceeds expectations – was able to perform IM injection proficiently and fast (50% of expectedtime)

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until performance is achieved. Additional performance opportunities are available oron an as needed separately scheduled basis.

Proctors: CUH Nurse Educators (8 nurses) and simulation personnel (4 education coordinators).

Materials required: 20 IM injection task trainers, alcohol swipes, needles, 10 cc syringes, and gauze.

2929

Approved 8/30/17

IM Injection; Pre-clerkship


Name:

Student ID#:

Task:

Intramuscular Injection

Description:

Utilizing alcohol swipes, needle, syringe, gauze, and a task trainer students will select an appropriate sitefor the IM injection, prepare site with proper antiseptic technique, demonstrate proper IM injectiontechnique (including safety check for inadvertent placement of needle into vascular structure, andsuccessfully injection of "medication."

Errors:

· Improper site selected for IM injection· Improper antiseptic technique· Holding syringe and needle incorrectly· Not performing safety check to assess for inadvertent placement of needle into vascular

structure before the injection· Recurrent IM injection mistake· Improper "Sharps Safety" (touch needle with hand, used needles not secured in sharps

container after procedure)

Proficiency Score:





Proctor Name:

Date:

3030

Approved 8/30/17


Course: Cardiovascular High Fidelity Simulation


Course Version: 2.0









Objectives

1. Define shock state and list the four types of shock.2. Distinguish pathophysiologic characteristics and pharmacologic strategies of shock states.3. Describe monitoring strategies and parameters that are helpful in shock state.4. List the equipment and steps necessary for insertion of a peripheral IV.5. Name and define at least 3 strategies for effective team dynamics.

Summary:



Observation, debriefing, and feedback by experienced simulation educators to achieve the above learningobjectives. Ensuring student engagement, professional interaction and communication with patient andpeers, and basic knowledge.

3131

Approved 8/30/17

Grading:






Materials required: Manikins x 4, basic monitors, IV access with fluid hanging, simulated patient chartwith history and lab values, bags labelled with various vasopressors/ionotropes, supporting images, IVstart kits, task trainers for PIV insertion x 10.

3232

Approved 8/30/17

Cardiovascular High Fidelity


Name:

Student ID#:


MeetsExpectations

ExceedsExpectations



Patient Care:Identification of instability and criticalillness:

Proctor Name:

Date:

3333

Approved 8/30/17


Course: Pulmonary High Fidelity Simulation


Course Version: 2.0









Objectives

1. Generate a differential diagnosis for hypoxemia that includes at least three diagnoses.2. Link the pathophysiology and clinical symptomatology of the various causes of hypoxemia.3. Describe the clinical symptomatology of obstructive disease and list three treatment options.4. List the equipment needed for basic bag/mask ventilation.5. Demonstrate bag/mask ventilation with basic equipment.6. Name and define at least 3 strategies for effective team dynamics.

Summary:


3434

Approved 8/30/17


Observation, debriefing, and feedback by experienced simulation educators to achieve the above learningobjectives. Ensuring student engagement, professional interaction and communication with patient andpeers, and task-based skill of basic bag/mask ventilation.

Grading:






Materials required: Manikins x 4, basic monitors, IV access with fluid hanging, simulated patient chartwith history and lab values, bags labelled with various vasopressors/ionotropes, supporting images,airway manikins for task training x 10, bag/mask and basic airway equipment.

3535

Approved 8/30/17

Pulmonary High Fidelity


Name:

Student ID#:


MeetsExpectations

ExceedsExpectations



Patient Care:Identification of instability and criticalillness:

Patient Care:Bag/Mask Ventilation

Proctor Name:

Date:

3636

Approved 8/30/17


Course: Renal High Fidelity Simulation


Course Version: 2.0









Objectives

1. List clinical scenarios that would necessitate urgent hemodialysis.2. Identify and distinguish symptomatology for pre-renal, intrinsic renal, and post-renal causes of

volume overload.3. Identify critical lab values related to acute renal failure.4. List the critical steps in the management of lab values found in renal failure.5. Use a defibrillator safely.6. Demonstrate three behaviors that enhance team behaviors.

Summary:



3737

Approved 8/30/17

Observation, debriefing, and feedback by experienced simulation educators to achieve the above learningobjectives. Ensuring student engagement, professional interaction and communication with patient andpeers, and task-based skill of using a defibrillator.

Grading:






Materials required: Manikins x 4, defibrillators x 14, crash cart x 4, basic monitors, IV access with fluidhanging, simulated patient chart with history and lab values, bags labelled with variousvasopressors/ionotropes, supporting images.

3838

Approved 8/30/17

Renal High Fidelity


Name:

Student ID#:


MeetsExpectations

ExceedsExpectations



Patient Care:Identification of instability and criticalillness

Patient Care:Demonstrate safe use of a defibrillator

Proctor Name:

Date:

3939

Approved 8/30/17


Course: Foley Placement


Course Version: 1.1


Level: Pre-clerkship, Renal Block Simulation Day



Course Layout: Student groups will attend a half-day session on Foley insertion. Session includes pre-course material, a lecture at the beginning of the course, followed by practice, then testing of Foleyinsertion on trainers.

Location: TBL

Course Director: Tolu Bakare

Course Co-Director: Ryan Hutchinson

Objectives:

1. Understand the principles of inserting an indwelling catheter using aseptic technique2. Select the appropriate equipment for inserting an indwelling catheter3. Demonstrate proficiency in the insertion of a Foley catheter

Summary:

Students are expected to watch training videos prior to their scheduled session. At the session, thestudents practice with Foley Insertion task trainers. They are supervised by Course Director and CourseCo-Director. Students perform the Foley insertion individually with evaluator present.


Direct observation of the task trainer exam and scoresheet completed by faculty / or evaluator.

Grading:




4040

Approved 8/30/17


Proctors:

Tolu Bakare, Ryan Hutchinson, Additional Simulation Center Staff

Materials required:

Foley Insertion Tray

Gloves

Task trainers

4141

Approved 8/30/17

Foley Placement


Name:

Student ID#:


MeetsExpectations

ExceedsExpectations

· Wash hands· Introduce yourself to the patient· Clarify their identity· Explain the procedure and gain

consent

· Position the patient· Don sterile gloves· Position fenestrated drape on

patient appropriately· Deposit lubricant into tray

compartment for Foley catheterlubrication

· Remove Foley catheter from wrapand lubricate catheter

Prepare patient

Female Patient: With a downward strokecleanse the right labia minora and discard theswab, repeat for left labia minora, and withthe last swab stick cleanse the middle areabetween the labia minoraMale Patient: Cleanse the penis in a circularmotion starting at the urethral meatus andworking outward

· Proceed with catheterization untilurine is visible in the drainage tube

· Inflate catheter balloon

Proctor Name:

Date:

4242

Approved 8/30/17


Course: Endocrine High Fidelity Simulation


Course Version: 2.0









Objectives

1. Develop a differential diagnosis for hemodynamic derangements as they relate to endocrinopathies.2. Perform a focused exam and work-up as it relates to the differential diagnosis.3. List steps necessary in the acute treatment of hemodynamic derangement as they relate to

endocrinopathies.4. Identify at-risk organ systems in the setting of hemodynamic derangements.5. Demonstrate three behaviors that enhance team behaviors.

Summary:



Observation, debriefing, and feedback by experienced simulation educators to achieve the above learningobjectives. Ensuring student engagement, professional interaction and communication with patient andpeers, and identification of critical illness.

4343

Approved 8/30/17

Grading:






Materials required: Manikins x 4, crash cart x 4, basic monitors, IV access with fluid hanging, simulatedpatient chart with history and lab values, bags labelled with various vasopressors/ionotropes, supportingimages.

4444

Approved 8/30/17

Endocrine High Fidelity


Name:

Student ID#:


MeetsExpectations

ExceedsExpectations



Patient Care:Identification of instability and criticalillness

Proctor Name:

Date:

4545

Approved 8/30/17


Course: Brain and Behavior High Fidelity Simulation


Course Version: 2.0









Objectives

1. Develop a differential diagnosis for seizures.2. Perform a focused exam and work-up as it relates to the differential diagnosis.3. Enumerate the steps necessary for acute management of a seizure.4. Describe the pathophysiology of hypertension and bradycardia and discuss treatment strategies.5. Identify the need for airway protection via endotracheal intubation.6. Name and demonstrate three behaviors that enhance team behaviors.

Summary:



4646

Approved 8/30/17

Observation, debriefing, and feedback by experienced simulation educators to achieve the above learningobjectives. Ensuring student engagement, professional interaction and communication with patient andpeers, and identification of critical illness.

Grading:






Materials required: Manikins x 4, crash cart x 4, basic monitors, IV access with fluid hanging, simulatedpatient chart with history and lab values, bags labelled with various vasopressors/ionotropes, basic drugsyringes, supporting images, Airway/intubating manikins and basic airway equipment.

4747

Approved 8/30/17

Brain and Behavior High Fidelity


Name:

Student ID#:


MeetsExpectations

ExceedsExpectations



Medical Knowledge:Identification of sequelae of criticallyelevated intracranial pressure.

Patient Care:Basic Endotracheal Intubation.

Proctor Name:

Date:

4848

Approved 8/30/17


Course: Lumbar Puncture (LP)


Course Version: 1.1


Level: Preclerkship, Brain and Behavior Block Simulation Day

Number of learners: 240 MS

On Site Time Allocation per Learner: 1 hour

Course Layout: Students receive group instruction and LP demonstration for 30 minutes with coursedirectors. Each student will have 10 minutes for procedural observation and competency check off.With 12 task trainers it will take 3.5 hours to check off all 240 students Course may be inter-digitized orsplit to accommodate this time need.

Location: TBL

Course Director: Jeff Van Dermark

Course Co-Director: Joe Martinez

Objectives

1. Review indications and contraindications for lumbar puncture2. Review the mechanical steps needed to perform the procedure3. Verbalize process for obtaining informed consent in lumbar puncture4. Demonstrate skills in performing a successful LP on dedicated task trainer

Summary:

Students will rotate to have an introductory session on the procedure, Lumbar Puncture. The coursedirector provides information about reasons to perform an LP, the actual procedure and controversiesas well as proper steps regarding informed consent. The students are shown a live demonstration of anLP using task trainer on a bench model using the TBL camera system. Students are provided with 2checklists to review while awaiting assigned time slot to perform the procedure as a posttest activity.Each student then undergoes a proctored post-test with the expectation that they correctly perform thetask including obtaining informed consent, hand hygiene, equipment set up and proper performance ofthe LP procedure.


4949

Approved 8/30/17

Direct proctor observation with no protocol violations for informed consent, equipmentchecklist review, sharps safety, and direct observation of successful LP

Grading: See Student LP Competency Checklist

Needs more practice –proficiency not achieved on the task (< 70% score on student checklist)

Meets expectations – proficiency is achieved on the task (>70% score on student checklist)

Exceeds expectations – proficiency is achieved on the task and the student is able todemonstrate unusually superior performance (as determined by the proctor) (>90% score onstudent checklist)

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until this level of performance is achieved. Additional practice opportunities areavailable on an as needed separately scheduled basis.

Proctors: Emergency Medicine course director and additional faculty.

Materials required: 15 LP trays, 12 LP task trainers with replaceable spine blocks, Liquid supply forpriming LP task trainers.

5050

Approved 8/30/17

Lumbar Puncture


Name:

Student ID#:

Description:

Students will rotate in the TBL learning space to have an introductory session on the procedure, Lumbar Puncture. The coursedirector provides information about reasons to perform an LP, the actual procedure and controversies as well as proper stepsregarding informed consent. The students are shown a live demonstration of an LP using task trainer on a bench model using theTBL camera system. Students are provided with 2 checklists to review while awaiting assigned time slot to perform the procedureas a posttest activity. Each student then undergoes a proctored post-test with the expectation that they correctly perform thetask including obtaining informed consent, hand hygiene, equipment set up and proper performance of the LP procedure. .

Errors:

Incorrectly state the indications for an LP Incorrectly identify equipment needed for LPIncorrectly state the contraindications for an LP Violation of sharps safetyIncorrectly verbalize the process of obtaining informed consent Unsuccessful perform LP task, and not obtain fluid

sample

Proficiency Score:



Direct proctor observation with no protocol violations for informed consent, equipment checklistreview, sharps safety, and direct observation of successful LP


ÿ Needs more practice – proficiency not achieved on the task (< 70% score on studentchecklist)

ÿ Meets expectations – proficiency is achieved on the task (>70% score on studentchecklist)

ÿ Exceeds expectations – proficiency is achieved on the task and the student is able todemonstrate unusually superior performance (as determined by the proctor) (>90 scoreon student checklist)

Proctor Name:

Date:

5151

Approved 8/30/17


Course: Advanced Cardiac Life Support

Course Number: 1B.99.17.17.1

Course Version: 1.1


Level: Pre-clerkship (Transition to Clerkships)



Course Layout: 36 groups of 6-7 students. Total of four half days. Groups divided and assigned individualschedules. First two half days include ACLS lectures, CPR/AED station and check off, Pacing/ElectricalTherapy, Airway Management of Respiratory Arrest, and Drugs and Protocol lecture. In addition, thestudents practice these stations for their exam. Second two half days include written exam and Megacodetesting with retest if required.

Location: D1.700, D1.600, L2.204, L2.206, L2.208, L2.212, L2.214, L2.216, L2.218, L2.222

Course Director: Angela Mihalic

Course Co-Director: Daniel Scott

Objectives

At the conclusion, participants should be able to:

1. Recognize and initiate early management of periarrest conditions that may result in cardiac arrestor complicate resuscitation outcome

2. Demonstrate proficiency in providing BLS care, including prioritizing chest compressions andintegrating automated external defibrillator (AED) use

3. Recognize and manage respiratory arrest4. Recognize and manage cardiac arrest until termination of resuscitation or transfer of care,

including immediate post–cardiac arrest care5. Recognize and initiate early management of acute coronary syndromes, including appropriate

disposition6. Recognize and initiate early management of stroke, including appropriate disposition7. Demonstrate effective communication as a member or leader of a resuscitation team and

recognize the impact of team dynamics on overall team performance

Summary:

As part of the Transitions to Clerkship course, students participate in the American Heart Associationapproved course on Advance Cardiac Life Support. UT Southwestern currently contracts with Emergency

5252

Approved 8/30/17

Medical Training Services to provide the instructors and materials for the course. Through a series oflectures, videos, hands on skills stations, and simulated clinical scenarios, students are providedcomprehensive information to identify emergency cardiovascular care and protocols for a patient incardiac arrest, post-resuscitative patient management, and core cases in ACLS according to currentguidelines. Students work with the instructor to complete ACLS skills practice and skills testing. Studentsalso complete a written exam.


Direct observation of via Megacode testing and a written exam.

Grading:



Successful completion is documented via provision of a ACLS card.

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until this level of performance is achieved. Additional practice opportunities areavailable immediately.

Proctors: Provided by EMTS911

Materials required: Provided by EMTS911

5353

Approved 8/30/17

Advanced Cardiac Life Support (ACLS)


Name:

Student ID#

*Scoresheet for ACLS provided by American Heart Association.

5454

Approved 8/30/17


Course: Introduction to Suturing and Knot Tying


Course Version: 1.1


Level: Preclerkship, Transitions Course



Course Layout: 4 groups of 60 students in 2 days, 2 hour sessions in TBL

Location: TBL

Course Director: Robert Rege

Course Co-Director: Daniel Scott

Objectives

1. Identify suture material and suturing instruments2. Have hands-on instruction regarding instrument and needle handling3. Demonstrate skills for performing a simple interrupted suture with instrument tying according

to observed practice

Summary:

As part of the transitions course, students rotate for 2 hours in the TBL learning space to have anintroductory session to suturing and knot tying. The course director provides information about thevarious types of suturing material, including suture and needle types, as well as suturing instruments.The students are shown a live demonstration of a simple interrupted suture using an instrument tyingtechnique on a bench model using the TBL camera system. Students then practice this task until theyfeel that they have reached proficiency in terms of doing all portions of the task correctly; note, there isno measurement of completion time for the task since this is an introductory course. Each student thenundergoes a proctored post-test with the expectation that they correctly perform the task, specifically,with regard to needle handling, instrument handling, and creation of a surgeon’s knot followed by 2square knots.


Direct proctor observation with no protocol violations for needle handling, instrument handling, andcreation of a surgeon’s knot followed by 2 square

5555

Approved 8/30/17

Grading:



Exceeds expectations – proficiency is achieved on the task and the student is able todemonstrate unusually superior performance (as determined by the proctor)


Proctors: 4 proctors and the course director.

Materials required: Instruments, suture, FLS penrose drain models with Velcro.

5656

Approved 8/30/17

Intro to Suturing and Knot Tying


Name:

Student ID#:

Task:

Suturing, Interrupted, Instrument Tie

Description:

At least 18cm length 3-0 dyed braided (silk, nurolon, vicryl, polysorb, polyester, etc.) on a tapered (SH orequivalent) needle, FLS penrose drain suture model, instrument tie surgeon's knot then 2 squares(3knots total)

Errors:

· Touching the needle with your hand· Holding an instrument incorrectly· Not tying a surgeon's knot as the initial knot· Not tying square knots

Proficiency Score:






Proctor Name:

Date:

5757

Approved 8/30/17


Course: Sterile Technique & Personal Protective Equipment


Course Version: 1.1


Level: Pre-clerkship, Transitions Course



Course Layout:

Pre-clerkship complete this course as a component of their Transitions to Clerkship course week. Eachstudent participates in one of two half-day sessions covering these topics.

Location: D1 conference rooms; Anatomy Cadaver Lab sinks

Course Director: Rohit Sharma

Course Co-Director: Mary Jane Pearson

Objectives:

1. Demonstrate proficiency in scrubbing2. Practice both self and assisted gowning/gloving3. Understand the basics of OR etiquette and sharps safety

Summary:

Students are expected to complete several course components prior to this session, all housed in theinstitutional curriculum website:

· Videos for scrubbing, gowning and gloving (created by UTSW Surgery and OBGYN departments)· Checklists for scrubbing with gels· CDC Sharps safety power point presentations· Didactic pre-test before completing the above and· Didactic post-test after completion

The student brings the certification of satisfactory completion of these materials to the session; theycannot proceed to the skills sessions without this.

The students are provided scrub brushes for practice prior to the session and are expected to use thisbrush at home.

5858

Approved 8/30/17


Scrubbing: Students are observed and a checklist is completed by faculty (OBGYN or Surgery) andproctors

Gowning and Gloving: Students are observed and a checklist is completed by faculty (OBGYN orSurgery) and proctors

Grading:



Exceeds expectations – N/A

At the end of the session, with satisfactory completion, they receive a sticker for their UTSW badgesdenoting this module has been completed.


Proctors: At least 10 proctors are needed.

Materials required:

Scrub sinks

Scrub brushes for practice (currently provided by Dr Bruce Meyer from CUH)-240

Scrub brushes for session date-240

Sterile gloves (large supply in place from CUH also)- 240, various sizes

Surgical gowns-300

Stickers of completion

5959

Approved 8/30/17

Performance Rating ToolSterile Technique: Surgical ScrubSimulation Scoresheet

Name:

Student ID#:

ONLY FACULTY/STAFF SHOULD WRITE BELOW

Surgical ScrubProcedural Steps

Check the box only if the step was done incorrectly

□ Remove jewelry/no hand or armjewelry in place

□ Wet hands and arms, apply soap, andlather with antimicrobial soap (optional– must for visibly soiled hands)

□ Clean under nails of both hands anddiscard nail pick into appropriatereceptacle

□ Scrub nails with brush perpendicular tofingertips – 30 strokes per hand

□ Scrub fingers of first hand – divide eachfinger into four planes – 20 strokeseach plane

□ Scrub each plane of hand (palm, back ofhand, and both sides) to wrist – 20strokes each plane

□ Repeat for opposite fingers and hand

□ Scrub ½ of distal arm on each of 4 armplanes – 20 strokes each plane

□ Repeat on distal ½ of opposite arm

□ Continue on same arm, scrub proximal½ to 2 inches above elbow – 20 strokeseach plane

Online Module Certification

Surgical Scrub

□ Satisfactorily completed

□ Needs remediation

Assisted Gowning and Gloving

□ Satisfactorily completed

□ Needs remediation

Self-Gowning/Gloving (if time allows)

□ Practice complete

□ Practice not complete

6060

Approved 8/30/17

□ Return to first arm and completeproximal ½ to 2 inches above elbow –20 strokes each plane

□ Discard brush in appropriate receptacle

□ Rinse with hands above the elbows –does not touch any part of sink orfaucet

□ Extend hand to receive towel fromevaluator

□ Keep towel away from scrub attire bybending slightly at waist and keepshands and arms above waist

□ Dry at beginning of fingertips of onehand and work up to elbow withoutretracing any area

□ Repeat on opposite hand and arm

□ Discard towel without dropping hands

OR Etiquette

Post Verification

Remediation completed(if required)

□ Scrub

□ Assisted gowning/gloving

Sticker issue date __________________

Proctor Name:

Date:

6161

Approved 8/30/17


Course: Basic Suturing and Knot Tying

Course Number: 1C.99.17.20.1

Course Version: 1.1


Level: Clerkship (Surgery)

Number of learners: 240 (all MS); approximately 40 per clerkship


Course Layout:

While on surgery clerkship, students rotate through skills on Wednesday afternoons (2 hour sessions x 7sessions total)


Course Director: Rohit Sharma

Course Co-Director: Alan Dackiw

Objectives

1. Become proficient in simple interrupted suture with instrument tie2. Become proficient in subcuticular interrupted suture with instrument tie

Summary:

Students are expected to watch training videos prior to the lab session, as pre-course study materials.During the lab session, they perform 1 rep of each task, observed and scored by a proctor. The tasksinclude simple interrupted suture and subcuticular interrupted suture using instrument tying. Studentsthen practice each task until they reach proficiency on 2 consecutive repetitions. They then undergo aproctored post-test with the expectation that they will achieve the proficiency score for each task.Other suturing (e.g. simple running, running subcuticular, etc.) and/or knot-tying tasks may be practicedon an informal basis at the discretion of the learner and if they have completed all required tasks.


Direct proctor observation, the learner is expected to achieve the student level proficiency (setat double the time as the resident level) according to time and error metrics for the followingtasks:

6262

Approved 8/30/17

1. simple interrupted suture with instrument tie2. subcuticular interrupted suture with instrument tie

Grading:

Needs more practice – if proficiency is not achieved on either task

Meets expectations – proficiency is achieved on both tasks

Exceeds expectations – was able to complete significant additional practice (on these or othersuturing and knot-tying tasks as determined by the proctor)

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until this level of performance is achieved. Additional practice opportunities areavailable during subsequent Wednesday afternoon skills sessions or on an as needed separatelyscheduled basis.

Proctors: This takes the SCMIS team of 4 proctors.

Materials required:

Instruments, suture, FLS penrose drain and Daisie models; ropes, books, knot-tying boards and ties foroptional practice.

6363

Approved 8/30/17

Basic Suturing and Knot Tying; Surgery Clerkship


Name:

Student ID#:

Task:

Suturing, Interrupted, Simple

Description:

At least 18cm length 3-0 dyed monofilament (nylon, prolene, PDS, etc.) on a cutting needle, FLS penrosedrain suture model, instrument tie surgeon's knot then 2 squares(3 knots total), time starts with needleloaded in needle driver in dominant hand, forceps in nondominant hand, the needle should be "loadedin the wound" using forceps (not by pulling up and loading by hand well away from the wound)

Errors:

· Accuracy = sum of distances in mm needle passed outside of each colored target· Gap (Air Knot) = distance in mm between targets on penrose drain (min = 2mm = no error)· Slippage = 0 points for secure knot, 10 points for slippage > 3mm, 20 points for disruption

(measure by cutting tails to 1 cm and "busting" the knot using pointed scissors)· Breakage = 20 points if ligature is broken during any portion of exercise· Loading (Not loading in the wound but loading by hand) = 1 point during each tissue bite phase

Scoring Formula:

Score = 240 - time - 10(sum of errors)

(Cutoff/Max time allotment = 240 seconds, Score = 0 if negative number is achieved)

Proficiency Score (student level): 204 (36 seconds with no errors)

Proficiency Training Protocol:

Achieve proficiency score on 2 consecutive repetitions (max 80 repetitions)

Proficiency Testing (Pre-test and Post-test) Protocol:

1 repetition

6464

Approved 8/30/17

Trainee Scores

Pre-test,Training,

Post-test,

RepeatPost-test Date

RepetitionNo. Time

AccuracyError x

10

GapError x

10

SlippageError x

10

BreakageError x

10

LoadingError x

10 Score123456789101112131415161718192021222324252627282930

Proctor Name:

Date:

6565

Approved 8/30/17


Course: OBGYN OSCE Pelvic and Breast Exams, Vaginal Delivery, Prescription Writing


Course Version: 1.1


Level: Clerkship (OBGYN)


On Site Time Allocation per Learner: 1.5 hours (full session each day is approximately 3 hours)

Course Layout: At the end of each clerkship, on the final Wednesday and Thursday morning of therotation

Location: L3 rooms (simulation pod of 6 rooms and separate conference room)

Course Director: Mary Jane Pearson

Course Co-Director: Tobi Fuller

Objectives:

1. Demonstrate the steps in the spontaneous vaginal delivery and answer case scenario questions2. Demonstrate the steps in the female pelvic examination and answer case scenario questions3. Demonstrate the steps in the clinical breast examination and answer case scenario questions4. Demonstrate correct format for written prescription

Summary:

On the first Tuesday of their ambulatory rotation, students attend a training session in which all 4objectives are taught. They then practice until comfortable with their skills. They are expected tosatisfactorily complete the OSCE at the end of each clerkship. Performance rating tools are used for eachtask.


Each clinical OSCE station is manned and scored by OBGYN faculty or midlevel providers. Each stationuses a performance rating tool, attached. Honors/High Pass/Pass/Fail for each station are determined byutilizing the number of items done correctly on the performance tool.

Grading:

Needs more practice –if Fail is scored

Meets expectations –if Pass is scored

6666

Approved 8/30/17

Exceeds expectations – if Honors or High Pass is scored


Proctors:

Simulation center(SP) staff to orient the students and direct the session-1

Simulation center (SP) to proctor the prescription writing station

6 minimum (8 ideal) OBGYN faculty and midlevel providers to man the clinical stations (midlevel providersreimbursed by UTSW )

Materials required:

Pelvic exam task trainers (2)

Breast exam task trainers (2)

SVD task trainers (2)

Gloves

Lubricant gel

Exam rooms (L3 simulation pod used)

Prescription writing forms

Wipes for cleaning models

6767

Approved 8/30/17


Course: Paracentesis


Course Version: 1.1


Level: Clerkship (Internal Medicine)


On Site Time Allocation per Learner: 60 minutes

Course layout: Students will receive group instruction and paracentesis demonstration for 20 minuteswith course directors. Each student will have 10 minutes for procedural observation and competencycheck off.

Location: TBL

Course Director: Neha Patel

Course Co-Directors: Anh Nguyen

Objectives:

1. Review the indications and contraindications to paracentesis2. Describe the steps needed to complete a diagnostic and therapeutic paracentesis successfully3. Demonstrate skills in performing a successful paracentesis on a dedicated trainer4. Analyze the results of paracentesis fluid for interpretation

Summary: The course director will review the reasons to perform a paracentesis, contraindications toparacentesis, the steps and a video to demonstrate the procedure and fluid tests to analyze. Studentsare shown a live demonstration of a paracentesis procedure using a task trainer. Students are providedchecklists to review while awaiting the time slot to perform the procedure as a post-test assessment.Each student undergoes a proctored post-test assessment with the expectation that they are able toobtain consent, review indications and contraindications, practice hand hygiene and assessment offluid pocket by physical exam or ultrasound if available, equipment/tray setup, sterile technique forneedle insertion, fluid aspiration, catheter drainage with suction canister, and then proper analysis offluid study results.

7272

Approved 8/30/17

Assessment Protocol and Performance Expectation: Direct proctor observation without variations forreview of indications/contraindications, equipment checklist and direct observation of successfulparacentesis.

Grading: See Student Paracentesis Competency Checklist

Needs more practice –proficiency not achieved on the task (< 70% score on student checklist)

Meets expectations – proficiency is achieved on the task (>70% score on student checklist)

Remediation: Anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until this level of performance is achieved. Additional practice opportunities areavailable as needed on a separately scheduled basis.

Proctors: 6-12 proctors and the course director and co-director.

Materials required: 6 task trainers for paracentesis, 15 paracentesis trays, and 15 suction drainagesystems, pens for skin marking, saline solution bags, and lidocaine solution.

Required viewing:

NEJM Video Paracentesis: http://www.nejm.org/doi/full/10.1056/NEJMvcm062234

Paracentesis OSCE video

https://www.youtube.com/watch?v=cxTbIr-ra6Q

Paracentesis checklist:

http://journals.sagepub.com/doi/pdf/10.1177/1062860612460399

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Approved 8/30/17

Paracentesis


Name:

Student ID#:

Task NeedsMorePractice

MeetsExpectations

ExceedsExpectations

1. Obtains informed consent2. Performs a pre-procedure time-out immediately before Procedure

· confirms patient ID, procedure, and site by all members of teamdoing procedure

· confirms no allergy to local anesthetic

3. Position patient appropriately

· Supine· Lateral decubitus also acceptable

4. Inspects abdominal wall

· notes location of scars, cellulitis, and collateral veins

5. Percusses the abdomen

· notes tympany versus dullness· • notes meniscus sign if present

6. Palpates the abdomen

· palpates and notes lateral border of rectus and anterior superioriliac spine bilaterally

7. Performs Ultrasound

· confirms location of ascites

8. Marks site with sterile pen or indentation

· site lateral to abdominus rectus· site not with collateral veins or scars· inferior to meniscus, if discernable· Lower quadrants, not through area of tympany· Site confirmed by ultrasound

9. Washes hands

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Approved 8/30/17

10. Opens kit

11. Applies cap, mask, and sterile gown

12. Applies sterile gloves

13. Arranges materials appropriately

14. Preps over marked site and surrounding skin(Circular motion)

· Uses a circular motion of scrub, center to peripheral

15. Injects 1% lidocaine at site of procedure

· Uses subcutaneous injection, wheal formation· Then goes deeper into skin· When peritoneal fluid is entered, injects 2-3 cc more

16. Allows for “Z-tracking” of needle insertion

· Gently pulls up on superficial skin· Z-tracking is accomplished by alternately pointing needle caudal

then cephalad as one· advances the needle

17. Inserts needle with surrounding catheter

· Stops insertion when fluid returns

18. When using a catheter-based system, slides catheter over the needle asneedle is withdrawn

19. Appropriately covers needle (method varies with type of needle)

20. Attaches a 60-mL syringe with or without a 3-way stopcock to catheter

· Removes 30-50 cc of fluid in 60-cc syringe· Has assistant immediately place in appropriate tubes or blood

culture bottles

21. Pulls out the catheter, gently applies pressure to site, and then appliesbandage

22. Disposes of needle in sharps container

23. Cleans up

24. Writes procedure note in appropriate spaceProctor Name: Date:

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Course: Introduction to Ultrasound


Course Version: 1.1


Level: Pre-clerkship, Transitions Course



Course Layout: Medical students will receive a group lecture covering physics, knobology and have ademonstration for 30 minutes with the course directors. Each student will have 10 minutes for proceduralobservation and competency check off. With 20 ultrasound machines and ultrasound models, this willtake 2 hours to check off all 240 students; 12 ultrasound machines and training models will take 3.3 hours.Course may be split to accommodate the time needed.

Location: TBL

Course Director: Jodi Jones

Course Co-Director: Mandy Pascual

Objectives

1. Learn ultrasound terminology2. Have hands-on instruction regarding machine use and image acquisition

a. Turn on machineb. Enter patient informationc. Enter student named. Choose appropriate transducere. Optimize depthf. Optimize gaing. Demonstrate indicator orientationh. Save image

3. Demonstrate skills for obtaining an optimal image on an ultrasound model or mannequin.

Summary:

As part of the transitions course, students rotate for 2 hours in the TBL learning space to have anintroductory session to ultrasound physics, terminology, machine operation and image acquisition. Thecourse director provides information about how diagnostic ultrasound produces images, the relationship

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between frequency/penetration/resolution, the various modes of ultrasound, and the relationshipbetween patient, probe and picture. The students are shown a live demonstration of ultrasound machinelayout including button location and functionality. Students then practice this task until they feel thatthey have reached proficiency in terms of doing all portions of the task correctly. Each student thenundergoes a proctored post-test with the expectation that they correctly perform the task, specifically,with regard to data input, probe selection and optimal image acquisition and storage.


Direct proctor observation with no protocol violations for data input, probe selection and optimalimage acquisition and storage.

Grading:



Exceeds expectations – proficiency is achieved on the task and the student is able to demonstrateunusually superior performance (as determined by the proctor)

Remediation: anyone not achieving a grade of “meets expectations” or higher is required to completeadditional practice until this level of performance is achieved. Additional practice opportunities areavailable on an as needed separately scheduled basis.

Proctors: 20 proctors and the course director.

Materials required: Ultrasound machine, ultrasound mannequin or models (fellow students or actors),ultrasound gel, wipes for cleaning machine, gloves.

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Introduction to Ultrasound Procedure ChecklistSimulation Scoresheet

Name:

Student ID#:

Introduction to Ultrasound Procedure Checklist

Yes No Partial1 Turn on the machine2 Input patient information, name and MRN3 Input student information4 Choose appropriate transducer5 Apply gel on transducer6 Verbalize orientation of probe and screen (right vs left

and superior vs inferior)7 Acquire image of RUQ8 Calibrate appropriately (depth and gain)9 Label the image10 Save the image, videos only

Proctor Name:Date:

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Course: Recognizing the Sick Patient


Course Version: 1.1


Level: Pre-Clerkship


On Site Time Allocation per Learner: 30 minutes, with 15 minutes of OSCE time for 2 brief cases,followed by 15 minutes of debriefing.

Course Layout: This OSCE course has six scenarios using Standardized Patients, with half being “Sick”and the other half being “Not Sick.” Each scenario is short (5 minutes), designed to be a History-TakingInterview, which will provide sufficient information to make the “sick, not sick” determination. Adebriefing will take place after the OSCE scenarios.

Location: UTSW L Building OSCE Clinical Skills rooms

Course Director: Joseph Martinez

Course Co-Director: Kavita Joshi

Objectives

1. Learn the concept of a “sick patient,” and how it differs from general patient care2. Given an OSCE scenario, determine if a standardized patient is “sick.”3. Given an OSCE scenario, determine if a standardized patient is “not sick.”4. Participate in a debriefing discussing common “sick, not sick” patient complaints

Summary:

Students will attend this OSCE course in groups of six students, where each student will do two of sixOSCE cases, one that is “sick” and one that is “not sick.” Each OSCE is a short five-minute History-TakingInterview, which will provide sufficient information to make the “sick, not sick” determination. Aphysical exam will not be necessary. After each OSCE scenario, the student will answer question, sick ornot sick. After completion of two OSCE scenarios, the group of six students will move to a debriefingroom and discuss all six OSCE scenarios.


The student is expected to achieve proficiency according to time and error metrics for thefollowing tasks:

1. Correctly identify the “sick” patient

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2. Correctly identify the “not sick” patient3. Attend the debriefing session and participate in the discussion

Grading:

Needs more practice – if incorrectly identifies either “sick” and “not sick” patients

Meets expectations – if correctly identifies one or both of the “sick” and “not sick” patients

Exceeds expectations – none

Remediation: Anyone not achieving a grade of “meets expectations” is required to repeat the OSCE untilperformance is achieved. Additional OSCE opportunities will be made available as needed, on aseparately scheduled basis.

Proctors: OME Standardized Patients, Emergency Medicine faculty/fellows for debriefing.

Materials required: For students: appropriate dress for Standardized Patient encounter. SimulationCenter: Six standardized patients.

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Sick, Not Sick; Pre-clerkship


Name:

Student ID#:

Task:

Recognizing the Sick Patient

Description:

Students will attend this OSCE course in groups of six students, where each student will do two of sixOSCE cases, one that is “sick” and one that is “not sick.” Each OSCE is a short five-minute History-TakingInterview, which will provide sufficient information to make the “sick, not sick” determination. Aphysical exam will not be necessary. After each OSCE scenario, the student will answer question, sick ornot sick.

Errors:

· Incorrectly identify the "sick" patient as "not sick"· Incorrectly identify the "not sick" patient as "sick"

Proficiency Score:


Sick Not Sick CorrectStation 1Station 2


ÿ Needs more practice – if incorrectly identifies either “sick” and “not sick” patientÿ Meets expectations – if correctly identifies one or both of the “sick” and “not sick”

patientsÿ Exceeds expectations – none

Proctor Name:

Date:

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Course: An Algorithmic Approach to Hypoxia


Course Version: 1.1


Level: Anesthesia Selective

Number of learners: approximately 12 per rotation


Course Layout: 12 students on Anesthesia selective; AM and PM groups of 6 for 3 weeks, 2 hrs per group,each group will run 3 scenarios.




Objectives

Scenario 1

1. Develop a differential diagnosis for hypoxemia.2. List the strategies to manage upper airway obstruction.3. Demonstrate basic competency of bag-mask ventilation with or without the use of an oral airway.4. Identify patient risk factors associated with airway obstruction especially in the setting of opiates and

other sedatives.

Scenario 2

1. Enumerate the resources necessary for uncomplicated intubation including basic airway equipment,suction, endotracheal tube and airways, and medications.

2. Demonstrate closed-loop communication and leadership/followership as it pertains to emergentairway management in a multi-disciplinary setting.

3. List the necessary maneuvers to confirm proper placement of an endotracheal tube.4. Discuss indications for endotracheal intubation.

Scenario 3

1. At the end of this scenario, learners will be able to develop a differential diagnosis for hypoxemia inthe intubated patient.

2. Recognize bronchospasm/wheezing on physical exam.

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3. Enumerate management strategies for bronchospasm.4. List communication strategies useful for the management of anxious family members

Summary:

Regardless of their chosen specialty, physicians are expected to have certain clinical, technical, and non-technical skills. These clinical and technical skills include but are not limited to the management ofhypoxemia and hemodynamic instability. Non-technical skills include the concepts of teamwork,communication and professionalism, and mobilization of a system’s resources especially in time of crisis.

Simulation-based education is an experiential learning practice. Learners participate in activities that aredeliberate, situated, and relevant to their clinical work in a setting that is familiar and functional (Yardley,Teunissen, & Dornan, 2012). The experience is immediately followed by reflection; a careful, guideddebriefing session in which the simulation educator engages the learners in a conversation about theirthoughts, emotions, and perceptions about the experience (Fanning & Gaba, 2007). Using a methodologycalled debriefing with good judgment, the facilitators expose the mental constructs through which thelearner acts, critique the decisions and behaviors observed, and clarify any questions that may ariseregarding medical content (Rudolph, Simon, Rivard, Dufresne, & Raemer, 2007). It is the reflectiveprocess that is critical to this, and any, experiential learning activity.

By developing a collection of simulated scenarios that address basic crises that all physicians should beable to triage and utilizing the methods of simulation-based education and debriefing, we propose that wecan instill in our learners some basic clinical, technical, and non-technical skills that are universal andvaluable as they progress through their undergraduate and transition into their graduate medicaleducation.


Observation, debriefing and feedback by experience simulation educators to achieve the above learningobjectives. Ensuring student engagement, professional interaction and communication with patient andpeers, and task based skill of placing monitors.

Grading:





Proctors: 2 simulation educators and 1 simulation staff for manikin management.

Materials required: Manikins, 2 airway task trainers for learning effective intubation.

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Algorithmic Approach to Hypoxia Scoresheet


Name:

Student ID#:


MeetsExpectations

ExceedsExpectations



Patient Care:Identification of instability and criticalillness.

Patient Care:Bag/Mask Ventilation/Intubation

Proctor Name:

Date:

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Medical Student Simulation Curriculum...implied, between any applicant, student or faculty member...

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