Nuts’and’Bolts’of’Simulaon’in’...
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Session #: T156 Nuts and Bolts of Simula7on in Physician Assistant Educa7on Jami S. Smith, MPA, MEd, PAC Rutgers University PA Program Nina Multak, PhD(c), MPAS, PAC Drexel University PA Department
Transcript of Nuts’and’Bolts’of’Simulaon’in’...
Session #: T156 Nuts and Bolts of Simula7on in Physician Assistant Educa7on
Jami S. Smith, MPA, MEd, PA-‐C Rutgers University PA Program Nina Multak, PhD(c), MPAS, PA-‐C Drexel University PA Department
• Presenters have no disclosures.
Objec7ves • Iden7fy the literature that supports the use of simula7on educa7onal strategies in medical and healthcare educa7on.
• Describe the resources including supplies, personnel and funding needed for implementa7on of simula7on educa7on strategies.
• Iden7fy the ARC-‐PA standards in which simula7on-‐based educa7on strategies can help to meet.
• Discuss the necessary components of a simula7on scenario.
Literature Example #1 • DM Gaba -‐ The future vision of simula1on in healthcare in The Journal of the Society for Simula7on in Healthcare
• Diverse applica7ons of simula7on and discussion of pa7ent safety
(Gaba, 2007)
Literature Example #2
• Motola, I , Devine, L, Chung, HS, et al, Simula1on in healthcare educa1on: A best evidence prac1cal guide. AMEE Guide No. 82 in Medical Teacher
• A guide for educators on the educa7onal principles that lead to effec7ve learning using simula7on, including topics such as debriefing and feedback, deliberate prac7ce, team training and curriculum integra7on.
(Motola, Devine & Chung, et al, 2007)
IMPLEMENTATION OF SIMULATION
4 Stages of Implementa7on
1. Establish the need for change 2. Plan for change 3. Ensure prompt response to opera7onal problems
4. Secure the viability of the curriculum
Iden7fica7on of Resources
• Personnel • Time • Facili7es • Funding Costs
(Kern, Thomas & Hughes, 2009)
Personnel
• Curriculum directors • Curriculum faculty instructors • Support staff – Curriculum administrator – Administra7ve assistant and support staff
– Addi7onal personnel
Time
• Curriculum directors • Faculty • Learners • Support Staff
Facili7es
• Includes space for learning ac7vity and equipment storage
• If clinical curricula, needs may include access to pa7ents and clinical equipment
Funding Costs
• Redeploying exis7ng resources • Addi7onal resources • Sufficient funding for a curriculum improves likelihood that the curriculum evalua7on and dissemina7on will be accepted for publica7on in a peer reviewed journal
Obtaining Support for the Curriculum
• Internal Support • External Support
Internal Support • Iden7fy the stakeholders • Encourage input from stakeholders during planning
• Help to educate stakeholders • May need to develop conflict resolu7on skills to nego7ate and develop poli7cal support
External Support
• Poten7al sources of external funding – Period of external funding may help to gain internal support to sustain curriculum afer cessa7on of external funding
• Influence of government agencies or professional socie7es may help to gain internal support for curriculum
• Consider faculty development monies from ins7tu7ons or professional socie7es
Administra7on of the Curriculum
• Administra7ve Structure • Communica7on • Opera7ons • Scholarship
An7cipa7ng Barriers
• Compensa7on • Personnel
COMPONENTS OF SIMULATION SCENARIOS
Components of Simula7on Scenarios
Scenario Title/Focus
Scenario Par<cipants (Include healthcare discipline and level of training. Will the scenario be interdisciplinary?): ü Physician Assistant student ü Dental professional student ü Nursing Student ü Medical Student/Resident ü Other healthcare professional student ü Medical Student/Resident ü Other par7cipants? (family members, confederates)
© 2014 PAEA
Scenario Content Consider purpose of scenario? Can be more than one � Primary Assessment
� Secondary Assessment
� Clinical Decision Making � Emergency Response
� Cardiac � Respiratory � Pediatric
© 2014 PAEA
Learning Objec<ves of Scenario • No more than 3 or 4 • Consider measurable/observable criteria to assess student performance/skill for each objec7ve): 1. 2. 3. 4.
© 2014 PAEA
SeCng the Stage • Se;ng:
In what clinical healthcare sekng will this scenario occur?
• Par1cipant Roles during scenario:
Consider number of par7cipants and what each par7cipant will be responsible for during the scenario.
• Scenario Timing: Typically 15-‐20 minutes
© 2014 PAEA
Pa<ent Case Background
Narra1ve: Describe your pa7ent and his/her medical background including HPI, PMH, drug therapy, allergies etc. Simulated Pa1ent Data: Chart clinic record -‐ consider diagnos7c tes7ng, objec7ve pa7ent findings (height, weight, pa7ent care flow sheets)
© 2014 PAEA
Ini<al manikin seCngs: � Heart Rate _____ � Respiratory Rate _____ � BP _____ � Temperature _____ � Lung sounds _____ � Heart sounds _____ � Acute care sekngs could include O2 satura7on, heart rhythm (ECG) � Vocal Sounds – what will the manikin say? Be complaining of?
© 2014 PAEA
Supplies and Equipment Needed: a. Typical clinic supplies b. Pa7ent chart/medical record c. Emergency response equipment d. Other Par<cipant Instruc<on: What do you expect the learner to do prior to the scenario? How can they best prepare themselves to be successful?
© 2014 PAEA
Debriefing Plan Guidelines:
1. What happens in simula7on stays in simula7on
2. Honest self and group cri7que is essen7al
3. Instructor is only the facilitator (let students talk) Specific debriefing ques1ons:
1. Were the learning objec7ves met?
2. What went well?
3. What didn’t go so well?
4. How did you feel about the experience?
5. What did you learn about yourself? Evalua1on/Assessment © 2014 PAEA
USING SIMULATION TO MEET ARC-‐PA STANDARDS
ARC-‐PA Standards that Simula7on Educa7onal Strategies Help to Meet
• B1:07 The curriculum must include instruc7on related to the development of problem solving and medical decision making skills.
• B1.08 The curriculum must include instruc7on to prepare students to work collabora5vely in inter-‐professional pa5ent centered teams.
• B2.04 The program curriculum must include instruc7on in interpersonal and communica5on skills that result in the effec7ve exchange of informa7on and collabora7on with pa7ents, their families and other health professionals.
• B2.06 The program curriculum must include instruc7on in the provision of clinical medical care across the life span.
• B2.07 The program must include instruc7on in technical skills and procedures based on current professional prac7ce.
• B2.13 The program must include instruc7on in pa5ent safety, quality improvement, preven5on of medical errors and risk management.
(ARC-‐PA, 2011)
• B1:07 The curriculum must include instruc7on related to the development of problem solving and medical decision making skills.
© 2014 PAEA
Problem Solving and Medical Decision Making
• Scenario: – High fidelity mannequin with complaint of chest pain – determine appropriate diagnos7c tes7ng, interpreta7on and treatment modali7es based on physical examina7on and history
• Modality: – High fidelity mannequin or standardized pa7ent – Use of cardiac monitor
© 2014 PAEA
• B1.08 The curriculum must include instruc7on to prepare students to work collabora<vely in interprofessional pa<ent centered teams.
© 2014 PAEA
Interprofessional Simula7on
• Scenario: – Group of interprofessional learners brought together for an obstetric case
– Each student can explore their individual role in the midst of a pa7ent centered team
• Modality: – high fidelity simula7on and standardized pa7ents – hybrid model
© 2014 PAEA
• B2.04 The program curriculum must include instruc7on in interpersonal and communica7on skills that result in the effec<ve exchange of informa<on and collabora<on with pa<ents, their families and other health professionals.
© 2014 PAEA
Effec7ve Informa7on Exchange
• Scenario – OSCE – Hybrid scenario
• Modali7es – Standardized pa7ent – High fidelity mannequin and confederate family member
– Call for a consult that requires a summary of case
© 2014 PAEA
• B2.06 The program curriculum must include instruc7on in the provision of clinical medical care across the life span.
© 2014 PAEA
Across the Life Span
• Scenario – Geriatric pa7ents for complete H&P – Discussion of code status and end of life choices – Pediatric or newborn exam or ill child
• Modality – Use of geriatric SPs or high fidelity mannequins obstetric (Noelle) or peds (SimBaby)
© 2014 PAEA
• B2.07 The program must include instruc7on in technical skills and procedures based on current professional prac<ce.
© 2014 PAEA
Technical Skills
• Task Trainers – Urinary catheteriza7on, intravenous cannula7on, injec7ons, lumbar puncture, central lines, suturing
© 2014 PAEA
Technical Skills • High fidelity simulators – Use of a scenario in conjunc7on with demonstra7on of technical skills
– Needle thoracostomy, intraosseous line placement, CPR, defibrilla7on, intuba7on
© 2014 PAEA
• B2.13 The program must include instruc7on in pa<ent safety, quality improvement, preven<on of medical errors and risk management.
© 2014 PAEA
Pa7ent Safety and Quality Improvement
• Scenario: – High fidelity simula7on involving incorrect administra7on of medica7ons and disclosure of mistakes to pa7ent and family
© 2014 PAEA
Pa7ent Safety and Quality Improvement
• Scenario – Cardiac arrest management via ACLS – Focus on crisis resource management skills to improve quality of care and pa7ent safety • Leadership skills • Assigning roles • Shared mental model • Closed loop communica7on
© 2014 PAEA
Summary
• Use literature to educate yourself and the stakeholders in your ins7tu7on
• Plan for the simula7on ac7vity as well as for the overall implementa7on of simula7on into the current curriculum structure
It is 7me! Healthcare simula7on is a extensively
researched, widely published educa7onal modality that has a place in the educa7on of
Physician Assistants.
References Accredita7on Review Commission on the Educa7on of the Physician Assistant, Inc., (2011). Accredita1on Standards for Physician Assistant Educa1on, 4th Ed. Gaba, D. (2007). The future vision of simula7on in healthcare. Simula1on In Healthcare, 2(2), 126-‐-‐135. Motola, I., Devine, L., Chung, H., Sullivan, J., & Issenberg, S. (2013). Simula7on in healthcare educa7on: A best evidence prac7cal guide. AMEE Guide No. 82. Medical Teacher, 35(10), 1511-‐-‐1530. Kern, D., Thomas, P., Hughes, M., (2009). Curriculum development for medical educa1on (2nd ed.). Bal7more: Johns Hopkins University Press. Images reproduced with permission from Microsof Office and Shuserstock
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