simming it up stat ltc jay baker, m.d. faculty development fellow madigan army medical center

Simming It Up STAT

LTC Jay Baker, M.D.Faculty Development Fellow

Madigan Army Medical Center

Objectives

• Learned why medical simulation is a superior teaching technique

• Applied the STAT method for– –Developing scenarios–Debriefing critical actions–Achieving learning objectives

Why sim?

Results

Outcomes # studiesPooled effect size

(95% CI)

Knowledge 118 1.20 (1.04-1.35)

Time skills 210 1.24 (1.03-1.25)

Process skills 426 1.09 (1.03-1.16)

Product skills 54 1.18 (0.98-1.37)

Time behaviors 20 0.79 (0.47-1.10)

Other behaviors 50 0.81 (0.66-0.96)

Direct patient effects 32 0.50 (0.34-0.66)

Technology Enhanced Simulation for Health Professions Education:

A Systematic Review and Meta-Analysis

Comfort Zone

Learning Zone

Sim is fun!

Scenario

Critical Actions

Debriefing

Learning Objectives

Scenario

Critical Actions

Debriefing

Learning Objectives

Determine Learning

Objectives

Write Critical Actions

Develop Case

Introduce the

SCENARIO ALGORITHMSET UP

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION

Simulation Training Assessment Tool (STAT)

Date: Examiner: Examinee(s):

Learning Objectives1.2.3.

CRITICAL ACTIONS ME NI SUSTAIN IMPROVE

Debriefing Phases1. Reaction– Blow off steam and elicit concerns2. Teaching—Address performance related to critical actions3. Summary– What did you do well? What did you learn for next time?

ME = Meets Expectations; NI = Needs Improvement

Introduce the


PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION







First

Introduce the


PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION







Then

Introduce the


PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION







Finally

Introduce the


Actor with bee stingO2 mask, Epipen

PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION



Learning Objectives1. Recognize anaphylaxis2.3.




Exercise #1

Lower the learning barrier

• Introduce learners to sim environment• Acknowledge sim deficiencies• Contract– The Basic Assumption

“We believe that everyone participating in simulation activities is intelligent, capable, cares about doing their best, and wants to improve.”

Scenario

Critical Actions

Debriefing

Learning Objectives

DetermineLearning

Objectives

Identify Critical Actions

Develop Case

Reaction Phase

Teaching Phase

Summary Phase

Reaction Phase

• Elicit and recognize concerns

• Clarify facts of case

• Incorporate concerns into

teaching

Teaching Phase

Teaching Styles

Summary Phase

• “What did you do well?”

• “What did you learn?”

OR• “Take aways?”

Introduce the


PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION







Observe performance

Run the scenario

Introduce the


PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION







Assess gaps

Run the scenario

Introduce the


PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION







Take notes

Run the scenario

Introduce the


PRE ARRIVAL

ARRIVAL

PRIMARY SURVEY

SECONDARY SURVEY

LABS & IMAGES

DISPOSITION







Debrief performance

Debrief the scenario

Exercise #2

• Introduce learner to environment• Run your scenario with a “learner”

– Identify performance gaps• Debrief the “learner”

–Close gaps through teaching• I will debrief your debriefing

Milestones

• EM Milestones “Suggested Evaluation Methods” –

ACGME Core Competency Sim/Total

Patient Care 11/14

Medical Knowledge 0/1

Professionalism 2/2

Interpersonal Communication Skills 2/2

Problem-Based Learning Improvement 2/2

Systems-Based Practice 2/3

Total 19/24

CRITICAL ACTIONS MSME

NI

SUSTAIN IMPROVE

Place safety net—IV, O2, monitor & begin ABCs

PC1

ID afib with RVR & assess patient as stable.

PC3PC4

Take thorough history and ID time of onset

PC2PROF1

Consider rate control with diltiazem 0.25 mg/kg—defers to patient wishes

PC5

Attempt pharmacologic cardioversion with procainamide 1 g IV/60 mins

PC9

Progress to synchronized cardioversion 120-200 J with sedation

PC10PC11SBP1

Choose appropriate sedation agents and doses

PC10PC11SBP1

Obs in ED x 1 hour then d/c home w/ f/u

PC6PC7

Demonstrate effective communication including closed loop feedback

ICS2

SCENARIO ALGORITHM

SET UP• Sim Man w/ live video feed & mic• Instructor will control Sim Man and

monitor case from video room• Resident will play role of RN• ECG available @ monitor

PRE ARRIVAL• 60 yo male with palpitations + mild

SOB x 30 mins. Tachy. Adenosine 6 mg given w/ no change.

• HR 125 BP 138/79 RR 24 Pox 97%

ARRIVAL• No change• PMH—Similar episode 4 y ago.

Txd w/ SCV in ED at that time.• Meds—None currently• All—None • SH—Tob x ½ ppd, etoh x1-2/day,

coffee x 4 cpd. Retail store owner, increased stress.

PRIMARY SURVEY• ABCs WNL except tachy as above

SECONDARY SURVEY• Pt remains stable throughout case

unless resident gives OD of sedation

LABS & IMAGES• CXR—WNL • Labs—All WNL including Troponin• ECG—Afib w/ RVR

DISPOSITION• Home

Simulation Training and Assessment Tool (STAT)– Stable Atrial Fibrillation with Rapid Ventricular Rate

Date: Instructor(s): Learner(s):

Learning Objectives:1. Assess patient as stable vs. unstable and diagnose atrial fibrillation2. Conduct appropriate work up of recent onset atrial fibrillation w/ rapid ventricular rate3. Appropriately treat and disposition


Milestones

Objectives

• Learned why medical simulation is a superior teaching technique

• Applied the STAT method for– –Developing scenarios–Debriefing critical actions–Achieving learning objectives

Questions?

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simming it up stat ltc jay baker, m.d. faculty development fellow madigan army medical center

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