LAerdal

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  • Good afternoon.
    My name is Frank Overly, and the title of our abstract is High fidelity Medical Simulation as an Assessment tool for pediatric residents airway management skills.
  • Helps if you are willing to share some of your own past errors, etc
    Ensure confidentiality—not laughing, etc
  • LAerdal

    1. 1. High-Fidelity Simulation to TeachHigh-Fidelity Simulation to Teach Communication Skills:Communication Skills: Potentially Difficult DiscussionsPotentially Difficult Discussions Stephanie N. Sudikoff, MDStephanie N. Sudikoff, MD Medical Director, SYN:APSE Simulation CenterMedical Director, SYN:APSE Simulation Center Yale New-Haven Health SystemYale New-Haven Health System Assistant Professor of PediatricsAssistant Professor of Pediatrics Pediatric Critical CarePediatric Critical Care Director, Pediatric SimulationDirector, Pediatric Simulation Yale University School of MedicineYale University School of Medicine
    2. 2. Many types of discussionsMany types of discussions  Between caregiver and patientBetween caregiver and patient  Between caregiver and familyBetween caregiver and family  Among interdisciplinary care teamAmong interdisciplinary care team
    3. 3. Delivery of Bad NewsDelivery of Bad News  Manner of delivery has significant impact onManner of delivery has significant impact on patients and familypatients and family  All caregivers (all levels) report discomfort andAll caregivers (all levels) report discomfort and lack of sufficient traininglack of sufficient training  Many studies into best pedagogical strategyMany studies into best pedagogical strategy  LecturesLectures  Small groups/role playingSmall groups/role playing  One on one with standardized patientOne on one with standardized patient
    4. 4. Ideal strategy…Ideal strategy…  InteractiveInteractive  Learner centeredLearner centered  Draws on prior experienceDraws on prior experience  RelevantRelevant  Allows for timely applicationAllows for timely application  Opportunity for repetitive practiceOpportunity for repetitive practice  Opportunity for feedback and reflectionOpportunity for feedback and reflection Provides basic steps practice, discuss concerns, receive feedbackProvides basic steps practice, discuss concerns, receive feedback
    5. 5. Delivery of Bad News: PediatricsDelivery of Bad News: Pediatrics  Frequently delivering news to parent and family,Frequently delivering news to parent and family, who are often present at the bedsidewho are often present at the bedside  In acute care settings, news must often beIn acute care settings, news must often be delivered in the midst of complex patient caredelivered in the midst of complex patient care
    6. 6. Why simulation?Why simulation?  Simulation facilitates:Simulation facilitates:  Repetitive practiceRepetitive practice  Safe environment for practice, reflection, discussion,Safe environment for practice, reflection, discussion, and feedbackand feedback  Hybrid model creates realistic situation involvingHybrid model creates realistic situation involving simultaneous patient care and family interactionsimultaneous patient care and family interaction  Faculty teaching without competing clinicalFaculty teaching without competing clinical responsibilities/time pressureresponsibilities/time pressure
    7. 7. Previous Simulation WorkPrevious Simulation Work  Gaba “Death Scenario”Gaba “Death Scenario”  Rosenzweig Standardized PatientsRosenzweig Standardized Patients Choose cases relevant to learnersChoose cases relevant to learners
    8. 8. Overly F, Sudikoff SN, Duffy S, Anderson A, Kobayashi L Teaching Difficult Discussions in Pediatric Emergency Medicine:  1) Sudden Infant Death 2) Child Abuse with Domestic Violence and 3) Medication Error. Simulation in Healthcare. Accepted December 2008
    9. 9. Participant FeedbackParticipant Feedback Survey question Relevance to your training/duties Realism of simulation scenario Realism of simulation environment Quality of simulation debriefing Overall simulation training experience Score Average (SD) 4.9 (0.4) 4.5 (0.7) 4.5 (0.5) 4.8 (0.4) 4.9 (0.4)
    10. 10. CommentsComments  ““The SIDS case is very worthwhile.The SIDS case is very worthwhile. Traumatizing but worthwhile”Traumatizing but worthwhile”  ““Great experience- very valuable to try out theseGreat experience- very valuable to try out these situations first at sim center rather than on thesituations first at sim center rather than on the floors.”floors.”  ““Very real, excellent learning experience”Very real, excellent learning experience”
    11. 11. Stages of debriefingStages of debriefing  ReactionsReactions  ““How did that feel?”How did that feel?”  UnderstandingUnderstanding  ““What results wereWhat results were produced?”produced?”  SummarySummary  ““How can weHow can we extrapolate thisextrapolate this information to a largerinformation to a larger context?”context?”  EventsEvents  EmotionsEmotions  EmpathyEmpathy  ExplanationsExplanations ““The four E’s”The four E’s”
    12. 12. Critical characteristics of an effectiveCritical characteristics of an effective debriefingdebriefing  Safe for the learnerSafe for the learner  Confidential and trustingConfidential and trusting  RespectfulRespectful  InteractiveInteractive  Non-threateningNon-threatening  Non-confrontationalNon-confrontational  Non-judgmentalNon-judgmental
    13. 13. Debriefing for this caseDebriefing for this case  Allow sufficient time for reactions stageAllow sufficient time for reactions stage  Sensitivity to powerful emotional responsesSensitivity to powerful emotional responses  Supportive environmentSupportive environment  Allow for reflection on learner performance: useAllow for reflection on learner performance: use their observations to transition to teaching “besttheir observations to transition to teaching “best practice” conceptspractice” concepts  Consider providing “gold standard” for frame ofConsider providing “gold standard” for frame of referencereference
    14. 14. Disclosure ofDisclosure of Medical Errors: TheMedical Errors: The Art (and Science) ofArt (and Science) of ApologyApology
    15. 15. Medical errorMedical error  The failure of a planned action to be completed asThe failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aimintended or the use of a wrong plan to achieve an aim  Serious errorSerious error  Minor errorMinor error  Near missNear miss  An error that could have caused harm but did notAn error that could have caused harm but did not …by chance or timely intervention…by chance or timely intervention  Most are due to system breakdown vs. individual failureMost are due to system breakdown vs. individual failure
    16. 16. The ImportanceThe Importance  To Err is HumanTo Err is Human  U.S. National Institute of Medicine report, 1999U.S. National Institute of Medicine report, 1999  Over 100,000 deaths annually in the U.S.Over 100,000 deaths annually in the U.S.
    17. 17. Hospitals 'more dangerous' thanHospitals 'more dangerous' than air travel (Reuters, 2005)air travel (Reuters, 2005)  If you feel safer in hospital than on a airplane, think again.If you feel safer in hospital than on a airplane, think again.  The risk of being killed in a hospital in a developed country due to medicalThe risk of being killed in a hospital in a developed country due to medical error is around one in 300, while the risk of dying in an air accident is one inerror is around one in 300, while the risk of dying in an air accident is one in 10 million10 million, Britain's chief medical officer said on Monday., Britain's chief medical officer said on Monday.  "Paradoxically, people are more frightened of air travel than they are of"Paradoxically, people are more frightened of air travel than they are of healthcare," Liam Donaldson, who also chairs the World Healthhealthcare," Liam Donaldson, who also chairs the World Health Organization's (WHO) World Alliance for Patient Safety, told a conference.Organization's (WHO) World Alliance for Patient Safety, told a conference.  He argued such a gulf in safety standards was unacceptable - even allowingHe argued such a gulf in safety standards was unacceptable - even allowing for the poor condition of many patients entering hospital - and healthcarefor the poor condition of many patients entering hospital - and healthcare professionals needed to learn from other sectors on how to make safety a topprofessionals needed to learn from other sectors on how to make safety a top priority.priority.  ""Other high-risk industries have systematically improved safety over a periodOther high-risk industries have systematically improved safety over a period of decades in a way that healthcare has not, the airline industry being theof decades in a way that healthcare has not, the airline industry being the most high-profile examplemost high-profile example," Mr Donaldson said.," Mr Donaldson said.
    18. 18. What we knowWhat we know  Medical errors occur frequentlyMedical errors occur frequently  Agreement exists that errors should be disclosedAgreement exists that errors should be disclosed  FamilyFamily  StaffStaff  Risk managementRisk management  Caregivers receive little trainingCaregivers receive little training
    19. 19. What can we do?What can we do?  Simulation as a tool to decreaseSimulation as a tool to decrease medical errorsmedical errors  Errors are multi-factorialErrors are multi-factorial  ““Shed light” on the problemsShed light” on the problems  PracticePractice  Teamwork and communicationTeamwork and communication
    20. 20. What can we do?What can we do?  Simulation as a tool to teach disclosureSimulation as a tool to teach disclosure  AdvantagesAdvantages  Includes medical managementIncludes medical management  Requires focus, multi-taskingRequires focus, multi-tasking  Interaction with standardized patient or actorInteraction with standardized patient or actor  Practice the wordsPractice the words  View on videoView on video  DisadvantagesDisadvantages  Limitations of the simulatorLimitations of the simulator  Requires “buy in”Requires “buy in”
    21. 21. Disclosure of Medical ErrorsDisclosure of Medical Errors  Video clipVideo clip  DebriefDebrief  Medical error disclosureMedical error disclosure  The literatureThe literature  AttitudesAttitudes  How we teach (and learn)How we teach (and learn)
    22. 22. What families want to knowWhat families want to know ????
    23. 23. What families want to knowWhat families want to know  What happened?What happened?  Why did it happen?Why did it happen?  What are the implications for their loved one?What are the implications for their loved one?  How can the problem be corrected?How can the problem be corrected?  How can future errors be prevented?How can future errors be prevented?
    24. 24. ApologyApology  4 components:4 components:  Acknowledgement of the offenseAcknowledgement of the offense  Explanation for committing the offenseExplanation for committing the offense  ““There is no excuse for what happened”There is no excuse for what happened”  ““We are still trying to find out what happened”We are still trying to find out what happened”  Expression of shame, remorse, humilityExpression of shame, remorse, humility  Reparation: making amendsReparation: making amends
    25. 25. Important factorsImportant factors  Important to choose who offers the disclosureImportant to choose who offers the disclosure  Timing is importantTiming is important  Insincere apology is worse than no apologyInsincere apology is worse than no apology
    26. 26. General recommendationsGeneral recommendations  Listen without interruptingListen without interrupting  Relay full informationRelay full information  Use easy-to-understand languageUse easy-to-understand language  Ensure that the parents comprehend theEnsure that the parents comprehend the informationinformation  Give aGive a sinceresincere apologyapology  Use nonverbal communication to expressUse nonverbal communication to express concernconcern
    27. 27. General recommendationsGeneral recommendations  Communicate your commitment to the patient’sCommunicate your commitment to the patient’s safetysafety  Convey the patient’s medical status and yourConvey the patient’s medical status and your expectationsexpectations  Solicit families opinionSolicit families opinion  Use open ended questionsUse open ended questions  Communicate to family members that youCommunicate to family members that you understand their concernsunderstand their concerns  Communicate what you plan to do to preventCommunicate what you plan to do to prevent this in the futurethis in the future
    28. 28. Communication among theCommunication among the interdisciplinary team:interdisciplinary team: The HandoffThe Handoff
    29. 29. High RiskHigh Risk  One of the most common scenarios in whichOne of the most common scenarios in which significant miscommunication can occursignificant miscommunication can occur  Also high risk for patient deterioration whileAlso high risk for patient deterioration while traveling throughout hospitaltraveling throughout hospital
    30. 30. Why simulation?Why simulation?
    31. 31. Response to need for processResponse to need for process improvementimprovement  MultidisciplinaryMultidisciplinary  ““Vetting” and refinementVetting” and refinement  ImplementationImplementation
    32. 32.  Well received by entire teamWell received by entire team  Real opportunity for all members to collaborateReal opportunity for all members to collaborate to create multidimensional toolto create multidimensional tool  Improved buy inImproved buy in

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