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Bauman & White HPSN 2011


Presentation given at HPSN 2011 titled: Simulation-Based Resuscitation - Team Leadership

Presentation given at HPSN 2011 titled: Simulation-Based Resuscitation - Team Leadership

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  • 1. Simulaon-­‐Based  Resuscitaon:   Team  Leadership   Eric  B.  Bauman,  PhD   RN,  Paramedic   Kae  White,  MD   Copyright  2011  E.  B.  Bauman  &  K.  White   All  Rights  Reserved  
  • 2. Disclosures  &  Affiliaons  Kae  White  is  a  Staff  Physician  at  Wm.  S.  Middleton  Veterans  Memorial  Hospital  and  a  Clinical  Instructor  at  the  University  of  Wisconsin  School  of   Medicine  and  Public  Health.  Dr.  White  is  also  a  Hospitalist  at  the   Stoughton  Hospital  and  hold  the  tle  of  associate  with  Clinical   Playground,  LLC.  
  • 3. Disclosures  &  Affiliaons   Eric  B.  Bauman  is  the  founding  and  managing  member  of  Clinical   Playground,  LLC.  Dr.  Bauman  is  a  special  event  staff  nurse  for  the   University  of  Wisconsin  Department  of  Athlecs’  and  a  Paramedic/Firefighter  for  the  Town  of  Madison  Fire  Department  and  a  Paramedic   for  the  City  of  Middleton  Department  of  EMS.  
  • 4. IRB  Approval  This  study  was  granted  an  Exemp&on  by  the   Health  Sciences  Internal  Review  Board  at  the   University  of  Wisconsin  -­‐  Madison  
  • 5. Needs  Assessment  •  Leadership  and  Crisis  Management  Skills  in  VA   Hospital  related  Cardiac  Resuscitaon   –  The  PGY2  Medicine  Residents  from  the  University  of   Wisconsin  School  of  Medicine  &  Public  Health  are   responsible  for  leading  a  mul-­‐professional  code-­‐blue   team   –  Residents  have  varied  experience  with  cardiac   resuscitaon   •  All  have  current  ACLS  Training   •  Few  if  any  have  any  Team  Leadership  experience  or  training    
  • 6. Idenfying  Cognive  and   Behavioral  Deficit      •  Anecdotally:  Based  on  Kae’s  experience  as   Chief  Resident  and  when  mentoring  junior   residents  •  Empirically:  Based  on  the  literature  and  our   pretest  quesonnaire     Bauman,  2007  
  • 7. Medical  Educaon  Literature   In  a  study  of  Internal  Medicine  Residents    (Hayes,  et  al,  2007)   •  49.3%  felt  inadequately  trained  to  lead  a  cardiac  arrest   •  50.3%  felt  that  standard  ACLS  training  did  not  provide   necessary  team  leadership  skills  related  to  resuscitaon   •  40%  indicated  they  received  no  addional  training  related  to   resuscitaon  beyond  a  standard  ACLS  course   •  52.15%  felt  prepared  to  lead  a  cardiac  resuscitaon  -­‐  55.3%   worried  they  made  errors   •  Residents  felt  unsupervised  -­‐  No  backup   •  Post  event  debriefing/feedback  was  lacking    This  was  very  consistent  of  the  PGY2  Medicine  Class  working  as  Medical  Officers  of  the  Day  
  • 8. Hypothesis  Simulaon  can  be  effecve  for  increasing  resident   comfort  with  ACLS  algorithms  and  resuscitaon  leadership  roles,  while  decreasing  anxiety  related  to   cardiac  resuscitaon  management.  
  • 9. Workshop  Objecves  •  Residents  will  demonstrate  the  ability  to  apply  knowledge  of  ACLS   protocols  in  a  high  fidelity  simulated  case-­‐based  sehng  with   emphasis  on  the  first  10  minutes  of  the  event  including  diagnosis  of   the  rhythm  and  underlying  process,  primary  survey,  and  inial   algorithm  selecon    •  Residents  will  demonstrate  team  leadership  and  team  member   skills  and  be  able  to  describe  the  importance  of  delegaon  of  tasks,   funconal  team  dynamics,  and  role  ownership  •  Residents  will  express  improved  confidence  with  code  team   leadership  and  decreased  anxiety  about  managing  code  situaons  •  Residents  will  become  aware  of  the  strengths  and  weaknesses  of   simulaon  as  a  learning  tool.  
  • 10. Study  Objecves  •  Increase  comfort  level  related  to  using  ACLS   Algorithms  •  Use  Simulaon-­‐Based  Educaonal   Intervenon  to  decrease  anxiety  associated   with  MOD  Role    •  Increase  perceived  comfort  level  with  code   leadership  •  Increase  parcipant  comfort  level  associated   with  simulaon-­‐based  learning  environment  
  • 11. The  theorecal  Framework   Based  Fink’s  Taxonomy  :  Theorecal  Framework  that  was   already  in  place  to  guide  educaonal  intervenons  and   resident  curricula  in  the  Department  of  Medicine  Fink,  D.  L.  ,2003  
  • 12. Learning    How  to  Learn:   Foundaonal  Knowledge:  • Becoming  a  beier  Student   Understanding  and  remembering   •   Informaon  •   Inquiring  about  a  subject   •   Ideas  •   Self-­‐direcng  learners   Caring:  Developing  new   Applicaon   •   Feelings   •   Skills   • Interests   • Values   Fink’s  Taxonomy   •   Thinking:                          Crical,  Creave,  &  Praccal  Thinking   •   Managing  projects   Human  Dimension:  Learning   Integraon:  Connecng   about   •   Ideas   •   Oneself   • People   •   Others   • Realms  of  life  
  • 13. Our  Pretest/  Pre-­‐Intervenon  Data   n=24  1-­‐5  Likert  Scale   Mean  Value  is  Reported  •  Comfort  with  ACLS  Algorithms  2.8  •  Comfort  with  Leadership  with  Acute  Ward   Situaon  2.68  •  Level  of  Anxiety  in  MOD  Role  4.08  (High  Anxiety   Level)  •  Comfort  with  Simulaon  as  a  Learning  Tool  3.52
  • 14. Curriculum  Development  •  Establish  Objecves   •  This  goes  beyond  a  desire  to  use  the  simulator  •  Idenfy  and  target  our  learners     •  Those  rounding  out  their  PGY1  Year  •  Storyboard  Scenarios  that  meet  intervenon   objecves  (Backfill  and  Narrave)   •  This  is  the  way  it  would  look  in  the  VA  •  Write/Repurpose  and  test  scenarios  
  • 15. Clovis  Nov.  2009   Timeline   Dec  1,  2009   Feb.  2010     Clovis  June  2010   July  2009    Kae  has  Baby   Tested  Scenarios  Kae  comes  for   Dec.  29,  2009   tour  of  the   Kae  and  Baby  (Maggie)  comes  to  Simlab   May  14,  2010   Simlab   Storyboard  Narraves  &  Backfill   2nd  of  4  Workshops     Nov  2009   June  14,  2010   Project  Incepon   January,  2010   4nd  of  4  Workshops     Target  Learners   Planning  connues   Idenfy   Outlined  workshop  Agenda   Objecves   June  7th,  2010   March  5,  2010   3nd  of  4  Workshops     First  of  4  Workshops  
  • 16. The  Agenda  •  7  Residents  per  workshop  •  3  Facilitators  per  workshop   –  Educator,  Aiending,  Chief  Resident  •  2.5  Hours   –  Icebreaker  Games  focusing  on  team  dynamics  and  leadership   –  Review  of  concepts  of  Crisis  Resource  Management  (Gaba  et  al,  2001)     –  Scenarios  with  Debriefing  (2  per  Session)   –  Wrap  Up  (Surveys  and  Feedback)  
  • 17. Environment   •  Icebreaker  Games  focusing  on  team  dynamics  and  leadership    Classroom   •  Review  of  concepts  of  Crisis  Resource  Management  Wrap  Up    Classroom   •  Scenarios  with  Debriefing  (2  per  Session)    Simulaon  Laboratory   •  Wrap  Up  (Surveys  and  Feedback)    Classroom  
  • 18. The  Scenarios  •  Based  previous  research  focusing  on   resuscitaon  and  crisis  management  (Bauman,   2007)   –    Two  Scenarios:  Pulseless  VT  and  ACS   •  Well  known  algorithms  but  sll  had  crical  thinking   components     –  Learners  “entered”  authenc  designed  experience   scenarios  without  defined  roles  (Squire,  2006  )  
  • 19. Video  Review  of  Sessions  •  Chief  Resident,  Department  of  Medicine   Educators,  Aiending  Staff  Physician  •  Provided  Wriien  feedback  to  all  parcipants  •  Opportunity  for  one-­‐on-­‐one  meeng  with   Chief  Resident  and/or  Aiending    
  • 20. What  were  they  looking  for?  •  Each  evaluator  was  assigned  to  one  or  two   residents  to  watch  through  each  videotaped   session  •  Evaluators  observaons’  were  compared  and   reconciled  so  that  consistent  feedback  could   be  provided  to  each  parcipant  •  All  parcipants  were  provided  with  wriien   feedback  whether  or  not  they  self  selected   into  a  leadership  or  followership  role.  
  • 21. Examples  •  Level  of  Parcipaon  •  Communicaon  Style:  Closed  Loop  technique,   asserveness,  appropriateness    •  Leadership  orientaon/posion  in  the  room  •  Ability  of  leader  to  effecvely  delegate    •  Decision  Making  ability        Gaba  et  al,  2001   Squire,  Giovaneio,  DeVane,    &  Durga,  2005  
  • 22. Our  Post-­‐test/Post-­‐Intervenon  Data   n=24    1-­‐5  Likert  Scale   Mean  Value  is  Reported  •  Comfort  with  ACLS  Algorithms  3.38  •  Comfort  with  Leadership  with  Acute  Ward   Situaon  3.44  •  Level  of  Anxiety  in  MOD  Role  3.7  (Decrease  in   anxiety)  •  Comfort  with  Simulaon  as  a  Learning  Tool   4.26   *All  results  were  stascally  significant  
  • 23. Resident  Comfort  Level  Survey  Results   1   0.8   0.6   Change  in  Resident  Survey  Ra;ngs   0.4   0.2   0   -­‐0.2   -­‐0.4   -­‐0.6   Comfort  with  ACLS   Comfort  with  code  team   Anxiety  about  code  team   Comfort  with  simulaon   Protocol   leadership   leadership   as  a  learning  tool  Change  in  Survey  Score   0.58   0.76   -­‐0.38   0.88   Denotes a statistically significant change from pre- to post-workshop.
  • 24. Limitaons    •  Time  Constraints   –  Release  from  clinical  responsibilies   –  Lab  Scheduling   –  No  everyone  was  able  to  play  the  role  of  leader   •  Primary  feedback  comment  from  parcipants  •  Resident  buy-­‐in  of  the  created  environment   –  Suspension  of  Disbelief   –  More  orientaon  me   –  More  Integraon  of  Simulaon  into  Resident  Training
  • 25. Final  Thoughts   •  Importance  of  theorecal   framework  when  designing   curricula  and  research   projects   •  Importance  of  objecve-­‐ based  curriculum  design   •  Knowing  our  learners   program  expectaons   •  Effecvely  targeng  your   audience    R.  Kyle  
  • 26. References  Bauman,  E.  (2007).  High  fidelity  simulaon  in  healthcare.  Ph.D.  dissertaon,  The   University  of  Wisconsin-­‐Madison,  United  States.  Dissertaons  &  Thesis  @  CIC   Instuons  database.  (Publicaon  no.  AAT  3294196)    Fink,  D.  L.    (2003)  Crea%ng  Significant  Learning  Experiences.  San  Francisco  Jossy-­‐Bass    Gaba,  D.  M.,  Howard,  S.  K.,  Fish,  K.,  Smith,  B.,  &  Sowb,  Y.  (2001).  Simulaon-­‐based   training  in  anesthesia  crisis  resource  management  (ACRM):  A  decade  of   experience.  Simula%on  &  Gaming,  32(2),  175-­‐193.    Hayes,  H.W.,  Rhee,  A.,  Detsky,  E.,  LeBlanc,  V.R.,  and  Wax,  R.S.  (2007).  Residents  feel   unprepared  and  unsupervised  as  leaders  of  cardiac  arrest  teams  in  teaching   hospitals:  A  survey  of  internal  medicine  residents.  Cri%cal  Care  Medicine  35(7),   1668-­‐1672.    Squire,  K.  (2006).    From  content  to  context:  Videogames  as  designed  experience.     Educaonal  Researcher.    35(8),  19-­‐29.    Squire,  K.,  Giovaneio,  L.,  DeVane,  B,.  &  Durga,  S.  (2005).  From  users  to  designers:   Building  a  self-­‐organizing  game-­‐based  learning  environment.  Technology  Trends,  49 (5),  34-­‐42.