Simulaon-‐Based Resuscitaon: Team Leadership Eric B. Bauman, PhD RN, Paramedic Kae White, MD Copyright 2011 E. B. Bauman & K. White All Rights Reserved
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.
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.
IRB Approval This study was granted an Exemp&on by the Health Sciences Internal Review Board at the University of Wisconsin -‐ Madison
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
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
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
Hypothesis Simulaon can be eﬀecve for increasing resident comfort with ACLS algorithms and resuscitaon leadership roles, while decreasing anxiety related to cardiac resuscitaon management.
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.
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
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
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
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 www.pamelaheath.com/Cartoons4.htm
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
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
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)
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 www.pamelaheath.com/Cartoons4.htm
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 )
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
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.
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
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
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.
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 www.pamelaheath.com/Cartoons4.htm
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
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.
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