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IPSS Webinar - EXPRESS

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Dr. Adam Cheng (Vancouver, BC - BC Children's & Alberta Health Services) talks about his Scripted Debriefing study in the EXPRESS Network and the results and ramifications on resuscitation education through the American Heart Association's PALS & ACLS Programs. Originally aired March 19, 2012.

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IPSS Webinar - EXPRESS

  1. 1. Assessing Simulation in Pediatrics: Improving Resuscitation Education Examining Pediatric Resuscitation Education using Simulation and Scripting (EXPRESS): A Multicenter Trial Adam Cheng, Elizabeth Hunt, Aaron Donoghue, Kristen Nelson, Walter Eppich, Vinay Nadkarni for the EXPRESS Investigators
  2. 2. • Research Grant Support – American Heart Association – EXPRESS project – Laerdal Foundation for Acute Medicine – Heart and Stroke Foundation of Canada – Canadian Institute for Health Research • Intellectual – Pediatric Subcommittee, American Heart Association – Contributing Editor, 2011 PALS Instructor Manual Assessing Simulation in Pediatrics: Improving Resuscitation Education Disclosure
  3. 3. • Trend: – More simulation in standardized resuscitation courses (PALS, ACLS) • Issue: – Thousands of instructors across North America – Instructor debriefing skills are variable Assessing Simulation in Pediatrics: Improving Resuscitation Education Background
  4. 4. • Proposed Solution: Debriefing Script – Sound debriefing principles – Framework – Specific wording and phrases – Promotes reflective learning Assessing Simulation in Pediatrics: Improving Resuscitation Education Debriefing Script
  5. 5. Multicenter Study • Prospective, RCT • Factorial design • Subjects: – Novice Instructors – Interprofessional pediatric healthcare teams Assessing Simulation in Pediatrics: Improving Resuscitation Education EXPRESS Study Low Realism (LoR) High Realism (HiR) Non-Scripted Debriefing (nS) nS - LoR nS - HiR Scripted Debriefing (S) S - LoR S - HiR
  6. 6. Assessing Simulation in Pediatrics: Improving Resuscitation Education EXPRESS Study Institution Investigator(s) BC Children’s Hospital Adam Cheng Children’s Hospital of Philadelphia Vinay Nadkarni, Aaron Donoghue, Akira Nishisaki Johns Hopkins Betsy Hunt, Kristen Nelson Children’s Medical Center Dallas Judy Leflore, Jeffrey Hopkins Cincinnati Children’s Mike Moyer, Mary Patterson Children’s Memorial Hospital Walter Eppich, Mark Adler Children’s Hospital Boston Marisa Brett-Fleegler, Monica Kleinman, Liana Kappus Children’s Hospital at Dartmouth Matthew Braga AI Dupont Susanne Kost, Glen Stryjewski Walter Reed / National Naval Steve Min, John Podraza, Joe Lopreiato Pittsburgh Children’s Melinda Fiedor-Hamilton Stollery Children’s Hospital Jonathan Duff Center for Medical Simulation Robert Simon, Jenny Rudolph Seattle Children’s Hospital Kimberly Stone, Jennifer Reid Oregon Health Sciences JoDee Anderson
  7. 7. • Task-based guidance • Performed Well vs. Needs Work • Debriefing Theory: Advocacy Inquiry Assessing Simulation in Pediatrics: Improving Resuscitation Education EXPRESS Script
  8. 8. Assessing Simulation in Pediatrics: Improving Resuscitation Education Debriefing Script
  9. 9. Assessing Simulation in Pediatrics: Improving Resuscitation Education EXPRESS – Study Design Interprofessional TeamInterprofessional Team Outcome Measures - Knowledge - Behavioural Performance - Cognitive Performance Outcome Measures - Knowledge - Behavioural Performance - Cognitive Performance Simulation Scenario - PRESimulation Scenario - PRE Simulation Scenario - POSTSimulation Scenario - POSTSimulation Scenario - POSTSimulation Scenario - POST Non-Scripted DebriefingNon-Scripted DebriefingScripted DebriefingScripted Debriefing Simulation Scenario - PRESimulation Scenario - PRE n=200n=187
  10. 10. Assessing Simulation in Pediatrics: Improving Resuscitation Education Review Team Cognitive Performance Tool (CPT) Behavioural Assessment Tool (BAT) Debriefing Assessment for Simulation in Healthcare (DASH) Stephanie Sudikoff Frank Overly Marino Festa Takanari Ikeyama John Podraza Glenn Stryjewski Aaron Donoghue Matthew Braga Kathleen Ventre Jonathan Duff Douglas Leonard Kristine Boyle Laura Corbin Mike Moyer JoDee Anderson Jeffrey Hopkins Walter Eppich Vinay Nadkarni Akira Nishisaki Elizabeth Hunt Kristen Nelson Monica Kleinman Marisa Brett-Fleegler Adam Cheng
  11. 11. Assessing Simulation in Pediatrics: Improving Resuscitation Education Research Portal
  12. 12. Assessing Simulation in Pediatrics: Improving Resuscitation Education Research Portal
  13. 13. Assessing Simulation in Pediatrics: Improving Resuscitation Education Research Portal Functionality LMS Res Portal Security Custom admin access Y Y Study Design Custom study design – arm / group / subject hierarchy Automated or custom assignment of subject codes N N Y Y Assessment Tools Custom tool creation Match assessment tools to videos Y Y Y Y Video Management Upload of video from multiple sites with different A/V systems Custom assignment of video to team OR individuals based on study arm View review and data entry online from multiple sites Y N N Y Y Y Data Management Download custom spreadsheets according to study arm or outcome measure N Y
  14. 14. Assessing Simulation in Pediatrics: Improving Resuscitation Education Results
  15. 15. Assessing Simulation in Pediatrics: Improving Resuscitation Education Validation of Assessment Tools
  16. 16. Assessing Simulation in Pediatrics: Improving Resuscitation Education EXPRESS Results
  17. 17. Why weren’t our results more significant? Scripted Debriefing: •One scenario – Difficulty? Enough exposure? •Length of debriefing Realism •High emotional, conceptual and environmental realism •Enough exposure? Assessing Simulation in Pediatrics: Improving Resuscitation Education Limitations
  18. 18. Assessing Simulation in Pediatrics: Improving Resuscitation Education Research Process
  19. 19. AHA Pediatric Subcommittee identified: •Existing PALS instructor material were inadequate •More debriefing instruction and guidance was required •Standardized method of debriefing needed to be introduced Assessing Simulation in Pediatrics: Improving Resuscitation Education PALS Instructor Training
  20. 20. • Online debriefing module • GAS Model – Gather – Analyze – Summarize Assessing Simulation in Pediatrics: Improving Resuscitation Education Structured and Supported Debriefing
  21. 21. Assessing Simulation in Pediatrics: Improving Resuscitation Education Challenge
  22. 22. Assessing Simulation in Pediatrics: Improving Resuscitation Education What worked… and What Didn’t EXPRESS Debriefing Script:
  23. 23. Assessing Simulation in Pediatrics: Improving Resuscitation Education New Debriefing Tool
  24. 24. Assessing Simulation in Pediatrics: Improving Resuscitation Education New Debriefing Tool
  25. 25. Assessing Simulation in Pediatrics: Improving Resuscitation Education New Debriefing Tool
  26. 26. Assessing Simulation in Pediatrics: Improving Resuscitation Education New Debriefing Tool
  27. 27. Assessing Simulation in Pediatrics: Improving Resuscitation Education Pilot Testing
  28. 28. • Structured and Supported Debriefing • Instructor Course • Instructor Manual – New debriefing chapter – Scenario Cards • Front : Scenario • Back : Debriefing Tool Assessing Simulation in Pediatrics: Improving Resuscitation Education 2011 PALS Instructor Training
  29. 29. Assessing Simulation in Pediatrics: Improving Resuscitation Education PALS Scenario Cards
  30. 30. Assessing Simulation in Pediatrics: Improving Resuscitation Education ACLS Scenario Cards
  31. 31. Assessing Simulation in Pediatrics: Improving Resuscitation Education PALS Debriefing
  32. 32. • Scripted debriefing helps to improve learning outcomes • Knowledge acquired from simulation-based research can be disseminated via collaboration with established associations • Future Directions – Research : instructor and learner feedback, compliance, usability, learner outcomes, patient outcomes – Use of debriefing tool in non-PALS context Effective knowledge translation = Greater Impact Assessing Simulation in Pediatrics: Improving Resuscitation Education Take Home Messages
  33. 33. Assessing Simulation in Pediatrics: Improving Resuscitation Education INSPIRE Network
  34. 34. • Attend meetings / webinars • Research – Single site studies – Multicenter studies • Primary or site investigator • Video reviewer • Consultant Assessing Simulation in Pediatrics: Improving Resuscitation Education INSPIRE Network • Distribution List: – Nicola Robertson – nicola.robertson@albertahealthservices.ca • Research: – Adam Cheng ch enger@me.com – Marc Auerbach dr.auerbach@gmail.com

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