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Simulation-based education: How could simulation be used for technical skills development in the future

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Deborah Rooney's, PhD, talk at Mersin University in Turkey on October 27, 2015.

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Simulation-based education: How could simulation be used for technical skills development in the future

  1. 1. Simulation-based education: How couldsimulationbeusedfortechnicalskills developmentinthefuture MersinŰniversitesi,FacultyofMedicine MESEKOK October27,2015 Deborah Rooney PhD MEDICAL SCHOOL UNIVERSITY  OF  MICHIGAN   Copyright 2015. All Rights Reserved.
  2. 2. Disclosures and conflicts of interest •  None
  3. 3. My Background
  4. 4. My Background
  5. 5. My Background •  Medical education since 1991 •  Nine years in surgical education •  PhD in Educational Psychology •  Director of Education and Research, Clinical Simulation Center, University of Michigan (UMCSC)
  6. 6. UM Clinical Simulation Center (UMCSC)
  7. 7. 231523142305 UMCSC Spaces
  8. 8. UMCSC Utilization
  9. 9. Today’s talk: Simulation-based education •  Brief history of developments that impacted simulation •  Current applications of simulation-based training for technical skills •  Projected trends in simulation-based training
  10. 10. Simulation-based education is not new
  11. 11. n = 3 n = 963 History of Simulation-based Education
  12. 12. Dr. Gordon introduces “Harvey” History of Simulation-based Education
  13. 13. 1973 “Harvey” 1970s Standardized Pts History of Simulation-based Education
  14. 14. 1980-90s MIS training 1973 “Harvey” 1970s Std Pts History of Simulation-based Education
  15. 15. 1980-90s Computers 1973 “Harvey” 1970s Std Pts 1980-90s MIS History of Simulation-based Education
  16. 16. 1998 Standards 1973 “Harvey” 1970s Std Pts 1980-90s MIS Computers History of Simulation-based Education
  17. 17. 2000 Error 1973 “Harvey” 1970s Std Pts 1980-90s MIS Computers 1998 Standards History of Simulation-based Education
  18. 18. Development & refinement of best practices •  Invention and proof of concept of specific simulators, skills curricula •  Development of practical tools to support learning and assessment in complex settings •  Application of educational theories History of SBE* for technical skills: 2000 to present *SBE= Simulation-based Education
  19. 19. Educational Theory and Technical Skills: Bloom Bloom, based on Dave, R. (1967). Psychomotor domain. Berlin: International Conference of Educational Testing. Higher order psychomotor skills Lower order psychomotor skills Watch instructor and repeat (copy) Complete task with verbal instruction Combine learned skills to meet novel requirements Apply automatic strategies Perform with expertise without assistance Naturalization Articulation Precision Manipulation Imitation GOAL
  20. 20. Frequency Urgency (cost) urgency frequency urgency frequency (CVC, code)( PE, IV) Current Trends: technical skills training
  21. 21. Address Gap Impact Pt Care Value ? Current Trends: technical skills training
  22. 22. Benefits of SBE for technical skills training Addresses the gap (improving KSA*) •  Lumbar puncture (LP) skills in the Neonatal Intensive Care Unit (Shafer et al, 2013) Improves patient outcomes •  Central venous catheter placement skills in the Medical Intensive Care Unit (Barsuk et al, 2009) Decreases hospital costs •  Central line placement skills in the Medical Intensive Care Unit (Cohen et al, 2010) *KSA= knowledge, skills, attitude
  23. 23. Learning Goals: •  Improve documentation (knowledge) •  Decrease traumatic tap rate (skills) •  Improve confidence amongst residents (attitude/affect) Shafer S, Rooney D, Schumacher R, Chapman R, House J. Neonatal Lumbar Punctures: Bridging the Clinical Gap. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9597 Addressing gaps: lumbar puncture in NICU**Neonatal Intensive Care Unit
  24. 24. Intervention •  Pre-assessment •  Simulation-based Curriculum (blocked, deliberate practice) •  Post-assessment Program Evaluation •  Compare pre- post measures (KSAs) •  knowledge (written test) •  performance assessment (sim and clinical) Shafer S, Rooney D, Schumacher R, Chapman R, House J. Neonatal Lumbar Punctures: Bridging the Clinical Gap. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9597 Addressing gaps: lumbar puncture in NICU
  25. 25. 0 0.5 1 1.5 2 2.5 3 Pre Post Addressing gaps: lumbar puncture in NICU*
  26. 26. What about impact to patient care?
  27. 27. Improves patient outcomes: Central Venous Catheter (CVC) placement in MICU Sim-based, mastery training central line placement skills in Medical ICU (MICU); •  Presentation with contra/indications for CVC •  Video demonstration of CVC IJ placement •  One-on-one instructor & trainee practice with feedback •  Pre-post training assessment Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne DB. Simulation based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009 Oct;37(10):2697-701.
  28. 28. CVC placement in Medical Intensive Care Unit (MICU) Sim-based, mastery training improved clinical measures; •  Fewer needle passes •  Fewer arterial punctures •  Fewer catheter adjustments Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne DB. Simulation based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009 Oct;37(10):2697-701.
  29. 29. Cohen ER, Feinglass J, Barsuk JH, et al. Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Simul Healthc. 2010 Apr;5(2):98-102. Follow-up research compared pre-post Catheter-Related Bloodstream Infections (CRBSI) and potential cost- savings for the hospital -Cohen and colleagues CVC placement in Medical Intensive Care Unit (MICU)
  30. 30. Cohen ER, Feinglass J, Barsuk JH, et al. Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Simul Healthc. 2010 Apr;5(2):98-102. 4.2/100 MICU CVC CRBSI/adm. 0.42/100 MICU CVC CRBSI/ adm. SBE CVC training improved infection rates
  31. 31. •  Training cost ~US$110,000 ( 319,000) •  Approximately 9.95 CRBSIs were prevented in MICU patients/ CVCs in the year after intervention •  Each translated to US$82,000 ( 240,000) and 14 added hospital days Cohen ER, Feinglass J, Barsuk JH, et al. Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Simul Healthc. 2010 Apr;5(2):98-102. 2M SBE CVC training reduced costs
  32. 32. What about the future?
  33. 33. Future Trends: technical skills training Frequency Urgency (cost) urgency frequency urgency frequency urgency frequency (CVC, code) ( Targeted learners) ( PE, IV)
  34. 34. Future trends: targeted procedural training
  35. 35. -Tavlasoglu et al (Diyarbakir Military Medical Hospital) Future trends: targeted procedural training
  36. 36. Barsness KA, Rooney DM, Davis LM, O'Brien E. Evaluation of three sources of validity evidence for a laparoscopic duodenal atresia repair simulator. J Laparoendosc Adv Surg Tech A. 2015 Mar;25(3):256-60. Tai B, Rooney D, Stephenson F, Liao P, Sagher O, Shih A, Savastano LE. Development of 3D-printing built ventriculostomy placement simulator. J Neurosurg. 2015 Jun 26:1-7. Future trends: targeted procedural training Neurosurgery and Pediatric Surgery •  Very small trainee group •  Target procedural skills
  37. 37. Challenges associated with SBE •  Cost •  Space •  Expertise •  Time (development and delivery)
  38. 38. •  Decrease space requirements •  Decrease faculty time commitment •  Increase learner access Addressing the challenges: Future training targets technical skills
  39. 39. •  Using available web-based curriculum on computer •  Self-directed training and assessment •  Addresses knowledge, skills, attitude Future Training: Streamlining technical skills training with technology
  40. 40. Future training targeting technical skills: retinal exam •  Originally developed for residents, soon to be adapted by medical students (n=170) •  3 weeks to teach retinal exam skills •  30 minutes/session = 85 teaching hours •  Teaching commitment = 0
  41. 41. Future training targeting technical skills: endoscopy Residents; •  Family medicine •  IM-Gastroenterology •  Surgery ü Self-directed learning ü 24 hour access ü Built-in assessment
  42. 42. and there’s more than technical skills…
  43. 43. Future SBE targets: moving beyond technical skills •  Communication and professionalism •  Patient safety & quality improvement •  More complex skills (decision-making)
  44. 44. Communication skills Pediatric ICU (PICU) “Bootcamp” Trainees: PICU fellows Learning Goals: Improve PICU fellows’ reflection/awareness of own communication skills Improve fellows’ awareness of patient/families’ perceptions Improve fellows’ communication skills with patients and families
  45. 45. Day 1 •  Introductions •  Presentation of family’s story from parent/child •  Self-evaluation Day 2 •  Faculty/Parent-educator facilitated simulation Ongoing Assessment & Evaluation •  360° (nursing staff, faculty, patient/parent, trainee-self) •  On-unit assessment Communication Bootcamp: logistics
  46. 46. Communication Skills: third-year medical students in Turkey
  47. 47. Conclusions
  48. 48. Thank you Questions?       Deborah  Rooney,  PhD   dmrooney@med.umich.edu    

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