The document describes 7 presentations on various medical education projects taking place at IMSH 2012. The projects focus on improving skills training and assessment in areas like clinical decision making, resuscitation, communication skills and organ donation. Each presentation provides background on an identified knowledge gap, states a PICO question, and outlines a proposed study approach to address the gap.
The University of Michigan Medical School is developing a competency-based curriculum that is driving the organization toward change. The Learning Informatics team that is part of Medical School Information Services is pulling together data from disparate systems that can be facilitated by the use of standards. They are leading the charge toward a well-integrated portfolio system.
Several factors contribute to the trend toward earlier clinical learning in undergraduate medical
education programs. This excerpt outlines factors driving significant change at a large Caribbean medical school which prepares students for practice in the United States-consistent with adult learning theory.
Dear friends its ppt belongs to psychiatric nursing i have done research regarding “ A study to evaluate the effectiveness of structured teaching program on knowledge regarding clinical skills in psychiatric nursing assessment among third year BSc nursing students at selected Nursing colleges of Jaipur.”
Geoff Norman, PhD
McMaster University
Presented at Perspectives in Competency Assessment
A Symposium by Touchstone Institute
www.touchstoneinstitute.ca
As the healthcare industry becomes more competitive, the demand for groundbreaking resources and tools to support and improve services becomes highly demanded.
The University of Michigan Medical School is developing a competency-based curriculum that is driving the organization toward change. The Learning Informatics team that is part of Medical School Information Services is pulling together data from disparate systems that can be facilitated by the use of standards. They are leading the charge toward a well-integrated portfolio system.
Several factors contribute to the trend toward earlier clinical learning in undergraduate medical
education programs. This excerpt outlines factors driving significant change at a large Caribbean medical school which prepares students for practice in the United States-consistent with adult learning theory.
Dear friends its ppt belongs to psychiatric nursing i have done research regarding “ A study to evaluate the effectiveness of structured teaching program on knowledge regarding clinical skills in psychiatric nursing assessment among third year BSc nursing students at selected Nursing colleges of Jaipur.”
Geoff Norman, PhD
McMaster University
Presented at Perspectives in Competency Assessment
A Symposium by Touchstone Institute
www.touchstoneinstitute.ca
As the healthcare industry becomes more competitive, the demand for groundbreaking resources and tools to support and improve services becomes highly demanded.
Chnaging trends in Medical Education Oct 23.pptxRajan Duda
Teaching : Latest concepts in medical education
how best to optimize medical education
new trends in undergraduate and post graduate teaching in pediatrics
Are you committed to preventing unintended pregnancies among your school-based health center clients? Learn how school-based health centers in Oakland, CA implemented an effective approach to provider training for Long-Acting Reversible Contraceptives (LARCs). Workshop participants will learn about a process for provider skill building and increased comfort with LARCs. Health care providers and SBHC administrators will be able to identify strategies for implementing LARCs and LARC education at their SBHCs.
Throughput, cost and standardization: Does a serious game in healthcare work ...INSPIRE_Network
Throughput, cost and standardization: Does a serious game in healthcare work for teaching parents and clinician neuro assessment in Children with VP Shunt?
The International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) is a collaborative research network with investigators and educators from around the globe (http://www.inspiresim.com/) focusing on improving the lives of children using rigorous simulation-based research. This is the 3rd annual report that highlights the work within INSPIRE and by INSPIRE members.
INSPIRE @ IMSH 2016 in San Diego, CA was a hit for newcomers and prior attendees. Learn about the growth and progress of INSPIRE, simulation-based research, and new projects down the pipeline.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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2. Format
• Discuss project for 30 minutes
– Presenter stays at table
– Consultants rotate tables x 3
• Transition for 5 minutes
– Summarize state of consultation
– Presenter highlights key questions
3. 1. Chang- Script Concordance LP
2. Barry- BVM training
3. Kummett- Neonatal Skills
4. Mehta- Health literacy
5. Sherzer- Epi pen community
6. Levy- PALS tool validation
7. Maa- PALS performance tool
8. Maa- Hybrid-simulator
9. Meyer- Donation after Cardiac Death
10.Overly- Structured-patient encounter
5. Background
• Assessing Clinical Decision Making Skills
(CDMS) is difficult but necessary
• Script Concordance Testing (SCT)
– Has been validated as a method of assessing
trainees in many subspecialties
– Is currently being studied for infant lumbar punctures
(LP) to assess infant LP management
6. Background
• Text-based questions and team-based simulations may
not isolate individual’s CDMS
– Multimedia questions have lower scores than text-
based
Holtzman KZ, Swanson DB, Ouyang W, Hussie K, Allbee K. Use of Multimedia on the Step 1 and Step 2 Clinical Knowledge
Components of USMLE: A Controlled Trial of the Impact on Item Characteristics. Acad Med 2009; 84(10s): s90-s93
7. SCT
A 1-month-old male has a rectal temperature of
40.3 Celsius. There is mild rhinorrhea.
Does the following change your likelihood to
perform an LP: He is RSV+
-2 Much less likely
-1 Less likely
0 No change
+1 More likely
+2 Much more likely
8. PICO Question
• Population
– In pediatric residents, subspecialty fellows, and
attendings
• Intervention
– Does the use of Multimedia depictions of clinical
scenarios
• Comparison
– Compared with text-based depictions
• Outcome
– Affect SCT scores negatively?
9. Approach
• Create 2 versions of every SCT question:
– text-based case scenario
– multimedia-based (screen-based simulation)
case scenario
Q1. An alert 2-week-old infant is RSV+
and has a respiratory rate of 70 and
subcostal retractions
Q1. 2-week-old RSV+
10. Approach
• Optimize a 15-question SCT set to test 2 CDMS:
– Infant Lumbar Puncture
– Infant/Pediatric/Adolescent Intubation
• Randomize multimedia vs. text-based &
administer questions
• Evaluate score differences against training
status, (sub)specialty status, and self-reported
experience
11. 3 Questions
• How do we create the optimal multimedia
element – VR vs. true patients?
• Should randomization be per question or per
student?
• Are there more optimal methods of validating the
SCT question set?
Todd Chang, MD
dr.toddchang@gmail.com
12. Improving the Effectiveness of Bag and
Mask Ventilation Training in an
Academic Center NICU
Jim Barry
Medical Director, University of
Colorado Hospital NICU
13. Background
• BMV is a simple skill that is simply done wrong
frequently
• Simulation and Learning (and not forgetting)
Theory
– Retrieval based testing/learning improves short and
long term memory- THE WAY WE TEST MATTERS
– Partial task trainers and deliberate practice can
improve skill attainment in trainees (LP)
• Knowledge Gaps
– Can the combination of deliberate practice and
retrieval testing improve skill acquisition and retention
for BMV ?
14. PICO Question
• Population
– Primary- 2011- 2012 Pediatric Residents from Univ Co
– Secondary- other NICU staff: RNs, RTs, NNPs, MDs
• Intervention
– Formal training: deliberate practice, knowledge (retrieval vs
recognition), spacing
• Comparison
– Subjects in 3 groups varied by testing: Recognition, Retrieval,
Retrieval+Practice
• Outcome
– Changes in BMV Knowledge and Skill at 1 month and 6-12
months later
15. Approach
• Randomized controlled study
1. Randomize teams monthly into 1 of 3 study groups
2. Knowledge evaluation with pre/post-test (Retrieval or
Recognition) beginning/end of month and 6-12 months
3. Pretest, questionnaire to determine BMV experience and
career choice
4. Evaluate BMV skill and equipment knowledge with video-
recorded session using apneic neonatal partial task
trainer
5. BMV scoring tool and mastery learning applied
6. Pre/PostData collected: Knowledge, BMV skill
16. 3 Questions
• What would be the best format/time to evaluate
long(er) term retention? 3,6,9 months
• Currently at single center, could this be
replicated at other sites?
• How could this education/intervention be applied
to patient outcomes?
18. Background
• 60 second delay of effective ventilation in adults
after cardiopulmonary arrest decreased survival
by 9%.
• Bag mask ventilation training
– Improves skills immediately post training
– Requires significant exposure to achieve proficiency
– Skills decay rapidly with time (6-7 months)
• Knowledge gaps
– Does early establishment of ventilation improve
pediatric outcomes?
– What is the training interval to maintain proficiency?
19. PICO Question
• Population
– Pediatric and Family Practice residents at a tertiary medical
center
• Intervention
– will receive bag mask ventilation training every two months
• Comparison
– compared to conventional training (NRP/PALS at orientation)
• Outcome
– Improved procedural skills competency six months after initial
training
20. Approach
• Randomized controlled study
1. Provide initial training to all residents to achieve
baseline proficiency
2. Randomize residents into one of two study groups
3. Re-training at two month intervals to study group
4. Respiratory arrest scenario at 6 months (videotaped
with objective mannequin feedback)
5. Feedback and debriefing
21. 3 Questions
• What are the technical requirements of the
simulator for this study?
– Taking the test to the tester/simulator portability
– Obtaining objective data
• What issues do we need to consider when
standardizing the research across study sites?
– Initial training, testing, re-training, re-testing
• What are clinically significant differences in
performance?
23. Background
• Poor health literacy (HL) is associated with adverse
patient outcomes, poor patient satisfaction and
possible litigation.
• This may be related, in part, to communication
mismatches with providers and the healthcare system.
• Thus we seek to improve upon this gap by developing a
multi-modal, interprofessional communication training
method that can be utilized to enhance providers’
communication skills.
24. P.I.C.O
1. Participants will be health care students (medical, nursing,
Pharmacy and allied health care providers).
2. Online lecture focusing on HL and communication skills,
interaction with the VP software, learning strategies for clear
and sensitive ways to communicate with parents, and
Interprofessional team training simulation workshop where
subjects will communicate with a Standardized Patient (SP)
acting as a parent .
3. Pre and post intervention comparison of appropriate HL
communication between control and intervention groups.
4. Improvement in low health Literacy sensitive communication
between pre and post intervention using standardized parent.
25. Approach
Development
of Multi
stakeholder
case scenario
Interdisciplin Health literacy
ary team communicatio Online lecture
training
n curriculum
Virtual parent
software
26. Questions
1. What is the best way to set up a
interdisciplinary team training
2. What are practical outcome
3. What assessment tools will be helpful.
27. ALERT Presentation:
Using an Epipen educational
module to improve Food
Anaphylaxis Recognition and
Response
D.J. Scherzer
28. Background
• Incorrect outpatient epinephrine-injector usage
leads to preventable mortality among food allergy
children in the U.S.
– The devices are prescribed with inadequate teaching and
follow-up.
• Succinct educational modules improve competence
when directed towards specific goals (eg. AED).
• Competency Gaps
– Incomplete knowledge of indications
– Complexity of a multi-step process
– Lack of confidence, concern for treatment risks
29. PICO Question
• Population
– Parents, patients, school personnel, healthcare staff
– Prescribers
• Intervention
– Succinct educational module comprised of MCQ, practicum and
video
• Comparison
– Historical control – before and after
• Outcome
– Improve ability to know when and how to use epinephrine
injector and to be prepared to actually do it.
– Improve ability to teach others to do above.
30. Approach
• Prospective longitudinal study; learner outcomes
• Subjects serve as their own controls.
• Pre- assessment survey of subjects:
• Experience and confidence questions
• Knowledge and case management questions
• 1:1 practical performance assessment.
• Post- assessment:
• Review practicum and repeat until success with individuals
• Group presentation of edu-video c Q&A.
• Immediate resurvey of individuals with confidence and case
management questions
• Follow-up with confidence question and case
management questions in 3-6 months. Mock scenario on
site?
31. 3 Questions
• Do the case management questions and
practicum get at the active ingredients of food
anaphylaxis competency?
• How can we make the practicum feel more
realistic?
• Can we roll this out in a way that is easier
logistically? More eLearning? Mock scenarios
on site rather than 1:1 practicum.
32. Development and validation of a generalizable tool to
assess pediatric resuscitations
Yasaman Shayan and Arielle Levy
Pediatric Emergency Department
Sainte-Justine Hospital, Montreal, Canada
33. Background
• Resuscitation of a pediatric patient presents many challenges
• Competency in pediatric resuscitation skills gained by:
– Formal training (PALS) Rapid decline in skills
– Experience Rarity of pediatric cardiopulmonary arrest
• These points highlight the importance of simulation as an essential
teaching tool
– Essential to have a valid and reliable assessment tool
34. Objectives
• To develop a short, objective, easy to use and
generalizable scoring tool to assess trainees
during simulated pediatric resuscitations
scenarios
– To determine its validity
– To analyse its inter-rater reliability
35. Tool development
Content Validity
Identification
AHA 2010 of specific Review of
objective scoring items
PALS elements for by subject-
curriculum each domain matter experts
(C-A-B)
36. Tool validation
• Convenience sample of residents rotating through ped ED
First week During the rotation Last week
5 video-taped 12-16 ER shifts 5 video-taped
simulated + simulated
resuscitation Simulation-based resuscitation
scenarios courses scenarios
- Asystole/PEA
Scored - Arrhythmias Scored
- Status epilepticus/ asthmaticus
- Shock
37. Discussion
• How to assure content validity
• Type of scoring system
– Checklist vs. GRS
• Inclusion of crisis resource management skills
– Communication, leadership…
38. ALERT presentation:
Code team leader assessment tool
and
correlation of event leader performance with
team performance
Tensing Maa, Ada Lin, Samantha Gee, Aaron Calhoun
39. Background
• Pediatric code blue events are rare = poor
experiential learning for trainees
• Code team leader simulation training may be
helpful.
• Knowledge gap/needs
– Generalizable scoring tool to assess code team
leader competency
– Does code leader performance correlate with
team performance and event outcome?
40. PICO question
• Population
1. Pediatric healthcare providers (APNs) or trainees
(residents, PICU, NICU, EM and anesthesia fellows)
who are expected to act as code team leaders.
2. Pediatric healthcare providers who are potential code
team members.
• Intervention
– Evaluation of event leaders’ and code teams’
performance during standardized simulated pediatric
codes using our scoring tools.
• Comparison
– Performance of event leader with that of the whole
team
• Outcome
– Assess interrater reliability and validity of team leader
scoring tool
– Correlate event leader performance with team
performance and event outcome
41. Approach
Prospective observational pilot study
1. Fine tune content and determine initial psychometric
benchmarks of event leader scoring tool
2. Perform simulations and collect data on event leaders
and team performance
– Scenarios will be standardized in terms of outcome to
assure reproducibility of results
– Separate raters will be used for the teamwork and
leadership tools to minimize potential biases
– Rating will be done based on live and video taped
performance
– Score results will be statistically compared with each other
as well as with the final outcomes of the session to look for
correlations
42. Questions
1. Suggestions on the content (domains or
behavioral anchors) of the team leader rating
tool?
2. Can you accurately separate team leader
performance from team performance when
you have other “experts” (ex. more
experienced fellows) on the team?
3. What about bias from inexperience with or
anxiety from simulation?
43. Hybrid-learning: a model for a comprehensive
curriculum incorporating online self-directed
modules and augmented by high fidelity
patient simulations
Samantha Gee, Ada Lin, and Tensing Maa
Nationwide Children’s Hospital, The Ohio State University
Section of Pediatric Critical Care
44. Background
• “Traditional pathway”
– Didactic learning + patient exposure
• Management of pediatric acute and chronic liver failure,
including the liver transplant patient, is complex:
– Acutely decompensated
– Multiorgan system dysfunction
– Life-threatening sequelae
• Knowledge gap:
– Firsthand experience is limited to liver transplant
centers
– High acuity level requires accurate decision-making
to successfully manage this rare patient population
– Competency and comfort level of fellows trained by
the traditional pathway may not be optimized
45. PICO Question
Population: Pediatric ICU and GI fellow trainees
Intervention: Comprehensive liver failure and
transplantation hybrid-learning curriculum:
◦ Core reading materials for background preparation
◦ Online self-learning modules in didactic form
◦ High fidelity simulation with immediate debriefing
sessions for learning recap and feedback
Comparison: Trainees taught by the traditional pathway
Outcome: Improved mastery of learning and ease of
transfer to practice for those who participate in the hybrid
curriculum as compared to traditional
46. Approach
Design: Prospective pilot study involving ICU and GI fellows
Revolving curriculum: 6 modules over 18 months
Online self-directed learning, including core readings and quizzes
A series of interdisciplinary, comprehensive simulations
Deliberate practice: Each scenario involves a patient in an acute situation,
providing the fellow an opportunity to:
Practice critical-thinking skills
Manage the patient accurately in a safe setting
Tie-in core concepts attained from online learning
Evaluation:
Measure knowledge base pre-/post-participation in the hybrid-learning
curriculum
Systematically scored based on the six core competencies outlined by the
ABP
47. Questions
How to detect a true effect?
Number of fellows
Account for test-taking ability
Is there a more accurate way to assess
performance?
Knowledge base
Clinical acumen
Comfort level
48. ALERT Presentation:
Donation after Cardiac Death (DCD): Improving
consent to donate, compliance with institutional
protocols and organ procurement
Elaine C. Meyer, Ph.D., R.N.
Kristen Nelson, M.D.
Elizabeth Hunt, M.D., Ph.D.
49. Background
• Patients awaiting organ transplantation far exceed
availability of healthy organs
• The Institute of Medicine has advocated for
Donation after Cardiac Death (DCD) protocols in
hospitals to expand the potential donor pool
• Staff knowledge and experience with DCD is limited
and may negatively impact the implementation of
protocols
• A simulation-based educational film is available
(focusing on ethics & family-staff conversations)
50. PICO Question
• Population
– Healthcare and organ procurement providers
• Intervention
– DCD educational film
• Comparison
– Each participating site will be compared to itself pre and post
educational intervention; aggregate comparison across
educational conditions
• Outcome
– Knowledge, attitudes, sense of preparation, confidence,
communicative ability, compliance with established DCD
protocols, use & evaluation of film, frequency of family-OPO staff
meetings to initiate and discuss organ donation, frequency of
consent to donate, frequency of organ procurement
51. Approach
• Survey to all INSPIRE sites to determine
absence/presence of DCD, current educational approach
and educational needs
• Among those with DCD, pre-post comparison after
educational intervention with educational arms (film to
hospital educators, film to OPO educators, partnership
and film to hospital & OPO)
• Among those without DCD, pre-post comparison
between film and no film
• Follow natural use, acceptability and efficacy of film as
per outcome measures
52. 3 Questions
• How many INSPIRE sites have DCD protocols? If no,
what is the likelihood that they would be willing or
able to institute DCD protocols in the near future?
• Outcomes such as frequency of family-OPO
meetings, consent to donate, and organ
procurement require partnership with regional
OPOs. How realistic is this?
• What aspect(s) of this proposal would be possible as
part of INSPIRE simulation centers and is external
funding needed?
53. The Structured Patient Encounter:
Improving the pediatric
patient/family experience using a
structure approach to clinical
interactions
Frank Overly, Linda Brown, Adam
Rojek, Linda Dykstra, Lynn Sweeney
54. Background
• Excellence in healthcare is no longer defined merely by the quality
of clinical care offered, but also by the superiority of service provided
to those who seek care.
• With increasing competition between health care systems,
administrators have increased their focus on service and patient
satisfaction as a barometer of how successful the institution is at
providing a high quality patient experience.
• Low satisfaction scores are significantly associated with malpractice
activity (United States).
• New 5 Step Structured Patient Encounter (SPE)
– Incorporated into a larger communication initiative at Rhode
Island Hospital designed to optimize the patient experience
• Knowledge Gaps
– despite a plethora of communication improvement initiatives,
there remains a paucity of published data objectively evaluating
these programs/interventions
55. PICO Question
• Population
– Residents caring for pediatric patients in the outpatient setting
• Intervention
– Exposure to, or training in the Structured Patient Encounter (SPE)
• Comparison
– compare baseline performance with performance after exposure
to, or training in the Structured Patient Encounter (SPE)
• Outcomes
– Families’ perception of the experience with the care provider
– Families’ perception of the overall clinical experience
56. Approach
• Randomized controlled study
1. Randomize groups into one of 4 study arms
1. Routine education, no exposure to SPE
2. Routine education and SPE cognitive aid
3. Routine education Sim enhanced education on SPE
4. Routine education Sim education and cognitive aid for SPE
2. Baseline scores for all individuals (parents’/patient’s
feedback from clinical encounters, sim observation score)
3. Intervention (cognitive aid, sim, sim + cognitive aid)
4. Follow up scores for all individuals (parents’/patient’s
feedback from clinical encounters, sim observation score)
57. Study Design
Standardized Patient Encounter(SPE)
Baseline measurement of individuals’ performances
1)Actual family/patient feedback
2)SPE Checklist evaluation in simulated case
Group 1 Group 2 Group 3 Group 4
Given sim Given sim
Routine Given SPE enhanced SPE enhanced SPE
Education cognitive aid training no training and
cognitive aid cognitive aid
Follow-up measurement of individuals’ performances
1)Actual family/patient feedback
2)Checklist evaluation in simulated case
58. 3 Questions
• Is it necessary to gather information in the
simulated setting?
• What confounding issues might we encounter?
How to overcome them? (ED issues: waiting
times, nursing issues, residents will have normal
progression of skills, acuity level of patient)
• How many encounters would you need to record
for each individual?
Editor's Notes
-Incomplete knowledge of indications-Complexity of a multi-step process-Lack of confidence, concern for treatment risksKnowledge of indications incomplete or misunderstoodPsychomotor sequence more difficult than anticipatedInadequate preparation for stress-induced hesitancy and discombobulation
Curriculum will be divided into 6 modules over an 18 month period, allowing for entire curriculum to be repeated x 1 during a 3 year training period.Deliberate practice: emphasize that simulation scenarios will be multidisciplinary (CC and GI) and comprehensive including procedures (endoscopy, sclerotherapy, biopsy with pathology interpretation…); including pediatric acute liver failure and acute on chronic liver failure-using a standardized set of questions