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Clinical Simulation in Family Medicine to address the ACGME Core Competencies Beth Anne Fox, MD, MPH Glenda F. Stockwell, PhD Martin Eason, MD, JD.

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Presentation on theme: "Clinical Simulation in Family Medicine to address the ACGME Core Competencies Beth Anne Fox, MD, MPH Glenda F. Stockwell, PhD Martin Eason, MD, JD."— Presentation transcript:

1 Clinical Simulation in Family Medicine to address the ACGME Core Competencies Beth Anne Fox, MD, MPH Glenda F. Stockwell, PhD Martin Eason, MD, JD

2 “…budding and experienced musicians, actors, lawyers…clergy…would not consider engaging in these activities without some form of rehearsal….” Ingrid Philibert, editor ACGME Bulletin December 2005

3 Resident Morale  When a resident is in the clinic or wards, he or she knows that the care of the patient takes priority over education.  In the simulation lab, the resident knows that education is the only priority.

4 Objectives  Describe the utilization of clinical simulation to address the core competencies  Design a scenario for clinical simulation choosing participants, equipment, and personnel participating  List concerns regarding implementation or utilization of clinical simulation

5 Outline  Overview of Clinical Simulation (10 Min.)  Clinical Simulation in Family Medicine (10 Min.)  Small Group Participation (20 Min.)  Clinical Simulation (20 Min.)  Large Group Debriefing and Questions (20 Min.)

6 Overview of Clinical Simulation  History  Use in other residencies/professions  Anesthesiology  Surgery  OB/GYN  Pediatrics  Nursing  EMS  Pharmacy  Summary of capabilities

7  Public demands for increased safety  Medical errors  Need for improved training, evaluation, and assessment  High cost of medical training  Decreased training time  Less exposure to uncommon events  Decreased availability of instructors Impetus for Simulation

8 Simulation in Family Medicine  Team and Leadership Building  Communication  History and Physical Examinations  Data Collection and Interpretation  Clinical Decision-Making  Procedures  Resource Utilization  Emergency Training

9 Scenario Components –The Recipe  Learning Objectives  Simulation Summary/Overview  ‘Patient’ Details  Labs and Additional Tests  Simulation Parameters  Participants  Expected Actions by Participants  Personnel/Props  Diagnostic Studies Needed  References  Competencies Addressed  Scenario Organization and Participant Instructions  Debriefing Goals and Objectives

10 Patient Care

11 Medical Knowledge  Acute coronary syndrome  Pulmonary embolus  Sepsis  Anaphylaxis  Acute respiratory failure

12

13 Interpersonal and Communication Skills

14 Professionalism

15 Systems-based Practice

16 Simulation Sessions  Involves a scenario with discrete objectives  May include varying procedural, cognitive, and behavioral objectives  All sessions are recorded for debriefing

17 Simulation Design  Objectives/Competency  Identification of participants  Determination of assessment criteria  Scenario sequence development  Debriefing

18 Things to think about….  What scenarios are important to your institution?  Do you have critical incidents that need improvement?  Are there trainee issues?  Are there specific experiences that need improving?  Are there specific skills/procedures which need developing?

19  Cognitive  Decision making  Procedural competence  Crisis management  Role clarity  Asset management  Communication  Resources management  Professionalism What is the scenario objective?

20 Learning Objectives  What do you want the residents to come away with?  Writing them out helps you to create the scenario around them  Learning objectives also help determine the length and complexity of the scenario (materials, personnel, ancillary equipment)

21 Participants  Which residents/years?  Multiple levels of complexity?

22 Simulation Overview  Brief description of purpose of simulation and evidentiary basis for scenario  This serves as form of documentation for future users (like computer programming documentation)  History, examination, laboratory values for patient (make them realistic and consistent with your scenario)  This serves as the script if using a voice for the mannequin

23 Simulation Parameters  Parameters – initial settings for mannequin  VS, breath sounds, physical findings  Scenario Summary – the sequence of events that occur to the mannequin depending on the actions of the participants  Materials needed  Data sheets  Radiographs, ECG’s, etc…  Personnel needed  Ancillary equipment, props

24 Expected Resident Actions  Serves as a checklist for assessment  May be used as a summative evaluation tool  Can be formalized (e.g. checklist) or informal to be used as teaching points during debrief

25 Simulation Summary  Properly orient participants  Record if possible  Be ready for unpredictability  Be ready to improvise  Keep a lookout for hidden teaching moments

26 Orientation  Introduce role of instructors and purpose of exercise  Inform participants of role in exercise  Familiarize learners with equipment, environment, and limitations of simulation and ways to overcome limitations  Stress that this a learning exercise

27 Debriefing  Explain purpose of debriefing  Allow for reflective learning  Always make it a positive experience – there are no mistakes, just learning opportunities  Most important part of simulation  Allows residents to review actions, reflect, and receive and provide feedback  Validate participants’ concerns  Summarize learning points  Discuss reference sources

28  Congestive heart failure  Post-partum hemorrhage  Anaphylactic shock  Neonatal resuscitation  Diabetic ketoacidosis  Trauma Sample Scenarios

29 Conclusion  Residents find simulation to be fun  Simulation can be important in fulfilling competency requirements  Creative attending physicians may enjoy the simulation exercises as much as the residents

30 Some final thoughts…..  You are limited only by your imagination  Involve everyone  The primary goal is LEARNING  HAVE FUN!!!!

31 Martin Eason MD, JD Assistant Professor Director, Center for Experiential Learning Quillen College of Medicine East Tennessee State University eason@etsu.edu Beth A. Fox, MD, MPH Associate Professor foxba@etsu.edu Glenda Stockwell, PhD Assistant Professor stockwel@etsu.edu Department of Family Medicine Quillen College of Medicine East Tennessee State University


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