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The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Improving Efficiencies in Simulation Education,

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Presentation on theme: "The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Improving Efficiencies in Simulation Education,"— Presentation transcript:

1 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Improving Efficiencies in Simulation Education, Blended Learning in Basic and Advanced Cardiac Life Support Training Geoffrey T. Miller Associate Director, Research and Curriculum Development Division of Prehospital and Emergency Healthcare Gordon Center for Research in Medical Education University of Miami Miller School of Medicine

2 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Session aims In the context of BLS and ACLS training: ◦ Review the fundamental benefits of simulation ◦ Discuss various examples of simulation ◦ Discuss key questions surrounding blended learning ◦ Explore practical applications of simulation ◦ Participate in simulation activities for BLS and ACLS training (Part 2)

3 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training What’s new in medical simulation…

4 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training What is medical simulation? “In general, medical simulations aim to imitate real patients, anatomic regions, or clinical tasks, or to mirror real-life situations in which medical services are rendered.” “simulation refers broadly to any device or set of conditions… that attempts to present patient problems authentically, whereas a simulator, more narrowly defined, is a simulation device.” Issenberg, SB, Scalese, RJ. Simulation in Healthcare Education. Perspectives in Biology and Medicine. Vol. 51, No. 1:

5 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Why use simulation? Benefits of medical simulation ◦ Safe environment, mistake forgiving ◦ Trainee focused vs. patient focused ◦ Controlled, structured, proactive clinical exposure ◦ Reproducible, standardized, objective ◦ Debriefing as a norm in everyday practice ◦ public trust in profession ◦ Deliberate and repetitive practice

6 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Why use simulation? Assessment of professional competence ◦ Patient care ◦ Medical knowledge ◦ Practice-based learning & improvement ◦ Communication skills ◦ Professionalism ◦ Systems-based practice

7 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Why use simulation? What does the science say… ◦ Overwhelmingly positive and favors use of simulation Examples: 2. A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills – Wayne DB, et. al. Academic Medicine, “ACLS skill improved significantly… cohort followed for 14 months and the skills did not decay” 3. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case- control study – Wayne DB, et. al. Chest, “Simulation-based educational program significantly improved the quality of care during actual events” 1.Written evaluation is not a predictor for skills performance in Advanced Cardiovascular Life Support course – Rodgers DL, et. al. Resuscitation 2010 “The ACLS written evaluation was not a predictor of participant skills in managing a simulated cardiac arrest event”

8 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Food for thought… and discussion "Excellence is an art won by training and habituation. We are what we repeatedly do. Excellence, then, is not an act but a habit." Aristotle

9 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Another interesting thought… How could learning style affect awareness, pattern recognition and “habits”?

10 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training A quick case study

11 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Inattentional blindness Inattentional blindness is the phenomenon of not being able to perceive things that are in plain sight ◦ Can result from:  no internal frame of reference, or  mental focus or attention which cause mental distractions

12 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training ‘Right conditions’ for learning in simulation Feedback should be provided during the learning experience Learners should engage in repetitive practice Simulation should be integrated into the overall curriculum Learners should practice with increasing levels of difficulty Multiple learning strategies should be employed Simulations should represent clinical variation The simulation environment should be controlled Simulations should foster individualized learning Outcomes must be clearly defined and measured The simulator should be valid as a representation of a human or situation Issenberg SB,McGaghie WC, Petrusa ER, Gordon D, Scalese RJ (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher 27(1): 10–28.

13 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Fidelity The degree of realism Types: ◦ Environmental ◦ Physical ◦ Technical ◦ Psychological Key Question: Is the simulation activity “realistic” enough to accomplish the desired outcomes.

14 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Fidelity and technology Low fidelity High technology Low fidelity High technology Low fidelity Low technology Low fidelity Low technology High fidelity High technology High fidelity High technology High fidelity Low technology High fidelity Low technology Fidelity Technology

15 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training “Realism versus relevance” Key Question: ◦ Which concept is more important in choosing and developing the learning activity? Realism Relevance

16 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Fidelity (realism) Adapted from: Alessi S. Design of Instructional Simulations. J Computer-based Instruction Realism and relevance Prior Learning Relevance Novice Experienced Expert Most cost-effective Best learning LowHighNone High

17 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Learning ladder BEME: multiple learning strategies and clinical variation

18 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training The ultimate goal?

19 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Where does simulation fit?

20 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training The ‘big picture” Attitude Knowledge Skill

21 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Miller’s Pyramid of Competence Knows Knows how Shows Does George E. Miller MD. The Assessment of Clinical Skills/Competence/Performance. Academic Medicine Vol. 65 No. 9: S63-67.

22 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Knows Knows how Shows Does “Knows” Assessment opportunities: Multiple-choice question Essay / Short answer Oral interview Learning Opportunities: Reading / Independent study Lecture Computer-based Colleagues / Peers

23 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Knows Knows how Shows Does Clinical Context Based Tests Multiple-choice question Essay / Short answer Oral interview “Knows how” Learning Opportunity Problem-based Ex. Tabletop exercises Direct observation Mentors

24 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Knows Knows how Shows Does “Shows” Performance Assessment Objective Structured Clinical Examination (OSCE) Standardized Patient-based Learning Opportunity Skill-based Exercises Repetitive practice Small group Role playing

25 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Knows Knows how Shows Does “Does” Performance Assessment Undercover / Stealth standardized patient- based Video Learning Opportunity Experience

26 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Key questions regarding blended learning models

27 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Who are our Learners? Key Questions: ◦ Who are our learners? ◦ Why do they Learn? ◦ What are their Motivations?

28 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Blended learning Key Questions: ◦ What is “blended learning? ◦ Where does it happen? ◦ What does this mean to me as a healthcare educator?

29 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Simulation methods

30 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Simulation technologies Low-tech simulation modalities: ◦ Patient management problems ◦ 3D Models ◦ Basic plastic manikin and simple skills trainers ◦ Simulated or standardized patients High-tech simulation modalities: ◦ Screen-based simulations ◦ Intelligent gaming ◦ Realistic high-tech interactive patient simulators

31 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training 3D models basic plastic manikins Heart and lung models

32 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Basic plastic manikins BLS manikins (Rescusi Anne) Simple simulators for teaching basic interventions and/or physical examination skills

33 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Standardized Patients Represent ultimate alternative to live patients ◦ Standardized role play of psychological and physiological aspects of patients Student examines patient Facilitator & peers evaluate student performance Facilitator & SP provide feedback & training

34 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Screen-based simulations Software driven systems that include multimedia and VR components. ◦ Ranges from simple non- interactive to fully interactive teaching programs. ◦ Enhance cognitive knowledge, clinical reasoning and decision making.

35 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Intelligent/Serious gaming

36 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Realistic high-tech interactive patient simulators Realistic full-sized manikin, computer, and interface devices that operate manikin physiology and drive monitors ◦ Can be used in a variety of settings (low to high fidelity)

37 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training “Testing force feedback virtual reality products for dogs”

38 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Learning and assessment opportunities

39 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Large group instructor led Reach many learners at once ◦ Additional equipment: cameras/projectors/AV Instructor needs practice Audience response system

40 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Small group instructor led Focused teaching Ability to assess individuals’ skills Hands-on, interactive Interest up to 2 hrs

41 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Individual self-directed learning Important for skills acquisition (deliberate practice) Ability to work at own pace Responsible for own learning

42 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Independent small group learning Less “hands-on” time Opportunity to exchange ideas & problem solve Practice team work Peer to peer

43 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Assessments Should include assessment of: ◦ Knowledge – not only factual recall, but comprehension, application, analysis, synthesis and evaluation of cognitive knowledge ◦ Skills – communication, physical exam, basic life support skills, airway management, IV therapy, defibrillation, time management, problem-solving ◦ Attitudes – behavior, teamwork, delivering “bad news”

44 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Assessment Assessment should be educational and formative ◦ Learning through testing ◦ Feedback to build knowledge and skill  Reflection - error correction – refinement “Assessment drives learning”

45 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training A case study in developing a blended learning curriculum

46 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Blended learning – model program Emergency Response to Terrorism Training ◦ Multiple healthcare professionals ◦ Many learner levels ◦ Methods of delivery  Lecture – case based  Psychomotor skill exercises ◦ Small group ◦ Individual / independent learner  Large group exercises  Integration exercises – SPE-OSCEs

47 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Templates and blueprints Key features: ◦ Maps out:  session/course objectives  learning opportunities and objects  assessment opportunities and objects  Provides instructor support materials and objects ◦ Allows assessment of omissions & redundancies ◦ Provides a common understanding

48 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training UM Course Design Day 1 ◦ Didactic  Response Concepts  Operations  PPE  Decontamination  ICS / IMS ◦ Psychomotor  PPE  Medical Management  Ambulatory DECON  Incapacitated DECON Day 2 ◦Didactic  Chemical Agents  Biological Agents  Radiological and Explosive Agents ◦Large Group Exercises  Triage – computer-based  Tabletop ◦Integration Exercises  OSCEs

49 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Case –Based Lecture Open-air concert 18,000 people Temp: 84° F Wind: ENE 12 knots Chemical weapon from a boat on shoreline

50 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Plume throughout concert area Initially mistaken as smoke machine (part of show) Hundreds with symptoms within minutes Concert Area Wind Plume Case –Based Lecture

51 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Individual Self-learning

52 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Small group instructor teaching

53 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Large group exercise (student directed)

54 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Web/eLearning integration

55 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Web/eLearning integration

56 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Assessment and feedback

57 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training The final result Course reduced to 8 hours, focused on hands on simulation based activities Enduring materials allow for on-time, on-demand access by learners for maintenance of knowledge and skill (to a lesser degree) Faculty time reduced and opportunity for training increased Student assessment scores increased

58 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Summary Simulation offers a wide array of learning and assessment opportunities for BLS and ACLS training Variation of learning methods and clinical difficulty is key to a successful learning ladder The greatest effect on sustained learning is developed through the application of a blended learning environment

59 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training Questions and discussion

60 The Gordon Center for Research in Medical Education Effective Uses of Simulation in BLS & ACLS Training For additional information: Geoffrey T. Miller


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