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The Capital Region of Denmark Forskning i færdighedstræning og simulation Nationalt lektor seminar 2011 Doris Østergaard, DIMS.

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Presentation on theme: "The Capital Region of Denmark Forskning i færdighedstræning og simulation Nationalt lektor seminar 2011 Doris Østergaard, DIMS."— Presentation transcript:

1 The Capital Region of Denmark Forskning i færdighedstræning og simulation Nationalt lektor seminar 2011 Doris Østergaard, DIMS

2 Capital Region of Denmark Oversigt Hvad er problemet? Hvilke initiativer Hvad er opgaven? Hvordan løser vi opgaven?

3 Capital Region of Denmark Patientsikkerhed Theoretical foundation Human factors perspective – human error (Reason J, 1990) Retrospektive studier har vist at fejl i kirurgi ofte skyldes utilstrækkelig kommunikation og samarbejde (1) Prospektive studier har vist at dårligt samarbejde øger risikoen for komplikationer (2) Teamtræning forbedrer kommunikation og samarbejde i operationsteamet (3) Gawande A et al. Analysis of errors reported by surgeons at three teaching hospitals. Surg 2003; 133: Mazzocco K et al. Surgical team behaviours and patient outcomes. Am J Surg 2009; 197: Spanager L, Rosenberg J, Østergaard D. Kirurger har også behov for ikke-tekniske færdigheder. Ugesk for Læger. I trykken.

4 Capital Region of Denmark Hvorfor færdigheds - eller simulationsbaseret træning? Træne i kontekst og dermed øge patientsikkerheden Omsætning af teori til praksis Patienten “skades” ikke Trygge omstændigheder Kompleksiteten kan kontrolleres Fejl er tilladt (gentagelse er mulig) Erfaring med sjældne, kritiske hændelser Team træning muligt Bygger på voksenlæringsprincipper (reflektion) Give mulighed for at træne – balancen mellem antal patienter og antal uddannelselsøgende

5 Capital Region of Denmark Challenges Research in the use of simulation technology is still in its infancy Provide assurances that simulation complement/substitute clinical experience Improve the quality and safety of patients Publications The state of medical educational research is comparable with medical research 20 years ago Identified priorities for medical educational research (Fincher et al. Acad Med 2010) Systematic reviews, task forces etc. (Bond et al Acad Med 2007, Gurusamy et al. Br J Surg 2008, Issenberg et al. Med Teacher 2005, Gaghie et al Med Edu 2010, Stefanidis Surg Clin North An 2010)

6 Capital Region of Denmark Few published journal articles on the effectiveness of high-fidelity simulations have been performed with enough quality and rigour to yield useful results. Only 5% of research publications in this field (31/670) meet or exceed the minimum quality standards.

7 Capital Region of Denmark / about BEME review 4 Features and uses of high-fidelity medical simulations that lead to effective learning: Barry Issenberg et al. sttarting a review sttarting a review shed reviews Providing feedback (47%) Repetitive practice (39%) Curriculum integration (25%) Range of difficulty Capture clinical variation Controlled environment Individualised learning Defined outcomes Simulator validity (3%)ctivitiesctivities

8 Capital Region of Denmark Deliberate Practice & Mastery Learning Skill Acquisition & Maintenance Transfer to Practice Educational & Professional Context Rigorous Outcome Measurement Non-technical Skills & Team Training Role of Instructor

9 Capital Region of Denmark 4 Tracks each with Educational and Evaluation Sub-groups Individual/Cognitive Expertise Group Expertise Technical Expertise Systems Expertise

10 Capital Region of Denmark Consensus Statements and Recommendations from the 14 th Ottawa Conference May ‘theme’ groups identified by organizing committee Criteria for a good assessment Technology-based assessment Performance assessment Assessment of professionalism Assessment for selection for healthcare professions and specialty training Research in assessment

11 Capital Region of Denmark 2010 Utstein Summit on Simulation-based Research Copenhagen, June simulation research experts from 8 countries

12 Capital Region of Denmark Participants Betsy Hunt Pamela Jeffries Nikki Maran Eldar Søreide Rachel Yudkowsky Peter Dieckmann Steven Howard Bill McGaghie Stephen Sollid Amitai Ziv Jacob Rosenberg Charlotte Ringsted Ian Curran James Gordon Roger Kneebone Paul Phrampus Jette L. Sørensen Barry Issenberg Jack Boulet Vicki LeBlanc Vinay Nadkarni Georges Savoldelli Dimitrios Stefanidis Doris Østergaard

13 Capital Region of Denmark Utstein type Meeting in Copenhagen June 2010 The goal of the meeting was to Identify the state of the art educational simulation based research Identify the future directions and headline topics and research questions Identify key methodological issues Provide recommendations of what to include in research papers Grant from the Laerdal Foundation

14 Capital Region of Denmark Future Research areas in Simulation Guidelines for reporting research on simulation 1. Instructional design Designing and planning Science of learning Systems considerations Faculty – the selection, the role and training programs 2. Outcome measures 3. Translational research Identification of researchable problems Framing general research questions Identify conceptual and theoretical frameworks

15 Capital Region of Denmark Translation to Clinical Setting

16 Capital Region of Denmark Which factors influence chances of resuscitation ? « All breakthrough, no follow through NIH Implementation Research Conference Jan 2009 The relatively weaker factors, where there are most improvements to make

17 Capital Region of Denmark “…meaningfully contributing to discussions of ‘Why did it work?’ or ‘Why didn’t it work’ can go a long way towards …prompting previously unthought ways of dealing with inherently difficult issues.”

18 Capital Region of Denmark “…Regehr’s article is a call to move away from research that is intended to prove the effectiveness of our educational endeavours and towards research that aims to understand the complexity inherent in those activities.” K. Eva

19 Capital Region of Denmark CLINICAL ENVIRONMENT SIMULATED ENVIRONMENT Identify learning need Simulator based practice Reapply skill Review Further practice as needed Patients Clinical supervision Tutor support Simulators Continue

20 Capital Region of Denmark January 20-22, 2011 – New Orleans Opening Remarks & Summit Overview

21 Capital Region of Denmark Simulation Research With / On Individual Learning System Developm. Human Factors Studies Outcome Studies Formative Assessment Research Reporting Summative Assessment Team Learning Human Factors Tools Focus Areas

22 Capital Region of Denmark Research – how to do it?

23 Capital Region of Denmark Bordage and Dawson, Med Education 2003 ”The research question is the keystone of the entire Enterprise, followed by the selection of an optimal study design and the control of possible confounding variables. No study is perfect. The researchers must constantly weigh advantages and disadvantages and select the most scientifically sound and feasible alternatives”

24 Capital Region of Denmark Good Research Question States an independent variable Learner’s level of training Number of practice hours Feedback present (or not) States an outcome Speed to complete simulation Errors in completing the simulation Errors in real clinical task McGaghie et al from IMSH 2008 States a direction of outcome “….will be greater than…..” “….will show a positive relationship “….a greater proportion of learners will….” States subjects in the study Medical students Post graduate/staff Teams

25 Capital Region of Denmark Research in medical education Research is about inquiry into general problems, phenomena, and mechanisms of learning, teaching, training, education Research in medical education is neither about solving concrete, local problems nor about providing universal solution Regehr ME 2010

26 Capital Region of Denmark Research approaches Medical education is a complex phenomenon operating in a complex system Multiple research approaches are warranted An overview model – “The cycle of research” Campbell et al, BMJ Framework for design and evaluation of complex interventions to improve health. Cook et al, Med Educ Description, justification and clarification: a framework for classifying the purposes of research in medical education. Bordage, Med Educ Conceptual frameworks to illuminate and magnify ++++ Ringsted 2010

27 Capital Region of Denmark The cycle of research Experimental studies Observational studies Justifying Implementing Translational studies PredictingModelling Exploratory studies Conceptual theoretical framework Ringsted 2010

28 Capital Region of Denmark JAMA. 2007;298(9): MERSQI – 10 item measure of medical education research study quality MERSQI scores independently associated with Previous publications by 1 st author Study funding ≥ $20,000 USD (↑ scores w/ ↑ funds)

29 Capital Region of Denmark The future - collaboration The role of the different societies Bringing multi professional researches together – establishing teams across disciplines and professions Multi-centre studies – increase power Funding


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