Implementation of Full Patient Simulation Training in Surgical Residency Gladys L. Fernandez, MD Baystate Medical Center Tufts University School of Medicine Baystate Simulation Center, ACS-accredited Level I Education Institute 2010 APDS Annual Meeting, San Antonio, Texas

Disclosure Consultant for Medical Education Technologies, Inc.

Objectives Review course of Patient Simulation implementation in our surgical residency Review course of Patient Simulation implementation in our surgical residency Discuss aims and methods of Patient Simulation integration into curriculum Discuss aims and methods of Patient Simulation integration into curriculum Describe our program experiences Describe our program experiences Explore future implementation plans Explore future implementation plans

Surgical Patient Simulation Clinical management performed in a high fidelity simulation environment using a manikin simulator Clinical management performed in a high fidelity simulation environment using a manikin simulator Specifically modeled experiential Specifically modeled experiential learning learning Knowledge Knowledge Skills Skills Behaviors Behaviors

Evolution of Surgical Patient Simulation at BMC Phase III Team Training 1 st PS use ACS EI accreditation 1 st Boot Camp Center expansion Curriculum integration Curriculum development QA/HCQ initiatives Trauma Orientation

Curriculum Design Needs assessment based Needs assessment based Critical management problems Critical management problems –Objectives-based –Patient management skills –Clinical decision-making –Learner-specific needs –Assessment around core competencies

Curriculum Content Introduction / orientation Introduction / orientation Modeling Best Practice Modeling Best Practice Global initiatives Global initiatives Institutional M & M Institutional M & M Institutional QA / HCQ Institutional QA / HCQ Remediation Remediation

Preparation Teaching Team Preparation Teaching Team Preparation –Facilitator –Embedded educator Scene preparation Scene preparation Rehearsal Rehearsal –“Flow” –Educational cues

Simulated Clinical Experiences One hour sessions One hour sessions –Shock states –Trauma –Critical Care –Preoperative processes –Postoperative complications Multi-item assessment Multi-item assessment

Debriefing Structured Structured Objectives-based Objectives-based Assessment Assessment Learner-driven Learner-driven Self-reflective Self-reflective Positives Positives Challenges Challenges Video playback Video playback Take-home messages Take-home messages Teaching Team Debrief Teaching Team Debrief

Results July 2006—June 2009 July 2006—June ± 1.4 sessions per academic year 4.5 ± 1.4 sessions per academic year 39 PGY 1, 2, 3 residents 39 PGY 1, 2, 3 residents –10 followed PGY 1  2 –4 followed PGY 1  2  3

Results

Results 81 ± 5 vs 86 ± 4 (p<0.01 ) 82 ± 4 vs 86 ± 2 vs 91 ± 1 (p<0.005)

Results 39 residents 8 > 2 SD below mean 5 = clinical

Conclusions Patient simulation training was successfully implemented in our surgical residency. Patient simulation training was successfully implemented in our surgical residency. Assessment instrument can detect predictable improvements across years Assessment instrument can detect predictable improvements across years Challenges: Challenges: –Competition with other educational activities –Fidelity and realism Further work required to determine effects on resident clinical competency Further work required to determine effects on resident clinical competency

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