1. Using simulation to assess and teach patient safety in resident orientation
May 2017
Kathy Zoppi PhD MPH
Jafreen Sadeque MD
Stephanie Nader LCSW
Ann Cunningham DO

2. Disclosures
Speakers have no commercial disclosures or conflicts to report.

3. Objectives At the end of this presentation, participants will:
Understand methods of using simulation to create scenarios for patient safety and quality
Identify approaches for assessment of new intern skills
Identify possible types of cross program scenarios
Identify methods for group observation, team debriefing

4. Background
ACGME requires assessment of baseline skills of each new trainee
New residents may not come with equal confidence for urgent situations
Cross program evaluation variable
Orientation provides short window for team building
Safety cannot wait until later in year
Previous years didactics about culture of safety did not “stick”
Faculty new to simulations
Our organization has multiple programs:
Family medicine: allopathic and osteopathic
Psychiatry
Podiatry
Proctology
Entering group N=20

5. Orientation simulation event
Half day in pre-July orientation
Developed by team from various programs
All incoming residents included, in groups
Rented simulation center at Marian Medical School
Observers from faculty who were asked to give feedback and debrief
Residents paired in each scenario, across programs
Residents who were not in scenario were observing
Standardized patients, family members, health care team members

6. Scenarios
Patient in ambulatory examination room, domestic violence scenario
Two SPs, one presents as patient, other as partner
Presentation of depression and anxiety
Hostile partner requires separation
Patient in ambulatory examination room, neurology examination
Possible stroke
Residents must order tests, do MSE and neuro exams
Admit to ICU
Talk with family

7. Scenarios Patient in hospital room, fallen onto floor and bleeding
Patient is bleeding onto floor (SP, fake blood) and is suspended awkwardly from bed
Fall precautions not enacted
Evaluate and ask for assistance prior to moving
Report incident (Midas)
Patient suffered medical error, disclosure and management needed
Patient has AML
SP and partner (wife)
Chemo given yesterday was excessive dosage
Disclosure, management with safety team

8. Patient Safety Orientation SIM June 14th
Day format
Patient Safety Orientation SIM June 14th
1:00 – 1:45  
Case: Domestic Violence - Exam 1
Observer: Laura and Angie
Debrief -3
Group 1
Resident Participating:
Case: Neuro Case-SIM LAB 1
Observer: Dr Cunningham
Debrief -1
Group 4
Residents Participating:  
Case: Disclosure of Medical Error- Exam 2
Observer: Stephanie
Debrief-4
Group 2
Case: Patient Fall - SIM LAB 2
Observer: Dr. Zoppi
Debrief- 2
Group 3
Residents Participating:
1:55 – 2:40
Case: Domestic Violence- Exam 1
Case: Neuro Case -SIM LAB 1
Case: Patient Fall- SIM LAB 2
2:50 – 3:35
Debrief -4
3:45 – 4:30
Observer: Dr Cunningham Debrief -1

9. Resident feedback Better than didactic Some anxiety about performance
Mostly interesting and fun
Got to know other residents

10. outcomes
Scholarly activity: ACGME case building session with other programs
Resident safety and quality awareness
Teamwork and “lived” reliance on others

11. References, resources
Graduate medical education that meets the nation’s health needs.
Eden, J; Berwick, D; Wilensky, G., Eds. Institute On Medicine, National Academy 2014

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