Educating Resuscitators: Seeking “Conscious Competence” Peter Brindley MD FRCPC FRCP-Edin Clinical Intensivist…and proud of it Other Stuff: Professor, CCM, UofA Adjunct Professor, Ethics Adjunct Professor, Anesthesia Division of Critical Care Medicine
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Peter Brindley MD FRCPC FRCP-EdinClinical Intensivist…and proud of it
Other Stuff: Professor, CCM, UofA
Adjunct Professor, EthicsAdjunct Professor, Anesthesia
Division ofCritical Care Medicine
Resuscitation circa 1780
“Sophisticated intensive care often becomes unnecessarily
expensive terminal care when the
pre-ICU system fails”
Peter Safar 1974
Resuscitation circa 1970s
Impending collapse
Vulnerable patient
Resuscitation circa 2014
ICU Competencies:ResuscitationDiagnosisDisease ManagementProceduresPerioperative-CareComfort and recoveryEnd of Life CarePaediatricsTransportSafetyProfessionalism
How do we learn/teach
DON’T KNOW & aren’t aware
Not always good learners
DON’T KNOWbut aware
Often GOOD LEARNERS
KNOW, but not always why
Not alwaysgood teachers
KNOW, but takes effort
Often GOOD TEACHERS
Noel Burch/Gordon Training Inst
“Every system produces results that it is designed to…”
“Accidental Curriculum”: what do we teach?
“Accidental Competence”: how do we teach?
“Accidental Curriculum”Aron D. 2002
Safety data not widely shared
We don’t know if what we teach works
Rely upon random presentation
Train, educate…or simulateAron D. Qual Saf Health Care 2002
Brindley Crit Care 2010
What competence is most important in patient safety?
A.Factual Knowledge?
B.Procedural dexterity?
C.Communication/team skills?
Errors in Medicine
Human factors > 80%
Communication/teamwork >70%
Gaba DM, et al. Crisis Management in Anesthesiology. 1994St Pierre et al. Crisis Management in Acute Care Settings.2008Sutcliffe KM. Acad Emerg Med 2004Khan FA et al. Anesthesia 2001Brindley Critical Care 2011; J Crit Care 2011Etc, Etc, Etc
“Meant is not said
Said is not heard
Heard is not understood
Understood is not done”
“Close the loop”
“Verbal dexterity”
“Avoid mitigating language”
“5 levels of advocacy”
“Repeat back method”
Rall and Gaba 2007Brindley and Reynolds J Crit Care 2011
SBAR
Skate to where the puck will be
“Never let an aircraft take you somewhere your brain didn’t already go”
“fly ahead of the plane”Ron Coley, US Marines
Failure to plan= plan to fail• Shared mental model• Give your team advanced permission • Airway: verbalize a plan A,B,C