Implementation of Full Patient Simulation Training in Surgical Residency Gladys L. Fernandez, MD Baystate Medical Center Tufts University School of Medicine.

Implementation of Implementation of Full Patient Simulation Full Patient Simulation Training Training in Surgical Residencyin Surgical Residency

Gladys L. Fernandez, MDGladys L. Fernandez, MDBaystate Medical CenterBaystate Medical Center

Tufts University School of Medicine Tufts University School of Medicine

Baystate Simulation Center, ACS-accredited Level I Education Baystate Simulation Center, ACS-accredited Level I Education InstituteInstitute

2010 APDS Annual Meeting, San Antonio, Texas2010 APDS Annual Meeting, San Antonio, Texas

DisclosureDisclosure

Consultant for Medical Education Technologies, Consultant for Medical Education Technologies, Inc.Inc.

ObjectivesObjectives

Review course of Patient Simulation Review course of Patient Simulation implementation in our surgical implementation in our surgical residency residency

Discuss aims and methods of Patient Discuss aims and methods of Patient Simulation integration into Simulation integration into curriculumcurriculum

Describe our program experiencesDescribe our program experiences Explore future implementation plansExplore future implementation plans

Surgical Patient Surgical Patient SimulationSimulation

Clinical management performed in a high Clinical management performed in a high fidelity simulation environment using a fidelity simulation environment using a manikin simulatormanikin simulator

Specifically modeled experientialSpecifically modeled experiential

learninglearning KnowledgeKnowledge SkillsSkills BehaviorsBehaviors

Evolution of Surgical Patient Evolution of Surgical Patient Simulation at BMCSimulation at BMC

Phase III

2005 2007 2008 20092006

Team Training

1st PS use

ACS EI accreditation

1st Boot Camp

Center expansion

Curriculum integration

Curriculum development

QA/HCQ initiatives

Trauma Orientation

Curriculum DesignCurriculum Design

Needs assessment basedNeeds assessment based Critical management problemsCritical management problems

– Objectives-based Objectives-based – Patient management skillsPatient management skills– Clinical decision-makingClinical decision-making– Learner-specific needsLearner-specific needs– Assessment around core competenciesAssessment around core competencies

Curriculum ContentCurriculum Content

Introduction / orientationIntroduction / orientation Modeling Best PracticeModeling Best Practice Global initiativesGlobal initiatives Institutional M & M Institutional M & M Institutional QA / HCQ Institutional QA / HCQ RemediationRemediation

PreparationPreparation

Teaching Team PreparationTeaching Team Preparation– FacilitatorFacilitator– Embedded educatorEmbedded educator

Scene preparationScene preparation RehearsalRehearsal

– ““Flow”Flow”– Educational cuesEducational cues

Simulated Clinical Simulated Clinical ExperiencesExperiences

One hour sessionsOne hour sessions– Shock statesShock states– TraumaTrauma– Critical CareCritical Care– Preoperative processesPreoperative processes– Postoperative complicationsPostoperative complications

Multi-item assessmentMulti-item assessment

DebriefingDebriefing

StructuredStructured Objectives-basedObjectives-based AssessmentAssessment Learner-drivenLearner-driven Self-reflectiveSelf-reflective PositivesPositives ChallengesChallenges Video playbackVideo playback Take-home messagesTake-home messages Teaching Team DebriefTeaching Team Debrief

ResultsResults

July 2006—June 2009July 2006—June 2009 4.5 ± 1.4 sessions per academic 4.5 ± 1.4 sessions per academic

yearyear 39 PGY 1, 2, 3 residents39 PGY 1, 2, 3 residents

– 10 followed PGY 1 10 followed PGY 1 2 2– 4 followed PGY 1 4 followed PGY 1 2 2 3 3

ResultsResults

88

90

99

70

75

80

85

90

95

100

AY '06-'07 AY '07-'08 AY '08-'09

% A

tte

nd

an

ce

PS Compliance over Successive Years

ResultsResults

60

65

70

75

80

85

90

95

100

A B C D E F G H I J

Scor

e (%)

Resident

PS Performance Over 2 Years [n = 10]

PGY-1

PGY-2

60

65

70

75

80

85

90

95

100

A B C D

Scor

e (%)

Resident

PS Performance Over 3 Years [n=4]

PGY-1

PGY-2

PGY-3

81 ± 5 vs 86 ± 4

(p<0.01)

82 ± 4 vs 86 ± 2 vs 91 ± 1

(p<0.005)

ResultsResults

39 39 residentsresidents

88 > 2 SD

below mean

5 5 = clinical

ConclusionsConclusions

Patient simulation training was Patient simulation training was successfully implemented in our surgical successfully implemented in our surgical residency.residency.

Assessment instrument can detect Assessment instrument can detect predictable improvements across yearspredictable improvements across years

Challenges:Challenges:– Competition with other educational activitiesCompetition with other educational activities– Fidelity and realismFidelity and realism

Further work required to determine Further work required to determine effects on resident clinical competencyeffects on resident clinical competency

XX