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

Disclosures Speakers have no commercial disclosures or conflicts to report.

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

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

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

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

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

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

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

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

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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