Simulated Case Scenario Project Banner Good Samaritan Medical Center B. Stiegler, D.O

Program Restriction of resident work hours has prompted a need for creativity in developing efficient supplemental forums for medical education. Format involves residents interacting with simulated patients, obtaining a history and performing a physical examination, then using this information to write hospital admission orders.

Purpose To ensure new senior residents can competently and safely manage basic and common inpatient diagnoses To utilize simulation technology to objectively evaluate developmental milestones expected after twelve months of internal medicine training

Objectives Primary Create direct observation opportunities Evaluate Educational Innovations Project (EIP) well defined resident milestones Secondary Encourage interaction/communication b/t internal medicine, subspecialty attendings re: management expectations for common floor emergencies

The Core Competencies Accreditation Council for Graduate Medical Education (ACGME) Guidelines for training programs based on agreements of those elements that define a competent physician Interpersonal and Communication Skills Medical Knowledge Patient Care Practice Based Learning and Improvement Systems-Based Practice Professionalism

The Milestones Within the Core Competencies, the Educational Innovations Project (EIP) committee has further outlined developmental milestones Specific skills or skill sets that a resident should be able to perform adequately by a certain month in their training. Milestones are used to guide the development of case scenarios for the simulation center.

Simulation Training Used for assessing clinical performance by attempting to imitate a real clinical problem Incorporate wide variety of options Allow examinees to reason through a clinical problem with minimal cueing Permit examinees to make life threatening errors w/o hurting patients Provide instant feedback to allow for correction Rate examinees performance on clinical problems that are difficult to evaluate in real life circumstances

Simulation Training Formats include Paper/pencil patient management problems Role playing situations Anatomic models/mannequins Good Samaritan Simulated Case Scenario Project combines all three simulation forms

Good Sam Simulation Center Staff Karen Josie, RN, SIMS Center Manager Christine Roberts, MSN, RN Simulation Specialist Yesenia Preciado, Admin Assistant, Simulation Education and Training Center Bridget Stiegler, D.O., AMS Liaison New Senior residents (2 nd year) Monthly Case scenario Include residents on elective rotations Tuesday AM, no clinics 1.5 hours – return to elective after your case

Good Sam Simulation Center Prior to test day Literature relevant to case 2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer Quiz Encourage preparedness, guide study Gather in the SIMS Center lobby at assigned time 0800, 0830, 0900, 0930

Good Sam Simulation Center 30 minutes to perform H&P. 30 minutes to complete admission orders. 30 minutes for one-on-one feedback session with your attending. Discuss the article, your quiz, your H&P style, your admission orders, and questions about case. Attending then fills out comprehensive evaluation Professionalism, Pre-test score, Preparedness, Assessment of Milestones.

Runners–The Voice of the Mannequin Program director Inpatient teaching attendings Outpatient teaching attendings Chiefs Fellows Specialists Neutropenic Fever: Dr. Echevarria, Dr. McKellar

How is This Useful? For the Resident… Useful resources to gain knowledge A platform to translate your knowledge into action Positive reinforcement for well performed skills Feedback for skills that need work Opportunities to practice doctoring in a non- threatening atmosphere

How is This Useful? For Our Program… Allows us to comprehensively address multiple ACGME core competencies Assess developmental milestones expected from a resident entering 2 nd year of training Allows us to utilize unique technology to provide a more comprehensive training environment Provides a method for highlighting individual strengths/weaknesses and thus adapting 3 rd year experiences to the specific needs of each resident

Future Direction Procedure Courses Third year milestones program Intern cross-cover emergencies

SIMS Center Committee Development of new simulated cases Development of procedure practice programs Technology, medical education interest