1. If you cannot find a seat, lecture theatre 2 is being used as an overflow
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2. Scenario-based Skill Teaching ATLS ® 10th Edition

3. 7 skills stations Airway (x2) Breathing Circulation Disability
Secondary Survey
Adjuncts
Trauma Team

4. Skills stations Airway Breathing Circulation Disability
Secondary Survey
Adjuncts
Trauma Team
Appear in the course in a logical order – for all candidates A
B/C
D…………

5. Skills stations Airway Breathing Circulation Disability
Secondary Survey
Adjuncts
Trauma Team
Multiple stations need to run in parallel
eg. 4 airway stations for 16 candidates

6. Skills stations Airway Breathing Circulation Disability
Secondary Survey
Adjuncts
Trauma Team
Skills taught or demonstrated in the context of unfolding scenario(s)
Stimulus questions

7. Skills stations Airway Breathing Circulation Disability
Secondary Survey
Adjuncts
Trauma Team
Need to know (cognitive) skills (demo/discuss)
Need to do (psychomotor) skills (DO)

8. 1. airway Basic Advanced Paediatric/Surgical Airway assessment
demo/discuss
Laryngeal mask (or tube) insertion – DO
Basic airway (paed v adult)
Jaw thrust
LEMON
Nasal airway, suction, oral airway - DO
Oral endotracheal intubation – demo/discuss
Surgical cricothyroidotomy - DO
Bag Valve Mask (1 and 2 person) - DO
Needle cricothyroidotomy - Do

9. 2. breathing (1) Breathing assessment – DO or demo/discuss
Needle decompression – DO
Chest drain (thoracostomy tube) insertion – DO
Elderly chest injury – demo/discuss
Sucking chest wound – demo/discuss
Severe chest injury scenario – demo/discuss

10. 2. breathing (2) Introduction and skill level ascertainment
scenario 1 (m-cycle)
Assessment to detect life-threatening injuries – DO or interactive discussion
case 1 progression
Needle decompression of tension pneumothorax – DO
case 1 what next?
Insertion of intercostal drain – DO
close scenario

11. 2. breathing (3) scenario 2 (elderly fall) case 2 progression
Assessment to detect life-threatening injuries – re-cap
case 2 progression
Management of haemo-pneumothorax in elderly – interactive discussion

12. 2. breathing (4) scenario 3 (propellor) case 3 progression
Assessment to detect life-threatening injuries – re-cap
case 3 progression
Management of open (sucking) pneumothorax - demo/discuss occlusive dressing
case 3 what next?
Insertion of intercostal drain – re-cap
Surgical referral - discuss

13. 2. breathing (5) ? ? ? Summary and closure scenario 4 (car)
Assessment to detect life-threatening injuries – re-cap
case 4 progression
Management of life-threatening injuries – discussion
Aortic injury
case 4 what next?
Interventions and investigations
Definitive (surgical) care
? ? ? Summary and closure

14. 3. circulation Assessment of Shock – demo/discuss
Wound packing – demo/discuss
Application of tourniquet – demo/discuss
Insertion of intra-osseous needle – DO
Application of pelvic binder – demo/discuss
Femoral access – DO or demo/discuss
Non-haemorrhagic shock – demo/discuss

15. 4. disability Assessment of neurological status – demo/discuss
Evaluation of C spine injury – demo/discuss
Reassessment of changing neurological status – demo/discuss
Referral process – demo/discuss
Detailed neurological exam – demo/discuss
Log roll – demo/discuss (rotate all roles)
Elderly patient assessment of neurological status – demo/discuss
Central cord syndrome assessment – demo/discuss

16. 5. secondary survey Application of hard collar - DO
Perform secondary survey patient 1 – demo/discuss
Perform secondary survey patient 2 – demo/discuss
Open fracture management – demo/discuss
Perform secondary survey patient 3 – demo/discuss
Perform secondary survey patient 4 – demo/discuss

17. 6. adjuncts eFAST probe positioning/scanning – demo/discuss
Chest X ray interpretation – DO
Pelvic X ray interpretation – DO
Spine X ray interpretation - DO

19. 10th edition Scenario Based Teaching
Scenarios unfold throughout the skills stations
At relevant point in scenario, students identify a skill to be performed
Skill is taught using 4 stage model
Scenario continues
Skills are identified as:
Demonstration only (need to know of)
Performance (need to do)

20. Miller’s Pyramid Metacognitive knowledge Procedural knowledge
Conceptual knowledge
Factual knowledge
Miller, GE, 1990;65

21. Krathwohl’s modified Bloom’s Cognitive Taxonomy
Real Life Practice
Initial Assessment
Skills scenarios
Manual & m learning
Krathwohl, 2002, p216

26. Skills station 1 video

27. Principles of teaching a psychomotor skill (ATLS)
Conceptualisation – scenario drawing on knowledge from manual
Visualisation – seeing the skill
Verbalisation – hearing the skill, then describing the skill
Practice – performing the skill
Reinforcement & correction – whilst performing the skill
Skill mastery
Skill autonomy

28. ATLS model of skill acquisition
Conceptualisation – facilitator does, all watch
Visualisation – facilitator does and describes,
(all watch and listen)
3. Verbal – facilitator does and learner A describes
4. Practical – learner A describes and then does (instructor auto corrects)

29. Skills station 2 video

30. Skills station 3 video

31. Skills station 4 video

32. Why scenarios?
Greater participant engagement - asking and answering questions
Improved integration of knowledge and skill
Improved transfer of knowledge and understanding through application
More opportunity to identify gaps – immediate feedback
Alpha testing showed more engagement from learners
Mimics learning in clinical practice

34. Facilitators will: Present scenarios to contextualise ATLS principles
Ask range of questions to elicit application of knowledge
Build on questioning to help students identify interventions
Use four stage approach to facilitate skill acquisition
Scaffold different levels of learning
Immediate situational feedback

35. Learners will:
Demonstrate understanding of context by responding to scenario questions
Apply knowledge from manual by suggesting interventions
Develop relevant skills by 4 stage approach
Be engaged throughout
Identify knowledge gaps with immediate feedback
Relate scenario to real life practice

36. Pitfalls or risks Not using scenario, just teaching skills
Lecturing, using no questions
Discussion, no skills
Lack familiarity with scenario and skill
Side tracking – requiring facilitator focus
Multiple conversations – requiring group dynamics management
Errors made in 4th stage – requiring immediate facilitator correction
Time!

37. ?