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Simming It Up STAT LTC Jay Baker, M.D. Faculty Development Fellow
Madigan Army Medical Center
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Objectives Learned why medical simulation is a superior teaching technique Applied the STAT method for– Developing scenarios Debriefing critical actions Achieving learning objectives
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Why sim?
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Technology Enhanced Simulation for Health Professions Education:
A Systematic Review and Meta-Analysis Results Outcomes # studies Pooled effect size (95% CI) Knowledge 118 1.20 ( ) Time skills 210 1.24 ( ) Process skills 426 1.09 ( ) Product skills 54 1.18 ( ) Time behaviors 20 0.79 ( ) Other behaviors 50 0.81 ( ) Direct patient effects 32 0.50 ( ) Simulation teaching is “consistently associated with large effects for outcomes of knowledge, skills, and behaviors and moderate effects for patient-related outcomes.”
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Learning Zone Comfort Zone
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Sim is fun!
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Learning Objectives Critical Actions
Scenario Debriefing Critical Actions
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Determine Learning Objectives Write Critical Actions
Scenario Determine Learning Objectives Write Critical Actions Develop Case Debriefing Critical Actions
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Simulation Training Assessment Tool (STAT)
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Introduce the Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Simulation Training Assessment Tool (STAT)
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. First CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Introduce the Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Simulation Training Assessment Tool (STAT)
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Then Introduce the Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Simulation Training Assessment Tool (STAT)
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Finally Introduce the Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Simulation Training Assessment Tool (STAT)
Exercise #1 SCENARIO ALGORITHM SET UP Actor with bee sting O2 mask, Epipen PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. Recognize anaphylaxis 2. 3. CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Introduce the The “actor” is one of the participants writing the case Choose the “learner” from additional staff or audience. Not me, because that makes it harder to help case and debrief. Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Lower the learning barrier
Introduce learners to sim environment Acknowledge sim deficiencies Contract– The Basic Assumption “We believe that everyone participating in simulation activities is intelligent, capable, cares about doing their best, and wants to improve.”
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DetermineLearning Objectives Identify Critical Actions
Scenario DetermineLearning Objectives Identify Critical Actions Develop Case Reaction Phase Teaching Phase Summary Phase Debriefing Critical Actions
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Reaction Phase Elicit and recognize concerns Clarify facts of case
Incorporate concerns into teaching
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Teaching Phase Observe performance of critical actions
Investigate reasons for performance gaps Close gaps through discussion and teaching Generalize— Apply lessons to home context
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Teaching Styles
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Summary Phase “What did you do well?” “What did you learn?” OR
“Take aways?”
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Simulation Training Assessment Tool (STAT)
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Run the scenario Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Observe performance Introduce the Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Simulation Training Assessment Tool (STAT)
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Run the scenario Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Assess gaps Introduce the Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Simulation Training Assessment Tool (STAT)
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Run the scenario Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Take notes Introduce the Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Simulation Training Assessment Tool (STAT)
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Debrief the scenario Simulation Training Assessment Tool (STAT) Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Debrief performance Introduce the Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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Exercise #2 Introduce learner to environment
Run your scenario with a “learner” Identify performance gaps Debrief the “learner” Close gaps through teaching I will debrief your debriefing Choose a “learner”, either one of the other faculty or an audience volunteer. Direct them to diagnose asthma initially and give albuterol before recognizing anaphylaxis and giving epi.
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Simulation Training Assessment Tool (STAT)– Debrief the Debriefers
SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION Simulation Training Assessment Tool (STAT)– Debrief the Debriefers Date: Examiner: Examinee(s): Learning Objectives 1. Learn and demonstrate the Debriefing as Formative Assessment technique 2. Show concern for learner and subject CRITICAL ACTIONS SUSTAIN IMPROVE Introduce learner to scenario Achieve credible level of realism Take notes with FAST Apply Reaction phase in debrief Apply Teaching phase in debrief Apply Summary phase in debrief Teach with concern for learner Teach with concern for subject Introduce the ME = Meets Expectations; NI = Needs Improvement
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Milestones EM Milestones “Suggested Evaluation Methods” –
ACGME Core Competency Sim/Total Patient Care 11/14 Medical Knowledge 0/1 Professionalism 2/2 Interpersonal Communication Skills Problem-Based Learning Improvement Systems-Based Practice 2/3 Total 19/24
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Simulation Training and Assessment Tool (STAT)– Stable Atrial Fibrillation with Rapid Ventricular Rate Milestones SCENARIO ALGORITHM SET UP Sim Man w/ live video feed & mic Instructor will control Sim Man and monitor case from video room Resident will play role of RN ECG monitor PRE ARRIVAL 60 yo male with palpitations + mild SOB x 30 mins. Tachy. Adenosine 6 mg given w/ no change. HR 125 BP 138/79 RR 24 Pox 97% ARRIVAL No change PMH—Similar episode 4 y ago. Txd w/ SCV in ED at that time. Meds—None currently All—None SH—Tob x ½ ppd, etoh x1-2/day, coffee x 4 cpd. Retail store owner, increased stress. PRIMARY SURVEY ABCs WNL except tachy as above SECONDARY SURVEY Pt remains stable throughout case unless resident gives OD of sedation LABS & IMAGES CXR—WNL Labs—All WNL including Troponin ECG—Afib w/ RVR DISPOSITION Home Date: Instructor(s): Learner(s): Learning Objectives: Assess patient as stable vs. unstable and diagnose atrial fibrillation Conduct appropriate work up of recent onset atrial fibrillation w/ rapid ventricular rate Appropriately treat and disposition CRITICAL ACTIONS MS ME NI SUSTAIN IMPROVE Place safety net—IV, O2, monitor & begin ABCs PC1 ID afib with RVR & assess patient as stable. PC3 PC4 Take thorough history and ID time of onset PC2 PROF1 Consider rate control with diltiazem 0.25 mg/kg—defers to patient wishes PC5 Attempt pharmacologic cardioversion with procainamide 1 g IV/60 mins PC9 Progress to synchronized cardioversion J with sedation PC10 PC11 SBP1 Choose appropriate sedation agents and doses Obs in ED x 1 hour then d/c home w/ f/u PC6 PC7 Demonstrate effective communication including closed loop feedback ICS2 ME = Meets Expectations; NI = Needs Improvement ME = Meets Expectations; NI = Needs Improvement
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Objectives Learned why medical simulation is a superior teaching technique Applied the STAT method for– Developing scenarios Debriefing critical actions Achieving learning objectives
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Questions? simmingitup.blogspot.com
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Simulation Training Assessment Tool (STAT)
Date: Examiner: Examinee(s): Learning Objectives 1. 2. 3. SCENARIO ALGORITHM SET UP PRE ARRIVAL ARRIVAL PRIMARY SURVEY SECONDARY SURVEY LABS & IMAGES DISPOSITION CRITICAL ACTIONS ME NI SUSTAIN IMPROVE Debriefing Phases Reaction– Blow off steam and elicit concerns Teaching—Address performance related to critical actions Summary– What did you do well? What did you learn for next time? ME = Meets Expectations; NI = Needs Improvement
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