1. Assessing and Enhancing Clinical Competency with Simulation Norbert Werner City of Edmonton Emergency Medical Services EMS Program Development Norbert.Werner@Edmonton.ca

2. The painful post-lunch lecture!!

3. Presentation Objectives: At the end of this brief session, you will be able to: 1. Appreciate the need and importance of assessing competency in your staff. 2. Discuss a few benefits of full-scale medical simulation and its potential to enhance clinical competency. 3. Apply several innovative and practical tools regarding simulation that can be used in your workplace.

4. Important Questions How do we produce a competent student? How do we produce a competent student? How well prepared are our graduates and future employees? How well prepared are our graduates and future employees? Are there ways to supplement the clinical practicum experience? Are there ways to supplement the clinical practicum experience? As employers and educators, how do we maintain and enhance clinical competency in our staff and students? As employers and educators, how do we maintain and enhance clinical competency in our staff and students?

5. CMA Conjoint Accreditation Goal: To ensure that educational programs enable their students to acquire the knowledge, skills, and attitudes to function as a competent health practitioner for the benefit of all Canadians. To ensure that educational programs enable their students to acquire the knowledge, skills, and attitudes to function as a competent health practitioner for the benefit of all Canadians. What happens after graduation? What happens after graduation? What about 1, 5, or 25 years after graduation? What about 1, 5, or 25 years after graduation?

6. Simulation... …is simply a tool.

8. Aviation Industry Purpose of Simulation: To prevent error and death To prevent error and death Accelerates your experiential learning curve. Accelerates your experiential learning curve. Mastery of knowledge or skill in safe environment Mastery of knowledge or skill in safe environment

9. Ideal Learning Environment Clinical Care Corrections during performance Corrections during performance Others point out errors Others point out errors Others tell you how you performed Others tell you how you performed You move on to the next clinical task You move on to the next clinical taskSimulation Consequences of decisions seen Consequences of decisions seen You realize/prioritize errors You realize/prioritize errors You observe how you performed You observe how you performed You repeat the challenge You repeat the challenge

10. University of Calgary Study: PI: Dr. Rob Hall BSc, MD Study Question HUMAN PATIENT SIMULATOR (SIM group) versus OPERATING ROOM (OR group)

11. University of Calgary Study: Overall Intubation Success Rate Difference of 3.0%

12. Implications Paramedic students should be trained ETI on a patient simulator prior to the OR rotation Paramedic students should be trained ETI on a patient simulator prior to the OR rotation Improved airway training Improved airway training Reduce OR time Reduce OR time Simulator training should not entirely replace the OR experience Simulator training should not entirely replace the OR experience

13. Medical Control Guidelines Continuing Education Program Purpose: Continuous training Continuous training Maintenance and enhancement of skill- sets and knowledge Maintenance and enhancement of skill- sets and knowledge Proactive, regular face-to-face needs assessment Proactive, regular face-to-face needs assessment

14. Medical Control Guidelines Continuing Education Program Part A: Quarterly con-ed module Quarterly con-ed module Topic based on one or two MCG’s Topic based on one or two MCG’s Topic driven by staff Topic driven by staff Interactive design Interactive design

15. Medical Control Guidelines Continuing Education Program Part B: Simulation educational session for all staff Simulation educational session for all staff No fore-warning/ random selection No fore-warning/ random selection Simulator or live standardized patient Simulator or live standardized patient Debriefing time Debriefing time

16. What Makes Simulation Successful? The 6 R’s: Real time Real time Real environment Real environment Real people Real people Real actions Real actions Real drugs Real drugs Real stress Real stress

17. Most importantly….Real fun!!

18. Debriefing Session:

19. Create a safe, non-threatening environment Create a safe, non-threatening environment Encourage experiential learning Encourage experiential learning Encourage feedback and self-evaluation Encourage feedback and self-evaluation Allow the participant to vent, affirm, or redeem their performance Allow the participant to vent, affirm, or redeem their performance

20. Debriefing Session: What NOT to do! What NOT to do! Instead, encourage student-driven learning and discovery Instead, encourage student-driven learning and discovery

21. Assessment of Students Performance Two categories for evaluation: 1. Team behaviors 2. Critical actions Debriefing session includes: Reviewing key learning objectives Reviewing key learning objectives Individually-targeted training Individually-targeted training Addressing everyone’s unique needs Addressing everyone’s unique needs

22. Cardiac Arrest Simulation

23. Is Simulation Worth the Effort? Three “feel good” stories: 1. Junior crew: difficult airway/GSW 2. Cricothyrotomy success 3. Cardiac dysrhythmia patient

24. Questions to Ask Ourselves Do we encourage lifelong learning in our students/staff? Is training a priority? Do we encourage lifelong learning in our students/staff? Is training a priority? As educators and employers, do we offer safe, non-threatening opportunities for remediation and enhancement of competency? As educators and employers, do we offer safe, non-threatening opportunities for remediation and enhancement of competency? As an educator or clinical preceptor, how do I currently maintain my own competency? As an educator or clinical preceptor, how do I currently maintain my own competency?

25. Summary Assessing clinical competency of staff needs to be a priority. Assessing clinical competency of staff needs to be a priority. Simulation and other forms of technology can enhance competency of students and employees. Simulation and other forms of technology can enhance competency of students and employees. Simulation can supplement or “fill the gaps” in the clinical education that you currently offer your staff and students. Simulation can supplement or “fill the gaps” in the clinical education that you currently offer your staff and students.

26. Thank you!!