Christine Werner PhD, PA-C, RD Saint Louis University (SLU)

Department of Physician Assistant Education (DPAE)

St. Louis, Missouri

Education Innovation Session: 1058

Purpose of this study was to determine whether medical emergency care (MEC) simulation training improves students’ sense of confidence and preparedness in assisting with:

Trauma cases

Cardiac codes

Medically unstable patients

Emergency department setting

Robotic Simulation at SLU

History of the Curriculum 2003 – 2008

School of Medicine and Air Force collaboration

Created a 2 week trauma care training program for active duty personnel:

“C-STARS” – Center for Sustainment of Trauma & Readiness Skills

Air Force, Air Force Reserve, Air National Guard, physicians, nurses and medics

PA students provided limited opportunity into the trauma lab

History of the Curriculum Continued

2009

Partnership between SLU, Air Force and School of Medicine

One of three corporative program in U.S.

Space allocated for a full time simulation laboratory

SLU healthcare students

SLU hospital employees

C-STARS - separate location

Figures of the SLU Simulation Laboratory

One full time technician Scheduling Training Operation

One “trauma” suite Adjacent video room Cardiac monitor Crash cart Defibrillator Ventilator TV monitor

Case presentation Radiographs Laboratory results

Figures of the High-Fidelity Mannequin Ears: can leak blood/spinal fluid Neck: trachea with realistic anatomical landmarks Pulses: pulses can be palpated at: • Carotids • Radials • Brachials • Femorals • Dorsalispedis Gender: transferable Limbs: transferable

Eyes: blink and automatically responds to light stimuli

Mouth: speaks, tongue can swell, airway can close

Thorax: -heart sounds • regular • irregular • arrhythmias -Lungs • breath sounds • create pneumothorax

Medical Emergency Care (MEC)

Cardiology Module

Emergency Medicine

Essentials course

Clerkship

Traditional clerkship preparation

Basic Life Support (BLS)

Advanced Cardiac Life Support (ACLS)

Task trainer chest thoracostomy lab

Task trainer central line placement lab

2009 - present

Enhanced MEC simulation training curriculum reflective of course/rotation evaluations:

Intimidation factor of “ED” setting -

especially if 1st rotation

Lack of confidence

Lack of preparedness

Assisting with cardiac codes

Hesitation towards working with the

team to stable trauma/ medically

unstable patients

MEC Curriculum

Educational competencies:

Basic Life Support (BLS) Protocol

Advanced Cardiac Life Support (ACLS) Protocol

Primary trauma survey

Secondary trauma Survey

Clinical competencies:

Focused physical examination

Critical decision making

Accuracy of stabilization plan

Team communication skills

MEC Curriculum continued..

Didactic Year

Cardiology and EM courses

Introduction to the lab:

Equipment

Mannequin

Airway management

Oxygen masks

Intubation devices

Ventilator protocol

Chest tube thoracostomy

Log roll

Safety measures

Expected /unexpected physical findings

Breath sounds

Cardiac sounds

Cardiac rhythms

Other organ/system

findings

Practice as a team

MEC Curriculum continued.. Didactic and Clinical Year

Practicum

Teams of 4-5 students

20 min to stabilize patient

Initial assessment BLS

Primary survey

Secondary survey

Accuracy of plan

Communication skills

Professional conduct

Faculty-guided video debriefing

Immediate feedback

Done in both didactic and clinical year curriculum

Self reflection

Strengths

Areas to improve

Team effort

Communication

Evaluation of MEC training curriculum

Methods

Two consecutive classes (2011, 2012)

Qualtrics survey

Anonymous responses

Five point Likert scale

Strongly Agree – Agree – Neutral – Disagree – Strongly Disagree

Five questions

Comments

Descriptive statistics

SAS 9.3

Surveyed after emergency medicine rotation

Evaluation of MEC training curriculum

Survey Components

Statements of Beliefs

Q 1 - MEC training helped prepare me for their Emergency

Medicine (EM) Rotation.

Q 2 - Various procedures/survey practice prepared me to

assist with trauma cases/codes.

Q 3 - MEC training helped improve my confidence and

communication skills with EM preceptors.

Q 4 - MEC training increased interest in EM.

Q 5 - ACLS certification prior to MEC training helped prepare me to

assist with codes/care of unstable patients.

Evaluation of MEC training curriculum: Results

Q 1 - Preparation for EM rotation

Q 2 – Confident in conducting procedures/primary and secondary surveys

Q 3 – Improved confidence/communication skills

Q 4 - Increased interested in EM

Q 5 - ACLS certification prepared with code assist/care of the unstable patient

Evaluation of MEC training curriculum

Results

Response rate: 72.5%

Majority of responses (classes combined)

Strongly Agreed or Agreed

Q 1 - Preparation for EM rotation (89%)

Q 2 – Confident in conducting procedures/surveys (88%)

Q 3 – Improved confidence/communication skills (92%)

Q 4 - Increased interested in EM (90%)

Q 5 - ACLS certification (92%)

Evaluation of MEC training curriculum

Student comments

Training was fantastic

Trained on more things than I was able to do in EM rotation but this will help in the job setting

Felt I made great strides with the combo of didactic MEC training, then the EM rotation

Didactic prep was a plus to feel prepared in EM

More practice, more time, more training in trauma lab

Robotic Simulation in Medical Emergency Care Training

Conclusion

MEC training using robotic simulation prior to clinical rotations:

Improved students’ confidence

Preparedness

Function as a team member for EM events.

Overall demonstrate usefulness of robotic medical simulation in MEC education.

Acknowledgments

Saint Louis University School of Medicine

Medical Simulation Laboratory

Wesley Q Burch, EMT, Education Specialist

Anthony J Scalzo, MD, FAAP, FACMT

Saint Louis University

Doisy College of Health Sciences

Patrick Kelly, PhD, Statistician

References

DilgM. Battlefield ready. UNIVERSITAS Saint Louis University. Summer 2009: 16-19.

ER meets MASH in the new simulation lab. Saint Louis University Newslink. 2009:

February.

Chakravarthy B, Ter Haar E, Bhat SS, McCoy CE, Denmark TK, Lotfipour S. Simulation in medical school education: review for emergency medicine. West J Emerg Med. 2011;12(4):461-466.

Konia M, Yao A. Simulation-a new educational paradigm? J Biomed Res. 2013;27(2):75-80.

McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011;86(6):706-711.

Okuda Y, Bryson EO, DeMaria S Jr, Jacobson L, Quinones J, Shen B, Levine AI. The utility of simulation in medical education: what is the evidence? Mt Sinai J Med. 2009;76(4):330-343.