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Presentation given at HPSN 2011 titled: Simulation-Based Resuscitation - Team Leadership
Citation preview
Simula'on-‐Based Resuscita'on: Team Leadership
Eric B. Bauman, PhD RN, Paramedic
Ka'e White, MD Copyright 2011 E. B. Bauman & K. White
All Rights Reserved
Ka'e White is a Staff Physician at Wm. S. Middleton Veterans' Memorial Hospital and a Clinical Instructor at the University of Wisconsin School of
Medicine and Public Health. Dr. White is also a Hospitalist at the Stoughton Hospital and hold the 'tle of associate with Clinical
Playground, LLC.
Disclosures & Affilia'ons
Disclosures & Affilia'ons
Eric B. Bauman is the founding and managing member of Clinical Playground, LLC. Dr. Bauman is a special event staff nurse for the University of Wisconsin Department of Athle'cs’ and a Paramedic/
Firefighter for the Town of Madison Fire Department and a Paramedic for the City of Middleton Department of EMS.
IRB Approval This study was granted an Exemp&on by the Health Sciences Internal Review Board at the
University of Wisconsin -‐ Madison
Needs Assessment
• Leadership and Crisis Management Skills in VA Hospital related Cardiac Resuscita'on – The PGY2 Medicine Residents from the University of Wisconsin School of Medicine & Public Health are responsible for leading a mul'-‐professional code-‐blue team
– Residents have varied experience with cardiac resuscita'on
• All have current ACLS Training • Few if any have any Team Leadership experience or training
Iden'fying Cogni've and Behavioral Deficit
• Anecdotally: Based on Ka'e’s experience as Chief Resident and when mentoring junior residents
• Empirically: Based on the literature and our pretest ques'onnaire
Bauman, 2007
Medical Educa'on Literature In a study of Internal Medicine Residents (Hayes, et al, 2007)
• 49.3% felt inadequately trained to lead a cardiac arrest • 50.3% felt that standard ACLS training did not provide
necessary team leadership skills related to resuscita'on • 40% indicated they received no addi'onal training related to
resuscita'on beyond a standard ACLS course • 52.15% felt prepared to lead a cardiac resuscita'on -‐ 55.3%
worried they made errors • Residents felt unsupervised -‐ No backup • Post event debriefing/feedback was lacking
This was very consistent of the PGY2 Medicine Class working as Medical Officers of the Day
Hypothesis
Simula'on can be effec've for increasing resident comfort with ACLS algorithms and resuscita'on
leadership roles, while decreasing anxiety related to cardiac resuscita'on management.
Workshop Objec'ves • Residents will demonstrate the ability to apply knowledge of ACLS
protocols in a high fidelity simulated case-‐based sehng with emphasis on the first 10 minutes of the event including diagnosis of the rhythm and underlying process, primary survey, and ini'al algorithm selec'on
• Residents will demonstrate team leadership and team member skills and be able to describe the importance of delega'on of tasks, func'onal team dynamics, and role ownership
• Residents will express improved confidence with code team leadership and decreased anxiety about managing code situa'ons
• Residents will become aware of the strengths and weaknesses of simula'on as a learning tool.
Study Objec'ves
• Increase comfort level related to using ACLS Algorithms
• Use Simula'on-‐Based Educa'onal Interven'on to decrease anxiety associated with MOD Role
• Increase perceived comfort level with code leadership
• Increase par'cipant comfort level associated with simula'on-‐based learning environment
The theore'cal Framework Based Fink’s Taxonomy : Theore'cal Framework that was already in place to guide educa'onal interven'ons and
resident curricula in the Department of Medicine
Fink, D. L. ,2003
Learning How to Learn: • Becoming a beier Student
• Inquiring about a subject • Self-‐direc'ng learners
Founda'onal Knowledge: Understanding and remembering • Informa'on • Ideas
Applica'on • Skills • Thinking: Cri'cal, Crea've, & Prac'cal Thinking
• Managing projects
Integra'on: Connec'ng • Ideas • People • Realms of life
Caring: Developing new • Feelings • Interests • Values
Fink’s Taxonomy
Human Dimension: Learning about • Oneself • Others
Our Pretest/ Pre-‐Interven'on Data n=24 1-‐5 Likert Scale
Mean Value is Reported
• Comfort with ACLS Algorithms 2.8
• Comfort with Leadership with Acute Ward Situa'on 2.68
• Level of Anxiety in MOD Role 4.08 (High Anxiety Level)
• Comfort with Simula'on as a Learning Tool 3.52
www.pamelaheath.com/Cartoons4.htm
Curriculum Development
• Establish Objec'ves • This goes beyond a desire to use the simulator
• Iden'fy and target our learners • Those rounding out their PGY1 Year
• Storyboard Scenarios that meet interven'on objec'ves (Backfill and Narra've)
• This is the way it would look in the VA • Write/Repurpose and test scenarios
Timeline
Nov 2009 Project Incep'on Target Learners
Iden'fy Objec'ves
July 2009 Ka'e comes for tour of the Simlab
Dec. 29, 2009 Ka'e and Baby (Maggie) comes to Simlab
Storyboard Narra'ves & Backfill
Feb. 2010 Tested Scenarios
March 5, 2010 First of 4 Workshops
January, 2010 Planning con'nues
Outlined workshop Agenda
May 14, 2010 2nd of 4 Workshops
June 7th, 2010 3nd of 4 Workshops
June 14, 2010 4nd of 4 Workshops
Dec 1, 2009 Ka'e has Baby
Clovis Nov. 2009
Clovis June 2010
The Agenda • 7 Residents per workshop • 3 Facilitators per workshop
– Educator, Aiending, Chief Resident • 2.5 Hours
– Icebreaker Games focusing on team dynamics and leadership
– Review of concepts of Crisis Resource Management (Gaba et al, 2001)
– Scenarios with Debriefing (2 per Session) – Wrap Up (Surveys and Feedback)
Environment
• Icebreaker Games focusing on team dynamics and leadership Classroom
• Review of concepts of Crisis Resource Management Wrap Up Classroom
• Scenarios with Debriefing (2 per Session) Simula'on Laboratory
• Wrap Up (Surveys and Feedback) Classroom
www.pamelaheath.com/Cartoons4.htm
The Scenarios • Based previous research focusing on resuscita'on and crisis management (Bauman, 2007) – Two Scenarios: Pulseless VT and ACS
• Well known algorithms but s'll had cri'cal thinking components
– Learners “entered” authen'c designed experience scenarios without defined roles (Squire, 2006 )
Video Review of Sessions
• Chief Resident, Department of Medicine Educators, Aiending Staff Physician
• Provided Wriien feedback to all par'cipants
• Opportunity for one-‐on-‐one mee'ng with Chief Resident and/or Aiending
What were they looking for?
• Each evaluator was assigned to one or two residents to watch through each videotaped session
• Evaluators observa'ons’ were compared and reconciled so that consistent feedback could be provided to each par'cipant
• All par'cipants were provided with wriien feedback whether or not they self selected into a leadership or followership role.
Examples
• Level of Par'cipa'on • Communica'on Style: Closed Loop technique, asser'veness, appropriateness
• Leadership orienta'on/posi'on in the room
• Ability of leader to effec'vely delegate • Decision Making ability Squire, Giovaneio, DeVane, & Durga, 2005
Gaba et al, 2001
Our Post-‐test/Post-‐Interven'on Data n=24 1-‐5 Likert Scale Mean Value is Reported
• Comfort with ACLS Algorithms 3.38 • Comfort with Leadership with Acute Ward Situa'on 3.44
• Level of Anxiety in MOD Role 3.7 (Decrease in anxiety)
• Comfort with Simula'on as a Learning Tool 4.26
*All results were sta's'cally significant
Comfort with ACLS Protocol
Comfort with code team leadership
Anxiety about code team leadership
Comfort with simula'on as a learning tool
Change in Survey Score 0.58 0.76 -‐0.38 0.88
-‐0.6
-‐0.4
-‐0.2
0
0.2
0.4
0.6
0.8
1
Chan
ge in Residen
t Survey Ra
;ngs
Resident Comfort Level Survey Results
Denotes a statistically significant change from pre- to post-workshop.
Limita'ons
• Time Constraints – Release from clinical responsibili'es – Lab Scheduling – No everyone was able to play the role of leader
• Primary feedback comment from par'cipants
• Resident buy-‐in of the created environment – Suspension of Disbelief – More orienta'on 'me – More Integra'on of Simula'on into Resident Training
www.pamelaheath.com/Cartoons4.htm
Final Thoughts
• Importance of theore'cal framework when designing curricula and research projects
• Importance of objec've-‐based curriculum design
• Knowing our learners program expecta'ons
• Effec'vely targe'ng your audience
R. Kyle
References Bauman, E. (2007). High fidelity simula'on in healthcare. Ph.D. disserta'on, The
University of Wisconsin-‐Madison, United States. Disserta'ons & Thesis @ CIC Ins'tu'ons database. (Publica'on no. AAT 3294196)
Fink, D. L. (2003) Crea%ng Significant Learning Experiences. San Francisco Jossy-‐Bass Gaba, D. M., Howard, S. K., Fish, K., Smith, B., & Sowb, Y. (2001). Simula'on-‐based
training in anesthesia crisis resource management (ACRM): A decade of experience. Simula%on & Gaming, 32(2), 175-‐193.
Hayes, H.W., Rhee, A., Detsky, E., LeBlanc, V.R., and Wax, R.S. (2007). Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: A survey of internal medicine residents. Cri%cal Care Medicine 35(7), 1668-‐1672.
Squire, K. (2006). From content to context: Videogames as designed experience. Educa'onal Researcher. 35(8), 19-‐29.
Squire, K., Giovaneio, L., DeVane, B,. & Durga, S. (2005). From users to designers: Building a self-‐organizing game-‐based learning environment. Technology Trends, 49(5), 34-‐42.