Medical Simulation Center
Transportable Simulation-Based Training Curriculum and Validated Human Performance System
by Marc J. Shapiro, MD, Principal Investigator
Federal Project Officer: Carl Taylor
Rhode Island Hospital Medical Simulation Center
Rhode Island Hospital
CMS Contract No. 18-P-92332/1-01
The statement contained in this report are solely those of the authors and do not necessarily the views or the policies of the Centers for Medicare and Medicaid Services. The contractor assumes responsibility for the accuracy and completeness of the information contained in this report.
Project Narrative Summary
Abstract
Graduate medical education has traditionally placed limited attention on human factors training to promote patient safety. Human error has long been recognized as a significant component of error in both aviation and medicine. 1,2 But despite this belief and the national patient safety momentum initiated by the IOM report 3 most resident training programs have not changed significantly, with the exception of the mandatory work hour restriction. Cultural change is occurring in medicine and it is essential that the human component be recognized as a system along with technology as an important factor in helping hospitals become high reliability organizations. 4 Recently the Accreditation Council of Graduate Medical Education (ACGME) Outcomes Project has required more comprehensive assessment of resident physician competency but did not provide the methodology and tools to achieve this goal. Objective structured clinical examinations (OSCE) are considered by some medical educators to be the criterion standard but it cannot be applied to high risk and procedural cases. 5 High fidelity simulation has been suggested as a training and assessment method in many of the competency areas (patient care, communication and systems-based practice) but limited literature is available to support reliability or validity of assessment. This program will focus on development of reliable assessment tools and content validity (skill and knowledge competencies). At this level of funding it will not be possible to compare competency assessment in the simulator to other suggested or proven methodologies (concurrent validity). Realistic whole-body high fidelity simulation has clearly emerged as a new educational paradigm to revise the old “do one, see one, teach one” culture of medicine. Simulation offers a method to assess performance in low frequency but high-risk situations in an environment, which most closely replicates daily clinical work. There is an ethical imperative to better prepare our resident physicians for clinical challenges and protect our patients from harm. 6 This demonstration program will develop a transportable simulation-based curriculum to provide patient safety and human factors training for resident physicians at teaching hospitals, which care for Medicare and Medicaid patients. The specific areas of focus will be on: 1) Clinician recognition of cognitive biases which lead to diagnostic error, 2) Teamwork in emergent resuscitations, 3) Authority gradients and cultural change (e.g. medical error disclosure), and 4) Transitions in care. By providing this training and formative assessment to physicians they will be better prepared to successfully navigate the complex systems in practice of medicine.
Executive Summary
Patient safety has received significant press and funding to advance the science of patient since the initial IOM report in 1999. However the difficult process of fostering cultural change in medicine requires that new educational methods, curriculum and assessment tools are instituted at the earliest possible opportunity in medical education. The project faculty has previously researched the synergism of simulation and didactics for teams in the emergency department (view article online), which has encouraged them to broaden the scope of simulation-based patient safety education. This demonstration project has identified educational deficits in Graduate Medical Education (GME) and employed the use of the expanding field of medical simulation to augment and expand traditional resident teaching.
This endeavor is in keeping with the priorities of the Accreditation Council of Graduate Medical Education (ACGME) Outcomes Project initiated in 2002 to increase emphasis on educational outcomes in 6 domains to improve resident education and ensure competency in the independent practice of medicine. To this end this project has developed an introductory simulation-based curriculum in high priority patient safety topics, not routinely covered in GME, but essential to improve the reliability of medical care delivery.
Results
During this project the Rhode Island Hospital Medical Simulation Center has successfully served as an agent for change to increase cooperation among medical specialties and develop a multidisciplinary curriculum for patient safety. Residencies involved in this project included, Emergency Medicine, Pediatrics and Pediatric Emergency Medicine, Internal Medicine, Radiology and Trauma Surgery.
Through the use of domain expert in patient safety the project has identified topics well suited to teaching in a high fidelity medical simulation environment. The patient safety topics of most interest and potentially greatest impact for improved performance and cultural change include teamwork training, critical thinking and decision making, medical error disclosure, authority gradients and transitions in care.
Medical simulation scenarios accompanied by traditional didactic materials for priority topics were developed, tested and implemented into GME education for a diverse group of medical and surgical specialties. Collaboration with patient safety experts in specific high priority areas contributed didactic material to augment material created by this project.
This project was successful in combining its efforts and funding with internal funding through our risk management department. Two particular areas of collaboration included pediatric residents and internal medicine residents with a clinical focus on airway management, acute resuscitation skills and teamwork.
Participant surveys and performance data of residents and teams were collected and uniformly show high levels of acceptance and satisfaction with simulation-based medical education.
While measuring actual improvement in patient outcomes is not possible surrogate measures of performance were collected. In a program jointly supported by this project and our hospital risk management department pediatric residents did show an improvement in crucial skills such as airway and resuscitation management, team performance and overall competency.
Dissemination of our material has been done locally through posting on our center’s web site. Nationally and internationally the project faculty has presented abstracts at various scientific meetings, published manuscripts and has submitted simulation cases to specialty specific and American Association of Medical Colleges case bank
Didactic and Simulation Modules
- Critical Thinking and Decision Making
This module will have a PowerPoint and simulation case to illustrate the basic concepts of the continuum of decision making and cognitive and biases to which clinicians are vulnerable.
- Teamwork and Leadership Training for Crisis Management
This module will have a PowerPoint and simulation case to illustrate the basic concepts of teamwork and its impact on improved performance and patient safety.
- Medical Error Disclosure
This module will have a PowerPoint and simulation case to illustrate the basic concepts of medical error disclosure and how improved communication with patients will help foster the transformation of our medical culture.
- Transitions in Patient Care
This module will have a PowerPoint and simulation case to illustrate the basic concepts of transitions in care of patients between health care providers and the potential for threats and opportunities for recovery which arise on a daily basis.
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