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Developing a Simulation-based Procedural Skills Curriculum
Developing a Simulation-based Procedural Skills Curriculum Taylor Sawyer DO, MEd1, Anne Ades, MD2, Marjorie White , MPPM, MEd3 , JoDee Anderson, MD, MEd 1. University of Washington/Seattle Children’s, 2. University of Pennsylvania/Children’s Hospital of Philadelphia, 3. University of Alabama at Birmingham/ Children's of Alabama, 4. Oregon Health Science University Disclosures • The presenters have nothing to disclose Learning Objectives • Define key components required to teach procedural skills using simulation • Identify methods that can be used to assess procedural competency using simulation • Develop a model for a simulation-based procedural skills curriculum in your program Agenda • Introductions and didactic session • Divide large group into subspecialty groups (as best as possible) • 10 min - small group discussion on teaching procedural skills • 10 min report back and large group discussion • 10 min - small group discussion on assessing procedural competency • 10 min report back and large group discussion • 10 min - small group discussion on developing a simulation-based procedural skill curriculum • 10 min report back and large group discussion • Final discussion and review of INSPIRE’s work on procedural skills “Procedural skills” • “the mental and motor activities required to execute a manual task” Foley RP, Spilansky J. Teaching techniques- a handbook or health professionals. New York, McGraw Hill; 1908: 71-91 “Simulation” • Task trainers • Manikin-based • Virtual reality • Standardized patients Why is this important? • ACGME requirements • Pediatric Subspecialty (focused revision, effective 7/2013) • IV.A.5.a).(2) Fellows must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice. • IV.A.5.a).(2).(a).(i) Fellows must acquire the necessary procedural skills and develop an understanding of their indications, risks, and limitations. • IV.A.5.a).(2).(a).(ii) Each fellow’s experience in such procedures must be documented by the program director and such documentation must be available for review. • Patient safety • Fellows as teachers http://www.acgme.org/acgmeweb/ProgramandInstitutionalGuidelines/MedicalAccreditation/Pediatrics.aspx Theories/Frameworks of Skill Acquisition •Dreyfus (1986) •Simpson (1966) •Fits & Posner (1967) Dreyfus S, Dreyfus, H. A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition. 1980 Psychomotor Skill Development Level 1: Guided response Skill performed through imitation and trial and error Level 2: Mechanism When the skill has started to become habitual Level 3: Complex overt response Characterized by an accurate and efficient performance of the skill Level 4: Adaptation When the skill has been so well internalized that it can be adapted for different contexts and situations Level 5: Origination Involves the creative development of new psychomotor skills Simpson 1966 Fitts and Posner: 3 phase model Cognitive phase - when the skill is being learned Associative phase - when skill is becoming ingrained Autonomous phase - when the skill has become automatic and can be carried out without thinking about it What is Competency? • Merriam-Webster- “having requisite or adequate ability or qualities” • The ability to perform a certain task required for a work situation • Competency is a mental construct • “competent” vs. “evidence of competency” • Competency is contextual • Relationship between the person’s abilities to perform the task and the particular situation in the real world • Competency is mutable • Changes with time as the learner progresses/digresses Framework for Clinical Assessment Psychomotor Skill with a Medical Procedure Expert Proficient Competent Advanced Beginner Novice Residency Simulation-based training Clinical experience Attending Dashed line represents skill development and maintenance overtime http://martinsj2.wordpress.com/2010/08/26/and-now-for-something-completely-different/ Divide into groups of 4-6, by subspecialty Academic Pediatrics Adolescent Medicine Cardiology Child Abuse Critical Care Medicine Developmental-Behavioral Pediatrics Emergency Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Pulmonology Rheumatology Small group session 1: Discuss/brain-storm on how best to teach procedural skills using simulation (focus on teaching- we’ll do assessment next) What procedures will you teach? How will the teaching be conducted? What materials/simulators do you need? Small group session 1: Report back What procedures will you teach? How will the teaching be conducted? What materials/simulators do you need? Small group session 2: Discuss/brain-storm on how best to assess procedural competency using simulation (focus on assessment - we’ll do curriculum development next) How will you define competency? What type of assessment- formative vs. summative? When will you do the assessment? What tools will you use for the assessment? Small group session 2: Report back How will you define competency? What type of assessment- formative vs. summative? When will you do the assessment? What tools will you use for the assessment? Small group session 3: Discuss/brain-storm on how best to establish a curriculum to teach and evaluate procedural skills using simulation How can you combine the teaching plan and the assessment plan into a curriculum? How will you integrate the curriculum into your program? How will you get buy-in from fellows? How will you get participation by faculty? Small group session 3: Report back How can you combine the teaching plan and the assessment plan into a curriculum? How will you integrate the curriculum into your program? How will you get buy-in from fellows? How will you get participation by faculty? 112 Institutions around the world International Network for Simulation-based Pediatric Innovation, Research and Education http://www.inspiresim.com/ Foundation for Advancement of International Medical Education and Research AI duPont Hospital for Children Alberta Children's Hospital Arkansas Children’s Hospital Armed Forces Simulation Institute for Medicine Athena Learning Services LLC Baylor College of Medicine Bristol Royal Hospital for Children Cardinal Glennon Children's Medical Center Central Manchester University Hospitals Children’s Hospital of Alabama Children’s Hospital of Philadelphia Children's Hospital at Dartmouth Children's Hospital at Montefiore Children's Hospital at Westmead, Sydney, NSW, Australia Children's Hospital Los Angeles Children's Hospital of Boston Children's Hospital of Eastern Ontario Children’s Hospital of Michigan Children's Hospital of Orange County Children's Hospital of Pittsburgh Children's Hospital of The King's Daughters Children's Memorial Hospital (Lurie Children's) Children's Mercy Hospitals and Clinics Children's National Medical Center Children's Hospital of Minnesota CHU de Poitiers CHU Sainte Justine Cincinnati Children’s Hospital Cleveland Clinic Children's Hospital Cohen Children's Medical Center Columbia University Medical Center Comer Children's Hospital Connecticut Children's Medical Center Dalhousie University Dell Children's Medical Center Emory Children’s Center Georgia Health Sciences University Hamilton Health Sciences Hasbro Children's Hospital- Brown Hospital Clinico Universitario de Santiago de Compostela Indiana University-Purdue University Indianapolis Innomar Strategies - AmerisourceBergen INOVA Fairfax Hospital Israel Center for Medical Simulation, Jacobi Medical Center Johns Hopkins Children’s Hospital King Abdulaziz Medical Center - NGHA Kingston General Hospital Kosair Children's Hospital LeBonheur Children's Hospital Lehigh Valley Hospital Loma Linda University Children's Hospital Lucile Packard Children's Hospital Maria Farreri Children's Hospital Westchester Medical Center McMaster University Medical University of South Carolina Memorial University Montreal Children's Hospital Morristown Medical Center Mount Sinai Hospital Nationwide Children's Hospital New York University New York-Presbyterian Hospital NYU Bellvue Oregon Health & Science University Paediatric Simulation Research Collaborative South Tyrol Phoenix Children's Hospital Red Forest Consulting, LLC and University of Michigan Health System Rio Grande Regional Hospital Seattle Children's Hospital Hospital for Sick Kids St Barnabas Hospital St George's Healthcare St. Michael's Hospital Stanford University Stollery Children's Hospital Stony Brook University Medical Center Texas Children's Hospital The Austen BioInnovation Institute in Akron The Royal Children's Hospital The University of Chicago Comer Children's Hospital TriHealth - Bethesda North Hospital Tripler Army Medical Center Tufts Medical Center Tulane University UMass Amherst UMDNJ/Robert Wood Johnson Medical School Uniformed Services University of the Health Sciences Universidad Autonoma de Coahuila University of Maryland University College Cork University Hospital of Strasbourg British Columbia Children's Hospital University of Colorado (Denver) School of Medicine University of Illinois University of Iowa Children's Hospital University of Michigan University of Pittsburgh University of Rochester University of Saskatoon University of South Florida University of Texas at Arlington University of Texas Southwestern University of Utah University of Wisconsin School of Medicine Wake Forest Baptist Medical Center Wake Forest University School of Medicine Walter Reed National Military Medical Center Weill Cornell Yale New Haven Health System Yale University Procedural Skills Training using Simulation Remediation See Learn Learning about procedure via videos and online Training • Cognitive skills test Demonstration by instructor • • Integrated skills Individual steps Practice Prove Formative assessment on simulator Summative assessment on simulator • • • Deliberate practice Mastery learning Just in time Do Performance on human with formative assessment • • • Cognitive Phase Psychomotor Phase Maintain Maintenance of skill through clinical practice supplemented by simulation as needed Structured observation and feedback Procedure logs Evidence of competency International Network for Simulation-based Pediatric Innovation, Research and Education http://www.inspiresim.com/ Questions/Comments?
