Using Medical Simulation in Residency Education: Final Wrapup

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Using Medical Simulation in Residency
EducationFinal Wrap-up

• LTC Ross Colt, MD, MBA, FAAFP

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Take home points

• When you LIVE learning, you remember it!
• Standardize safely for rapid expertise
• On the fly adaptation is crucial

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Why SIM?

• Mistakes that teach rather than harm
• Planned experience of rare events
• Experiential learning through activation

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Read the ACGME tea leaves

• ACGME Bulletin, December 2005
• Clinical skills should be learned as far away
  from the patient as possible
• Health care is one of the few industries that
  does not conduct routine rehearsals
• Familiarity with protocols becomes clear during
  simulations
• Simulation determines how residents respond to
  different situations
• Offers a controlled way to learn systems-based
  practice
• Simulation will be a part of the redesign of GME

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Its all about arousal
A Circumplex Model of Affect, by J. A. Russell,
1980, Journal of Personality and Social
Psychology, 39, p. 1164.
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Evidence behind SIM

• Endoscopy simulator increased learning velocity
  (Clark, 2005)
• VR colonoscopy 4.5x success rates (Ahlberg, 2005
  Tassios, 1999)
• Obstetrical dystocia- more rapid delivery
  (Deering, 2004), increased success rates (Crofts,
  et al 2006)

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Family Medicine Simulation Curriculum
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Quarterly Sim Days

• Target specific areas
• OB scenarios
• Trauma / ER scenarios
• Adult medicine / pediatric scenarios
• Procedural hands-on
• Incorporate simulation with cases
  and didactics
• 1 / 2 day each during CME

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Endoscopy Training

• Incorporate into procedures rotation
• Complete scenarios on simulator
• 12 flexible sigmoidoscopy
• 18 colonoscopy
• Must meet specific criteria
• Approximately 1 day to complete
• Additional time for colonoscopy

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Mock Codes / CRM

• Several times / year
• Clinic-based
• Residents, staff, nurses
• Various scenarios
• Newborn (NRP)
• Child (PALS)
• Adult (ACLS)
• OB (ALSO)

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Lessons Learned from teaching SIM

• KISS Keep It Simple, Stupid!
• One good point gt three crappy ones
• On-the-fly changes
• Patient gets better, patient gets worse
• Consider tech person plus facilitator
• Doctor learners WILL think of actions you didnt
  plan for
• Doctor learners WONT think of basic stuff

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Common Pitfalls

• Checklists
• Experts disagree
• Is skipping steps OK?
• Technology WILL fail- roll with it, agree
• We like to lecture- fight this urge
• Some disbelief is normal- make it real

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Debriefing Defined

• The act of reviewing a real or simulated event
  in which participants explain, analyze and
  synthesize information and emotional states to
  improve performance in similar situations
• -- Center for Medical Simulation

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3 Stages of Debriefing

• Reactions
• Understanding
• Summary

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Need some help?

• Centralized Simulation Committee (CSC)
• https//madigan-sharepoint.mamc.amedd.army.mil/sit
  es/CSC/default.aspx

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Take home points

• When you LIVE learning, you remember it!
• Standardize safely for rapid expertise
• On the fly adaptation is crucial

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Questions?
Thank you!