Rami A. Ahmed

Early bedside care during preclinical medical education: can technology-enhanced patient simulation advance the Flexnerian ideal?

Flexner wanted medical students to study at the patient bedside—a remarkable innovation in his time—so that they could apply science to clinical care under the watchful eye of senior physicians. Ever since his report, medical schools have reserved the latter years of their curricula for such an “advanced” apprenticeship, providing clinical clerkship experiences only after an initial period of instruction in basic medical sciences. Although Flexner codified the segregation of preclinical and clinical instruction, he was committed to ensuring that both domains were integrated into a modern medical education. The aspiration to fully integrate preclinical and clinical instruction continues to drive medical education reform even to this day. In this article, the authors revisit the original justification for sequential preclinical–clinical instruction and argue that modern, technology-enhanced patient simulation platforms are uniquely powerful for fostering simultaneous integration of preclinical–clinical content in a way that Flexner would have applauded. To date, medical educators tend to focus on using technology-enhanced medical simulation in clinical and postgraduate medical education; few have devoted significant attention to using immersive clinical simulation among preclinical students. The authors present an argument for the use of dynamic robot-mannequins in teaching basic medical science, and describe their experience with simulator-based preclinical instruction at Harvard Medical School. They discuss common misconceptions and barriers to the approach, describe their curricular responses to the technique, and articulate a unifying theory of cognitive and emotional learning that broadens the view of what is possible, feasible, and desirable with simulator-based medical education.

Errors as allies: error management training in health professions education

This paper adopts methods from the organisational team training literature to outline how health professions education can improve patient safety. We argue that health educators can improve training quality by intentionally encouraging errors during simulation-based team training. Preventable medical errors are inevitable, but encouraging errors in low-risk settings like simulation can allow teams to have better emotional control and foresight to manage the situation if it occurs again with live patients. Our paper outlines an innovative approach for delivering team training.

In situ simulation to assess workplace attitudes and effectiveness in a new facility.

Introduction In situ simulation within new facilities holds the promise of identifying latent safety threats. The aim of this study was to identify if in situ simulation can also impact important employee perceptions and attitudes. Methods In the current study, health care professionals of an adult, urban, community teaching hospital level 1 trauma center participated in simulated scenarios in a new emergency department. Before and after the simulated scenarios, participants provided responses to the variables regarding their ability to work in the new facility and other work-related variables. Results Significant increases in communication (P = 0.05), facility clinical readiness (P < 0.05), self-efficacy (P < 0.01), trauma readiness (P < 0.01), and work space satisfaction (P < 0.05) were found from presimulation to postsimulation. The results also demonstrated a significant decrease from presimulation to postsimulation with performance beliefs (P < 0.001). Finally, cardiac readiness did not reveal a significant change from presimulation to postsimulation. Discussion In situ simulation exercises before practicing clinically in a new facility can both increase familiarity with new clinical environments and impact important organizational outcomes. Thus, simulation in a new work space can influence factors important to employees, organizations, and patients.

Teledebriefing: connecting learners to faculty members

Simulation has become widespread among medical educators. Although simulation facilities are available at most teaching institutions, the number of qualified instructors to facilitate post‐simulation debriefing is inadequate, resulting in sub‐par educational experiences for learners.

Simulation-Based Selection of Surgical Trainees: Considerations, Challenges, and Opportunities

Received April 23, 2016; Revised May 17, 2016; Accepted May 23 From the Department of Surgery, University of Texas Southwester cal Center, Dallas (Gardner), Department of Surgery, Houston M Hospital, Houston (Dunkin), TX, Department of Surgery, Uniform vices University and Walter Reed National Military Medical Bethesda, MD (Ritter), Department of Surgery, Louisiana State U Health Sciences Center, New Orleans, LA (Paige), Department o gency Medicine, Summa Akron City Hospital, Akron, OH (Ahm Department of Surgery, Baystate Medical Center, Springfiel (Fernandez). Correspondence address: Aimee K Gardner, PhD, Department of University of Texas Southwestern Medical Center, 5323 Harry Hin Dallas, TX 75390. email: aimee.gardner@utsouthwestern.edu

Transforming Trauma Teams Through Transactive Memory: Can Simulation Enhance Performance?

Background In situ simulation holds promise to enhance the effectiveness of performance. However, a dearth of theory remains to explain the efficacy of simulation-based education within health care teams. Aim The aim of this study was to examine team cognitive processes across two trauma simulations and to identify whether these processes impact observer-rated performance. Method Twenty-four health care professionals within an emergency department participated in one of two 30-minute trauma scenarios. Before and after participating, they reported their team transactive memory perceptions. Performance in the scenarios was video recorded for evaluation. Results Participants reported significant increases in transactive memory (p < .05) after participating in the trauma simulations. Furthermore, transactive memory was positively related to observer-rated performance (r = .58, p < .01). Conclusion Our results suggest that simulation has potential to be an effective method to increase transactive memory perceptions among team members. In addition, the increase in transactive memory systems is associated with higher performance ratings. Further consideration concerning the design and evaluation of simulation-based training programs to facilitate the development of such cognitive processes among teams is recommended.

Ten Tips for Maximizing the Effectiveness of Emergency Medicine Procedure Laboratories.

Incorporating simulation-based medical education techniques is paramount to ongoing training of emergency physicians. Effective procedure laboratories give learners hands-on experience in life-saving procedures they may otherwise not have clinical exposure to and also prevent skill decay. Using procedural education, adult learning theory, deliberate practice, and mastery learning strategies, the authors offer 10 tips to educators for designing an effective emergency medicine procedure laboratory.

Coaching From the Sidelines: Examining the Impact of Teledebriefing in Simulation-Based Training.

Introduction Although simulation facilities are available at most teaching institutions, the number of qualified instructors and/or content experts that facilitate postsimulation debriefing is inadequate at many institutions. There remains a paucity of evidence-based data regarding several aspects of debriefing, including debriefing with a facilitator present versus teledebriefing, in which participants undergo debriefing with a facilitator providing instruction and direction from an off-site location while they observe the simulation in real-time. We conducted this study to identify the effectiveness and feasibility of teledebriefing as an alternative form of instruction. Methods This study was conducted with emergency medicine residents randomized into either a teledebriefing or on-site debriefing group during 11 simulation training sessions implemented for a 9-month period. The primary outcome of interest was resident perception of debriefing effectiveness, as measured by the Debriefing Assessment for Simulation in Healthcare-Student Version (See Appendix, Supplemental Digital Content 1, http://links.lww.com/SIH/A282) completed at the end of every simulation session. Results A total of 44 debriefings occurred during the study period with a total number of 246 Debriefing Assessment for Simulation in Healthcare-Student Version completed. The data revealed a statistically significant difference between the effectiveness of on-site debriefing [6.64 (0.45)] and teledebriefing [6.08 (0.57), P < 0.001]. Residents regularly evaluated both traditional debriefing and teledebriefing as “consistently effective/very good.” Conclusions Teledebriefing was found to be rated lower than in-person debriefing but was still consistently effective. Further research is necessary to evaluate the effectiveness of teledebriefing in comparison with other alternatives. Teledebriefing potentially provides an alternative form of instruction within simulation environments for programs lacking access to expert faculty.

Mechanical Ventilation Boot Camp: A Simulation-Based Pilot Study

Objectives. Management of mechanically ventilated patients may pose a challenge to novice residents, many of which may not have received formal dedicated critical care instruction prior to starting their residency training. There is a paucity of data regarding simulation and mechanical ventilation training in the medical education literature. The purpose of this study was to develop a curriculum to educate first-year residents on addressing and troubleshooting ventilator alarms. Methods. Prospective evaluation was conducted of seventeen residents undergoing a twelve-hour three-day curriculum. Residents were assessed using a predetermined critical action checklist for each case, as well as pre- and postcurriculum multiple-choice cognitive knowledge questionnaires and confidence surveys. Results. Significant improvements in cognitive knowledge, critical actions, and self-reported confidence were demonstrated. The mean change in test score from before to after intervention was +26.8%, and a median score increase of 25% was noted. The ARDS and the mucus plugging cases had statistically significant improvements in critical actions, p < 0.001. A mean increase in self-reported confidence was realized (1.55 to 3.64), p = 0.049. Conclusions. A three-day simulation curriculum for residents was effective in increasing competency, knowledge, and confidence with ventilator management.

Emergency Medicine Residency Boot Camp Curriculum: A Pilot Study

Introduction Establishing a boot camp curriculum is pertinent for emergency medicine (EM) residents in order to develop proficiency in a large scope of procedures and leadership skills. In this article, we describe our program’s EM boot camp curriculum as well as measure the confidence levels of resident physicians through a pre- and post-boot camp survey. Methods We designed a one-month boot camp curriculum with the intention of improving the confidence, procedural performance, leadership, communication and resource management of EM interns. Our curriculum consisted of 12 hours of initial training and culminated in a two-day boot camp. The initial day consisted of clinical skill training and the second day included code drill scenarios followed by interprofessional debriefing. Results Twelve EM interns entered residency with an overall confidence score of 3.2 (1–5 scale) across all surveyed skills. Interns reported the highest pre-survey confidence scores in suturing (4.3) and genitourinary exams (3.9). The lowest pre-survey confidence score was in thoracostomy (2.4). Following the capstone experience, overall confidence scores increased to 4.0. Confidence increased the most in defibrillation and thoracostomy. Additionally, all interns reported post-survey confidence scores of at least 3.0 in all skills, representing an internal anchor of “moderately confident/need guidance at times to perform procedure.” Conclusion At the completion of the boot camp curriculum, EM interns had improvement in self-reported confidence across all surveyed skills and procedures. The described EM boot camp curriculum was effective, feasible and provided a foundation to our trainees during their first month of residency.