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

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

Psychomotor Skill Development

Simpson 1966

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

Fitts and Posner: 3 phase model

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

Expert

Proficient

Competent

Advanced

Beginner

Novice

Residency Attending

Psy

cho

mo

tor

Sk

ill

wit

h a

Me

dic

al

Pro

ced

ure

Dashed line represents skill development and maintenance overtime Simulation-based training Clinical experience

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?

International Network for Simulation-based

Pediatric Innovation, Research and Education

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

112 Institutions around the world

http://www.inspiresim.com/

Learn See Practice Prove Do Maintain

Remediation

Learning about

procedure via

videos and online

Training• Cognitive skills

test

Demonstration

by instructor• Integrated

skills

• Individual

steps

Formative

assessment on

simulator • Deliberate practice

• Mastery learning

Summative

assessment

on simulator • Just in time

Performance

on human with

formative

assessment• Structured

observation

and feedback

• Procedure

logs

• Evidence of

competency Cognitive Phase Psychomotor Phase

Maintenance of skill

through clinical practice

supplemented by

simulation as needed

Procedural Skills Training using Simulation Procedural Skills Training using Simulation Procedural Skills Training using Simulation Procedural Skills Training using Simulation

International Network for Simulation-based Pediatric

Innovation, Research and Education

http://www.inspiresim.com/

Questions/Comments?