ANA REYNOLDS (PORTUGAL) International conference on Simulation-based training in medicine

Kyiv, Ukraine

19-20 March 2015

“STRUCTURING A SIMULATION-BASED TRAINING PROGRAMME”

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COGNITIVE SCIENCES RESEARCH

LEARNING IS A MULTI-STEP PROCESS

Acquisition of information (encoding in the brain – memory);

Retention and maintenance;

Retrieval (activation of association networks).

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DEPENDING ON HOW INFORMATION IS PRESENTED:

Students can use several intelligences to process it

A major understanding will come via their strongest ones.

“There are seven independent types of intelligence”

(Gardner H. The theory of multiple intelligences,1983)

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Verbal-linguistic

Visual/Spatial

Bodily- kinetic

Logical-mathematical

Musical

Interpersonal Intrapersonal

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LEARNING OUTCOMES IMPROVE IF STUDENT’S LEARNING STYLE IS MATCHED BY APPROPRIATE TEACHING METHODS.

https://youtu.be/rg37kafMsWk

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HOW SIMULATION CAN IMPROVE THE

EDUCATIONAL EFFICACY IN MEDICINE

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BECAUSE IT ALLOWS To extend forms of presentation of information and…

Deliberate (Repetitive) practice; Reflection; Educational feedback; Maran NJ et al , 2003

Issenberg SB et al, 2005 (Features and uses of high-fidelity medical simulations that lead to effective learning. BEME Systematic review)

Integration (of simulation-based exercises) into the standard curriculum.

Issenberg SB et al, 2005 (Features and uses of high-fidelity medical simulations that lead to effective learning. BEME Systematic review)

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SO WHAT?… “HOW WILL I STRUCTURE A SIMULATION-BASED TRAINING PROGRAMME?” (SBME)

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PRE-GRADUATION;

POST-GRADUATION;

CONTINUING EDUCATION.

1. EDUCATIONAL GOALS: COMPETENCES/SKILLS

INDIVIDUAL;

TEAM (multiprofessional; multitidisciplinar; same or different graduation level of trainees).

KEY ISSUES

2. UNIT OF PARTICIPATION

3. FEEDBACK - DEBRIEFING METHOD; FORMATIVE ASSESSMENT

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e.g.S

(Integration of simulation into the standard curriculum)

OF STRUCTURE SIMULATION-BASED TRAINING PROGRAMMES

(SBME)

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e.g. 1. PRE-GRADUATION (SBME)

5 Sim sessions at the first 2 of a 5 weeks rotating block, Groups of 15+15 students (on average) 2 instructors

September 2005 →

OBST/GYN 5th YEAR MEDICAL STUDENTS (Faculty of Medicine, Porto University)

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Clinical history and Obst/Gyn examination;

Family planning and preconception;

Prenatal care;

Intra-partum care Monitoring of labour progress

Active conduction of normal deliveries;

Obst/Gyn pathology (Clinical history and examination).

CONTENT OF THE SESSIONS (1.30h)

Main skills to develop: Conceptual Knowledge; Psychomotor skills; Professionalism (attitude with the patients).

13 Prompt™ (Limbs & Things®,Lda)

Noelle™ (Gaumard®)

Pelvic model (Limbs & Things®,Lda) Pelvic model (3B Scientific ®)

SIMULATORS

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Instruments

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INTRODUCTION (30´) - EACH SESSION AIM: Demonstration of actions and manoeuvres

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Introduction of gynaecological speculum

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Collection for pap smear

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Pelvic examination

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Histerometry

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Family planning Contraceptive methods

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Leopold manoeuvres

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Uterine height Evaluation of Foetal Heart Rate

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Intrapartum care: • Vaginal examination • Cervical characteristics: Position, Consistency, Effacement, Dilatation.

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Intrapartum care: • Diagnosis of an occiput presentation: Identification of sagital suture, small

fontanel, large fontanel. • Determination of foetal position and variety.

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Intrapartum care: • Identification of ischial spines: evaluation of the level of descent of foetal head.

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Intrapartum care: • Conduction of a normal delivery (vertex): Assessment of head descent, Assessment of internal rotation, Protection of the perineum, Delivery of the head, Identification of nuchal cords.

Delivery of the shoulders

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Intrapartum care: • Clamping and cutting the umbilical cord

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Intrapartum care: • Evaluation of placental separation and placenta delivery

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Intrapartum care: • Evaluation of post-delivery uterine contraction

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• Pacient actor / Role Play

• Pelvic examination on the simulator

• Gynaecological history;

• Obstetrical history

LAST SESSION: Gynaecological and obstetrical pathology.

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The Portuguese College of Obstetrics and Gynaecology adopted two simulation-based training programmes in Obstetrics as part of residency training:

“Basic Interventions in Labor and Delivery” “Obstetric Emergencies”

2010 →

eg 2. POST-GRADUATION/CONTINUING EDUCATION

OBST/GYN RESIDENTS AND OBSTETRIC STAFF

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TARGET POPULATION • 1st to 3rd year Obst/Gyn residents

GOALS • Develop knowledge and technical skills essential for intra-partum care

(acquisition of basic skills);

• Promote knowledge, technical and behavioral skills necessary to deal with an obstetric emergency.

• Avoid initial training with the patient;

“Basic Interventions in Labor and Delivery”

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•Presentation;

•Intra-partum care;

•Concepts and training in the simulator of:

•Birth in cephalic vertex presentation;

•Instrumented birth (concepts and training in the simulator):

- Vaccum;

- Non-rotational forceps;

•Breech delivery (concepts and training in the simulator);

•Introduction to "obstetric emergencies“: the resolution of dystocia shoulder;

•Evaluation of the training by the trainees;

•Closing.

PROGRAMME CONTENT (theoretical and practical session)

DURATION AND SCHEDULE: 5 HOURS (1 session)

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TARGET POPULATION • Obst/Gyn residents and specialists

• Midwifes (nurses specialized in maternal/obstetrical health)

GOALS • Develop skills to deal with obstetric emergencies (individually and as

team member: knowledge, technical skills and attitudes/behavior/ inter-personal relationship).

• Be aware/interiorization of management protocols;

• Avoid initial training with the patient.

“Obstetric Emergencies”.

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•Presentation; • Resolution of 6 obstetric emergency situations (simulated) intercalated by brief interactive sessions (reinforce concepts, presentation of the management protocol and self-assessment of performance); • Evaluation of the training by the trainees; • Closing.

PROGRAMME CONTENT (theoretical and practical session)

DURATION AND SCHEDULE: 6 HOURS (1 session)

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CONCLUSION

Development of a Structured SBME programme

(from pre to continuing education).

SBME handbook

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PRE-GRADUATION

CONTINUING EDUCATION

ESTABLISHED CLINICAL PRACTICE COMPETENCES

POST-GRADUATION

ESTABLISHED CLINICAL MANAGEMENT PROTOCOLS

ESTABLISH TRAINING GOALS (SBME) (knowledge, technical or non technical skills)

SBME handbook

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Target population Trainees’ qualification,…

• Pedagogical methodology and form of training organization Programme content, design stations/scenarios; debriefing methodology,…

Duration of training and schedule (number of sessions and their distribution) Type of evaluation (formative versus summative) Use validated assessment tools for summative evaluation.

Define trainee’s curricular gains with the training (attendance certificate versus competence certification)

Set minimum attendance criterion

Obtain trainees’ feedback on the training (satisfaction questionnaire)

ESTABLISH PEDAGOGICAL METHODOLOGIES (SIMULATION-BASED)

SBME handbook

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THANK YOU