Author: Brian S McGowan, PhD

SESSION TITLE:
Critical Care Posters IISESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM – 02:15 PMPURPOSE: Simulation in medical education enables learners to practice necessary skills in an environment that allows for errors and professional growth without risking patients’ safety. The purpose of this study was to develop and test a simulation based rapid sequence intubation curriculum for fellows in pulmonary and critical care training. The hypothesis was that knowledge, assessed by pre-post testing, would improve after simulation training.
METHODS:
We assembled a committee of staff intensivists and a representative from respiratory care. We conducted a literature search for guidelines and best practices in rapid sequence intubation. The Delphi technique was used for defining: recommended medications, protocol steps, decision making algorithm, pocket reference card, simulation scenarios, and pre/post test questions. We created a list of reference articles and a slide presentation for review by fellows before the pre-test. Five simulation scenarios were created for airway assessment based on LEMON (Lung 2011; 189:181-192) and MACOCHA (Am J Respir Crit Care Med 2013; 187(8):832-839) scoring systems. Seven scenarios were created for rapid sequence intubation emphasizing medications and expected difficulties. Training was conducted with Sim-Man 3G mannequins by one committee intensivist for about 6 trainees. Two additional committee members tracked activity sequencing and behind the scenes mannequin manipulations. Pre-testing (15 questions) was performed just prior to training. Post-testing (same questions) was performed immediately after training and debriefing. We also administered a short survey to assess student feedback. Median test scores were compared pre and post training using Mann-Whitney Rank Sum test (P<0.05 considered significant).
RESULTS:
Testing data were collected for 39 fellows from 4 training dates. Median post-test scores improved by 32% (P < 0.001). The feedback survey indicated that 100% of responders judged their skills improved after training.
CONCLUSIONS:
Results from this study indicate that simulation based training in airway management is effective and may translate into safer practices during intubation, appropriate use of medications; decrease the number of failed attempts. We are currently collecting patient data to test these assumptions.
CLINICAL IMPLICATIONS:
We can utilize simulation based technology to teach necessary skills and test if the acquired knowledge translates into safer clinical practice.

via Simulation training results in improved knowledge abou… [Chest. 2014] – PubMed – NCBI.

BACKGROUND:
Recognizing the need to minimize human error and adverse events, clinicians, researchers, administrators, and educators have strived to enhance clinicians’ knowledge, skills, and attitudes through training. Given the risks inherent in learning new skills or advancing underdeveloped skills on actual patients, simulation-based training (SBT) has become an invaluable tool across the medical education spectrum. The large simulation, training, and learning literature was used to provide a synthesized yet innovative and “memorable” heuristic of the important facets of simulation program creation and implementation, as represented by eight critical “S” factors-science, staff, supplies, space, support, systems, success, and sustainability. These critical factors advance earlier work that primarily focused on the science of SBT success, to also include more practical, perhaps even seemingly obvious but significantly challenging components of SBT, such as resources, space, and supplies. SYSTEMS: One of the eight critical factors-systems-refers to the need to match fidelity requirements to training needs and ensure that technological infrastructure is in place. The type of learning objectives that the training is intended to address should determine these requirements. For example, some simulators emphasize physical fidelity to enable clinicians to practice technical and nontechnical skills in a safe environment that mirrors real-world conditions. Such simulators are most appropriate when trainees are learning how to use specific equipment or conduct specific procedures.
CONCLUSION:
The eight factors-science, staff, supplies, space, support, systems, success, and sustainability-represent a synthesis of the most critical elements necessary for successful simulation programs. The order of the factors does not represent a deliberate prioritization or sequence, and the factors’ relative importance may change as the program evolves.

via Eight critical factors in creatin… [Jt Comm J Qual Patient Saf. 2014] – PubMed – NCBI.