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Growth of a Simulation Lab: Engaging the Learner is Key to Success

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Growth of a Simulation Lab: Engaging the Learner is Key to Success
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  December, 2007 Kharasch, et al. Growth of a Simulation Lab: Engaging the Learner is the Key to Success 1 Growth of a Simulation Lab: Engaging the Learner is Key to Success Morris Kharasch, MD: Director of Special Projects, Emergency Medicine, Evanston  Northwestern Healthcare John Vozenilek, MD: Director, Center for Simulation Technology and Academic Research, Emergency Medicine, Evanston Northwestern Healthcare Ernest Wang, MD: Associate Residency Coordinator, Emergency Medicine, Evanston  Northwestern Healthcare Jorge del Castillo, MD: Associate Head, Division of Emergency Medicine, Evanston  Northwestern Healthcare Jeffrey G. Graff, MD: Head, Division of Emergency Medicine, Evanston Northwestern Healthcare Pamela Aitchison, RN: Emergency Medicine, Evanston Northwestern Healthcare Christopher Pettineo, BA: Emergency Medicine, Evanston Northwestern Healthcare Laura Seul, BA: Emergency Medicine, Evanston Northwestern Healthcare  December, 2007 Kharasch, et al. Growth of a Simulation Lab: Engaging the Learner is the Key to Success 2 Abstract:   High-fidelity simulation (HFS) is increasingly utilized for Emergency Medicine education. The Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Emergency Medicine indicates that simulation may serve as an adjunct for the documentation of competencies. As simulation technology matures, institutions will be investing increasing resources to develop simulation centers at their own hospitals and universities. A focused well-defined approach using  basic teaching concepts in any educational forum is essential in the initial set-up of a simulation center. The areas we examined for our success at Evanston Northwestern Healthcare were: 1) the physical plant, 2) the simulation equipment, 3) the curriculum, and 4) our teaching methodology. Engaging the learner to want to return is truly the success of our program. This is the critical launching point for anyone interested in developing a simulation lab as it will drive volume, generate financial support, and foster academic production. The academic discussions and the nuances of the machines were only meaningful when this most basic requirement was met, making people want to return. We provide a brief review of high fidelity simulation, and the key elements that led to growth and operational success of our center.  December, 2007 Kharasch, et al. Growth of a Simulation Lab: Engaging the Learner is the Key to Success 3 Introduction: High-fidelity simulation (HFS) is a fundamental tool for teaching healthcare workers. Currently the American College of Surgeons has created a multilevel certification of educational centers. 1  The American Society of Anesthesiologists Workgroup on Simulation Education has begun to characterize simulation centers for the purposes of “approval” as a site to provide continuing medical education credits. 2  The Accreditation Council for Graduate Medical Education ACGME Residency Review Committee [RRC] for Emergency Medicine has determined that simulation may serve as an adjunct for the documentation of competencies. 3  Use of HFS is  becoming increasingly integrated into undergraduate and graduate medical educational curricula. 4   The primary benefit of utilizing HFS as an educational and evaluative tool is that learners can practice medical decision-making and procedural skills on simulated  patients in an environment where the risk of error will not harm an actual patient. 5  These technologies were developed to practice skills without incurring risk: in the military for war games exercises, in the aerospace industry for flight training of pilots and astronauts, and in the nuclear power industry to train personnel. 6  Bridging the gap  between other industries and medicine, Gaba et al. pioneered the use of simulation in anesthesia in order to train anesthesiologists. 7  Simulation has also received favorable reviews as an effective model for teaching medicine. 8, 9  The attractiveness of HFS as a method of teaching stems from its  December, 2007 Kharasch, et al. Growth of a Simulation Lab: Engaging the Learner is the Key to Success 4 ability to allow learners of all levels to “practice” medicine in an environment without risk to actual patients and to provide an environment that bridges basic science and clinical medicine. 10,   11  Gordon et al write, “Consider the issue of patient safety, and imagine a practitioner who makes a clinical mistake; immediately after realizing the error, he or she will experience an emotional reaction that is powerfully instructive –  but only for the next patient. What if educators could . . . [allow] trainees to “live through” a compendium of important cases in a fraction of real-time?” Emotional involvement allows students to integrate and understand information at a deeper cognitive level. 12  As “learning by doing” becomes less acceptable to the general public, simulation exercises, done well, provide learners with meaningful repetition, reinforcement of concepts in the debriefing session, and self-reflection that is critical to improved learning so that residents may “. . . see one,  simulate many , do one competently , and teach everyone .” 13  There is a growing body of Emergency Medicine literature describing the use of HFS in the educational curriculum. Its adaptability to a wide array of educational situations makes it a particularly useful tool for enhancing educational objectives. Educators are documenting their applications of HFS to address core competencies, 14, 15  low incidence but high stakes procedures, 16  crisis resource management, 17  team training, 18,   19,   20  IV access, 21  resident professionalism in ethical dilemmas, 22  cognitive forcing strategies, 23  bioterrorism, 24  disaster training, 25, 26  flight crew airway management, 27  multiple patient encounters for error reduction, 28  comparative evaluation of resident performance, 29,   30  systems-based modular residency curriculum, 31  and medical student education. 32,   33,   34,   35  The significant literature and successful implementation around the country is driving demand for HFS training and proliferation  December, 2007 Kharasch, et al. Growth of a Simulation Lab: Engaging the Learner is the Key to Success 5 of training facilities will necessarily follow. Discussion: As our center reached its four-year mark, we reflected on the key areas that fostered our growth. Our simulation education involves local and national training curricula of emergency medicine residents, nurses, medical students and pre-hospital care programs. A brief review of the growth of our center is presented along with key elements for expansion. The HFS center at our community-based academic center was conceived with the following goals: to provide medical education utilizing HFS technology, to provide a safe learning environment, and, with an open-minded approach, to determine just what HFS could achieve. Like many centers, ours had a very modest start. An internal grant provided funding for an adult HFS device, but we did not have a dedicated space to begin this training. A small 3.048m x 4.572m conference room was the beginning of our project, with the caveat that after we were done “playing” we had to “put away our toys” and return the conference room to its srcinal state. Ten medical residents were the first group to participate in this new technology. Our first cases were a few cardiac arrests emphasizing Advanced Cardiac Life Support (ACLS) skills. Our control room was separated from our simulation area by an accordion screen. Our debriefing style was personal and supportive, but not standardized. We stood around the mannequin and talked about how we could improve our management of the simulated cases. In four years our center has grown tremendously, not just in physical size and technical sophistication, but in the expansion of our applications of and research about

Portfolio Paper 1

Apr 28, 2018
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