Tag Archives: education development
Written on February 10, 2015 at 7:55 am, by John Vozenilek, MD, FACEP
Clinical simulation has come a long way in the preparation of learners for practice. It’s now the norm for medical schools and nursing schools. At Jump, we have built an outstanding facility for the training and education of these professionals.
This course is a multi-departmental UICOMP effort, led by a core group of key faculty. Dr. Matt Mischler served as course director, with Drs. Sara Krzyzaniak, Gerald Wickham, Trina Croland, Francis McBee Orzulak, and Meenakshy Aiyer committing countless hours of their time to the effort. Previously, Dr. Barker identified Four Questions to Improve Health Care Education, and one of the results from that process was the adoption of a boot camp for fourth year UICOMP medical students (M4s). Question one was what was missing and what should they teach in the boot camp?
The boot camp is two weeks long, and we wanted to fill in with as much content as possible to prepare the multidisciplinary students for their upcoming internships. To get an idea of what classes to offer, we started with some initial research by benchmarking what other institutions are doing. Another initial source was data that showed what previous interns were not prepared for.
Next, we conducted some qualitative research by asking our program directors what they think might be beneficial. Focus groups with students were beneficial in determining what they wanted to spend more time learning or reviewing.
After the initial and qualitative research, we looked at current requirements and milestones as set by the Accreditation Council for Graduate Medical Education (ACGME), the Liaison Committee on Medical Education (LCME), and the Association of American Medical Colleges (AAMC) Entrustable Professional Activities (EPA). These organizations help determine what students should know at different stages in their path to becoming medical professionals.
Finally, with all of this data and information, we looked for topics that overlapped. To keep it relevant for all students, we limited our search to topics that were common among all disciplines.
Simulation versus Didactic Learning
The next question in the process was does this course need a simulation?
Simulation is best used when trying to apply knowledge and assess things in a complex environment. Simulation is also useful for high anxiety situations that happen in low volume in the real world – such as a code. Simulation education is about experiential learning – you won’t learn from mistakes until you see their impact.
As an analogy, you’re warned not to speed, but you won’t change your behavior until you actually get a ticket. In health care, the stakes are a lot higher than a speeding ticket. Simulation provides a safe environment to self-reflect and determine if an error was caused due to nerves, or if the learner really doesn’t know the material.
While learners prefer and want more use of simulation, didactic learning still has a place in curriculum. Didactic is useful for giving baseline knowledge and introducing new information to learners. It’s important to intermix small and large group discussions and role playing into didactic sessions to maintain elements of team building and working with each other.
During the boot camp, didactic courses are taught in the morning with simulations in the afternoon. Most simulations last between 5 and 10 minutes, then afterwards, they spend 2-3x the amount of time debriefing and self-evaluating their performance. The simulations are then repeated in the second week, and the learners are able to track their progress.
Currently, the boot camp is low stakes, meaning that there is no requirement for students to perform at a certain level. If it’s determined that a student needs more work in a certain area, then we individually target more educational resources to them.
The boot camp will continue to evolve and the curriculum will continue to shift after each session as we strive to better medical education.
Written on December 2, 2014 at 9:40 am, by Dustin Holzwarth
Any medical professional will tell you that kids are different. The medical treatment of a child is completely different from the treatment of an adult patient – for example, most medications are weight based, their vitals are different and tend to rapidly change, and some children are too small to communicate where or why they hurt. Simply stated, there are many specific factors at play when treating babies and children.
At Jump, we are focused on improving patient care across the board. With the University of Illinois College of Medicine at Peoria acting as a teaching liaison, Jump is marrying the resources of our state-of-the-art simulation center to create opportunities for more advanced curriculum with Children’s Hospital of Illinois.
The manikins at Jump are great learning tools, and are designed to provide the closest experience possible to treating a live person. Traditional patient care manikins, like Laerdal’s Mega Code Kid have been used for years to train students with because they are reliable, affordable and provide a great way to keep proficiencies up when using task based scenarios. Recently, the gold standard for pediatric patient care is moving towards patient simulators, such as Laerdal’s SimJunior.
SimJunior is a high-fidelity 6-year-old child with many features that allows the facilitators who manifest pediatric curriculum to really ramp up the realism. Some of the features of SimJunior are realistic chest rise and fall (breathing), stomach distention, changing lung sounds, heart tones, the ability to go into a seizure, and other life-like interactions including vocal responses. Unlike most patient care manikins, the simulation specialist can also control SimJunior, wirelessly. This adds a whole new layer to simulation.
For example, an EMS simulation may call for a patient to be taken from their house to an ambulance. This could not actually be done within the scenario if the manikin was hardwired to the crew delivering the simulation.
This capability is so important to the quality of the simulation that many patient care manikins are integrating the wireless technology similar to Laerdal’s SimPad. Furthermore, SimJunior gives us the means to deliver high quality in situ Simulations in the Hospital.
In situ is Latin for “in its original place,” meaning we take the simulation to the appropriate hospital unit. In most in situ simulations, leaners work as a team to reverse the declining vital signs of the young patient.
This is typically a surprise to the treatment teams arriving bedside, and having such a life-like manikin increases the realism of the event. This allows for the members of the treatment team to immerse themselves in the scenario at hand and treat the manikin as though he is a real 6-year-old boy in seizure, septic shock or respiratory arrest.
Introducing a New SimJunior Model
A recent exciting acquisition that we are beginning to use in simulation is Laerdal’s dark skin toned model of SimJunior. In addition to having the same life-like features as the light skin toned model of SimJunior, he provides facilitators the option to create curriculum featuring conditions that are more common among the nation’s African American population, such as health complications related to sickle cell anemia.
This capability further highlights for the learners not only the differences in treating pediatric patients, but also the differences in treating racially diverse patients. This is a great new adjunct for expanding curriculum throughout OSF HealthCare.
Understanding and utilizing SimJunior’s high fidelity features is something we pride ourselves on at Jump. We believe that working with facilitators to create realistic simulations of medical problems suffered by pediatric patients will encourage care providers to apply lessons learned from their simulation experience on the real life patients they treat and thus improve the level of care those patients receive.
Written on November 11, 2014 at 9:00 am, by Lisa Barker, MD
One of the challenges facing medical students is the transition from the highly supervised role of student to the intermittently supervised role of an intern after they graduate.
The Education branch of Jump brings together faculty from OSF Saint Francis Medical Center and University of Illinois College of Medicine (UICOMP), which allows for an integrated approach to students’ professional development toward independent practice. When simulation is identified as an ideal educational strategy, the Jump Curriculum Committee evaluates the program proposal using Dr. David Kern’s six-step process for Curriculum Development as a framework.
What is Missing?
One of the results of this process has been the adoption of a “boot camp” for fourth year medical students (M4s). Through step one (General Needs Assessment) of the six-step process, it was determined that there needed to be an elective to prepare M4s for residency. In step two (Targeted Needs Assessment), it was important to define the course, starting off by determining the goals and objectives that would benefit students the most.
Unfortunately, you can’t prepare for every possible residency match, so it’s important to choose universal skills. Time is also a big determinant on what skills are taught. The course director has to determine if they want to teach one complicated process that takes a long time, or two smaller and simpler processes that take half the time.
Does It Need a Simulation?
When determining the educational strategies in step four, often the first question asked is if the objective can be completed with or without a simulation. While it is easy to say that you want to use a simulation for everything, especially since learners find it to be an exciting tool, sometimes a simulation may not be the best option.
Simulations are used frequently in the boot camp however, ranging from lumbar punctures on task trainers to breaking bad news with the aid of Standardized Participants. Simulations provide the hands on, in-situation training that learning in a classroom setting can’t adequately provide.
How Do We Make the Vision the Reality?
Step five is the implementation. This part is when we determine and finalize all of the information that our simulation technicians (sim techs) and standardized participants (SPs) need to know. This information is put into a second document, known as the session template. The session template gives the learning objectives, and overview of how the simulation will run from start to finish, explaining different things the learners may say or do, and appropriate responses from the sim techs or SPs.
As experts in their field, our sim techs review the curriculum content and objectives, seeking to identify are any gaps that were missed. Not only is it helpful to have another pair of eyes look over the content, this helps the sim techs understand what is going on when setting up and running the simulation.
The session template is a great tool that facilitates consistent reproduction of the courses by standardizing the execution for every event – ensuring that every learner group has the same high quality experience.
How Did We Do?
Finally, step six is evaluating and obtaining feedback on the curriculum, as well as assessing the learner. It was determined that M4s who took the boot camp when it was an elective were more prepared and successful for internships.
“I feel ahead of the game compared to my co-interns from different medical schools,” said Charlie Jain, MD (UICOMP Class of 2014) an intern in the internal medicine residency program at Massachusetts General Hospital in Boston. “I know this prep training I received as a medical student has helped make me a better physician.”