International Faculty Exchange Program

International Faculty Fellow ProgramPrepared for: Michal Nowakowski, MD PhD, Jagiellonian University Medical College

Prepared by: John Vozenilek, MD, Director, Northwestern Simulation

Northwestern University, Feinberg School of Medicine

303 E Chicago Ave, WARD 18th Floor

Chicago, IL 60068

T 312.503.7700 [email protected]

simulation.northwestern.edu

International Faculty Fellowship 1

NORTHWESTERN SIMULATION

EXECUTIVE SUMMARY

ObjectiveOur objective is to expand the use of clinical simulation as a technique for education, outcomes research, and performance improvement to an international community. The time is right for this objective because learning technologies have advanced such that e-mentoring of faculty, even at great distance, is now within reach. We believe that a collaborative relationship between Jagiellonian University Medical College in Krakow and the Feinberg School of Medicine, Northwestern University, Chicago which sponsors and develops faculty in the field of Advanced Technology in Medical Education will be mutually beneficial for both institutions.

GoalsOur goals are to:

Create a faculty-level fellowship which supports international exchange of like-minded educators who will develop their skills and hone techniques in the United States and abroad. This fellowship will:

• focus on faculty development with advanced educational technologies,

• have 6 week immersion experiences in exchange countries,

• create continuous connections through high-speed private networks,

• endure beyond the fellowship exchange in the form of a collaborative network.

Certified InstructionThe Feinberg School has developed a Instructor's Certificate program. This is a formal, faculty development and mentorship program, which emphasizes low-cost, highly distributable, and practical teaching and assessment techniques. Simulation is a component of this program, among a variety of advanced technology tools designed to provide opportunities for deliberate practice and expert feedback. Our cornerstone is educational research founded on accepted principles in cognitive neuroscience. This certification includes a capstone a performance improvement project, completed at the home institution.


Criteria for success Faculty development is a continuum, and as such, there is not a definite endpoint to the collaborative relationship. Success, however, will be measured in the completion of competency assessments, designed to evaluate the knowledge, skills, and attitudes required of faculty for education of the highest quality. These assessments will include formative feedback on practical assignments and summative assessment of a capstone project.

• Hands-on practicum with simulation

• Hands-on web-based educational programs

• Interval practical assignments and mentorship

• Capstone performance improvement project

The Value Proposition The appeal of this program is the exchange of ideas and techniques on an international scale. Feinberg instructors will apply advanced techniques in education at a european AAMC-certified English-speaking medical school. Jagellionian instructors will engage in instruction at a top-tier program in the United States. Their mutual focus will be the use of low-overhead, advanced technologies for their learners, and will establish through mutual support, a network of international scholars.


ABOUT NORTHWESTERN SIMULATION

NORTHWESTERN UNIVERSITY FEINBERG SCHOOL OF MEDICINESIMULATION TECHNOLOGY AND IMMERSIVE LEARNING

OverviewAcquiring and maintaining excellent technical and non-technical skills has always been of paramount importance for high reliability organizations. For medical centers dealing with actual patient care, there is an increasing emphasis on patient safety and risk management concerns which have presented convincing arguments for including strategies that ensure that healthcare professionals develop and maintain a solid foundation in basic technical skills, hand-to-eye coordination, practice through repetitive exercises, and demonstration of skill competencies.

Additionally, non-technical skills such as problem-solving, effective teamwork, and communications are also of paramount importance to effective health care delivery. Deviations from standardized protocol in teamwork and communications create inefficiencies at the minimum and adverse healthcare outcomes at the worst.

Northwestern University Feinberg School of Medicine is a recognized national leader in simulation-based education for enhanced healthcare

reliability. To this end, we have created a center for Simulation Technology and Immersive Learning (STIL). The mission of this entity is to research, develop and deliver superlative outcomes-based healthcare professions education to address the acquisition and maintaining of technical and non-technical skills that are vital in healthcare settings.STIL is directed by John Vozenilek, MD, associate professor of Emergency Medicine, Medical Education and Healthcare Studies and an attending physician in the emergency department at Northwestern Memorial Hospital. Dr. Vozenilek has substantial experience in medical education with both standardized patients and high-fidelity human patient simulation. He is the chairman of the Society of Academic Emergency Medicine's Simulation Academy and the designer and editor of that society’s case library for simulation. In 2008, Dr Vozenilek co-chaired the AHRQ Consensus Conference entitled: Simulation in Healthcare, Defining and Developing Expertise. He


has been the principle investigator on the AHRQ funded project: “Simulation-Based Training Program to Augment Electronic Medical Record (EMR) Based Hand-off Tool.” That project reduced communication errors during patient hand-offs in the emergency department by implementing a patient-specific checklist based on an electronic medical record, and tested the effect of companion simulation-based training. STIL occupies a total of 12,000 square feet of space and is comprised of five patient rooms, two skill labs, a virtual reality training lab, and a large and small operating room. Outpatient encounters are experienced in the adjacent 12,000 square foot standardized patient Clinical Education Center. The space, when taken together, simulates a hospital

environment using state-of-the-art devices, including adult and pediatric care delivery women’s health services, including childbirth, and training in emergency preparedness and emergency medical services. An executive conference board room and three debrief rooms are also included in the space. Every room has audio/visual recording and playback capabilities operated through a central control room, and wireless mics allow for audio to be captured as learners move from room to room.


Our innovations laboratory builds new training devices and tests medical devices using simulation. The McCormick School of Engineering partners with Feinberg in this effort.

STIL offers multi-faceted, interconnected service lines which represent the core resources within STIL. These include:

a. STIL Education: Undergraduate and Graduation Medical Education;b. Northwestern Center for Advanced

Surgical Education (NCASE): for specialized surgical training and assessment;

c. Northwestern Simulation TM: a revenue generating arm for continuing medical education and outside vendors;

d. Media Lab: video and interactive web resources and durable learning objects;

e. Innovations Lab: for the creation of new devices in partnership with faculty from the McCormick School of Engineering;

f. Conferences: sponsorship of educational seminars for international audiences.

Who we serveThe center for Simulation Technology and Immersive Learning marshals its resources to support a number of groups:

1. Undergraduate medical education students: Approximately one of every five applicants to U.S. medical schools for the 2010-2011 academic year applied to the Feinberg School. The 170 members of the Class of 2014 include 89 men and 81 women who speak 24 different languages and have GPA averages of 3.79 overall and 3.74 in the sciences. This group ranked No. 12 in student selectivity, denoting outstanding matriculants to the MD Program. Historically known for recruiting outstanding students, Feinberg also enjoys a longstanding reputation for its undergraduate medical education curriculum, which we are currently in the process of renewing. Our objective is to transform ways of creating an innovative, integrated program that will provide students with earlier, substantive clinical experience, increased flexibility in designing a course of study, and the opportunity to explore scholarly areas of interest in greater depth.

Medical education is a lifelong process that requires the skills of self assessment, self reflection, continuous learning and professional accountability.


These skills must be developed at the undergraduate medical level and continue on through residency and practice. We are committed to helping our students develop the skills that the modern physician needs to care for patients and be a leader in the practice of medicine. Our competency-based curriculum is based upon eight skills: patient-centered medical care; effective communication and interpersonal skills; medical scholarship and knowledge; system awareness and team based care; personal awareness and self care; community engagement and service; continuous learning and quality improvement; and professional behavior and moral reasoning. The center for Simulation Technology and

Immersive Learning is a vital resource in the execution of our training program. For example, actors are hired to display symptoms and our students are videotaped as they take medical history and perform examinations. Our faculty instructors then review the tapes with the students to look for thoroughness of questions asked, tone and compassion exhibited to make the patient comfortable and aware, and comprehensiveness of exam leading to accurate diagnosis. Another example is sensor-enabled breast and prostate simulators that students utilize as training devices for the performance of learning examination techniques. The simulators allow for practice prior to performing on a patient and also enable instructors to know how comprehensive and gentle a student’s examination is since the sensors allow for the both the tracking of pressure used, areas touched and length of procedure

time.

2. Graduate medical education trainees: In addition to our highly regarded undergraduate medical education program, the Feinberg School trains over 1,250 residents and fellows annually. These MD graduates have matched at Northwestern to pursue their specialized training in a career field such as surgery, pediatrics, dermatology or general internal medicine. Also similar to our undergraduate medical education program, STIL is a vast resource in our efforts to prepare physicians prepared to begin their professional careers in practice.

Successful simulation education relies on two basic principles: deliberate practice (focused and repetitive practice to gain expertise) and expert feedback (constructive criticism from an experienced coach). These principles drive our graduate medical education training. We model the complex environment in which interdisciplinary teams work and provide the necessary context for patient care events. We also model hospital environments for complex immersive simulations to advance learning for interdisciplinary teams. Faculty are able to


not only assess the individual competencies but also the non-technical skills of the entire team, while assessing strengths and weaknesses of systems. For example, teaching models have been created for “death-talk”, enabling residents to effectively learn how to communicate the death of a patient. The learning process is videotaped and re-observed to ensure that a resident learns not only the key medical news that must be conveyed but also the proper empathetic way in which the news should be shared. The use of simulation enables trainees to both observe their body language and hear their approach as they learn to communicate this complex and painful news.

Additional, STIL is an effective training ground for specific surgical procedures, particularly the newest minimally-invasive surgery (MIS) techniques. MIS, now used in almost every surgical specialty, involves the use of very small tools that are inserted through tiny incisions, as opposed to traditional “open” surgery. For the physician performing MIS, the challenges are many: the surgeon must maneuver the instruments in three dimensions while viewing his or her work on a two-dimensional screen, using advanced imaging technology and technical skills that are non-intuitive to those who have been traditionally trained. The learning curve in this situation is steep; the ongoing and rapid introduction of new equipment and techniques make continuing medical education and upgrading of surgical skills vital. The variable quality of educators, increased operating room costs and educated patients who are understandably concerned about quality and potential errors add to the urgency for a new approach to surgical education. Many patients object to being the “subjects” of medical education and resist being treated at a teaching hospital for fear that medical students will be “practicing” on them.


Surgical education needs to take a cue from other fields such as the airline industry, in which commercial pilots are required to log 250 hours of flight time – including more than 20 hours on a simulator in order to fly certain models – before being allowed to carry passengers. Surgical patients are entitled to an equivalent level of expertise, and informed healthcare consumers will appreciate the fact that their surgeons have had intensive training. STIL is the home for the creation of new training techniques being introduced slowly but steadily, and preliminary studies have demonstrated that training using virtual reality simulators for laparoscopic surgery improves surgical residents’ operating room performance and decreases errors. It stands to reason that the intensive use of preclinical training should lead to major efficiencies, cost-savings and improved outcomes in the operating room for all types of surgery.

Finally, STIL also features dedicated resources to develop future innovations in simulation technology through partnership with the Northwestern University McCormick School of Engineering. Residents and Fellows can spend time in team-specific projects to discuss new devices that will advance medical care. Departments are also enrolling post-docs to training in STIL while earning a Master in Clinical Investigation degree. The outcome of work done will be the design and deployment of novel devices that will be used in surgical procedures.

3. Practicing physicians: the resources of STIL provide an exciting opportunity to help practicing physicians maintain their technical competencies. While STIL is easily modeled to help with continuing medical education for a regional health care network, it also can assist specific specialties with lifelong learning events when their professional medical organizations host conferences in Chicago. Under the auspices of Northwestern Simulation TM, STIL is operating a revenue generating arm that provides the most up-to-date medical education procedures using simulation so practicing physicians earn needed credits as part of their reaccreditation.


STIL will also support the continuing professional education of physicians through conferences geared at the attraction of national audiences.

4. Medical Centers/Clinics/Practice Groups: Through the training of the above mentioned clients, STIL can have a direct impact on the operations of medical delivery organizations such as Northwestern Memorial Hospital, Northwestern Medical Faculty Foundation and affiliated private practice groups. The resources of STIL are available to affiliated organizations to integrate simulation into the new hire process for employees during with patients, while also helping with recertification for current employees. STIL is also poised to deploy training and assessment that improve patient safety, save lives and reduce adverse events due to non-technical skills or procedural mishaps.

Within this area, faculty are conducting research and then incorporating findings into their clinical experience. For example, a study was conducted to determine “Cost Savings From Reduced Catheter-Related Bloodstream Infection After Simulation-Based Education for Residents in a Medical Intensive Care Unit.” Interventions to reduce preventable complications such as catheter related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of the study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training. Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. The overall findings therefore show that a simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings. Studies, such as this one, will be possible given the resources of STIL and with the opportunity of physician researchers seeking to assess and improve patient safety, adverse events and procedural mishaps.

5. Local, regional and national groups: On a larger scale, the maintenance of technical competence for a regional heathcare workforce can serve the Chicagoland area and broader areas in times of emergency/disaster relief. Within the Chicago-land area, the Metropolitan Chicago Healthcare Council (MCHC) maintains the Chicago-area database of Volunteer Health Professionals via the


Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP). ESAR-VHP is charged to provide: a national system of State-based programs for managing health professional volunteers; recruitment; advance registration; a licensure and credential verification; assignment of standardized credential levels; and mobilization of volunteers. There are 49 MRC units in Illinois. In the 40 mile radius surrounding the City of Chicago there are 20 units with 274 number of physicians and 1134 number of nurses. Currently MCHC maintains the database for the Chicago land area. Simulation can be used to verify skills and train new skills. It has been shown that simulation training is capable of improving patient outcomes, and is a viable tool for the mastery of new skills. STIL has submitted an application to the Homeland Security Funding Opportunity for a research proposal involving the use of simulation to enhance public-private community responsiveness and resiliency.

6. Corporations: STIL can serve a variety of industrial sectors to create, test, validate, and improve products. The Innovations Lab is specifically engineered for new product creation. Other STIL space can serve for further research and development testing. STIL can provide corporate partners with quality control and quality assurance measurements in both their pre- and post-marketing phases of development. Potential companies to access STIL include those involved in communications, consulting, health information technology, imaging, media, medical device and medical simulator manufacturing. Dedicated researchers will specifically study products under mutually-designed protocols for use efficiencies, process models, or other analyses under a variety of real-world conditions. These researchers can present results of data to other sponsoring company’s employees prior to public release. STIL maintains research integrity to assure all company-based research is conducted in confidence with competitors. As a university entity, STIL maintains the right to publish the results of its research in timely manner when it is prepared for disclosure into the public domain. STIL can serve as corporate employee training and education center for special products or new product releases.

ImpactMedical professionals are educated and trained to serve patients. If successful in achieving our mission to research, develop and deliver superlative outcomes-based healthcare professions education, we will impact human lives. We are seeking to monitor our progress and measure our impact by:

1. Tracking of attendees who attend STIL-sponsored conferences;2. Number of publications in high-impact journals that discuss improvement of

healthcare reliability;3. Tracking of healthcare professionals for courses;4. Number of designed or deployed novel devices;5. Reporting of competency-based metrics;


6. Tracking of the reduction of training times for new hires;7. Ability to secure local, state and federal funding, and well as philanthropic

investments;8. Ability to produce training at reduced cost over market rate; and9. A demonstration of the sustainment of organizational capacities and

competencies.

In the end, the deployment of our resources will lead Northwestern to be a recognized national leader in simulation-based education for enhanced healthcare reliability.

ABOUT OUR FACULTY

The simulation program (STIL) formally resides within the Center for Education in Medicine, and is led by Dr. John Vozenilek, a member of the Feinberg Academy of Medical Educators and Associate Director of the Center for Education in Medicine. There are six core faculty of STIL.

Dr. Christine Park, MD, Medical Director of Clinical Simulation and the Patient Safety Simulation Center

Dr. Carla Pugh, MS, PhD, Medical Director of the Northwestern Center for Advanced Surgical Education (NCASE)

Dr. Mark Adler, MD, Chair of the Research Planning Committee and Director of KidSTAR

Susan Eller, RN MSN. Director for Interprofessional Education

Dr. Deb Rooney, PhD, Psychometrician

Dr. David Salzman, MD Simulation Instructor

STIL also supports a number of "Faculty Scholars" who complete projects with the center. There are greater than 20 faculty affiliates who frequently use the simulation center for education and for research.

Amer Aldeen, MD


Assistant Professor in Emergency Medicine

STIL Affiliate

Katherine Barsness, MD

Assistant Professor in Surgery

NCASE Affiliate

Jeffrey Barsuk, MD! (View Video)

Associate Professor in Medicine – Hospital Medicine

STIL Affiliate

Anne-Marie Boller, MD

Assistant Professor in Surgery – Surgical Oncology

NCASE Affiliate

Melissa Brannen, MD, MEd

Instructor in Pediatrics

STIL Affiliate

Sandra Cadichon, MD! (View Video)

Assistant Professor in Pediatrics

STIL Affiliate

James Chandler, MD

Associate Professor in Neurological Surgery and Otolaryngology – Head and Neck Surgery

NCASE Affiliate

George Chiampas, DO


STIL Affiliate

David Conley, MD


Associate Professor in Otolaryngology – Head and Neck Surgery

NCASE Affiliate

Alberto De Hoyos, MD

Assistant Professor in Surgery – Thoracic Surgery and Medicine – Pulmonary

NCASE Affiliate

Gregory Dumanian, MD

Professor in Surgery – Plastic, Neurological Surgery, and Orthopaedic Surgery

NCASE Affiliate

Walter Eppich, MD, MEd

Assistant Professor in Pediatrics and Medical Education and Faculty Development

STIL Affiliate

Richard Fessler, MD

Professor in Neurological Surgery

NCASE Affiliate

Neil Fine, MD

Associate Professor of Clinical Surgery – Plastic

NCASE Affiliate

Robert Galiano, MD

Assistant Professor in Surgery – Plastic

NCASE Affiliate

Patricia Garcia, MD

Associate Professor in Obstetrics and Gynecology – Maternal Fetal Medicine

STIL Affiliate

Rama Gourineni, MD


Assistant Professor in Ken and Ruth Davee Department of Neurology

STIL Affiliate

Amy Halverson, MD

Associate Professor in Surgery – Surgical Oncology

NCASE Affiliate

Eric Hungness, MD

Assistant Professor in Surgery – Gastrointestinal and Endocrine

NCASE Affiliate

John Kim, MD

Assistant Professor in Surgery – Plastic and Dermatology

NCASE Affiliate

Alan Micco, MD

Associate Professor in Otolaryngology – Head and Neck Surgery and Neurological Surgery

NCASE Affiliate

Magdy Milad, MD

Professor in Obstetrics and Gynecology – Reproductive Endocrinology & Infertility

STIL Affiliate

Shari Myerson, MD

Associate Professor in Surgery – Thoracic Surgery and Medicine – Pulmonary

STIL Affiliate

Emilie Powell, MD, MBA! (View Video)


STIL Affiliate

Lalit Puri, MD


Assistant Professor in Orthopaedic Surgery

NCASE Affiliate

Gail Randel, MD

Assistant Professor in Anesthesiology

STIL Affiliate

Elizabeth Ryan, EdD

Assistant Professor in Family and Community Medicine

STIL Affiliate

David Salzman, MD


STIL Affiliate

Carol Schmidt, MD

Instructor in Ophthalmology

NCASE Affiliate

Nathaniel Soper, MD

Professor in Surgery – Gastrointestinal and Endocrine

NCASE Affiliate

S David Stulberg, MD

Professor of Clinical Orthopaedic Surgery

NCASE Affiliate

Jennifer Trainor, MD

Associate Professor in Pediatrics

STIL Affiliate

Richard Wixson, MD


Professor in Orthopaedic Surgery

NCASE Affiliate

Donna Woods, PhD, MEd

Research Assistant Professor in Institute for Healthcare Studies

STIL Affiliate

NORTHWESTERN SIMULATION BIBLIOGRAPHY

An up to date bibliography of publications from Northwestern Simulation and its faculty can be found here:

http://simulation.northwestern.edu/content/research/publications.aspx

There are greater than 20 publications in the field of medical education and simulation in 2011 alone.


Documents

International Faculty Exchange Program