Northwestern Simulation and Jagiellonian University

NorthwesternSIMULATIONCENTER FOR EDUCATION IN MEDICINE

International Faculty Fellowship ProgramClinical Simulation for Patient Safety and Performance Improvement

Prepared for: Michal Nowakowski, MD PhD, Jagiellonian University Medical CollegePrepared by: John Vozenilek, MD, Director, Northwestern SimulationNorthwestern University, Feinberg School of Medicine303 E Chicago Ave, WARD 18th FloorChicago, IL 60068T 312.503.7700 [email protected] simulation.northwestern.edu

CENTER FOR EDUCATION IN MEDICINE 2

International Faculty Fellowship Program

Our 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, contain a 6 week immersion experiences in exchange countries, create continuous connections through high-speed private networks, and endure beyond the fellowship exchange in the form of a collaborative network. Our objective is to expand the use of clinical simulation as a

technique for education, outcomes research, and performance improvement to an international community.

Fellowship Program with Jagiellonian University in Poland

On August 25th, 2011 Simulation Technology and Immersive Learning Director John Vozenilek and Director of Operations Paul Pribaz met with representatives from Jagiellonian University in Krakow, Poland. Professor Piotr Laidler, PhD, the representative of the Rector of the Jagiellonian University for Scientific Research and

MD, PhD, Vice-Dean for Educational Affairs and the Head of Department of Medical Education, Michal Nowakowski MD, PhD met with Dr. Vozenilek and Mr. Pribaz at this historic site.

The two sides discussed the International Faculty Fellow Program, a collaboration between the schools that will create a faculty-level fellowship exchange allowing instructors to develop their knowledge in the field of Advanced Technology and Medical Education in a new academic environment.

Under the proposed program which is scheduled to begin in spring of 2012, select Feinberg instructors will travel to Krakow for an approximate six week fellowship at Jagiellonian’s School of Medicine in English, one of the preeminent medical schools in Europe. There, they will teach classes and interact with Jagiellonian’s students and faculty, learning more about the human factors and patient safety within a prestigious, and uniquely different, medical system.

Likewise, Jagiellonian professors will travel to Northwestern, where they will take part in an Instructor’s Certificate program developed by Feinberg. This fellowship will focus on faculty development with advanced educational technologies, including a component on simulation. Jagiellonian instructors will return home with a new knowledge of low cost simulation technology, as well as a wealth of new relationships that will benefit both schools for years to come.

This fellowship exchange program is appealing to Feinberg and STIL because it allows for the mutual exchange of ideas and techniques on an international scale. Feinberg instructors will have the opportunity to apply advanced techniques in education at a European AAMC-certified English-speaking medical school. Jagiellonian instructors will have the opportunity to teach at one of the best medical schools in the United States. The schools' mutual focus of using low-overhead, advanced technologies for their learners, has the potential to generate a network of international scholars, build relationships, and develop collaborative networks that will last long after the faculty exchanges have ended.

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

Certificate Program TopicsOperationsRisk reduction and human factorsFacilitation and debriefing Simulation-based Clinical EducationEducational ResearchAdvanced topics in Simulation EducationHuman performance, skill development and retentionSimulation and Technology AdjunctsClinical Simulation for Team Performance

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Micchal Nowakowski MD, PhDHead of Department of Medical Education

Prof. Piotr Laidler, PhD Representative of the Rector of the Jagiellonian University for Scientific Research and International Co-operation at the Medical College.Head of Council of School of Medicine in EnglishHead of Department of Biochemistry

Vice-Dean for Educational AffairsHead of Department of Metabolic Diseases

John Vozenilek, MDDirector, Northwestern Program in Simulation Technology and Immersive Learning

Paul Pribaz, MSExecutive Director, Center for Education in Medicine

Wawel Castle, Krakow, Poland

Jagiellonian UniversityCollege of MedicineKrakow



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 a!liates who frequently use the simulation center for education and for research.

Selected Bibliography1: Eppich W, Howard V, Vozenilek J, Curran I. Simulation-based team training in healthcare. Simul Healthc. 2011 Aug;6 Suppl:S14-9. PubMed PMID: 21817858.

2: Pugh CM. Warm-ups, Mental Rehearsals and Deliberate Practice: Adopting the Strategies of Elite Professionals. J Surg Res. 2011 Jun 25. [Epub ahead of print]PubMed PMID: 21816430.

3: Pugh CM. Medical Education Meets Patient Safety. J Surg Res. 2011 Jun 25. [Epub ahead of print] PubMed PMID: 21816429.

4: McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefani-dis D. Evaluating the impact of simulation on translational patient outcomes. Simul Healthc. 2011 Aug;6Suppl:S42-7. PubMed PMID: 21705966; PubMed Central PMCID: PMC3153601.

5: Kushner RF, Kessler S, McGaghie WC. Using behavior change plans to improve medical student self-care. Acad Med. 2011 Jul;86(7):901-6. PubMed PMID: 21617509;PubMed Central PMCID: PMC3128665.

6: Barsuk JH, Brake H, Caprio T, Barnard C, Anderson DY, Williams MV. Process changes to increase compliance with the universal protocol for bedside procedures. Arch Intern Med. 2011 May 23;171(10):947-9. PubMed PMID: 21606103.

7: Pugh CM, Bevan MG, Duve RJ, White HL, Magee JH, Wiehagen GB. A Retrospective Review of TATRC Funding for Medical Modeling and Simulation Technologies. SimulHealthc. 2011 Aug;6(4):218-25. PubMed PMID: 21546864.

8: McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic com-parative review of the evidence. Acad Med. 2011 Jun;86(6):706-11. Review. PubMed PMID: 21512370; PubMed Central PMCID: PMC3102783.

9: O'Leary KJ, Buck R, Fligiel HM, Haviley C, Slade ME, Landler MP, Kulkarni N, Hinami K, Lee J, Cohen SE, Williams MV, Wayne DB. Structured interdisciplinary rounds in a medical teaching unit: improving patient safety. Arch Intern Med. 2011 Apr 11;171(7):678-84. PMID: 21482844.


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About Our Facility

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:

STIL Education: Undergraduate and Graduation Medical Education;;

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

Northwestern SimulationTM: a revenue generating arm for continuing medical education and outside vendors;;

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

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

Conferences: sponsorship of educational seminars for international audiences.



Engineering Safety:Human Factors and Simulation in HealthcareInstructor:John Vozenilek, MD FACEPAssociate Professor, Emergency Medicine, Healthcare Studies, Medical EducationFeinberg School of MedicineNorthwestern University 312.503.7700simulation@northwestern.edusimulation.northwestern.edu

Engineering Safety: Human Factors and Simulation in Healthcare

The Weick and Sutcliffe model for high reliability is extremely attractive to leaders in healthcare settings, where complications and mishaps may have a catastrophic effect on patients’ lives and well-being. Organizations seeking to provide highly reliable healthcare should expect the unexpected and be committed to resilient response and process improvement. Two techniques, human factors engineering and simulation, can be used to study, maintain, and improve the performance of the healthcare system and those who work within it. This course describes these two techniques and teaches the learner how to use them in the context of the clinical environment.


Course Goals

On the successful completion of the course, learners will:Evaluate the clinical environment using a human factors perspectiveAnticipate the needs and expectations of clinicians and patientsCompose clinical simulations for risk assessmentUse healthcare simulation for human factors assessmentApply human factors engineering and simulation to healthcare contexts in which reliability improvement is sought

Course structure

This is a highly dynamic course, consisting of interactive didactic sessions and frequent clinical simulations. This class meets for a total of 40 hours with approximately 20 hours of lecture and 20 hours of clinical simulation. Each class will meet three times a week for a total of ten hours per week for four weeks.

Course materials

Learners will use the following text:

Sydney Dekker. Patient Safety: A Human Factors Approach. Boca Raton: CRC Press, 2011

Additional materials to be posted. Details provided in class.

Course requirements

Learners will be expected to participate in healthcare simulations, operate within small creative teams, and provide feedback to peers. Successful simulation requires the willing and full participation of all learners. Learners will workshop each other’s scenarios and ideas. Criticism and feedback will need to be specific, thoughtful, and collegial. Learners will have assignments that draw heavily on reading. Preparedness is essential.

Clinical Simulation



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.

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-certi"ed 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.

Advanced study in

Work in progress...

Feinberg views this fellowship collaboration with Jagiellonian University as one that will lead to additional collaborations with other universities around the world. With a focus on faculty development and how medical educators are teaching given today’s technological opportunities, Feinberg hopes to further establish itself as a leader in medical education through these partnerships, and develop an expansive network of medical contacts with other universities.

In October, Jagiellonian University professor, Dr. Piotr Laidler, is scheduled to visit Northwestern to further discuss and plan this exciting endeavor with STIL staff. For more information on Jagiellonian University, you can visit their website at http://www.uj.edu.pl/en_GB/. In addition, you can follow @NorthwesternSim on Twitter to receive updates from STIL about this and other projects within the school as they are released.



About the Feinberg School of MedicineNorthwestern UniversityApproximately 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.

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About Jagiellonian University Medical College

Jagiellonian University is one of the oldest continuously operating Universities in European history. Founded in 1364, it is also the largest higher education institution in the Malopolska region of Poland. Since its origin, JU has held a leadership role in education not only in Poland but also in middle Europe. At the moment there are over 50 thousand students being taught by over 3000 faculty members. Large portions of our international students, numbering in the thousands, are not Polish citizens, coming to Krakow to study medicine. In September of 2011, there are greater than 600 international students studying medicine in English at JU. Many others have chosen JU for European studies, mathematics, law, chemistry, biotechnology or ecology. Most are enrolled in masters programs in Krakow.

JU is a leading Polish research center. The Polish Ministry of Science and Higher Education Rankings places JU in one of top positions, based on the number and high impact of publications in Polish and international journals, and the large number of international research grants won. JU Medical College is one the largest Faculties of JU second only to faculty of Law and Administration.

Over 4500 students are trained in one of seven different MD programs. Over 800 Faculty teach three MD programs in English. JU composes a great and diverse learning and teaching environment. Yearly evaluations have earned JU many awards, and JU has always been listed as one of the top three medical schools in Poland-- both for teaching and for research. International bodies includinga the Association of American Medical Colleges, the Department of Education, and the Medical Board of California also

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recognize JU Medical College as a leader.

Department of Medical EducationOur DME was created 13 years ago as only the second of its kind in Poland. JU has revitalized medical education at JUMC and has served in a leadership role for other medical schools in Poland. The strength of the DME sprung from its use of simulation and innovative devices and phantoms it created in medical education, to become one of the key educational facilities and a central point of educational excellence. The use of simulation is at various levels of medical training, reflected by our key target areas. These include:

Undergraduate medical studentsEach and every JU student of medicine learns the basics of his future profession under the guidance of DME staff. The basics of physical examination and history taking form the outline for the development of communication skills by undergraduates. They learn the basics of key medical procedures on simulators to make their future training safer and easier. The DME helps students to achieve competence in skills including catheterization, venupuncture, basic and advanced life support, as well as suturing and knot tying just to name a few.

Graduate trainees JU DME faculty has begun to innovate the training of residents. The development of surgical skill laboratories has allowed residents to develop their skills in a safe and efficient manner. The first courses were held in 2010 and we hope to increase their numbers. These programs are of the highest quality and have already earned the JUMC significant recognition in Poland.


Faculty membersOne of the main goals of the DME is to provide our teachers with the tools to improve their teaching skills, to give them opportunities to learn modern ways to educate students. This is why the DME created the Faculty Development Program. It is composed of 14 educational courses with approximately 320 teaching hours. More than 250 faculty-participants attend every year. Topics include techniques in medical education as well as very specialized courses for future leaders in the faculty, such as course and clerkship directors. Our highly specialized instructors in medical simulation, OSCE administration, and PBL instructors are graduates of the Faculty Development Program.

Medical scholarsAnother goal for the DME is research and scholarship. The faculty are engaged in research to prove that the curriculum that JU produces is not only the most modern, but also highly evidence-based. JUMC aspires to participate in development of scholarship of the highest quality, focused on how to teach better doctors for the benefit of our society.


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ResourcesTo fulfill these goals, the JU DME has facilities dedicated to medical education and a large group of well trained and experienced medial educators.

FacultyThe permanent staff of the department consists of 12 full time and part time employees. The majority of these are physicians and professors of various specialties ranging from the basic sciences through internal medicine and primary care to emergency medicine and surgical specialties. Dozens of scholars are also assigned for short periods of time, ranging from few weeks to few months, to attend to DME goals. They are carefully chosen from JU’s large pool of highly trained educators.

FacilitiesThe JUMC DME facilities include 500 square meters devoted to various simulation rooms, skill laboratories, and


training rooms. The teaching complex where the DME is located, provides access to four large lecture rooms and five seminar rooms in addition to the training space. All available facilities are fully equipped for audio and video support and linked. Training and simulation rooms are equipped with basic and advanced simulation phantoms and the audio and video equipment essential to the training process. In summary, the Jagiellonian University Medical College is well-poised to lead the future of medical training.

Documents

Northwestern Simulation and Jagiellonian University