Developing a Simulation-based Procedural Skills Curriculum
Taylor Sawyer DO, MEd1, Anne Ades, MD2, Marjorie White , MPPM, MEd3 , JoDee Anderson, MD, MEd
1. University of Washington/Seattle Children’s, 2. University of Pennsylvania/Children’s Hospital of Philadelphia, 3. University of Alabama at Birmingham/ Children's of Alabama, 4. Oregon Health Science
University
Disclosures
• The presenters have nothing to disclose
Learning Objectives
• Define key components required to teach procedural skills using simulation
• Identify methods that can be used to assess procedural competency using simulation
• Develop a model for a simulation-based procedural skills curriculum in your program
Agenda
• Introductions and didactic session
• Divide large group into subspecialty groups (as best as possible)
• 10 min - small group discussion on teaching procedural skills
• 10 min report back and large group discussion
• 10 min - small group discussion on assessing procedural competency
• 10 min report back and large group discussion
• 10 min - small group discussion on developing a simulation-based procedural skill curriculum
• 10 min report back and large group discussion
• Final discussion and review of INSPIRE’s work on procedural skills
“Procedural skills”
• “the mental and motor activities required to execute a manual task”
Foley RP, Spilansky J. Teaching techniques- a handbook or health professionals. New York, McGraw Hill; 1908: 71-91
“Simulation”
• Task trainers
• Manikin-based
• Virtual reality
• Standardized patients
Why is this important?
• ACGME requirements
• Pediatric Subspecialty (focused revision, effective 7/2013)
• IV.A.5.a).(2) Fellows must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.
• IV.A.5.a).(2).(a).(i) Fellows must acquire the necessary procedural skills and develop an understanding of their indications, risks, and limitations.
• IV.A.5.a).(2).(a).(ii) Each fellow’s experience in such procedures must be documented by the program director and such documentation must be available for review.
• Patient safety
• Fellows as teachers
http://www.acgme.org/acgmeweb/ProgramandInstitutionalGuidelines/MedicalAccreditation/Pediatrics.aspx
Theories/Frameworks of Skill Acquisition
•Dreyfus (1986)
•Simpson (1966)
•Fits & Posner (1967)
Dreyfus S, Dreyfus, H. A Five-Stage Model of the Mental
Activities Involved in Directed Skill Acquisition. 1980
Level 1: Guided response
Skill performed through imitation and trial and error
Level 2: Mechanism
When the skill has started to become habitual
Level 3: Complex overt response
Characterized by an accurate and efficient performance of the skill
Level 4: Adaptation
When the skill has been so well internalized that it can be adapted for different contexts and
situations
Level 5: Origination
Involves the creative development of new psychomotor skills
Psychomotor Skill Development
Simpson 1966
Cognitive phase - when the skill is being learned
Associative phase - when skill is becoming ingrained
Autonomous phase - when the skill has become automatic and
can be carried out without thinking about it
Fitts and Posner: 3 phase model
What is Competency?
• Merriam-Webster- “having requisite or adequate ability or qualities”
• The ability to perform a certain task required for a work situation
• Competency is a mental construct
• “competent” vs. “evidence of competency”
• Competency is contextual
• Relationship between the person’s abilities to perform the task and the particular situation in the real world
• Competency is mutable
• Changes with time as the learner progresses/digresses
Framework for Clinical Assessment
Expert
Proficient
Competent
Advanced
Beginner
Novice
Residency Attending
Psy
cho
mo
tor
Sk
ill
wit
h a
Me
dic
al
Pro
ced
ure
Dashed line represents skill development and maintenance overtime Simulation-based training Clinical experience
http://martinsj2.wordpress.com/2010/08/26/and-now-for-something-completely-different/
Divide into groups of 4-6, by subspecialty
Academic Pediatrics
Adolescent Medicine
Cardiology
Child Abuse
Critical Care Medicine
Developmental-Behavioral Pediatrics
Emergency Medicine
Endocrinology
Gastroenterology
Hematology-Oncology
Infectious Diseases
Neonatal-Perinatal Medicine
Nephrology
Pulmonology
Rheumatology
Small group session 1:
Discuss/brain-storm on how best to teach procedural skills using simulation (focus on teaching- we’ll do assessment next)
What procedures will you teach?
How will the teaching be conducted?
What materials/simulators do you need?
Small group session 1:
Report back
What procedures will you teach?
How will the teaching be conducted?
What materials/simulators do you need?
Small group session 2:
Discuss/brain-storm on how best to assess procedural competency using simulation (focus on assessment - we’ll do curriculum development next)
How will you define competency?
What type of assessment- formative vs. summative?
When will you do the assessment?
What tools will you use for the assessment?
Small group session 2:
Report back
How will you define competency?
What type of assessment- formative vs. summative?
When will you do the assessment?
What tools will you use for the assessment?
Small group session 3:
Discuss/brain-storm on how best to establish a curriculum to teach and evaluate procedural skills using simulation
How can you combine the teaching plan and the assessment plan into a curriculum?
How will you integrate the curriculum into your program?
How will you get buy-in from fellows?
How will you get participation by faculty?
Small group session 3:
Report back
How can you combine the teaching plan and the assessment plan into a curriculum?
How will you integrate the curriculum into your program?
How will you get buy-in from fellows?
How will you get participation by faculty?
International Network for Simulation-based
Pediatric Innovation, Research and Education
Foundation for Advancement of International Medical Education and Research
AI duPont Hospital for Children
Alberta Children's Hospital
Arkansas Children’s Hospital
Armed Forces Simulation Institute for Medicine
Athena Learning Services LLC
Baylor College of Medicine
Bristol Royal Hospital for Children
Cardinal Glennon Children's Medical Center
Central Manchester University Hospitals
Children’s Hospital of Alabama
Children’s Hospital of Philadelphia
Children's Hospital at Dartmouth
Children's Hospital at Montefiore
Children's Hospital at Westmead, Sydney, NSW, Australia
Children's Hospital Los Angeles
Children's Hospital of Boston
Children's Hospital of Eastern Ontario
Children’s Hospital of Michigan
Children's Hospital of Orange County
Children's Hospital of Pittsburgh
Children's Hospital of The King's Daughters
Children's Memorial Hospital (Lurie Children's)
Children's Mercy Hospitals and Clinics
Children's National Medical Center
Children's Hospital of Minnesota
CHU de Poitiers
CHU Sainte Justine
Cincinnati Children’s Hospital
Cleveland Clinic Children's Hospital
Cohen Children's Medical Center
Columbia University Medical Center
Comer Children's Hospital
Connecticut Children's Medical Center
Dalhousie University
Dell Children's Medical Center
Emory Children’s Center
Georgia Health Sciences University
Hamilton Health Sciences
Hasbro Children's Hospital- Brown
Hospital Clinico Universitario de Santiago de Compostela
Indiana University-Purdue University Indianapolis
Innomar Strategies - AmerisourceBergen
INOVA Fairfax Hospital
Israel Center for Medical Simulation,
Jacobi Medical Center
Johns Hopkins Children’s Hospital
King Abdulaziz Medical Center - NGHA
Kingston General Hospital
Kosair Children's Hospital
LeBonheur Children's Hospital
Lehigh Valley Hospital
Loma Linda University Children's Hospital
Lucile Packard Children's Hospital
Maria Farreri Children's Hospital Westchester Medical Center
McMaster University
Medical University of South Carolina
Memorial University
Montreal Children's Hospital
Morristown Medical Center
Mount Sinai Hospital
Nationwide Children's Hospital
New York University
New York-Presbyterian Hospital
NYU Bellvue
Oregon Health & Science University
Paediatric Simulation Research Collaborative South Tyrol
Phoenix Children's Hospital
Red Forest Consulting, LLC and University of Michigan Health System
Rio Grande Regional Hospital
Seattle Children's Hospital
Hospital for Sick Kids
St Barnabas Hospital
St George's Healthcare
St. Michael's Hospital
Stanford University
Stollery Children's Hospital
Stony Brook University Medical Center
Texas Children's Hospital
The Austen BioInnovation Institute in Akron
The Royal Children's Hospital
The University of Chicago Comer Children's Hospital
TriHealth - Bethesda North Hospital
Tripler Army Medical Center
Tufts Medical Center
Tulane University
UMass Amherst
UMDNJ/Robert Wood Johnson Medical School
Uniformed Services University of the Health Sciences
Universidad Autonoma de Coahuila
University of Maryland
University College Cork
University Hospital of Strasbourg
British Columbia Children's Hospital
University of Colorado (Denver) School of Medicine
University of Illinois
University of Iowa Children's Hospital
University of Michigan
University of Pittsburgh
University of Rochester
University of Saskatoon
University of South Florida
University of Texas at Arlington
University of Texas Southwestern
University of Utah
University of Wisconsin School of Medicine
Wake Forest Baptist Medical Center
Wake Forest University School of Medicine
Walter Reed National Military Medical Center
Weill Cornell
Yale New Haven Health System
Yale University
112 Institutions around the world
http://www.inspiresim.com/
Learn See Practice Prove Do Maintain
Remediation
Learning about
procedure via
videos and online
Training• Cognitive skills
test
Demonstration
by instructor• Integrated
skills
• Individual
steps
Formative
assessment on
simulator • Deliberate practice
• Mastery learning
Summative
assessment
on simulator • Just in time
Performance
on human with
formative
assessment• Structured
observation
and feedback
• Procedure
logs
• Evidence of
competency Cognitive Phase Psychomotor Phase
Maintenance of skill
through clinical practice
supplemented by
simulation as needed
Procedural Skills Training using Simulation Procedural Skills Training using Simulation Procedural Skills Training using Simulation Procedural Skills Training using Simulation
International Network for Simulation-based Pediatric
Innovation, Research and Education
http://www.inspiresim.com/
Questions/Comments?