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Weiss M, Morrison EW, Szyld D. I like what you are saying, but only if i feel safe: Psychological safety moderates the relationship between voice and perceived contribution to healthcare team effectiveness. Front Psychol 2023; 14:1129359. [PMID: 37139001 PMCID: PMC10150701 DOI: 10.3389/fpsyg.2023.1129359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/09/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Are nurses who voice work-related concerns viewed as positive contributors to a team? We propose that the extent to which healthcare professionals consider voice by nurses as helpful for the team depends on how psychologically safe they feel. Specifically, we hypothesized that psychological safety moderates the relationship between voice of a lower ranking team member (i.e., a nurse) and perceived contribution by others, such that voice is more likely to be seen as valuable for team decision-making when psychological safety is high but not when it is low. Methods We tested our hypotheses with a randomized between-subjects experiment using a sample of emergency medicine nurses and physicians. Participants evaluated a nurse who either did or did not speak up with alternative suggestions during emergency patient treatment. Results Results confirmed our hypotheses: At higher levels of psychological safety the nurse's voice was considered as more helpful than withholding of voice for team decision-making. This was not the case at lower levels of psychological safety. This effect was stable when including important control variables (i.e., hierarchical position, work experience, gender). Discussion Our results shed light on how evaluations of voice are contingent on perceptions of a psychologically safe team context.
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Affiliation(s)
- Mona Weiss
- School of Business and Economics, Department of Management, Freie Universität Berlin, Berlin, Germany
- *Correspondence: Mona Weiss,
| | - Elizabeth W. Morrison
- Stern School of Business and Economics, Department of Management, New York University, New York, NY, United States
| | - Demian Szyld
- School of Medicine, Boston University, Boston, MA, United States
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Fey MK, Roussin CJ, Rudolph JW, Morse KJ, Palaganas JC, Szyld D. Teaching, coaching, or debriefing With Good Judgment: a roadmap for implementing “With Good Judgment” across the SimZones. Adv Simul (Lond) 2022; 7:39. [DOI: 10.1186/s41077-022-00235-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/03/2022] [Indexed: 11/28/2022] Open
Abstract
AbstractSimulation-based learning occurs in multiple contexts, and one teaching style cannot adequately cover the needs at each learning level. For example, reflective debriefing, often used following a complex simulation case, is not what is needed when learning new skills. When to use which facilitation style is a question that educators often overlook or struggle to determine. SimZones is a framework used to clarify the multiple contexts in simulation. This framework, combined with elements of Debriefing With Good Judgment, can help educators match the appropriate facilitation style with learner needs and learning context. We have distilled the core elements of the “with good judgment” approach to debriefing and applied them to the SimZones framework to guide educators with (1) what type of learning can be expected with each learning context, (2) what behaviors and activities can be expected of the learners in each learning context, (3) what instructional strategies are most effectively used at each stage, and (4) what are the implications for the teacher-learner relationship.
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3
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Ahmed RA, Wong AH, Musits AN, Cardell A, Cassara M, Wong NL, Smith MK, Bajaj K, Meguerdichian M, Szyld D. Accreditation of Simulation Fellowships and Training Programs: More Checkboxes or Elevating the Field? Simul Healthc 2022; 17:120-130. [PMID: 34175883 DOI: 10.1097/sih.0000000000000593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY STATEMENT As the field of healthcare simulation matures, formal accreditation for simulation fellowships and training programs has become increasingly available and touted as a solution to standardize the education of those specializing in healthcare simulation. Some simulation experts hold opposing views regarding the potential value of simulation fellowship program accreditation. We report on the proceedings of a spirited debate at the 20th International Meeting on Simulation in Healthcare in January 2020. Pro arguments view accreditation as the logical evolution of a maturing profession: improving training quality through standard setting, providing external validation for individual programs, and enhancing the program's return on investment. Con arguments view accreditation as an incompletely formulated construct; burdensome to the "financially strapped" fellowship director, misaligned with simulation fellows' needs and expectations, and confusing to administrators mistakenly equating accreditation with credentialing. In addition, opponents of accreditation postulate that incorporating curricular standards, practice guidelines, and strategies derived and implemented without rigor, supporting evidence and universal consensus is premature. This narrative review of our debate compares and contrasts contemporary perspectives on simulation fellowship program accreditation, concluding with formal recommendations for learners, administrators, sponsors, and accrediting bodies.
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Affiliation(s)
- Rami A Ahmed
- From the Division of Simulation (R.A.A.), Indiana University School of Medicine, Indianapolis, IN; Yale Center for Medical Simulation (A.H.W.), New Haven, CT; Lifespan Medical Simulation Center (A.N.M.), Warren Alpert Medical School of Brown University, Providence, RI; Department of Emergency Medicine (A.C.), Maimonides Medical Center, New York City; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (M.C.), Northwell EMSL Simulation Fellowship, Northwell Health Patient Safety Institute, Hempstead, NY; VHA SimLEARN (N.L.W.), Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA; Michigan State University Learning and Assessment Center (M.K.S.), East Lansing, MI; Department of Obstetrics and Gynecology (K.B.), Albert Einstein College of Medicine, Jacobi Medical Center, NYC H+H Simulation Center; Department of Emergency Medicine (M.M.), Harlem Hospital Center, Health +Hospitals, Columbia University, New York City, NY; and Institute for Medical Simulation (D.S.), Center for Medical Simulation, Harvard Medical School, Boston, MA
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Abstract
PURPOSE OF REVIEW Millions of perioperative crises (e.g. anaphylaxis, cardiac arrest) may occur annually. Critical event debriefing can offer benefits to the individual, team, and system, yet only a fraction of perioperative critical events are debriefed in real-time. This publication aims to review evidence-based best practices for proximal critical event debriefing. RECENT FINDINGS Evidence-based key processes to consider for proximal critical event debriefing can be summarized by the WATER mnemonic: Welfare check (assessing team members' emotional and physical wellbeing to continue providing care); Acute/short-term corrections (matters to be addressed before the next case); Team reactions and reflections (summarizing case; listening to team member reactions; plus/delta conversation); Education (lessons learned from the event and debriefing); Resource awareness and longer term needs [follow-up (e.g. safety/quality improvement report), local peer-support and employee assistance resources]. A cognitive aid to accompany this mnemonic is provided with the publication. SUMMARY There is growing literature on how to conduct proximal perioperative critical event debriefing. Evidence-based best practices, as well as a cognitive aid to apply them, may help bridge the gap between theory and clinical practice. In this era of increased attention to burnout and wellness, the consideration of interventions to improve the quality and frequency of critical event debriefing is paramount.
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Affiliation(s)
- Alexander F Arriaga
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
- Center for Surgery and Public Health
- Ariadne Labs
| | - Yun-Yun K Chen
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
| | - Marc Philip T Pimentel
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
| | - Angela M Bader
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
- Center for Surgery and Public Health
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital
- Center for Medical Simulation, Boston, Massachusetts, USA
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5
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Diaz-Navarro C, Leon-Castelao E, Hadfield A, Pierce S, Szyld D. Clinical debriefing: TALK© to learn and improve together in healthcare environments. Trends in Anaesthesia and Critical Care 2021. [DOI: 10.1016/j.tacc.2021.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Stafford JL, Leon-Castelao E, Klein Ikkink AJ, Qvindesland SA, Garcia-Font M, Szyld D, Diaz-Navarro C. Clinical debriefing during the COVID-19 pandemic: hurdles and opportunities for healthcare teams. Adv Simul (Lond) 2021; 6:32. [PMID: 34526150 PMCID: PMC8441031 DOI: 10.1186/s41077-021-00182-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/24/2021] [Indexed: 01/26/2023] Open
Abstract
The COVID-19 pandemic and the subsequent pressures on healthcare staff and resources have exacerbated the need for clinical teams to reflect and learn from workplace experiences. Surges in critically ill patients, the impact of the disease on the workforce and long term adjustments in work and life have upturned our normality. Whilst this situation has generated a new 'connectedness' within healthcare workers, it also continues to test our resilience.An international multi-professional collaboration has guided the identification of ongoing difficulties to effective communication and debriefing, as well as emerging opportunities to promote a culture of dialogue. This article outlines pandemic related barriers and new possibilities categorising them according to task management, teamwork, situational awareness and decision making. It describes their direct and indirect impact on clinical debriefing and signposts towards solutions to overcome challenges and, building on new bridges, advance team conversations that allow us to learn, improve and support each other.This pandemic has brought clinical professionals together; nevertheless, it is essential to invest in further developing and supporting cohesive teams. Debriefing enables healthcare teams and educators to mitigate stress, build resilience and promote a culture of continuous learning and patient care improvement.
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Affiliation(s)
- Jody L Stafford
- Department of Perfusion/Cardiothoracic Surgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Esther Leon-Castelao
- Clinical Simulation Laboratory, Faculty of Medicine and Healthcare Sciences, University of Barcelona, Barcelona, Spain
| | - Albert J Klein Ikkink
- Wenckebach Simulation Center for Training, Education and Research, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Munt Garcia-Font
- Clinical Simulation Laboratory, Faculty of Medicine and Healthcare Sciences, University of Barcelona, Barcelona, Spain
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Affiliation(s)
- Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA .,Institute for Medical Simulation, Center for Medical Simulation, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander F Arriaga
- Harvard Medical School, Boston, Massachusetts, USA.,Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Ariadne Labs, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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8
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Szyld EG, Aguilar A, Lloret SP, Pardo A, Fabres J, Castro A, Dannaway D, Desai PV, Capelli C, Song CH, Enriquez D, Szyld D. Self-directed video versus instructor-based neonatal resuscitation training: a randomized controlled blinded non-inferiority multicenter international study. J Perinatol 2021; 41:1583-1589. [PMID: 33589725 PMCID: PMC7883882 DOI: 10.1038/s41372-021-00941-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/16/2020] [Accepted: 01/19/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the efficacy of video-assisted self-directed neonatal resuscitation skills course with video-assisted facilitator-led course. METHODS This multicenter, randomized, blinded, non-inferiority-controlled trial compared two methods of teaching basic neonatal resuscitation skills using mask ventilation. Groups of novice providers watched an instructional video. One group received instructor facilitation (Ins-Video). The other group did not (Self-Video). An Objective Structured Clinical Exam (OSCE) measured skills performance, and a written test gauged knowledge. RESULTS One hundred and thirty-four students completed the study. Sixty-three of 68 in the Self-Video Group (92.6%) and 59 of 66 in the Ins-Video Group (89.4%) achieved post-training competency in positive pressure ventilation (primary outcome). OSCE passing rates were low in both groups. Knowledge survey scores were comparable between groups and non-inferior. CONCLUSIONS Video self-instruction taught novice providers positive pressure ventilation skills and theoretical knowledge, but it was insufficient for mastery of basic neonatal resuscitation in simulation environment.
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Affiliation(s)
- Edgardo G. Szyld
- grid.266902.90000 0001 2179 3618The University of Oklahoma Health Sciences Center, Oklahoma City, OK USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | - Santiago Perez Lloret
- grid.441606.10000 0004 0489 6641Universidad Abierta Interamericana-Centro de Altos Estudios en Ciencias Humanas y de la Salud, Consejo Nacional de Investigaciones Cientificas y Tencnicas. (UAI-CAECICHS.CONICET), Buenos Aires, Argentina
| | - Amorina Pardo
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Fabres
- grid.7870.80000 0001 2157 0406Department of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Adriana Castro
- Hospital Interzonal De Agudos Evita, Lanus, Buenos Aires, Argentina
| | - Douglas Dannaway
- grid.266902.90000 0001 2179 3618The University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Purnahamsi V. Desai
- grid.137628.90000 0004 1936 8753New York University School of Medicine, New York, NY USA
| | - Carola Capelli
- grid.411197.b0000 0004 0474 3725Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Clara H. Song
- grid.266902.90000 0001 2179 3618The University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Diego Enriquez
- Simulacion Medica Roemmers, Olivos, Buenos Aires, Argentina
| | - Demian Szyld
- Center for Medical Simulation, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
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9
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Servotte JC, Welch-Horan TB, Mullan P, Piazza J, Ghuysen A, Szyld D. Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19. Adv Simul (Lond) 2020; 5:32. [PMID: 33292850 PMCID: PMC7656224 DOI: 10.1186/s41077-020-00150-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic. METHODS We reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions. An end-of-shift huddle format for the debriefs allowed multiple cases of suspected or confirmed COVID-19 illness to be discussed in the same session, promoting situational awareness and team learning. A novel ED-based clinical debriefing tool was implemented and titled Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE). A facilitator experienced in simulation debriefings would facilitate a short (10-25 min) discussion of the relevant cases by following a scripted series of stages for debriefing. Data on the number of debriefing opportunities, frequency of utilization of debriefing, debriefing location, and professional background of the facilitator were analyzed. RESULTS During the study period, the ED treated 3386 suspected or confirmed COVID-19 cases, with 11 deaths and 77 ICU admissions. Of the 187 debriefing opportunities in the first 8-week period, 163 (87.2%) were performed. Of the 24 debriefings not performed, 21 (87.5%) of these were during the four first weeks (21/24; 87.5%). Clinical debriefings had a median duration of 10 min (IQR 7-13). They were mostly facilitated by a nurse (85.9%) and mainly performed remotely (89.8%). CONCLUSION Debriefing with DISCOVER-PHASE during the COVID-19 pandemic were performed often, were relatively brief, and were most often led remotely by a nurse facilitator. Future research should describe the clinical and organizational impact of this DISCOVER-PHASE.
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Affiliation(s)
- Jean-Christophe Servotte
- Public Health Sciences Department, University of Liege, Liege, Belgium
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
| | - T. Bram Welch-Horan
- Director of Simulation, Section of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Paul Mullan
- Director of Research and Quality Improvement, Division of Emergency Medicine, Children’s Hospital of the King’s Daughters, Eastern Virginia Medical School, Norfolk, VA USA
| | - Justine Piazza
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
- Emergency Department, University Hospital Centre of Liege, Liege, Belgium
| | - Alexandre Ghuysen
- Public Health Sciences Department, University of Liege, Liege, Belgium
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
- Emergency Department, University Hospital Centre of Liege, Liege, Belgium
| | - Demian Szyld
- Senior Director, Institute for Medical Simulation, Center for Medical Simulation, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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Affiliation(s)
- Alexander F Arriaga
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Ariadne Labs, Boston, MA, USA; Center for Surgery and Public Health, Boston, MA, USA.
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Medical Simulation, Boston, MA, USA. https://twitter.com/debriefmentor
| | - May C M Pian-Smith
- Center for Medical Simulation, Boston, MA, USA; Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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11
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Azizoddin DR, Vella Gray K, Dundin A, Szyld D. Bolstering clinician resilience through an interprofessional, web-based nightly debriefing program for emergency departments during the COVID-19 pandemic. J Interprof Care 2020; 34:711-715. [PMID: 32990108 DOI: 10.1080/13561820.2020.1813697] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The COVID-19 pandemic has instigated significant changes for health care systems. With clinician burnout rising, efforts to promote clinician resilience are essential. Within this quality improvement project, an interprofessional debriefing program (Brigham Resilience in COVID-19-pandemic Emergency Forum-BRIEF) was developed within two emergency departments (EDs). An interprofessional group of ED providers led optional, nightly debriefings using a web-based portal to connect with ED clinicians for six weeks. In total, 81 interprofessional staff participated in nightly debriefings with a 47% attendance rate. On average, three participants attended the BRIEF nightly (range = 2-8) to discuss the challenges of social distancing, scarce resources, high acuity, clinician burnout and mental health. Participation increased as rates of COVID-19 positive patients rose. Debriefing leaders provided ED leadership with summaries of clinician experiences and suggestions for improvements. Feedback supported quality improvement initiatives within the ED and greater mental health support for staff. Clinicians and administrators provided positive feedback regarding the program's impact on clinician morale, and clinical processes that promoted the safety and quality of patient care. Optional debriefing with receptive departmental leadership may be a successful tool to support clinicians and hospitals during critical events.
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Affiliation(s)
- Desiree R Azizoddin
- Department of Emergency Medicine, Brigham and Women's Hospital , Boston, MA, USA.,Harvard Medical School , Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute , Boston, MA, USA
| | - Kristen Vella Gray
- Department of Emergency Medicine, Brigham and Women's Hospital , Boston, MA, USA
| | - Andrew Dundin
- Department of Emergency Medicine, Brigham and Women's Hospital , Boston, MA, USA
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital , Boston, MA, USA.,Harvard Medical School , Boston, MA, USA.,Center for Medical Simulation , Boston, MA, USA
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12
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Molina MF, Szyld D, Wilcox SR, Wittels KA. An Ominous Rash. J Emerg Med 2020; 59:435-438. [PMID: 32800638 DOI: 10.1016/j.jemermed.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Melanie F Molina
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kathleen A Wittels
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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13
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Ingrassia PL, Capogna G, Diaz-Navarro C, Szyld D, Tomola S, Leon-Castelao E. COVID-19 crisis, safe reopening of simulation centres and the new normal: food for thought. Adv Simul (Lond) 2020; 5:13. [PMID: 32690997 PMCID: PMC7363498 DOI: 10.1186/s41077-020-00131-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background The world is facing a massive burden from the coronavirus disease 2019 (COVID-19) pandemic. Governments took the extraordinary step of locking down their own countries to curb the spread of the coronavirus. After weeks of severe restrictions, countries have begun to relax their strict lockdown measures. However, reopening will not be back to normal. Simulation facilities (SF) are training spaces that enable health professionals and students to learn skills and procedures in a safe and protected environment. Today’s clinicians and students have an expectation that simulation laboratories are part of lifelong healthcare education. There is great uncertainty about how COVID-19 will impact future training in SF. In particular, the delivery of training activities will benefit of adequate safety measures implemented for all individuals involved. This paper discusses how to safely reopen SF in the post-lockdown phase. Main body The paper outlines 10 focus points and provides operational tips and recommendations consistent with current international guidelines to reopen SF safely in the post-lockdown phase. Considering a variety of national advices and regulations which describe initial measures for the reopening of workplaces as well as international public health recommendations, we provide points of reflection that can guide decision-makers and SF leaders on how to develop local approaches to specific challenges. The tips have been laid out taking also into account two main factors: (a) the SF audience, mainly consisting of undergraduate and postgraduate healthcare professionals, who might face exposure to COVID-19 infection, and (b) for many simulation-based activities, such as teamwork training, adequate physical distancing cannot be maintained. Conclusions The planning of future activities will have to be based not only on safety but also on flexibility principles. Sharing common methods consistent with national and international health guidelines, while taking into account the specific characteristics of the different contexts and centres, will ultimately foster dissemination of good practices. This article seeks to further the conversation. It is our hope that this manuscript will prompt research about the impact of such mitigation procedures and measures in different countries.
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Affiliation(s)
- Pier Luigi Ingrassia
- Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie, SIMNOVA, Università del Piemonte Orientale, Via Lanino 1, 28100 Novara, Italy
| | - Giorgio Capogna
- Scuola di Anestesia, Centro di Simulazione EESOA, Rome, Italy
| | - Cristina Diaz-Navarro
- Department of Peri-operative Care, Cardiff and Vale University Health Board, Cardiff, UK
| | - Demian Szyld
- Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA USA
| | - Stefania Tomola
- Centro di Simulazione (CeSi) at the Centro Professionale Sociosanitario, Lugano, Switzerland
| | - Esther Leon-Castelao
- Clinical Simulation Laboratory, School of Medicine and Healthcare Sciences, University of Barcelona, Barcelona, Spain
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14
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Servotte JC, Bragard I, Szyld D, Van Ngoc P, Scholtes B, Van Cauwenberge I, Dardenne N, Goosse M, Pilote B, Guillaume M, Ghuysen A. Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department. West J Emerg Med 2019. [DOI: 10.5811//westjem.2019.8.43441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jean-Christophe Servotte
- University of Liège, Department of Public Health Sciences, Liège, Belgium University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
| | - Isabelle Bragard
- University of Liège, Department of Public Health Sciences, Liège, Belgium University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
| | - Demian Szyld
- Institute for Medical Simulation, Center for Medical Simulation, Brigham and Women’s Hospital, Harvard Medical School
| | - Pauline Van Ngoc
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Beatrice Scholtes
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | | | - Nadia Dardenne
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Manon Goosse
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Bruno Pilote
- Université Laval, Faculté des sciences infirmières, Québec, Canada
| | - Michele Guillaume
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Alexandre Ghuysen
- University of Liège, Department of Public Health Sciences, Liège, Belgium University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
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15
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Servotte JC, Bragard I, Szyld D, Van Ngoc P, Scholtes B, Van Cauwenberge I, Donneau AF, Dardenne N, Goosse M, Pilote B, Guillaume M, Ghuysen A. Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department. West J Emerg Med 2019; 20:893-902. [PMID: 31738716 PMCID: PMC6860397 DOI: 10.5811/westjem.2019.8.43441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills. Methods Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule. Results Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience. Conclusion A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.
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Affiliation(s)
- Jean-Christophe Servotte
- University of Liège, Department of Public Health Sciences, Liège, Belgium.,University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
| | - Isabelle Bragard
- University of Liège, Department of Public Health Sciences, Liège, Belgium.,University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
| | - Demian Szyld
- Institute for Medical Simulation, Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School
| | - Pauline Van Ngoc
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Béatrice Scholtes
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | | | | | - Nadia Dardenne
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Manon Goosse
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Bruno Pilote
- Université Laval, Faculté des sciences infirmières, Québec, Canada
| | - Michèle Guillaume
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Alexandre Ghuysen
- University of Liège, Department of Public Health Sciences, Liège, Belgium.,University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
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Matterson HH, Szyld D, Green BR, Howell HB, Pusic MV, Mally PV, Bailey SM. Neonatal resuscitation experience curves: simulation based mastery learning booster sessions and skill decay patterns among pediatric residents. J Perinat Med 2018; 46:934-941. [PMID: 29451862 DOI: 10.1515/jpm-2017-0330] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/18/2018] [Indexed: 11/15/2022]
Abstract
Background Following neonatal resuscitation program (NRP) training, decay in clinical skills can occur. Simulation-based deliberate practice (SBDP) has been shown to maintain NRP skills to a variable extent. Our study objectives were (a) to determine whether a single 30 min simulation-based intervention that incorporates SBDP and mastery learning (ML) can effectively restore skills and prevent skill decay and (b) to compare different timing options. Methods Following NRP certification, pediatric residents were randomly assigned to receive a video-recorded baseline assessment plus SBDP-ML refresher education at between 6 and 9 months (early) or between 9 and 12 months (late). One year following initial certification, participants had repeat skill retention videotaped evaluations. Participants were scored by blinded NRP instructors using validated criteria scoring tools and assigned a global performance rating score (GRS). Results Twenty-seven participants were included. Residents in both early and late groups showed significant skill decay 7 and 10 months after initial NRP. SBDP-ML booster sessions significantly improved participants' immediate NRP performance scores (p<0.001), which persisted for 2 months, but were again lower 4 months later. Conclusions NRP skills may be boosted to mastery levels after a short SBDP-ML intervention and do not appear to significantly decline after 2 months. Brief booster training could potentially serve as a useful supplement to traditional NRP training for pediatric residents.
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Affiliation(s)
- Heideh H Matterson
- Neonatal Intensive Care Unit, Hackensack University Medical Center at Pascack Valley, Westwood, NJ, USA
| | - Demian Szyld
- Center for Medical Simulation and Brigham and Women's Hospital, Boston, MA, USA
| | - Brad R Green
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Heather B Howell
- Division of Neonatology, New York University School of Medicine, New York, NY, USA
| | - Martin V Pusic
- New York University School of Medicine, New York, NY, USA
| | - Pradeep V Mally
- Division of Neonatology, New York University School of Medicine, New York, NY, USA
| | - Sean M Bailey
- Division of Neonatology, New York University School of Medicine, 462 First Ave, Suite 8S15, New York, NY 10016, USA
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Suarez C, Maxide J, Szyld D, Maestre JM. Anesthesia Simulator-Based Functional Capacity Evaluation of an Anesthesiologist After Radial Fracture. A A Pract 2018; 10:133-135. [DOI: 10.1213/xaa.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Szyld D, Uquillas K, Green BR, Yavner SD, Song H, Nick MW, Ng GM, Pusic MV, Riles TS, Kalet A. Improving the Clinical Skills Performance of Graduating Medical Students Using "WISE OnCall," a Multimedia Educational Module. Simul Healthc 2017; 12:385-392. [PMID: 29076970 PMCID: PMC5768220 DOI: 10.1097/sih.0000000000000254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION "Transitions to residency" programs are designed to maximize quality and safety of patient care, as medical students become residents. However, best instructional or readiness assessment practices are not yet established. We sought to study the impact of a screen-based interactive curriculum designed to prepare interns to address common clinical coverage issues (WISE OnCall) on the clinical skills demonstrated in simulation and hypothesize that performance would improve after completing the module. METHODS Senior medical students were recruited to participate in this single group prestudy/poststudy. Students responded to a call from a standardized nurse (SN) and assessed a standardized patient (SP) with low urine output, interacted with a 45-minute WISE OnCall module on the assessment and management of oliguria, and then evaluated a different SP with low urine output of a different underlying cause. Standardized patients assessed clinical skills with a 37-item, behaviorally anchored checklist measuring clinical skills (intraclass correlation coefficient [ICC], 0.55-0.81). Standardized nurses rated care quality and safety and collaboration and interprofessional communication using a 33-item literature-based, anchored checklist (ICC, 0.47-0.52). Standardized patient and SN ratings of the same student performance were correlated (r, 0.37-0.62; P < 0.01). Physicians assessed clinical reasoning quality based on the students' patient encounter note (ICC, 0.55-0.68), ratings that did not correlate with SP and SN ratings. We compared pre-post clinical skills performance and clinical reasoning. Fifty-two medical students (31%) completed this institutional review board -approved study. RESULTS Performance as measured by the SPs, SNs, and the postencounter note all showed improvement with mostly moderate to large effect sizes (range of Cohen's d, 0.30-1.88; P < 0.05) after completion of the online module. Unexpectedly, professionalism as rated by the SP was poorer after the module (Cohen's d, -0.93; P = 0.000). DISCUSSION A brief computer-based educational intervention significantly improved graduating medical students' clinical skills needed to be ready for residency.
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Affiliation(s)
- Demian Szyld
- From the Department of Emergency Medicine (D.S.), Brigham and Women's Hospital; The Center for Medical Simulation (D.S.), Boston, MA; New York Simulation Center for the Health Sciences (G.N., T.S.R., A.K.), New York; Institute for Innovations in Medical Education (M.V.P., T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Obstetrics and Gynecology (K.U.), University of Southern California, Los Angeles, CA; Department of Emergency Medicine (B.R.G.), The Ohio State University, Cleveland, OH; Program for Medical Education and Technology (M.W.N., T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Journalism (S.D.Y.), Central Connecticut State University; Department of Education (H.S.), Georgian Court University, Lakewood, NJ; Department of Surgery (T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Medicine (A.K.), Division of General Internal Medicine, Research on Medical Education Outcomes (ROMEO) Unit, and Program for Medical Education Innovation and Research (PrMEIR) (A.K.), NYU School of Medicine, New York, NY
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Kalet A, Zabar S, Szyld D, Yavner SD, Song H, Nick MW, Ng G, Pusic MV, Denicola C, Blum C, Eliasz KL, Nicholson J, Riles TS. A simulated "Night-onCall" to assess and address the readiness-for-internship of transitioning medical students. Adv Simul (Lond) 2017; 2:13. [PMID: 29450014 PMCID: PMC5806245 DOI: 10.1186/s41077-017-0046-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competency-based, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic "night on call" experience for near graduating students and build measurements of students' readiness for this transition framed by the Association of American Medical College's Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education.
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Affiliation(s)
- Adina Kalet
- New York Simulation Center for the Health Sciences, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
- Department of Surgery, NYU School of Medicine, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Sondra Zabar
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Demian Szyld
- Department of Emergency Medicine, Center for Medical Simulation, Institute for Medical Simulation, Harvard Medical School, Boston, MA USA
| | - Steven D Yavner
- Department of Journalism, Central Connecticut State University, New Britain, CT USA
| | - Hyuksoon Song
- Department of Education, Georgian Court University, Lakewood, NJ USA
| | - Michael W Nick
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
| | - Grace Ng
- New York Simulation Center for the Health Sciences, New York, New York USA
| | - Martin V Pusic
- Department of Emergency Medicine, NYU School of Medicine, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
| | - Christine Denicola
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Cary Blum
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
| | - Kinga L Eliasz
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
| | - Joey Nicholson
- Health Science Library, NYU School of Medicine, New York, New York USA
| | - Thomas S Riles
- New York Simulation Center for the Health Sciences, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
- Department of Surgery, NYU School of Medicine, New York, USA
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Natal B, Szyld D, Pasichow S, Bismilla Z, Pirie J, Cheng A. Simulation Fellowship Programs: An International Survey of Program Directors. Acad Med 2017; 92:1204-1211. [PMID: 28379935 DOI: 10.1097/acm.0000000000001668] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To report on the evolution of simulation-based training (SBT) by identifying the composition and infrastructure of existing simulation fellowship programs, describing the current training practices, disclosing existing program barriers, and highlighting opportunities for standardization. METHOD Investigators conducted a cross-sectional survey study among English-speaking simulation fellowship program directors (September 2014-September 2015). They identified fellowships through academic/institutional Web sites, peer-reviewed literature, Web-based search engines, and snowball sampling. They invited programs to participate in the Web-based questionnaire via e-mail and follow-up telephone calls. RESULTS Forty-nine programs met the inclusion criteria. Of these, 32 (65%) responded to the survey. Most programs were based in the United States, but others were from Canada, England, and Australia. Over half of the programs started in or after 2010. Across all 32 programs, 186 fellows had graduated since 1998. Fellows and directors were primarily departmentally funded; programs were primarily affiliated with hospitals and/or medical schools, many of which had sponsoring centers accredited by governing bodies. Fellows were typically medical trainees; directors were typically physicians. The majority of programs (over 90%) covered four core objectives, and all endorsed similar educational outcomes. Respondents identified no significant universal barriers to program success. Most directors (18/28 [64%]) advocated standardized fellowship guidelines on a national level. CONCLUSIONS Paralleling the fast growth and integration of SBT, fellowship training opportunities have grown rapidly in the United States, Canada, and beyond. This study highlights potential areas for standardization and accreditation of simulation fellowships which would allow measurable competencies in graduates.
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Affiliation(s)
- Brenda Natal
- B. Natal is an independent contractor in emergency medicine and health care simulation education and was, at the time of this research, assistant professor, Department of Emergency Medicine, and simulation director, Clinical Skills Center, Division of the Office of Education, Rutgers New Jersey Medical School, Newark, New Jersey. D. Szyld is attending physician, Department of Emergency Medicine, Brigham and Women's Hospital, and senior director, Institute for Medical Simulation, Center for Medical Simulation, Boston, Massachusetts. S. Pasichow is postgraduate year 2 resident, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, and vice chair, Simulation Division, Emergency Medicine Residents Association, Providence, Rhode Island. Z. Bismilla is assistant professor, University of Toronto, academic clinician, Hospital for Sick Children, and lead, Hospital for Sick Children Learning Institute Simulation Fellowship Program, Toronto, Ontario, Canada. J. Pirie is associate professor, University of Toronto, pediatric emergency medicine (PEM) physician, and director of PEM simulation and the PEM Simulation Fellowship Program, Hospital for Sick Children, Toronto, Ontario, Canada. A. Cheng is associate professor, Department of Pediatrics, University of Calgary, director, KidSIM-ASPIRE Simulation Research Program, and scientist, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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Guinez-Molinos S, Martínez-Molina A, Gomar-Sancho C, Arias González VB, Szyld D, García Garrido E, Maragaño Lizama P. A collaborative clinical simulation model for the development of competencies by medical students. Med Teach 2017; 39:195-202. [PMID: 27841066 DOI: 10.1080/0142159x.2016.1248913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Herein, we present a new collaborative clinical simulation (CCS) model for the development of medical competencies by medical students. The model is a comprehensive compendium of published considerations and recommendations on clinical simulation (CS) and computer-supported collaborative learning (CSCL). Currently, there are no educational models combining CS and CSCL. The CCS model was designed for the acquisition and assessment of clinical competencies; working collaboratively and supported by technology, small groups of medical students independently design and perform simulated cases. The model includes four phases in which the learning objectives, short case scenarios, materials, indices, and the clinical simulation are designed, monitored, rated and debriefed.
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Affiliation(s)
| | | | | | | | - Demian Szyld
- d Ronald O. Perelman Department of Emergency Medicine , New York University , New York , NY , USA
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Winkel AF, Gillespie C, Uquillas K, Zabar S, Szyld D. Assessment of Developmental Progress Using an Objective Structured Clinical Examination-Simulation Hybrid Examination for Obstetrics and Gynecology Residents. J Surg Educ 2016; 73:230-237. [PMID: 26868313 DOI: 10.1016/j.jsurg.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/10/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The Test of Integrated Professional Skills (TIPS) is an objective structured clinical examination-simulation hybrid examination that assesses resident integration of technical, cognitive, and affective skills in Obstetrics and Gynecology (OBGYN) residents. The aim of this study was to analyze performance patterns and reactions of residents to the test to understand how it may fit within a comprehensive assessment program. DESIGN A retrospective, mixed methods review of the design and implementation of the examination, patterns of performance of trainees at different levels of training, focus group data, and description of use of TIPS results for resident remediation and curriculum development. SETTING OBGYN residents at New York University Langone Medical Center, a tertiary-care, urban academic health center. PARTICIPANTS OBGYN residents in all years of training, postgraduate year-1 through postgraduate year, all residents completing the TIPS examination and consenting to participate in focus groups were included. RESULTS In all, 24 residents completed the TIPS examination. Performance on the examination varied widely among individuals at each stage of training, and did not follow developmental trends, except for technical skills. Cronbach α for both standardized patient and faculty ratings ranged from 0.69 to 0.84, suggesting internal consistency. Focus group results indicated that residents respond to the TIPS examination in complex ways, ranging from anxiety about performance to mixed feelings about how to use the data for their learning. CONCLUSION TIPS assesses a range of attributes, and can support both formative and summative evaluation. Lack of clear developmental differences and wide variation in performance by learners at the same level of training support the argument for individualized learning plans and competency-based education.
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Affiliation(s)
- Abigail Ford Winkel
- Department of Obstetrics & Gynecology, New York University School of Medicine.
| | - Colleen Gillespie
- Institute for Innovations in Medical Education, Department of Medicine, New York University School of Medicine, NYU-HHC Clinical and Translational Sciences Institute, New York, New York
| | - Kristen Uquillas
- Simulation and Education, New York Simulation Center for the Health Sciences, Department of Obstetrics & Gynecology, New York University School of Medicine, New York, New York
| | - Sondra Zabar
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, New York
| | - Demian Szyld
- Department of Emergency Medicine, New York Simulation Center for the Health Sciences, New York University School of Medicine, New York, New York
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Patrawalla P, Eisen LA, Shiloh A, Shah BJ, Savenkov O, Wise W, Evans L, Mayo P, Szyld D. Development and Validation of an Assessment Tool for Competency in Critical Care Ultrasound. J Grad Med Educ 2015; 7:567-73. [PMID: 26692968 PMCID: PMC4675413 DOI: 10.4300/jgme-d-14-00613.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound is an emerging technology in critical care medicine. Despite requirements for critical care medicine fellowship programs to demonstrate knowledge and competency in point-of-care ultrasound, tools to guide competency-based training are lacking. OBJECTIVE We describe the development and validity arguments of a competency assessment tool for critical care ultrasound. METHODS A modified Delphi method was used to develop behaviorally anchored checklists for 2 ultrasound applications: "Perform deep venous thrombosis study (DVT)" and "Qualify left ventricular function using parasternal long axis and parasternal short axis views (Echo)." One live rater and 1 video rater evaluated performance of 28 fellows. A second video rater evaluated a subset of 10 fellows. Validity evidence for content, response process, and internal consistency was assessed. RESULTS An expert panel finalized checklists after 2 rounds of a modified Delphi method. The DVT checklist consisted of 13 items, including 1.00 global rating step (GRS). The Echo checklist consisted of 14 items, and included 1.00 GRS for each of 2 views. Interrater reliability evaluated with a Cohen kappa between the live and video rater was 1.00 for the DVT GRS, 0.44 for the PSLA GRS, and 0.58 for the PSSA GRS. Cronbach α was 0.85 for DVT and 0.92 for Echo. CONCLUSIONS The findings offer preliminary evidence for the validity of competency assessment tools for 2 applications of critical care ultrasound and data on live versus video raters.
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Affiliation(s)
- Paru Patrawalla
- Corresponding author: Paru Patrawalla, MD, Mount Sinai Beth Israel, Division of Pulmonary, Critical Care, and Sleep Medicine, 7 Dazian, First Avenue and 16th Street, New York, NY 10003, 212.420.2892,
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Griswold-Theodorson S, Ponnuru S, Dong C, Szyld D, Reed T, McGaghie WC. Beyond the simulation laboratory: a realist synthesis review of clinical outcomes of simulation-based mastery learning. Acad Med 2015; 90:1553-60. [PMID: 26375271 DOI: 10.1097/acm.0000000000000938] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE Translational educational outcomes have been defined as starting in simulation laboratories (T1) and moving downstream to improved patient care practices (T2), patient outcomes (T3), and cost/other value outcomes (T4). The authors conducted a realist synthesis review of the literature to evaluate the translational effect of simulation-based mastery learning (SBML) principles beyond the laboratory. They also sought to address future directions in SBML to improve patient care processes and outcomes and, thus, the quality of health care delivery. METHOD The authors searched multiple databases for simulation-based medical education (SBME) studies published through April 2013. They screened articles using the PICO method-population (P), intervention (I), control (C), outcome (O)-to answer the research question: For (P) any health care providers, does the (I) implementation of SBML training, compared with (C) other training methodologies or no extra training, result in (O) a change in patient care practices or T2-T4 outcomes? Studies implementing SBME interventions with training methodologies that met all SBML principles and reporting T2-T4 outcomes were identified. RESULTS The 14 included studies used pre/post or cohort study designs; the majority were limited to individual performance and procedural competency. They reported improvement after SBML training in procedure performance, task success, patient discomfort, procedure time, complication rates, or T4 impacts (e.g., cost reduction). CONCLUSIONS Findings suggest health professions education conducted using SBML methodology can improve patient care processes and outcomes. Further research is needed to understand the translational impact of SBML for nontechnical skills, including teamwork, and skill retention.
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Affiliation(s)
- Sharon Griswold-Theodorson
- S. Griswold-Theodorson is director, Master of Science in Medical and Healthcare Simulation Program, director, Division of Simulation, Department of Emergency Medicine, and professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. S. Ponnuru is fellowship director, Division of Simulation, Department of Emergency Medicine, and assistant professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. C. Dong is assistant director of medical education, National University of Singapore Yong Loo Lin School of Medicine, Singapore. D. Szyld is medical director, New York Simulation Center for the Health Sciences, and assistant professor of emergency medicine, New York University School of Medicine, New York, New York. T. Reed is assistant dean and director of clinical simulation and associate professor, Department of Emergency Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois. W.C. McGaghie is professor of medical education, Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Djukic M, Adams J, Fulmer T, Szyld D, Lee S, Oh SY, Triola M. E-Learning with virtual teammates: A novel approach to interprofessional education. J Interprof Care 2015; 29:476-82. [DOI: 10.3109/13561820.2015.1030068] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Blackstock U, Munson J, Szyld D. Bedside ultrasound curriculum for medical students: report of a blended learning curriculum implementation and validation. J Clin Ultrasound 2015; 43:139-44. [PMID: 25123564 DOI: 10.1002/jcu.22224] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/06/2014] [Accepted: 07/22/2014] [Indexed: 05/12/2023]
Abstract
BACKGROUND Medical students on clinical rotations rarely receive formal bedside ultrasound (BUS) training. We designed, implemented, and evaluated a standardized BUS curriculum for medical students on their Emergency Medicine (EM) rotation. Teaching was aimed toward influencing four cognitive and psychomotor learning domains: BUS instrumentation knowledge, image interpretation, image acquisition, and procedural guidance. METHODS Participants viewed three instructional Web-based tutorials on BUS instrumentation, the Focused Assessment for Sonography in Trauma (FAST) examination and ultrasound-guided central venous catheter (CVC) placement. Subsequently, participants attended a 3-hour hands-on training session to discuss the same content area and practice with faculty coaches. A Web-based, multiple-choice questionnaire was administered before and after the session. During the final week of the rotation, students returned for skills assessments on FAST image acquisition and CVC placement. RESULTS Forty-five medical students on an EM rotation were enrolled. Sonographic knowledge overall mean score improved significantly from 66.6% (SD ±11.2) to 85.7% (SD ±10.0), corresponding to a mean difference of 19.1% (95% CI 15.5-22.7; p < 0.001). There were high pass rates for FAST (89.0%, 40/45) and CVC (96.0%, 43/45) skills assessments. There was no significant difference between medical student posttest and EM resident test scores 85.7% (SD ±10.0) and 88.1% (SD ± 7.6) (p = 0.40), respectively. CONCLUSIONS A formal BUS curriculum for medical students on EM rotation positively influenced performance in several key learning domains. As BUS competency is required for residency in EM and other specialties, medical schools could consider routinely incorporating BUS teaching into their clinical rotation curricula.
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Affiliation(s)
- Uché Blackstock
- NYU School of Medicine/Bellevue Hospital Center, Department of Emergency Medicine, 462 First Avenue, OBV-A349A, NY, New York, 10016
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Winkel AF, Niles P, Lerner V, Zabar S, Szyld D, Squires A. Notes from the Field: Residents' Perceptions of Simulation-Based Skills Assessment in Obstetrics and Gynecology. Eval Health Prof 2014; 39:121-5. [PMID: 25511557 DOI: 10.1177/0163278714563601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Simulation in obstetrics and gynecology (OBGYN) training captures a range of interpersonal, cognitive, and technical skills. However, trainee perspectives on simulation-based assessment remain unexplored. After an observed structured clinical examination (OSCE) simulation hybrid exam, two focus groups of residents were conducted. Analysis grounded in a thematic coding guided the qualitative research process. Responses suggest a valuation of cognitive and technical skills over interpersonal skills. Realism was seen as critical and residents perceived the assessment as more valuable for the educator than the learner. Feedback was highly valued. Resident perspectives on this exam give insight into their perceptions of simulation-based assessment as well as their conceptions of their own learning through simulations.
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Affiliation(s)
| | - Paulomi Niles
- New York University College of Nursing, New York, NY, USA
| | - Veronica Lerner
- New York University Langone Medical Center, New York, NY, USA
| | - Sondra Zabar
- New York University School of Medicine, New York, NY, USA
| | - Demian Szyld
- New York Simulation Center for the Health Sciences, New York, NY, USA
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Pusic MV, Brydges R, Kessler D, Szyld D, Nachbar M, Kalet A. What's your best time? Chronometry in the learning of medical procedures. Med Educ 2014; 48:479-488. [PMID: 24712933 DOI: 10.1111/medu.12395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/02/2013] [Accepted: 10/11/2013] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Most medical procedures have a time element. It is uncommon, however, to explicitly use chronometry, the measurement of time, in the learning of these procedures. This study considered whether instructional designs that include chronometry could improve deliberate practice and be used in meaningful formative assessments. METHODS A selective review of the medical education literature was undertaken to identify how chronometry was used in a broad sampling of medical education research in the learning of medical procedures. We identified prior publications in which time measurement was used either directly as a pedagogic intervention or as an assessment method in a medical school programme. RESULTS Our review suggests a number of desirable features of chronometry. For the individual learner, procedural time measurements can demonstrate both improving ability and increasing consistency. Chronometry can enhance instructional designs involving deliberate practice by facilitating overlearning (i.e. learning that goes beyond minimum competence), increasing the challenge level and enhancing self-regulation of learning (e.g. self-competition). Breaking down chronometric data into meaningful interval or split times might further inform instructional designs. CONCLUSIONS Chronometry has the potential to contribute to instructional designs and assessment methods in medical procedures training. However, more research is needed to elucidate its full potential and describe possible negative consequences of this widely available but underutilised educational tool.
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Affiliation(s)
- Martin V Pusic
- Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
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Winkel AF, Gillespie C, Hiruma MT, Goepfert AR, Zabar S, Szyld D. Test of integrated professional skills: objective structured clinical examination/simulation hybrid assessment of obstetrics-gynecology residents' skill integration. J Grad Med Educ 2014; 6:117-22. [PMID: 24701321 PMCID: PMC3963767 DOI: 10.4300/jgme-d-13-00055.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/13/2013] [Accepted: 07/29/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Assessment of obstetrics-gynecology residents' ability to integrate clinical judgment, interpersonal skills, and technical ability in a uniform fashion is required to document achievement of benchmarks of competency. An observed structured clinical examination that incorporates simulation and bench models uses direct observation of performance to generate formative feedback and standardized evaluation. METHODS The Test of Integrated Professional Skills (TIPS) is a 5-station performance-based assessment that uses standardized patients and complex scenarios involving ultrasonography, procedural skills, and evidence-based medicine. Standardized patients and faculty rated residents by using behaviorally anchored checklists. Mean scores reflecting performance in TIPS were compared across competency domains and by developmental level (using analysis of variance) and then compared to standard faculty clinical evaluations (using Spearman ρ). Participating faculty and residents were also asked to evaluate the usefulness of the TIPS. RESULTS Twenty-four residents participated in the TIPS. Checklist items used to assess competency were sufficiently reliable, with Cronbach α estimates from 0.69 to 0.82. Performance improved with level of training, with wide variation in performance. Standard faculty evaluations did not correlate with TIPS performance. Several residents who were rated as average or above average by faculty performed poorly on the TIPS (> 1 SD below the mean). Both faculty and residents found the TIPS format useful, providing meaningful evaluation and opportunity for feedback. CONCLUSIONS A simulation-based observed structured clinical examination facilitates observation of a range of skills, including competencies that are difficult to observe and measure in a standardized way. Debriefing with faculty provides an important interface for identification of performance gaps and individualization of learning plans.
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Maestre JM, Szyld D, Del Moral I, Ortiz G, Rudolph JW. The making of expert clinicians: reflective practice. Rev Clin Esp 2014; 214:216-20. [PMID: 24439667 DOI: 10.1016/j.rce.2013.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/29/2013] [Accepted: 12/01/2013] [Indexed: 12/30/2022]
Abstract
Debriefing is a rigorous reflection process which helps trainees recognize and resolve clinical and behavioral dilemmas raised by a clinical case. This approach emphasizes eliciting trainees'assumptions about the situation and their reasons for performing as they did (mental models). It analyses their impact on actions, to understand if it is necessary to maintain them or construct new ones that may lead to better performance in the future. It blends evidence and theory from education research, the social and cognitive sciences, and experience drawn from conducting and teaching debriefing to clinicians worldwide, on how to improve professional effectiveness through "reflective practice".
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Affiliation(s)
- J M Maestre
- Hospital virtual Valdecilla, Servicio de Anestesiología y Reanimación, Hospital Valdecilla, Santander, España.
| | - D Szyld
- New York Simulation Center for the Health Sciences, Emergency Medicine, New York University School of Medicine, Nueva York, EE.UU
| | - I Del Moral
- Hospital virtual Valdecilla, Servicio de Anestesiología y Reanimación, Hospital Valdecilla, Santander, España
| | - G Ortiz
- Instituto de Simulación Médica, Cuidados Críticos, Hospital Santa Clara, Bogotá, Colombia
| | - J W Rudolph
- Center for Medical Simulation, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, EE.UU
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Winkel AF, Lerner V, Zabar SR, Szyld D. A simple framework for assessing technical skills in a resident observed structured clinical examination (OSCE): vaginal laceration repair. J Surg Educ 2013; 70:10-14. [PMID: 23337664 DOI: 10.1016/j.jsurg.2012.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 07/11/2012] [Accepted: 08/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Educators of trainees in procedure-based specialties need focused assessment tools that are valid, objective, and assess technical skills in a realistic context. A framework for hybrid assessment using standardized patient scenarios and bench skills testing might facilitate evaluation of competency. METHODS Seven PGY-1 obstetrics and gynecology residents participated in a hybrid assessment that used observed structured clinical examination (OSCE) by a standardized patient who had sustained a vaginal laceration during vaginal delivery. The residents elicited a history and counseled the patient, and then completed a laceration repair on a pelvic model. The residents were rated on their performance in the scenario, which included issues of cultural competency, rapport-building, patient counseling. The technical skills were videotaped and rated using a modified global assessment form by 2 faculty members on a 3-point scale from "not done" to "partly done" to "well-done." Residents also completed a subjective assessment of the station. RESULTS Mean technical performance of the residents on the technical skills was 55% "well-done," with a range of 20%-90%. The assessment identified 3 residents as below the mean, and 1 resident with areas of deficiency. Subjective assessment by the residents was that juggling the technical, cognitive, and affective components of the examination was challenging. CONCLUSIONS Technical skills can be included in a case-based assessment using scenarios that address a range of cognitive and affective skills required of physicians. Results may help training programs assess individuals' abilities as well as identify program needs for curricular improvement. This framework might be useful in setting standards for competency and identifying poor performers.
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Affiliation(s)
- Abigail Ford Winkel
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA.
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Pusic MV, Kessler D, Szyld D, Kalet A, Pecaric M, Boutis K. Experience curves as an organizing framework for deliberate practice in emergency medicine learning. Acad Emerg Med 2012; 19:1476-80. [PMID: 23230958 DOI: 10.1111/acem.12043] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/26/2012] [Accepted: 04/30/2012] [Indexed: 12/13/2022]
Abstract
Deliberate practice is an important skill-training strategy in emergency medicine (EM) education. Learning curves display the relationship between practice and proficiency. Forgetting curves show the opposite, and demonstrate how skill decays over time when it is not reinforced. Using examples of published studies of deliberate practice in EM we list the properties of learning and forgetting curves and suggest how they can be combined to create experience curves: a longitudinal representation of the relationship between practice, skill acquisition, and decay over time. This framework makes explicit the need to avoid a piecemeal, episodic approach to skill practice and assessment in favor of more emphasis on what can be done to improve durability of competence over time. The authors highlight the implications for both educators and education researchers.
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Affiliation(s)
- Martin V. Pusic
- Department of Emergency Medicine; New York University School of Medicine; New York; NY
| | - David Kessler
- Clinical Pediatrics; Columbia University Medical Center; New York; NY
| | | | - Adina Kalet
- Division of General Internal Medicine; New York University School of Medicine; New York; NY
| | | | - Kathy Boutis
- Department of Pediatrics; The Hospital for Sick Children, University of Toronto; Toronto; Ontario; Canada
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Griswold S, Ponnuru S, Nishisaki A, Szyld D, Davenport M, Deutsch ES, Nadkarni V. The emerging role of simulation education to achieve patient safety: translating deliberate practice and debriefing to save lives. Pediatr Clin North Am 2012; 59:1329-40. [PMID: 23116529 DOI: 10.1016/j.pcl.2012.09.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Simulation-based educational processes are emerging as key tools for assessing and improving patient safety. Multidisciplinary or interprofessional simulation training can be used to optimize crew resource management and safe communication principles. There is good evidence that simulation training improves self-confidence, knowledge, and individual and team performance on manikins. Emerging evidence supports that procedural simulation, deliberate practice, and debriefing can also improve operational performance in clinical settings and can result in safer patient and population/system outcomes in selected settings. This article highlights emerging evidence that shows how simulation-based interventions and education contribute to safer, more efficient systems of care that save lives.
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Affiliation(s)
- Sharon Griswold
- Department of Emergency Medicine, Simulation Center, Drexel University College of Medicine, Philadelphia, PA 19102, USA
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Khandelwal S, Bernard AW, Wald DA, Manthey DE, Fisher J, Ankel F, Williams SR, Szyld D, Riddle J, Anders Ericsson K. Developing and assessing initiatives designed to improve clinical teaching performance. Acad Emerg Med 2012; 19:1350-3. [PMID: 23216823 DOI: 10.1111/acem.12029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
Abstract
To improve the teaching performance of emergency physicians, it is necessary to understand the attributes of expert teachers and the optimal methods to deliver faculty development. A working group of medical educators was formed to review the literature, summarize what is known on the topic, and provide recommendations for future research. This occurred as a track of the 2012 Academic Emergency Medicine (AEM) consensus conference "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success." The group concluded that the current state of research on these topics is limited. Improvement in understanding will come through research focusing on Kirkpatrick's higher levels of evaluation (behavior and results).
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Affiliation(s)
- Sorabh Khandelwal
- Department of Emergency Medicine; The Ohio State University College of Medicine (SK, AB); Columbus; OH
| | - Aaron W. Bernard
- Department of Emergency Medicine; The Ohio State University College of Medicine (SK, AB); Columbus; OH
| | - David A. Wald
- Department of Emergency Medicine; Temple University School of Medicine (DAW); Philadelphia; PA
| | - David E. Manthey
- Wake Forest University School of Medicine (DEM); Winston-Salem; NC
| | - Jonathan Fisher
- Department of Emergency Medicine; Beth Israel Deaconess Medical Center (JF); Boston; MA
| | - Felix Ankel
- Regions Hospital; University of Minnesota School of Medicine (FA); Saint Paul; MN
| | - Sarah R. Williams
- Department of Emergency Medicine; Stanford University School of Medicine (SRW); Stanford; CA
| | - Demian Szyld
- Department of Emergency Medicine; NYU Medical Center (DS); New York; NY
| | - Janet Riddle
- Department of Medical Education; University of Illinois at Chicago College of Medicine (JR); Chicago; IL
| | - K. Anders Ericsson
- Department of Psychology; Florida State University (KAE); Tallahassee; FL
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Blackstock U, Munson J, Yeboah N, Szyld D. 312 Bedside Ultrasonography Knowledge and Image Interpretation Gains by Medical Students on Emergency Medicine Rotation. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pines JM, Isserman JA, Szyld D, Dean AJ, McCusker CM, Hollander JE. The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain. Am J Emerg Med 2010; 28:771-9. [DOI: 10.1016/j.ajem.2009.03.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 03/13/2009] [Accepted: 03/19/2009] [Indexed: 10/19/2022] Open
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Panebianco NL, Fredette JM, Szyld D, Sagalyn EB, Pines JM, Dean AJ. What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access. Acad Emerg Med 2009; 16:1298-1303. [PMID: 19912132 DOI: 10.1111/j.1553-2712.2009.00520.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Ultrasound (US) has been shown to facilitate peripheral intravenous (IV) placement in emergency department (ED) patients with difficult IV access (DIVA). This study sought to define patient and vein characteristics that affect successful US-guided peripheral IV placement. METHODS This was a prospective observational study of US-guided IV placement in a convenience sample of DIVA patients in an urban, tertiary care ED. DIVA patients were defined as having any of the following: at least two failed IV attempts or a history of difficult access plus the inability to visualize or palpate any veins on physical exam. Patient characteristics (demographic information, vital signs, and medical history) were collected on enrolled patients. The relationships between patient characteristics, vein depth and diameter, US probe orientation, and successful IV placement were analyzed. RESULTS A total of 169 patients were enrolled, with 236 attempts at access. Increasing vessel diameter was associated with a higher likelihood of success (odds ratio [OR] = 1.79 per 0.1-cm increase in vessel diameter, 95% confidence interval [CI] = 1.37 to 2.34). Increasing vessel depth did not affect success rates (OR = 0.96 per 0.1-cm increase of depth, 95% CI = 0.89 to 1.04) until a threshold depth of 1.6 cm, beyond which no vessels were successfully cannulated. Probe orientation and patient characteristics were unrelated to success. CONCLUSIONS Success was solely related to vessel characteristics detected with US and not influenced by patient characteristics or probe orientation. Successful DIVA was primarily associated with larger vessel, while vessel depth up to >1.6 cm and patient characteristics were unrelated to success. Clinically, if two vessels are identified at a depth of <1.6 cm, the larger diameter vessel, even if comparatively deeper, should yield the greatest likelihood of success.
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Affiliation(s)
- Nova L Panebianco
- From the Department of Emergency Medicine, University of Pennsylvania School of Medicine (NLP, JMF, DS, EBS, JMP, AJD), Philadelphia, PA; and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania (JMP), Philadelphia, PA
| | - Jenna M Fredette
- From the Department of Emergency Medicine, University of Pennsylvania School of Medicine (NLP, JMF, DS, EBS, JMP, AJD), Philadelphia, PA; and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania (JMP), Philadelphia, PA
| | - Demian Szyld
- From the Department of Emergency Medicine, University of Pennsylvania School of Medicine (NLP, JMF, DS, EBS, JMP, AJD), Philadelphia, PA; and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania (JMP), Philadelphia, PA
| | - Emily B Sagalyn
- From the Department of Emergency Medicine, University of Pennsylvania School of Medicine (NLP, JMF, DS, EBS, JMP, AJD), Philadelphia, PA; and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania (JMP), Philadelphia, PA
| | - Jesse M Pines
- From the Department of Emergency Medicine, University of Pennsylvania School of Medicine (NLP, JMF, DS, EBS, JMP, AJD), Philadelphia, PA; and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania (JMP), Philadelphia, PA
| | - Anthony J Dean
- From the Department of Emergency Medicine, University of Pennsylvania School of Medicine (NLP, JMF, DS, EBS, JMP, AJD), Philadelphia, PA; and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania (JMP), Philadelphia, PA
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Panebianco N, Fredette J, Szyld D, Sagalyn E, Pines J, Dean A. 61: Ultrasound-Guided Peripheral IV Access: Patient Pain, Anxiety and Preference. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Umscheid CA, Maguire MG, Pines JM, Everett WW, Baren JM, Townsend RR, Mines D, Szyld D, Gross R. Untreated hypertension and the emergency department: a chance to intervene? Acad Emerg Med 2008; 15:529-36. [PMID: 18616438 DOI: 10.1111/j.1553-2712.2008.00132.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Untreated hypertension (HTN) is a major public health problem. Screening for untreated HTN in the emergency department (ED) may lead to appropriate treatment of more patients. The authors investigated the accuracy of identifying HTN in the ED, the proportion of ED patients with untreated HTN, patient characteristics predicting untreated HTN, and provider documentation of untreated HTN. METHODS The authors performed a retrospective cross-sectional study on a random sample of 2,061 adults treated at an urban academic ED. The validity of six candidate definitions of HTN in the ED was assessed in a subsample using outpatient clinic records as the reference standard. "Untreated HTN" was HTN without a HTN medication listed in the ED history. "Documentation of untreated HTN was documentation of HTN as a visit problem, specific referral for HTN, or ED discharge with a HTN" information sheet or a HTN medication. Multivariable logistic regression was used to determine associations. RESULTS The preferred definition of HTN in the ED had sensitivity of 86% (95% confidence interval [CI] = 80% to 90%), specificity of 78% (95% CI = 69% to 85%), and accuracy of 83% (95% CI = 78% to 87%). Of the 42% (95% CI = 40% to 44%) of ED patients with HTN, 43% (95% CI = 39% to 46%) had untreated HTN. Patients who were younger and male, without primary care physicians, with fewer prior ED visits, and without cardiovascular comorbidities, had higher odds of untreated HTN. Of those with untreated HTN, 8% (95% CI = 5% to 11%) had their untreated HTN documented. CONCLUSIONS Untreated HTN was common in the ED but rarely documented. Providers can use ED blood pressures along with patient characteristics to identify those with untreated HTN for referral to primary care.
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Affiliation(s)
- Craig A Umscheid
- Center for Clinical Epidemiology and Biostatistics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Pines JM, Szyld D. Risk tolerance for the exclusion of potentially life-threatening diseases in the ED. Am J Emerg Med 2007; 25:540-4. [PMID: 17543658 DOI: 10.1016/j.ajem.2006.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 10/04/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Given the same pretest probability (10%) for subarachnoid hemorrhage (SAH), pulmonary embolism (PE), and acute coronary syndrome (ACS), we determined if differences exist in the risk tolerance for disease exclusion according to published guidelines given a negative test result. METHODS Published guidelines that make practice recommendations on the evaluation of ACS, PE, and SAH were sought using the National Guideline Clearinghouse in low-risk settings. Second-order Monte Carlo simulation was performed to determine point estimates and confidence intervals (CIs) for posttest probabilities assuming a pretest probability of 10%. RESULTS Guidelines recommend that patients with low-risk suspected ACS should undergo stress testing. For SAH, computed tomography (CT) followed by lumbar puncture (LP) is recommended without mention of pretest probability; and D-dimer testing is recommended to exclude PE in low-risk patients. Test sensitivity for thallium-201 single photon emission computed tomography (SPECT) was 89%, exercise echocardiogram was 85%, D-dimer testing was 95%, and CT/LP for SAH was 100% (as a gold standard) and CT only was 97.5%. Given a negative test result, for PE, posttest probability was 0.5% (95% CI 0.1%-0.9%); for SPECT, 1.1% (SD 0.5%-1.6%); and for exercise echocardiogram, 1.5% (95% CI 0.5%-2.5%) compared with a posttest probability of 0% for CT followed by LP for SAH. Using a CT-only approach gives a posttest probability of 0.2% (95% CI 0.2%-0.4%). CONCLUSIONS Guidelines for suspected PE and ACS allow small but nonzero calculated risk end points in low-risk settings, whereas SAH guidelines afford no misses. Because many gold standard tests are more invasive and can have adverse effects, guideline authors should consider adopting a standard acceptable miss rate as an end point for workups with low clinical suspicion to avoid the overuse of invasive testing.
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Affiliation(s)
- Jesse M Pines
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Umscheid C, Maguire M, Pines J, Everett W, Baren J, Townsend R, Mines D, Szyld D, Gross R. The Prevalence of and Risk Factors Associated with Untreated Hypertension in ED Patients. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Umscheid C, Maguire M, Szyld D, Pines J, Everett W, Baren J, Townsend R, Mines D, Gross R. Test Characteristics of Six Definitions of Hypertension in the ED for the Detection of Hypertension Outside of the ED. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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