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Center at the National Institutes of Health in
Bethesda, MD.
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effort in training today's investigators and discovering
tomorrow's cures.
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>> TODAY WE'RE
HONORED TO OUR SPEAKERS
DR. JOSEPH LOPRIEATO, WITH THE
UNIVERSITY OF HEALTH SCIENCES
ISSUES DR. NITINSEAM CRITICAL
MEDICINE DEPARTMENT NIEKS H
CLINICAL CENTER AND DR. MABEL
GOMEZ FACILITATOR FOR THE NIH
CLINICAL CENTER.
DR. LOP REIATO AND A NATIONAL
RECOGNIZE TD HEALTHCARE
SIMULATOR, HE EARNED HIS DEGREE
FROM GEORGE TOWN IN 1981 AND
MASTERS OF PUBLIC HEALTH FROM
UNIVERSITY OF TEXAS.
HE COMPLETED HIS RESIDENCY IN
BETHESDA MARYLAND IN 1984 AND
FELLOWSHIPS AND DEVELOPED ACTIVE
PEDIATRICS AT MICHIGAN STATE
UNIVERSITY AND UNIVERSITY OF
TEXAS HELT SCIENCE CENTER SAN
ANTONIO.
DR. LOPREIATO, SERVED A 31
DISTINGUISHED CAREER IN
PEDIATRIC MEDICINE AS A EDUCATOR
AND PRACTITIONER.
DR. SEAM IS A PROFESSOR OF
MEDICINE AND NURSING AT
[INDISCERNIBLE] UNIVERSITY AS A
MEDICAL DIRECTOR AT THE
[INDISCERNIBLE] SIMULATION
CENTER.
DR. LOPREIATO WITH THE FELLOW OF
AMERICAN PEDIATRICS WITH THE
AMERICAN PEDIATRIC SOCIETY,
ASSOCIATION OF STANDARDIZED
PATIENT EDUCATORS IS PAST
PRESIDENT FOR THE SOCIETY OF
SIMULATION HEALTHCARE.
HE IS CERTIFIED AT THE
HEALTHCARE SIMULATOR HEALTHCARE
BY SOCIETY.
HE COMPLETED CONSULTATIONS FOR
PEDIATRIC TRAINING PROGRAMS FOR
THE ASSOCIATION OF PEDIATRIC
PROGRAM DIRECTOR AND IS A CASE
DIRECTOR FOR NATIONAL BOARD
MEDICAL EXAMINER STEP 2 CLINICAL
SKILLS EXAM NATION,
DR. LOPRIEATO IS A RECIPIENT OF
SEVERAL WARKSDS INCLUDING THE
PEDIATRIC RAY HELPER AWARD FOR
CLINICAL EDUCATION, AMERICAN
PEDIATRIC EDUCATION AWARD AND
ASSOCIATION OF PEDIATRIC PROGRAM
DIRECTORS WALTER TENNISON AWARD
FOR EXTRAORDINARY OR INNOVATIVE
CONTRIBUTIONS IN PEDIATRIC
GRADUATE MEDICAL EDUCATION.
OUR SECOND SPEAKER IS DR. NITIN
SEAM, ASSOCIATE CHIEF CRITICAL
CARE MEDICINE AT NIH CLINICAL
KACCT, FELLOWSHIP FOR THE
CRITICAL CARE FELLOWSHIP AND THE
SENIOR RESEARCH PHYSICIAN.
HE IS A CLINICAL PROFESSOR OF
MEDICINE AT GEORGE WASHINGTON
UNIVERSITY AND [INDISCERNIBLE]
UNIVERSITY.
DR. SEAM COMPLETES HIS
UNDERGRADUATE EDUCATION AT JOHNS
HOPKINS AND EARNED HIS MEDICAL
DEGREE AT GEORGE WASHINGTON
UNIVERSITY AND GRADUATE WITH
DISTINCTION.
HE COMPLETED HIS TRAINING IN A
TERMUS ALONG WITH CHIEF
RESIDENCY AT GEORGE WASHINGTON
HOSPITAL FOLLOWED BY CRITICAL
CARE MEDICINE FELLOWSHIP AT NIH
ALONG WITH SOCIAL, TRAINING AND
MULL MONITORARY MEDICINE AND TW,
IT RELATES TO INNOVATION AND
PROFESSION EDUCATION INCLUDING
WEB BASED LEARNING AND
SIMULATION, CLINICAL EXPERTISE
IN VENTILATION AND ACUTE
RESPIRATORY SIS DROAM AND
NATIONALLY RECOGNIZED AND HAS
GIVEN SEVERAL TALKS ON THESE
TOPICS.
HE IS CURRENTLY THE INTERIM
CHIEF OF HEF COLSCHOLAR A HEALTH
EDUCATION JOURNAL AND PREVIOUS
SERVED AS ASSOCIATE EDITOR OF
THE AMERICAN JOURNAL REZONING
PIRATTORY CLINICAL CARE
MEDICINE.
PAST CHAIR OF PLINICAL CARE
SECTION OF THE SOCIETY FOR
SIMULATION AND HEALTHCARE.
OUR THIRD SPEAKER IS DR. MABEL
GOMEZ, CLINICAL FACILITATOR AT
THE NIH CLINICAL FACILITATOR.
DR. GOMEZ IS THE GRADUATE OF THE
[INDISCERNIBLE] UNIVERSITY IN
BOGOTA, COLUMBIA, FOLLOWING HER
RESIDENCY IN BOGATA IN 2004, SHE
BECAME AN CARDIOLOGIST IN BOGGAO
BOGOTA, DR. GOMEZ HELD
INCREASING LEVEL OF
RESPONSIBILITY IN CARDIOLOGY AND
CRITICAL CARE DEPARTMENTS ULRICH
MINNATING AS ASSOCIATE DIRECTOR
FOR CRITICAL CARE DEPARTMENT OF
[INDISCERNIBLE] BOGOTA.
IN 2019 DR. GOMEZ COMPLETED A
FELLOWSHIP IN CLINICAL MEDICAL
CANNED WHAT, CLINICAL MEDICAL
SIMULATION AT THE CENTER FOR
MEDICAL SIMULATION AT HARVARD
UNIVERSITY.
FOLLOWING HER FOLLOW OSHIP IN
2019 SHE JOINED THE NIH CLINICAL
CENTERS OF AS A CLINICAL
SIMULATION FACILITATOR.
SHE FOLLOWED THE IMPLEMENTATION
OF THE CLINICAL WIDICISMULATION
PROGRAM, STANDARDIZING AND
APPROVING EXISTING SIMULATION
CAPABILITIES WITHIN THE CLINICAL
CENTER AND LED A TEAM OF FAC
FACULTY AND DEVELOPED EXECUTION
OF SIMILAR INITTIAIVE ITS
FOCUSING ON HIGH VOLUME PATIENT
MIX OF THE NIH AND SUPPORTING
HIGHLY SPECIALIZED CONCRETE
RESEARCH TRAINING PROTOCOLS.
PLEASE WELCOME OUR FIRST SPEAKER
DR. LOPRIEATO, WHO WILL SPEAK ON
THE EVIDENCE SUPPORTING
SIMULATION BASED MEDICAL
EDUCATION.
WELCOME DR. LOPREIATO.
>> THANK YOU DOCTOR FOR THAT
WARM INTRODUCTION.
THANK YOU FOR THE INVITATION FOR
THIS TRIO ON HEALTHCARE
SIMULATION DURING HEALTHCARE
SIMULATION WEEK WHICH IS AN
INTERNATIONALLY HIGHLIGHTED WEEK
WHERE WE HIGHLIGHT SIMULATION IN
HEALTHCARE.
I AM JOSEPH LOPREIATO, AT THE
UNIVERSITY SERVICES UNIVERSITY,
I'M THE ASSOCIATE DEAN FOR
ASSOCIATE EDUCATION, THIS
PRESENTATION IN THIS
PRESENTATION MYSELF AND THE
OTHER 3 SPEAKER VS NO FINANCIAL
DISCLOSURES OR CONFLICTS OF
INTEREST TO DECLARE AND THIS
PRESENTATION REPRESENTS MY
OPINIONS AND DOES NOT REFLECT
THE OFFICIAL POLICY OF THE
DEPARTMENT OF DEFENSE OR THE
UNIFORM SERVICES UNIVERSITY.
SO MY JOB WAS TO GIVE YOU AN
OVERVIEW OF HEALTHCARE
SIMULATION, WHAT IT IS AND SO I
WANT TO BRING EVERYBODY UP TO
SPEED AND TALK ABOUT THE HIGH
LEVEL TOPICS IN THE SIMULATION
BASED MEDICAL EDUCATION.
LET'S START OFF WITH
DEFINITIONS.
SO HEALTHCARE SIMULATION IS NOT
A TECHNOLOGY, IT'S REALLY A
METHODOLOGY AND IT'S SIMPLY A
PROCESS OF RECREATING A MEDICAL
ENVIRONMENT EITHER USING PEOPLE,
HUMANS, MACHINES, LIKE
MANNEQUINS OR COMPUTERS TO
RECREATE THAT MEDICAL
ENVIRONMENT AND IT'S USED TO
EITHER TEACH A SKILL OR TO
REFRESH A SKILL.
I KIND OF LIKEN HEALTHCARE
SIMULATION TO BATTING PRACTICE
BEFORE A BIG BALL GAME WHERE YOU
SEE THE BALL PLAYERS TAKING
SWINGS AT THE BAT IN A SIMULATED
GAME WITH THEIR COACHES
WATCHING, ALL IN PREPARATION FOR
THE BIG GAME IN THE EVENING.
SO IN THIS CASE, HEALTHCARE
SIMULATION IS BATTING PRACTICE
BEFORE WE GO TO THE BIG GAME AND
WORK ON REAL PATIENTS IN THE
HOSPITAL.
IF YOU WANT MORE DEFINITIONS
ABOUT HEBLGHT CARE SIMULATION, I
WILL PUT A PLUG IN HERE FOR THE
HEALTHCARE SIMULATION DICTIONARY
PRODUCED FOR HEALTHCARE QUALITY
AND RESEARCH.
IF YOU GOOGLE HEALTHCARE
SIMULATION DICTIONIONARY, YOU
WILL GET VERSION 2.1 AND YOU
WILL HAVE THE COPY OF THE LATEST
DEFINITIONS FOR HEALTHCARE
SIMULATION.
WE IN THE HEALTHCARE SIMULATION
COMMUNITY HAVE MOWR MAIN
METHODOLOGIES WE USE TO EMPLOY
HEALTHCARE SIMULATION IN MEDICAL
EDUCATION AND THESE 4
METHODOLOGIES ARE STANDARDIZED
OR SIMULATED PATIENTS, THESE ARE
HUMANS, HUMAN BEINGS SO WE
RECRUIT TO PORTRAY PATIENTS AND
TO ASSESS WHETHER THE LIMITED
PARTNERSHIPPER INTERACTING WITH
THAT PATIENT DONE A GOOD JOB
ACCORDING TO USUALLY A CHECK
LIST SO WE CALL THOSE SPs, THE
NEXT 1 IS NOT SCREEN BASED
SIMULATION AND SHOULD BE
MANNEQUIN BASED SIMULATION,
THESE ARE FULL SIZED PLASTIC
HUMANS WHO HAVE ALL THE
PHYSIOLOGY OF A HUMAN SO THEY
LOOK LIKE A HUMAN, ALTHOUGH
THEIR SKIN IS PLASTIC, THEY HAVE
PULSES, THEY CAN HAVE A BLOOD
PRESSURE, THAT CAN BE INTUBATED,
THEY CAN BE SHOCKED.
SO THINGS WE CAN'T DO TO HUMANS
NOR WOULD WE EVER WANT TO DO TO
HUMANS WE CAN DO ON THESE
HUMANOID PLASTIC MANNEQUINS.
THE NEXT METHODOLOGY OF TASK
TRAINING, THESE ARE PIECES OF
BODY PARTS WE USE TO PRACTICE
PROCEDURES, THINK A PORTION OF A
BACK TO PRACTICE LUMBAR PUNCTURE
OR A PORTION OF THE CHEST TO
PRACTICE CENTRAL LINE INSERTION,
OR KNEE TO PRACTICE KNEE
INJECTIONS, THESE ARE CONSIDERED
TASK TRAINERS AND LAST WE WE
HAVE SCREEN BASED SIMULATION
WHICH INCLUDE THE ENTITIES OF
VIRTUAL REALITY, AUGMENTED
REALITY AND MIXED REALITY IN
COME A COMPUTER CREATES THE
SCENARIO OR THE ENVIRONMENT
RATHER THAN A PLASTIC MANNEQUIN
OR RATHER THAN A HUMAN.
THOSE ARE THE 4 MAIN
METHODOLOGIES THAT WE CURRENTLY
USE.
THESE METHODOLOGIES ARE
IMPORTANT BECAUSE NOW THE
EDUCATIONAL LANDSCAPE AS SHIFTED
IN THE LAST DECADE FROM SIMPLY
KNOWLEDGE IN YOUR HEAD TO
COMPETENCIES, WHAT CAN YOU
ACTUALLY DO IN THE CLINICAL
WORLD AND HOW ARE WE MEASURING
THE OUTCOMES OF WHAT WE DO AND
WHAT YOU DO, WHETHER YOU'RE IN
TRAINING OR WHETHER YOU'RE IN
PRACTICE.
THERE'S MUCH MORE EMPHASIS NOW
ON CLINICAL SKILLS, CLINICAL
SKILLS BEING COMMUNICATIONS WITH
THE PATIENTS, PROFICIENCY AND
PROCEDURES, AND TEAM TRAINING
AND TEAM LEADERSHIP AND THERE'S
MUCH MORE OF PATIENT SAFETY
INITIATIVES, SO ALL OF THESE
COMBINED TO MAKE HEALTHCARE
SIMULATION REALLY A GROWTH
INDUSTRY AND PREVALENT AMONG ALL
HEALTHCARE ENTITIES PRETTY MUCH
NATIONWIDE TODAY.
SO IF WE GO TO USE SIMULATION,
WHERE DOES IT FIT IN THE
ASSESSMENT OF CLINICAL
COMPETENCE WHICH IS, AGAIN, 1 OF
THE HALLMARKS OF MEDICAL
EDUCATION TODAY.
GEORGE MILLER IN 1990 PROPOSED
THIS PYRAMID.
HE WAS DISTRAWOF THE BY THE FACT
THAT IN 1990 MOST CLINICAL
COMPETENTS WAS MEASUREMENT OF
KNOWLEDGE ALONE, THINK MULTIPLE
CHOICE QUESTIONS, FORWARD
QUESTIONS, THINGS LIKE THAT SO
HE PUT THAT AT THE BOTTOM OF
THIS PYRAMID THAT YES WE CAN
MEASURE CLINICAL COMPETENCE BY
WALKING AROUND HOW MUCH
KNOWLEDGE YOU HAVE IN YOUR HEAD
AND MEMORIZED OVER THE YEARS SO
THAT'S KNOWS AT THE BOTTOM.
PRETTY POSITIVE THERE ARE OTHER
ELEMENTS OF CLINICAL COMPETENCE
THAT NEED MORE EMPHASIS.
AGAIN, THIS WAS NOW 30 YEARS AGO
AND I AM HAPPY TO SAY WE HAVE
MOVED UP THIS PYRAMID SINCE
THEN.
BUT THE NEXT LEVEL UP IN
ASSESSING CLINICAL COMPETENCE
KNOWS HOW, IN OTHER WORDS,
DEMONSTRATE THAT YOU KNOW THE
STEPS, SO THESE ARE ESSAYS THAT
YOU USED TO WRITE IN BLUE BOOKS
OR YOU MAY HAVE TO DIAGRAM
SOMETHING OR GO THROUGH A
PATIENT CASE SCENARIO.
OR YOU MIGHT HAVE AN ORAL EXAM
NATION, THESE ARE AN ATTEMPT TO
TRY TO EXPLAIN, DO YOU KNOW HOW
TO DO THINGS, NOT ONLY DO YOU
HAVE THE KNOWLEDGE BUT DO YOU
KNOW HOW TO APPLY IT?
SHOWS HOUSE IS WHERE MILLER
POSITED THE SIMULATION HAS THE
STRENGTH.
YOU HAVE TO SHOW ME YOU CAN
INTEGRATE WHAT YOU KNOW AND THE
STEPS INTO HOW AND ACTUALLY
DOING IN THE SIM LAB OR THE REAL
CLINICAL WORLD FOR THAT MATTER,
WHAT IT IS THAT WE'RE WE'RE
TRYING TO MEASURE CONFIDENCE IN,
SO SHOW ME AND THEN DOES IS WHAT
HAPPENS EVERY DAY IN THE
CLINICAL WORLD, WHAT YOU DO, AND
WHETHER OR NOT YOU GET ANY
COACHING AND WHETHER OR NOT YOU
IMPROVE YOURSELF ON YOUR OWN IS
THE SORT OF TOP OF THE PYRAMID.
THE PYRAMID ALSO REP ARE SENTS
HOW FREQUENTLY THESE CLINICAL
COMPETENCIES ARE ASSESSED.
WE KNOW KNOWLEDGE IS ASSESSED
VERY, VERY FREQUENTLY THROUGHOUT
TRAINING AND POST TRAINING, ORAL
XASMS AND ESAYS ARE NOT AS
POPULAR AS THEY USED TO BE BUT
SHOWING HOW, SIMULATION IS NOW
WHERE WE DO MOST OF OUR
ASSESSMENT OF CLINICAL
COMPETENCE IN ADDITION TO
KNOWLEDGE.
IF YOUME YOU WANT TO KNOW OR RE1
PAPER TO DESCRIBE THE BEST
PRINCIPLES AND PRACTICES IN
MODERN HEALTHCARE SIMULATION,
READ THIS PAPER BY YVETTE
MOTOLA, SHE AND HER COLLEAGUES
HERE FROM THE UNIVERSITY OF
MIAMI FROM MT. SINAI HOSPITAL IN
TORONTO LOOK AT THE HEALTHCARE
SIMULATION OVER THE MAN YEARS
SINCE IT BEGAN THE MODERN ERA IN
THE MID80S AND TRIED TO
SUMMARIZE PRINCIPLES AND
PRACTICES THAT WE ALL SHOULD,A
BY BY WHEN WE PRACTICE
HEALTHCARE SIMULATION AND THERE
ARE A NUMBER OF IMPORTANT
PRACTICES BUT I WANT TO
HIGHLIGHT 2 FOR YOU AND THEN 2
PRACTICE POINTS THAT THAT
SIMULATION IS A METHODOLOGY THAT
IS DIFFERENT THAN OTHER
METHODOLOGIES LIKE LECTURE IN
THAT IT ALLOWS FOR DELIBERATE
PRACTICE AND ASSESSMENT, THINK
BATTING PRACTICE, SO YOU CAN
PRACTICE AS MANY TIMES AS YOU
WANT IN HEALTHCARE SIMULATION IN
A SAFE ENVIRONMENT, USUALLY A
SIM LAB OR WITH A TASK TRAINER
OR WITH A VIRTUAL REALITY HEAD
SET, WHATEVER YOU WOULD LIKE AND
YOU SHOULD BE ABLE TO GET A
COACHING AND FEEDBACK AND THIS
DELIBERATE PRACTICE AND
ASSESSMENT IS AT THE HEART OF
ALL GOOD PRACTICES IN HEALTHCARE
SIMULATION.
WE REALLY SHOULDN'T DO 1 SIM AND
BE DONE AND GO BACK TO WORK, WE
SHOULD DO SEVERAL SIMS IN
PRACTICE WITH COACHING BEFORE WE
GO BACK TO THE CLINICAL WORL FOR
XMPLE, PROCEDURES YOU DON'T HAVE
RETENTION IF YOU DO 1, SEE 1,
TEACH 1 AS WE LEARNED IN MY
GENERATION HOW TO DO PROCEDURES
THAT REALLY TO GET GOOD AT
SOMETHING, YOU NEED TO PRACTICE,
MANY, MANY, MANY TIMES UNDER THE
GUIDANCE OF A TUTOR OR COACH.
AND TEST OUT, SO WE CALL THIS
MYSTERIRY BASED LEARNING AND
THAT MASTERY BASED LEARNING HAS
GOOD EVIDENCE TO SUGGIEST THAT
IT IMPRIEWS THE SKILL
ACQUISITION AND MORE
IMPORTANTLY, SKILL RETENTION IS
LONGER THAN IF WE DID SKILL
TRAINING JUST SIMPLY BY 1 AND
DONE OR SEE 1 DO 1 TEACH 1.
SO THESE ARE 2 MAJOR PRINCIPLES
IN PRACTICE WE TRY ABIETD BY
WITH HEALTHCARE SIMULATIONS.
DOES IT WORK AND IS IT ANY
BETTER THAN WHAT WE USED TO DO,
WELL DAVID COOK AND HIS
COLLEAGUES TRIED TO ANSWER THIS
QUESTION, A FEW YEARS AGO WITH A
CLASSIC PAPER WHERE HE DID A
SYSTEMATIC REVIEW OF OVER 10,000
ARTICLES THAT LOOKED AT A
HEALTHCARE SIMULATION, SO HERE
HE MEANS, SIMULATION OTHER THAN
HUMAN SIMULATION WITH SP, SO
MANNEQUIN SIMULATION, TASK
TRAINER SIMULATION, AND THE
BURGEONING FEEL AT THIS TIME
COMPUTER BASED SIMULATION.
IT WASN'T ANY BETTER OR WORSE,
THAN THE USUAL,--DURING USUAL
METHODS, SO WE LOOKED AT A
VARIETY OF LEARNERS, CAN YOU SEE
HERE IN THESE--AMONG THESE
10,000 ARTICLES WE PICKED OUT
ABOUT 92 IS 92 STUDIES THAT COMD
SIMULATION TO TRADITIONAL
METHODS OF LEARNING.
HERE YOU SEE THE VARIETY OF
PARTICIPANTS, MEDICAL STUDENTS,
RESIDENTS,INOUSS AND OTHERS.
THAT THE THESE STUDIES COVERED
AND HERE ON THE BOTTOM, YOU SEE
TECHNOLOGY ENHANCED SIMULATION
COMPARED TO JUST TRADITIONAL
LECTURE, SMALL GROUP LEARNING,
PAPER AND PENCIL TESTS, VIDEOS,
SOME OF THESE VARIETY IN
DIFFERENT TRADITIONAL METHODS.
HOW DID SIMULATIONS STACK UP.
AND WHEN YOU LOOK AT THESE PLOTS
ON THE RIGHT, YOU CAN SEE AT THE
MOST PART, THE TECHNOLOGY AND
SIMULATION FAVORED THAT METHOD
AMONG THESE VARIED LEARNERS TO
LEARN BETTER COMPARED TO SOME
TRADITIONAL LEARNING.
AND THE POOL EFFECT SIZE HERE
APPROACHES .6 WITH THE A RANGE
OF .27 TO .97.
BUT .6 EFFECT SIZE IS A FAIRLY
MODERATE EFFECT SIZE FOR
SIMULATION COMPARED TO OTHER
METHODOLOGIES, SO YES,
SIMULATION AND HEALTHCARE DOES
WORK AND YES, IT IS MODERATELY
AFFECTED COMPARED TO TRADITIONAL
METHODS TO LEARN CLINICAL
SKILLS.
SO IF YOU ARE GOING TO PRACTICE
HEALTHCARE STIMULATION OR IF YOU
ARE A VICTIM OF HEALTHCARE
STIMULATION AS A LEARNER AND YOU
WANT TO PUBLISH YOUR RESULTS,
THIS TRIANGLE OR PYRAMID IS VERY
HELPFUL.
SO IN THE PAST WHEN SIMULATION
FIRST BEGAN, MUCH OF THE
LITERATURE ON THE EFFECT OF
SIMULATION WAS BASED ON THE
BOTTOM PYRAMID OF SATISFACTION,
THEY WOULD ASK THE LEARNER DID
YOU LIKE THE SIMULATION, DID YOU
FEEL CONFIDENT AFTER YOU
FINISHED THE SIMULATION, WE CALL
THESE THE FEEL GOOD SURVEYS AND
A LOT OF EARLY LITERATURE WAS IN
THIS SATISFACTION, DID YOU ENJOY
THE TRAINING, WHICH IS
INTERESTING AND USEFUL TO GATHER
BUT DOESN'T ADVANCE THE FIELD
MUCH.
NOW MOST JOURNAL EDITORS, AND
MOST RESEARCHERS WHO PUBLISH IN
SIM STRIE TO GO UP THIS
KIRKPATRICK HIRE ARCH EXPE TRY
TO MEASURE THINGS LIKE WAS THERE
AN INCREASE IN KNOWLEDGE BEFORE
AND AFTER THE SIMULATION?
THIS IS USUALLY MEASURED BY
MULTIPLE CHOICE QUESTIONS BEFORE
ORAL EXAM NATIONS SO WE'RE
MOVING UP THE FOOD CHAIN HERE OF
ASSESSMENT OF SIMULATION.
MORE AND MORE PAPERS ARE
STRARTSTARTING TO NOW REPORT BER
CHANGE IN THE CLINICAL WORLD
BECAUSE OF SIMULATION, A HIGHER
LEVEL OF ASSESSMENT AND A MUCH
MORE IMPORTANT 1 CLINICALLY, THE
ABSOLUTE TOP OF THE PYRAMID,
THESE 2 TOP PYRAMIDS HERE ARE
THE SORT OF GOLD STANDARD AND WE
ALL STRIVE FOR, GOALS OF
HEALTHCARE RESEARCH AND THAT IS
DO THOSE FOLKS WHO HAVE A CHANGE
IN THEIR BEHAVIOR IN THE SIM
LAB, WHEN THEY GO OUT TO THE
CLINICAL WORLD, DOES ANYBODY GET
ANY BETTER?
AND THEN EVERY CEO AND KMO IN
ANY HEALTH ORGANIZATION IS
WHAT'S MY RETURN ON INVESTMENT
AFTER INVESTING ALL THIS TIME
AND MONEY ON SIMULATION, DID THE
TRAINING IMPACT THE RESULTS OF
THE HOSPITAL OPERATIONS OR THE
CLINICAL OPERATIONS FOR THE
HEALTH OF A POPULATION.
THAT IS A VERY DIFFICULT AND
HARD ASSESSMENT TO MAKE AS YOU
WILL SEE IN A MINUTE BUT IT IS
THE TOP OF THE PYRAMID IN WHAT
WE ALL STRIVE FOR, SO RIGHT NOW
I THINK THE MAJORITY AND
PUBLISHED ACCORDINGLY, IN THE
IMPACT OR SO WE COME UP THE FOOD
CHAIN HERE A BIT BUT WE HAVE
SOME WAYS TO GO.
AND THIS IS THE KIRKPATRICK
TRIANGLE OF ASSESSMENT.
BILL [INDISCERNIBLE] WHO IS A
WELL PUBLISHED MEDICAL
RESEARCHER AND SIMULATIONIST
WITH COLLEAGUES OUT THE AT
NORTHWESTERN UNIVERSITY TOOK A
DIFFERENT TACT.
HE SAID IF YOU ARE GOING TO DO
RESEARCH IN HEALTHCARE
SIMULATION, THINK OF IT THE WAY
WE THINK OF ALL OTHER
TRANSLATIONAL RESEARCH AS T1, T2
AND T3.
THIS IS THE MAJORITY OF THE WORK
BEING DONE RIGHT NOW.
THIS IS 1 RESEARCH WHERE WE CAN
SHOW THAT PEOPLE GET BETTER OR
HAVE DIFFERENT PRACTICES OR
SKILL IMPROVES IN THE SINGLE
LAB, AGAIN USING THE SIMULATION
AND ASSESSMENT TOOLS WE TALKED
ABOUT PREVIOUSLY BUT HE URGED US
TO DO MORE T2 AND T3 RESEARCH.
SO T2 RESEARCH AND HEALTHCARE
SIMULATION HE WOULD SAY IS CAN
THE IMPROVE UPON WANTS WE SEE IN
THE SIM LAB TRANSFER TO IMPROVED
DOWN STREAM PATIENT CARE
PRACTICES.
SO FOR INDIVIDUALS GROUPS, DOES
ANYBODY GET ANY BETTER BECAUSE
OF WHAT WE DID IN THE SIM LAB
WITH INDIVIDUALS AND TEAMS.
THAT'S T2 TRANSLATIONAL RESEARCH
AND THE HOLY GRAIL IS THE T3
RESEARCH WHICH IS NOT VERY
FREQUENT BUT WHEN WE SEE IT,
REALLY APPLAUD, AND THAT IS CAN
WE IMPROVE PATIENT IN PUBLIC
HEALTH BECAUSE OF WHAT WE HAVE
DONE IN HEALTHCARE SIMULATION
WITH INDIVIDUALS OR WITH TEAMS.
SO THIS TYPE OF HIERARCHY CAN
GUIDE RESEARCHERS AS THEY PLAN
STUDIES AND REPORT STUDIES, A
LOT OF T1 AND TRY TO GET MORE T2
AND WE ULTIMATELY WANT TO GET TO
T3.
BUT IT IS NOT EASY.
I WILL GIVE YOU AN EXAMPLE.
SO JEFF BARSICK AND CLEANINGS AT
NORTHWESTERN HAD A PROBLEM, AND
THEY RECOGNIZED IN THEIR
HOSPITAL, THE CENTRAL LINE
ASSOCIATED BLOOD STREAM
INFECTIONS OR COLLAB Cs, IN
THE ICU AND IN THE ER, WERE
UNACCEPTABLY HIGH IN THEIR
HOSPITAL SYSTEM AND THEY WANTED
TO DO SOMETHING ABOUT IT SO THEY
THOUGHT THAT PERHAPS HEALTHCARE
SIMULATION DELIVERED PRACTICE
INSERTING AND CARING FOR CENTRAL
LINES MIGHT HELP WITH THIS
PROBLEM.
SO WHAT THEY DID WAS THEY LOOKED
AT THEIR CLABSI RATE FOR 2 YEARS
PRIOR TO STARTING AN
INTERVENTION AND THEN FOR EVERY
INTERNAL MEDICINE RESIDENT AND
EVERY EMERGENCY MEDICINE
RESIDENT WHO WOULD ROTATE
THROUGH THE IRU OR THE ER,
UNDERWENT IN THEIR SIM LAWS HOW
THEY CARE PER IT SO THEY
PRACTICE OVER AND OVER AND OVER
AGAIN USING TASK TRAINERS AND
CENTRAL LINE EQUIPMENT AS THEY
WOULD IN THE E. R. OR ICU AND
THEY DID NOT LEAVE THE SIM LAB
UNTIL THEY WERE VERY GOOD AND
PERFECT AND PUTTING IN AND
MAINTAINING CENTRAL LINES
ACCORDING TO A CHECK LIST AND
THEN HE MEASURED THE CLABSI RATE
IN THE HOSPITAL AFTER THESE
RESIDENTS ROTATED THROUGH THE E.
R. AND THE EMERGENCY ROOM, I'M
SORRY THE EMERGENCY ROOM AND ICU
AFTER 2 YEARS.
SO HERE'S THE RESULTS HE
REPORTED.
SO WHAT YOU CAN SEE ON THESE
ISSUES AT LEAST THE GRAPH ON THE
BOTTOM, THIS IS THE CLABSI RATE
IN THE HOSPITAL THAT HOVERED
HERE AROUND 5 INFECTIONS FOR A
THOUSAND LINE DAYS, WHERE I HAVE
A GREN LINE HERE AND THIS IS THE
PREINTERVENTION, 2 YEARS BEFORE
THEY STARTED TRAINING RESIDENTS
IN HOW TO CARE FOR AND INSERT
CENTRAL LINES WITH SIMULATION.
THIS WAS USUAL TRAINING WHICH IS
PROBABLY SEE 1, DO 1, TEACH 1 IF
I REMEMBER HOW THAT USED TO
WORK.
AND THEN HE INSTITUTED THIS
INTENSIVE SIMULATION TRAINING IN
CENTRAL LINES, JUST AMONG THE
RESIDENTS AND WHEN WE MEASURED
WAS THE CLABSI RATING IN THE
HOSPITAL, DRAMATIC LOAMACYY
IMPROVED, ALMOST REACHED 0 HERE
IN SEVERAL CASES WHICH WAS NOT
ALWAYS THE CASE IN THE
PREINTERVENTION ERA AND OTHER
RESIDENTS CAME IN THE FOLLOWING
YEAR WHO DIDN'T GET TRAINED FOR
WHATEVER REASON AND SEE THE RATE
WENT BACK UP BUT ONCE THEY WERE
TRAINED WENT BACK DOWN AGAIN.
SO THIS LOOKS VERY IMPRESSIVE AS
SORT OF T2 KIND OF PATIENT CARE
OUTCOMES IMPACTED BY SIMULATION
TRAINING EMPLOY BUT I WILL TELL
YOU THERE'S A PROBLEM.
IT'S NOT OFTEN POSSIBLE TO DRAW
A DIRECT LINE FROM PATIENT
OUTCOMES BACK TO SIMULATION,
WHY?
PATIENT OUTCOMES AS YOU
ULTIMATELY KNOW ARE VERY
COMPLICATED OUTCOMES, AND
PROBABLY THERE ARE MANY
VARIABLES THAT IMPACT PATIENT
OUTCOMES, IN THIS CASE, THERE
WERE PROBABLY OTHER VARIABLES
THAT COULD HAVE INFLUENCED THE
CLABSI RATE ONCE THE SIMULATOR
TRAINED RESIDENTS WERE RELEASED
INTO THE REAL WORLD, THINGS LIKE
NOW WE'RE PAYING ATTENTION TO
CENTRAL LINE INSERTION SO MAYBE
EVERYBODY WAS MORE AWARE OR HER
HAPPENS NURSES WERE INVOLVED IN
THIS TRAINING AND THEY SAW THE
RESIDENTS DOING SOMETHING
DIFFERENT AND I THAT DID A
BETTER JOB OF MAINTAINING
CENTRAL LINES OR MAYBE THERE WAS
A HOSPITAL WIDE EFFORT
INDEPENDENT OF SIMULATION TO
FOCUS ON THE CARE OF CENTRAL
LINES ONCE THEY WERE PLACED.
ALL THESE THINGS PROBE IMPACTED
PATIENT OUTCOMES SO DRAWING A
LINE DIRECTLY BACK TO THE SIM
LAB IS NOT EASY AND OFTEN THERE
ARE CO VARIABLES THAT HAVE TO BE
TAKEN INTO ACCOUNT.
AND BECAUSE OF THAT T2 RESEARCH
IS HARD.
CONTROLLING THESE OTHER
VARIABLES IS NOT EASY BUT IT IS
THE GOAL WE ALL LOOK FOR IN
HEALTHCARE SIMULATION, SO WHAT
IS MY TAKE HOME POINTS FOR YOU
TODAY?
ONE, SIMULATION BASED MEDICAL
EDUCATION DOES WORK, IT'S CALLED
THE EFAS CASSIE DATA I
PRESENTED, BUT IT TAKES TIME AND
RESOURCES AND IT TAKES MONEY.
AND ALL OF THESE ARE ALL QUS BUT
WE IN THE SIMULATION COMMUNITY
BELIEVE IT IS FIRMLY WORTH THIS
INVESTMENT.
PEASHT OUTCOMES YOU JUST SAW IS
THE GOLD STANDARD, WE ARE TRYING
TO,A CHIEF WITH HELT CARE
SIMULATION, BUT IT'S NOT EASY
BECAUSE THE CORRELATION IS
FRAUGHT WITH A LOT OF OTHER CO
VARIABLES THAT HAVE TO BE
ACCOUNTED FOR AND LASTLY WE NEED
MORE T2 AND T3 RESEARCH, WE WERE
PRETTY MUCH DONE WITH, I CAN
SHOW YOU I DO BETTER IN THE SIM
LAB, LET'S FOCUS MORE ON PATIENT
OUTCOMES AND POPULATION
OUTCOMES, AND THAT IS SORELY
NEEDED AND HOPEFULLY WILL BE
MORE AS THIS FIELD MATURES AND
AS WE GO FORWARD.
SO I WANT TO STOP HERE AND ALLOW
TIME FOR MY OTHER PRESENTERS TO
MAKE THERAPIST PRESENTATIONS, WE
WILL PROBABLY TAKE QUESTIONS
AFTERWARDS BUT THANK YOU AGAIN
FOR THE TIME AND STANDING BY FOR
YOUR QUESTIONS LATER ON IN THIS
PRESENTATION.
THANK YOU.
IT'S REALLY MY GREAT PLEASURE TO
BE PARTICIPATING IN THIS NIH
GRAND ROUNDS.
I'M SO GLAD WE ARE FOCUSED
DURING HEALTHCARE SIMULATION
WEEK ON TALKING ABOUT SIMULATION
AND I'M HERE TO DISCUSS
SIMULATION BASED EDUCATION AS IT
RELATES TO HIGH RISK LOW VOLUME
CARE, WHICH IS PARTICULARLY
RELEVANT TO THE PATIENTS WE CARE
FOR HERE AT NIH.
SO I THINK WE SHOULD ALWAYS
START WITH A DEFINITION, THERE
ARE SEVERAL DEFINITIONS BUT A
WIDELY ACCEPTED 1 FOR HIGH RISK
LOW VOLUME THERAPY, IS THAT
THESE ARE THERAPIES THAT ARE
PRACTICED INFETAL COMPARTMENT
QUENTLY AND YET CARRY AN
INCREASED RISK TO PATIENTS
BECAUSE OF THEIR COMPLEXITY.
HOWEVER, EVEN DEFINITION OF HIGH
RISK LOW VOLUME AS IT CREATES
CONTROVERSY AND HAS LIMITATIONS,
AND HOW DO WE PROCEED?
WE THINK OF THE PROCEDURE ITSELF
AND WE THINK OF THE SKILL OF THE
PERSON DOING THE PROCEDURE, IT'S
MUCH MORE COMPLICATED THAN THAT,
THE SAME OPERATION WOULD HAVE
DIFFERENT RISKS BEPENDING ON THE
PATIENT'S CLINICAL STATUS, A
HEALTHY OUTPATIENT COMPARED TO A
CRITICALLY ILL PATIENT AND
MULTIORGAN FAILURE IN THE ICU,
WE WILL HAVE DIFFERENT
PROCEDURAL RISKS.
AND THE RISKS ALSO RELATES TO
HOW WELL THE TEAM THAT'S
PROVIDING SUPPORTIVE CARE,
WHETHER THAT'S IN AN OPERATING
ROOM OR IN AN ICU OR ON A
MEDICAL FLOOR FOR EXAMPLE, ARE
PROVIDING SUPPORTIVE CARE AND
DOING THEIR BEST TO PREVENT
COMPLICATIONS.
SO IT IS--THERE ARE CLEAR
LIMITATIONS TO THIS DEFINITION,
HERE I'M SHOWING YOU THAT THE
NIH CLINICAL CENTER MISSION
STATEMENT AND I SHOW YOU THIS
BECAUSE, THE TYPE OF CARE WE
PROVIDE HERE REALLY IS WHAT
WE'RE TALKING ABOUT, WHEN WE
TALK ABOUT HIGH RISK LOW VOLUME
AND IT'S ACTUALLY ALLUDED TO IN
OUR MISSION STATEMENT.
I WILL POP UP THE RELEVANT
PORTION HERE SO CAN YOU SEE IT
BETTER, INNOVATIVE THERAPY AND
HIGH QUALITY CARE TREATING
PATIENTS WITH RARE AND SEVERE
DISEASES.
THIS CLEARLY REFERS TO HIGH RISK
LOW VOLUME CARE, SO NOT ONLY IS
THIS PART OF OUR MISSION
STATEMENT, HIGH RISK LOW VOLUME
CARE IS A PRIORITY OF STAFF AND
A FOCUS, SO THERE HAVE BEEN
INDEPENDENT SURVEYS THAT HAVE
BEEN DONE THAT HAVE BEEN
CONDUCTED BY BOTH THE CLINICAL
CENTER PATIENT SAFETY CLINICAL
PRACTICING QUALITY COMMITTEE AS
WELL AS THE NURSING DEPARTMENT
LEADERSHIP, WITH THOSE REACHING
OUT TO NURSES AND BEDSIDE
PATIENTS RESPECTIVELY.
AND LOW RISK HIGH VOLUME CARE
HAS BEEN IDENTIFIED BY BOTH
GROAPS AS A POTENTIAL
VOWELLERRENERRABILITY.
VOWELLERRENERRABILITY--VULNERABI
LITY.
WHEN WE DIG DEEPER INTO THESE
SURVEYS, THEY WANT TO ASSURE
THAT ALL MEMBERS OF THE TREATING
TEAM ARE PREPARED TO MANAGE
THESE COMPLEX PATIENTS.
AND BOTH GROUPS INDEPENDENTLY
REPORT THAT FURTHER TRAINING OF
THOSE TEAMS WOULD BE HELPFUL AND
I THINK THAT'S CLEARLY AN AREA
WHERE SIMULATION IS AN EXCELLENT
PLATFORM FOR US TO PROVIDE THAT
SORT OF EDUCATION SO NOW I WILL
DESCRIBE, GO ON TO DISCUSS WHAT
TYPE OF TRAINING IS MOST USEFUL.
WHEN WE'RE TALKING ABOUT MAKING
SURE THE WHOLE TEAM IS ON THE
SAME PAGE FOR TREATING THESE
COMPLEX PATIENTS.
SO,--HERE--YEAH.
SO WE HAVE HERE IS--I WANT TO
TART WITH A CASE PRESENTATION.
THIS PICTURE IS A DEPICTION HERE
OF AN EXAMPLE OF A CASE THAT WAS
PRESENTED AT AN M& M CONFERENCE
AT ANOTHER HOSPITAL.
THIS IS A TRAUMA PATIENT WHO
PRESENTED TO THE E. R. AFTER A
MOTOR VEHICLE ACCIDENT
COMPLAINING OF ABDOMINAL PAIN.
CAN YOU SEE EACH OF THE MEMBERS
OF THE PROFESSIONAL TEAM
PERFORMING RESPECTIVE ROLES AS A
PATIENT A CLINICAL STATUS
WORSENS, CAN YOU SEE HERE THE
ANESTHESIOLOGIST AND RESPIRATORY
THERAPIST AT THE HEAD OF THE
BED, THEY'RE WORKING TO
INTERNATIONAL
INTERNATIINTERNATIONAL CLASSIFIN
PATIENT, SECURE THE ENDOTRACHEAL
TUBE, SECURE OXYGEN WHILE
BAGGING THROUGH THE ENDOTRACHEAL
TUBE, CAN YOU SEE NURSES ON BOTH
SIDES WORKING TO GET IV ACCESS,
DRAWING BLOOD FOR LABS,
ADMINISTERING FLUIDS AND
MEDICATIONS FOR RESUSCITATION.
WE SEE A RESIDENT HERE TRYING TO
DO A RAPID--CALLED A FAST
ULTRASOUND TO LOOK AT HEART
FUNCTION, TO LOOK FOR EVIDENCE
OF ANY BLEEDING, OBVIOUSLY THIS
PATIENT HAD ABDOMINAL TRAUMA AND
THEN AT THE SAME TIME YOU SEE A
SURGEON EXAMINING THE PATIENT
DECIDING IF THIS REQUIRES--IF
THIS CASE REQUIRES GOING TO THE
O. R. URGENTLY @ FOOT OF THE BED
YOU SEE THE TEAM LEADER GUIDING
RESUSCITATION.
SADLY IN THE CASE THAT WAS
REVIEWED AT THE M& M, THE
PATIENT LATER DIED AND 1 OF THE
CONCERNS RAISED IN THE
CONFERENCE WAS WHETHER WAS THERE
DELAYED ACTIVATION OF A MASSIVE
TRANSFUSION PROTE PROTOCOL THATD
BE IMPLEMENTED IN PERSISTENT
HYPOTENSION IF PRESUMED
ABDOMINAL BLEEDING WERE THE
CAUSE OF HYPERTENSION.
SO WHEN WE TALK ABOUT THIS, THE
IMPORTANT QUESTION WE ASK IS HOW
DO WE IMPROVE TEAM CARE FOR THE
NEXT PATIENT WITH SIMILAR--WITH
A SIMILAR PRESENTATION.
I THINK 1 OF THE CHALLENGES WE
HAVE IN HEALTH PROFESSIONS
EDUCATION IS WE TRADITIONALLY
LEARNED IN SILOS BASED ON OUR
PEER GROUP, PHYSICIANS LEARN
TOGETHER, RESPIRATORY THERAPY
AND UPONNISTS COME OUT, NURSES,
FORM CYST, PTOT, ALL ARE GROUPS
OF PROVIDERS WE LEARN IN OUR
SEPARATE SILOS BUT WE CARE FOR
IN THOSE PATIENTS IN THE EXAMPLE
IS WITH PROFESSIONAL TEAMS SO
WHEN WE TALK ABOUT CONCEPT, WE
WILL TALK ABOUT IN MORE RETAIL
PRACTICE WE CAN'T DO THAT OF ANY
SILOS WE MUST BREAK OUT OF THEM
TO REALLY IMPROVE TEAM
PERFORMANCE.
WHEN WE WANT TO DO NOW IS REFER
TO A COUPLE DIFFERENT WAYS TO GO
ABOUT THIS WHEN WE TALK ABOUT
HIGH RISK FOR TRAINING, 1 IS
PROFESSIONAL EDUCATION I WILL
TALK A FAIR AMOUNT ABOUT THAT,
THAT OCCURS WHEN 2 OR MORE
PROFESSIONALS LEARN ABOUT FROM
AND WITH EACH OTHER TO ENABLE
EFFECTIVE COLLABORATION AND
IMPROVE HEALTH OUTCOMES, CAN YOU
SEE FOR EXAMPLE AN IRPT
PROFESSIONAL TEAM LIKE I SHOWED
IN THE CLINICAL EXAMPLE WOULD BE
1 IF THEY TOGETHER IN A
GROUP FOR A TEACHING, THAT WOULD
BE AN INTERPROFESSIONAL
EDUCATION, THIS IS FOR THE
PROGRAM HERE IS JUST IN TIME.
JUST IN TIME TRAINING IS A
PRACTICE OF A SKILL IMMEDIATELY
PRIOR TO A ROUGH ATOM SEEDURE, 1
CAN IMAGINE 1 OF THESE COMPLEX
SURGERIES FOR HIGH RISK LOW
VOLUME TREATMENTS WE DO HERE.
IF WE KNOW WE HAVE A SCHEDULED
ADMISSION FOR A PATIENT THAT WE
COULD GATHER THE TEAM TOGETHER
IN ADVANCE OF THAT SCHEDULED
ADMISSION AND PRACTICE WITH
PREDICTABLE POTENTIAL
COMPLICATIONS MIGHT BE.
SO NOW THAT YOU UNDERSTAND THESE
TERMS, LET'S TALK A LITTLE BIT
MORE ABOUT REFLECTIVE PRACTICE.
SO THIS A WELL KNOWN CONCEPT
OUTSIDE OF MEDICINE FOR A
PROFESSIONALS TO IMPROVE
PERFORMANCE IN A COLLABORATIVE
SETTING.
I THINK THE QUESTION BECOMES IF
WE'RE GOING TO IMPROVE FUTURE
CLINICAL OUTS, HOW DO WE
UNDERSTAND WHY WE PERFORM
CERTAIN ACTIONS THAT IMPACTED
THE RESULTS OF CLINICAL
OUTCOMES, RIGHT?
SO THE WHY HERES ARE FRAMED.
OR A MENTAL MODEL MAY BE ANOTHER
WORD YOU HEARD SO IN MEDICAL
EDUCATION, WHEN WE TALK ABOUT
FRAMES OUR PRIMARY EMPHASIS IS
HISTORICALLY BEEN ABOUT YOUR
KNOWLEDGE BASE, INCREASE IN
KNOWLEDGE BASE, TEACH PEOPLE,
JOE ALLUDED TO THAT IN HIS
PRESENTATION BUT THERE'S SO MANY
OTHER CONTRIBUTORS TO 1 FRAME
AND 1'S FRAME AGAIN INFLUENCES
PATIENT OUTCOMES.
SO THE EXAMPLE I SHOWED EARLIER
OF THE TRAUMA PATIENT WHY DIDN'T
TEAM MEMBERS SPEAK UP ABOUT
PERSISTENT HYPOATTENTION AND
ACTIVATE THE MASSIVE TRANSFUSION
PROTOCOL EARLIER?
THEY WERE DEFERRING TO THE TEAM
LEADER, RIGHT?
THAT RELATES TO WE GET TO
ASSUMPTIONS, WELL I WON'T SAY
ANYTHING BECAUSE I ASSUME THAT
THE TEAM LEADER RECOGNIZES THIS
AND RULES, HIERARCHY, THE NURSE,
OR MAYBE THE THERAPIST DOESN'T
FEEL EMPOWERED TO SPEAK ABOUT
ACTIVATING SOMETHING BECAUSE
THAT'S REALLY THE JOB OF THE
PHYSICIAN.
AND THEN MAYBE IN MANY OF THESE
CASES, THERE'S SO MUCH COGNITIVE
LOAD, THESE ARE HIGH STRESS
SITUATIONS THE TEAM LEADER MAY
HAVE LOST SITUATIONAL AWARENESS,
RIGHT?
BECAUSE THEY WERE TRYING TO HELP
WITH THE ULTRASOUND TO SEE IF
THERE WAS BLEEDING AND A
DIFFICULT EXAMINATION AND AGAIN
WE ARE NOT WORKING IN A VARMIS
VACUUM THAT TEAM LEADER HAD JUST
COME OUT FROM SEEING A PATIENT
WITHIN AN ACUTE MI AND WAITING
FOR THE CATH LAB TO CALL BACK
AND WORRY BODY THAT PATIENT SO
REALLY EXPLORING THESE FRAMES SO
WE CAN CHANGE ACTIONS AND
RESULTS IS VERYICAL CHALLENGING
IN MEDICINE BUT REALLY THE BEST
VENUE WE HAVE IS THE DEBRIEFING
AND SIMULATION AND OUR HOPE HERE
IS THAT ONCE WE IDENTIFY THESE
FRAMES AND AGAIN CAN BE MAYBE IN
THIS CASE RELATED TO HIERARCHY
AND ASSUMPTIONS THAT WE CAN
EFFECTIVELY DEBRIEF THEM TO
IDENTIFY IT AND THEN WE EMPOWER
TEAM MEMBERS TO SPEAK UP AND
HOPEFULLY FLATTEN HIERARCHYS AND
CHANGE THE FRAME SO WE CAN
IMPACT FUTURE ACTIONS.
AND SO HERE I SHOW YOU A SLIDE
OF A PICTURE FROM THE STANFORD
GROUP SHOWING AN EXAMPLE OF A
DEBRIEFING AND YOU CAN SEE THE
DEBRIEFER HERE IS LEADING A
GROUP OF PARTICIPANTS WHO ARE IN
A CODE BLUE SCENARIO AND THE
PROFESSIONAL TEAM TOOK PART ON
THAT AND ARE REVIEWING THE VIDEO
OF THE RESUSCITATION THE GOAL
HERE, GOING BACK TO WHAT WE WERE
TALKING ABOUT THE LAST SLIDE IS
TO UNDERSTAND THE GROUP MEMBER
SETTINGS, PARTICULARLY IN THE
SCENARIO WHERE THE ACTIONS WERE
SUBOPTIMAL AND THE GOAL IS TO
WORK THROUGH THAT SO THAT WE CAN
AN IMPROVEMENT IN DECISION
MAKING FOR THE NEXT TIME OR ALSO
IDENTIFY AND FIX UP SOME
PROCESSES THAT MIGHT BE IMPACTS
TEAM PERFORMANCE.
SO YOU CAN SEE ON THE LEFT SIDE
OF THE SCREEN, HERE THAT
THERE--YOU KNOW THERE'S A HUGE,
VERY ASPIRATIONAL QUADRUPLE AIM
OF INTERPROFESSIONAL EDUCATION,
RIGHT?
IF WE CAN WORK TOGETHER, WE
IMPROVE AND WE WORK EFFECTIVELY,
AND COLLABORATIVELY WE CAN
IMPROVE OUR PROVIDER EXPERIENCE
AND THAT TRANSLATES TO AN
IMPROVED PATIENT EXPERIENCE, AND
HOPEFULLY AGAIN, CHANGING
ACTIONS AND RESULTS, WE IMPROVE
PATIENT OUTCOMES AND HOPEFULLY
THE EFFICIENCY ALLOWS FOR A
LOWER COST OF CARE.
YOU KNOW UNFORTUNATELY IF IT
WERE ONLY THAT EASY, RIGHT?
THERE ARE SIGNIFICANT OBSTACLES
TO GETTING GROUPS TO TRAIN AND
LEARN TOGETHER AND THEY MUST BE
OVERCOME AND THAT'S WHY, FRANKLY
INTERPROFESSIONAL EDUCATION
STILL IS A COMMON PLACE.
WHY IT'S DIFFICULT ENOUGH TO
ORGANIZE A SINGLE GROUP OF
PEOPLE IN A SILO TO SCHEDULE FOR
JOINT TRAINING ORGANIZING ACROSS
POSITIONS, NURSES, THERAPISTS,
AND SO FORTH, IT'S QUITE
CHALLENGING.
BECAUSE WE'VE ALSO--BECAUSE
WE'RE USED TO LEARNING IN OUR
SILOED PEER GROUPS, THERE'S A
GREAT FEAR OF LEARNING OUTSIDE
OF THAT AND SO, YOU REALLY NEED
A SKILLED EDUCATOR WHO CREATES A
SAFE SPACE SO ALL LEARNERS FEEL
SAFE LEARNING THERE, BUT THEY
HAVE TO PUSH ENOUGH TO THE EDGE
OF THAT COMFORT ZONE TO REALLY
LEARN TO FIGURE OUT THESE FRAMES
AND TO IMPACT FUTURE
PERFORMANCE.
SO, YOU KNOW I THINK JOE ALLUDED
TO THIS AND I'M TALKING ABOUT
THE BARRIERS IN MY PRIOR SLIDE,
THERE'S A LOT OF TIME, EFFORT,
EXPENSE, STAKEHOLDER ENGAGEMENT
TO BE ABLE TO PROVIDE
PROFESSIONAL SIMULATION SO I
THINK WE'RE VERY COMMONLY HERE,
RIGHT?
WHAT IS THE EVIDENCE FOR
SIMULATION TRAINING AND
IMPROVING OUTCOMES AND I THINK
JOE TALKED ABOUT THE LIMITATIONS
AND THE CHALLENGES AND HOPEFULLY
THE GOALS FOR MORE PATIENT
CENTERED OUTCOMES BUT CERTAINLY
IT'S NOT THAT EASY.
I WILL TALK A BIT ABOUT THAT
GOING FORWARD, BUT I WANT TO
TALK ABOUT FLIGHT SIMULATION,
RIGHT?
AND THE EXAMPLE OF FLIGHT
TRAINING, SIMULATION IS REQUIRED
FOR PILOTS, BUT THERE IS NO
RANDOMIZED STUDY SHOWING A
REDUCED MORTALITY OF PASSENGERS
IN PLANES FLOWN BY I PILOTS WHO
ARE TRAINED ON SIMULATORS
COMPARED TO THOSE WHO DID NOT
RECEIVE ANY SIMULATION TRAINING,
RIGHT?
SIMULATION IS DONE IN FLIGHT
TRAINING BECAUSE IT MAKES SENSE.
IN THE EARLY DAYS OF FLYING,
THERE WAS NO SIMULATOR OPTION.
I WILL SHOW YOU A VIDEO CLIP AND
THIS PERSON WAS FINE, I FOUND A
CLIP THAT THE PERSON WAS
UNHARMED BUT THIS IS A VIDEO
CLIP OF A PILOT ATTEMPTING TO
FLY ON THE SIDE OF A MOUNTAIN
OBVIOUSLY AND THE COMPLEXITY AND
THE TEAM WORK REQUIRED IN CARING
FOR PATIENTS GOING BACK TO HIGH
RISK LOW VOLUME AND USED TO
PRACTICE AS A TEAM WITH
SIMULATION BEFORE WE'RE DOING
THAT IN A DECOMSAITING PATIENT
AND THAT'S AGAIN DESPITE THE
LIMITATIONS OF THE EVIDENCE
BASE.
SO NOW I DO WANT TO GO THROUGH A
COUPLE OF STUDIES THAT THEY TALK
ABOUT THE EVIDENCE BASE OF
IMPROVED OUTCOMES, WITH
INTERPROFESSIONAL SIMULATION,
AGAIN, I TRIED TO PULL A COUPLE
OF PAPERS THAT DIDN'T JUST HAVE
INCREASED CONFIDENCE AT THE
LOWER LEVELS OF THE PYRAMID THAT
JOE DESCRIBED.
SO HERE'S A STUDY THAT ASKS AN
INTERESTING QUESTION, IN TRAUMA
CENTERS IS THE USE OF TRAUMA
SIMULATIONS, THESE ARE PEDIATRIC
TRAUMA CENTERS,A ASSOCIATED WITH
THE CHANGE IN CLINICAL OUTCOME
AND SO THE AUTHORS OF THESE
PAPER AT JENSEN AND COLLEAGUES
THEY SERVE A PROGRAM LEADERSHIP
OF 124 CENTERS THAT PARTICIPATE
INDEED THE AMERICAN COLLEGE OF
SURGEONS PEDIATRIC TRAUMA
QUALITY IMPROVEMENT PROGRAM.
AND THESE CENTERS HAVE OUTCOME
DATA OVER THE TIME STUDIES FROM
ALMOST 58,000 PATIENTS.
IF YOU LOOK AT TABLE 2 FROM THE
PAPER HERE, WHAT YOU CAN SEE, IS
THE FIRST LOOKING AT UNADJUSTED
THE AVERAGE CENTER UNADJUSTED
MORTALITY WAS LOWEST IN CENTERS
WITH THE HIGH VOLUME OF
SIMULATION BASED TRAININGS, SO
LET ME ORIENT YOU TO THIS, SO
LET ME SEE THE UNADJUSTED
CENTERS SPECIFIC MORTALITY, AND
.88% IN THE CENTERS THAT DID NO
SIMULATION, OUT OF 40 CENTERS
INITIATIVES THE CENTERS THAT DID
1 TO 10 PEDIATRIC TRAUMA
SIMULATIONS, THE 19 CENTERS, THE
MORTALITY IS 1.59% AND THE 1S
THAT DID 11 + SIMULATIONS IN
THAT TIME PERIOD, AND OF 35
CENTERS, MORTALITY WAS EVEN
LOWER OF .03%.
NOW THE QUESTION IS THERE ARE SO
MANY FACTORS RIGHT, THAT
COULDN'T AFFECT MORTALITY AND WE
HAVE TO BE VERY CAREFUL ABOUT
THIS AND SO THE GROUP DID A
RISK--THEY DID A RISK ADJUSTED
MORTALITY, BASED ON A VALIDATED
TRAUMA QI PROGRAM MODEL, AND
THAT INCORPORATES AGE, SEX,
PRESENTATION, MECHANISM OF THE
INJURY OF THE TRAUMA AND YOU CAN
SEE HERE THE RISK OF THE
ADJUSTED MORTALITY IS STILL, WE
LOOK AT ODDS RATIO OF 0.55 AND
THE CONFIDENCE FOR BOTH, FOR THE
CENTERS THAT DID 1 TO 10
SIMULATIONS AND THOSE THAT DID
11 + COMPARED TO THE REFERENCE
OF NO SIMULATION, SO I DON'T
WANT TO OVERHYPE THAT SORT OF
PAPER, ASSOCIATION, CERTAINLY
DOES NOT IMPLY CAUSATION.
BUT, THIS IS CLEARLY AN
INTERESTING FINDING AND
THAT--AND OF BETTER OUTCOMES,
AND CENTERS THAT DO MORE
SIMULATION.
THE NEXT PAPER IS ABOUT AN
INTERESTING AREA THAT'S CALLED
KRA [INDISCERNIBLE] CPR, SO IT'S
INCREASED USE OF [INDISCERNIBLE]
CPR AND YOU MAY HAVE HEARD OF IT
AS ECNO, SO YOU HAVE TO
KAN--KANAULATE LARGE VESSELS TO
PUT THEM ON THE ECMOW CIRCUIT
AND THAT REQUIRES SKILLED
SURGEONS WITH AN ENTIRE TEAM AND
THEN TRYING TO DO THAT IN 1 OF
THE PATIENTS BEING RESUSCITATED
DURING CARDIAC ARREST IS MORE
COMPLEX, SO CAN YOU SEE HERE IN
THE PATIENTS IN THE CLINIC UPPER
THIS IS A MANIKIN, AND THIS WAS
IN A PEDIATRIC CENTER AS YOU SEE
THE SMALL MANNEQUINS RIGHT WITH
SPECIALLY DESIGNED EC ECMOW NECK
PATCH THAT ALLOW FOR CPR
SIMULATION, YOU CANY BELOW THAT
THE SURGICAL TEAM CAN PERFORM A
LIFE LIKE ECMO KAN--KANAULATION
DURING CPR, SO THERE'S A STUDY
OF THE TRAINING OF THESE CPR AND
THEY LOOK AT THIS LARGE
CHILDREN'S HOSPITAL IN SEATTLE
AND THEY COMPARED ECPROUTCOMES
IN PATIENTS BEFORE AND AFTER THE
SIMULATION I'M DESCRIBING WERE
START AND SO THESE SIMULATIONS
WERE HELD 1-2 TIMES PER MONTH IN
THE 3 PEDIATRIC ICOWS AND THE 29
SIMULATION SESSIONS, AND THEY
INCLUDED OVER 300 HEALTHCARE
PROFESSIONALS IN THESE SESSIONS.
THIS TABLE HERE SHOWS THE
CLINICAL OUTCOMES FROM THE EPC R
EEIVETS THAT OCCURRED AND IN THE
LEFT COLUMN IT'S FORCING
SIMULATION SO THE PC R AND THE
SIMULATION SESSIONS AND THEN IN
THE 16 AFTER THE SIMULATION
SESSIONS.
SO AGAIN, THAT'S A LOW END AND
THAT'S VERY COMMON IN HIGH RISK
LOW VOLUME STUDIES SO IT'S VERY
HARD TO ACHIEVE STATISTICAL
SIGNIFICANCE AND THAT'S CRUST A
FACT IN SOME AGAIN HIGH RISK LOW
VOLUME.
BY DEFINITION THE END WILL BE
LOW AND THANKFULLY, NEED FOR
CARDIAC ARREST IN CHILDREN
PUTTING THISEM ON ECPR IS A LOW
VOLUME EVENT.
BUT SO, WHAT WE SEE HERE IS A
STATISTICALLY SIGNIFICANT AND
SEEMS MEANINGFULLY SIGNIFICANT 5
MINUTE REDUCTION IN ACTIVATION
OF THE ECRP TEAM AFTER THE
SIMULATION SESSION SO CERTAINLY
YOU THINK 5 MINUTES IN CARDIAC
ARREST CAN BE THE DIFFERENCE
BETWEEN LIFE AND DEATH.
SO AGAIN, THAT'S AN INTERESTING
PAPER AND FINDING AND THESE ARE
2 PAPERS THAT SHOW IMPROVEMENTS
WITH SIMULATION BASED CARE.
SO I WANT TO TALK A LITTLE BIT
IN THE LAST FEW MINUTES ABOUT
WHAT WE'RE DOING HERE AT THE NIH
CLINICAL CENTER AND WE'RE REALLY
AGAIN FOCUSED ON TEAM TRAINING
WHEN WE'RE TALKING ABOUT HIGH
RISK LOW VOLUME HERE.
SO IN OUR CRITICAL CARE GROUP,
WE DO WEEKLY INTERPROFESSIONAL
CRITICAL CARE SESSIONS AND WHEN
I TALKED EARLIER ABOUT
REFLECTIVE PRACTICE WE REALLY
HAVE AN EMPHASIS IN CRISIS
RECOURSE MANAGEMENT WHICH IS A
TERM THAT COMES UP A LOT IN
EMERGENCY AND CRITICAL CARE
MANAGEMENT.
WE'RE WORKING WITH PINS PELS
DEALING WITH COGNITIVE AND
INTERPERSONAL BEHAVIORS AND
THOSE THAT CONTRIBUTE TO OPTIMAL
TEAM PERFORMANCE AND IT GOES
BACK SIMILAR TO WHAT WE'RE
TALKING ABOUT IN UNDERSTANDING
PEOPLE'S FRAMES IN OPTIMIZING
PERFORMANCE.
AND EVERY WEEK WE HAVE A
SIMULATION THAT'S AN
INTERPROFESSIONAL SIMULATION,
PHYSICIAN, NURSES AND
RESPIRATORY THERAPISTS.
CAN YOU SEE AN EXAMPLEOT RIGHT
OF A PATIENT, THE MANNEQUIN OF
COURSE BUT A SIMULATED PATIENT
DECOMPENSATING ON A VENTILATOR
AND THE PROFESSIONAL, THE TEAM
RESUSCITATING THE PATIENT.
SO THE OTHER THING WE DO IS WE
DEBRIEF BY EDUCATORS OF VARIED
EDUCATIONAL BACKGROUNDS SO WE
HAVE RESPIRAT TORTHERAPISTSES
ARE PHYSICIANS AND NURSES TO
PROVIDE A SAFE SPACE FOR
LEARNING FOR ALL MEMBERS OF THE
TEAM.
SO ANOTHER INITIATIVE,
SIMULATION INITIATIVE THAT,
RELATES TO ACUTE ILLNESS RELATES
TO NEUROLOGIC EMERGENCIES AT
NIH.
WE SEE HERE ON THE RIGHT A
PATIENT WITH A DILATED PUPIL AND
THAT CAN BE A SIGN OF INCREASED
INTERCRANIAL PRESSURE, AT NIH,
WE CARE PER MANY PATIENTS AT
COMPLEX DISEASES AND RISK FOR
ACUTE NEUROLOGIC DECOMPENSATION
AND SO HAVING A TEAM THAT CAN
QUICKLY AND EFFECTIVELY RESPOND
TO NEUROLOGICAL EMERGENCIES IS
VERY IMPORTANT.
SO BECAUSE OF IT, THE CLINICAL
CENTER LEADERSHIP DECIDED TO
IMPLEMENT A BRAIN CO SHORT
HOTTER THAT WOULD ALLOW
IMMEDIATE MOBILIZATION OF THE
RESOURCES AND PROVIDERS LIKE
CODE BLUE TEAM, ICU TEAM,
NEUROLOGY, AND THE ABILITY TO
GET A STAT HEAD CT TO RESPOND TO
A NEUROLOGICAL EMERGENCY.
FORTUNATELY WE WERE ALLOWED AND
ABLE, WE WERE ABLE TO DEVELOP A
SIMULATION TO PRACTICE THIS
BEFORE WE ROLLED OUT PATIENT
CARE RM.
SO YOU CAN SEE HERE IT'S AN
INSITU SIMULATION MEANING IT WAS
DONE ON A HOSPITAL BED, WE DID
THIS ON THE FLOOR OF THE
NEUROLOGY FLOOR AND TESTED OUT
THE BRAIN CODE WITH THE
MANNEQUIN HAVING AN ACUTE
NEUROLOGIC DECOMMIZATION AND
HERE THE MANNEQUIN HAS BEEN
RESUSCITATED INTUBATED AND THE
REZONING PIRATTORY THERAPIST IS
BAGGING THE MANNEQUIN AND
THEY'RE GOING DOWN FROM THE
SEVENTH FLOOR, YOU SEE THE
ELVITTOR THERE TO THE FIRST
FLOOR FOR A STAT HEAD CT.
IN THIS SIMULATION WAS EXTREMELY
USEFUL BECAUSE IT WAS HELPFUL IN
IDENTIFYING SEVERAL ISSUES THAT
WERE ADDRESSED BEFORE THE
PROGRAM WAS ROLLED OUT IN ACTUAL
PATIENT CARE.
YOU SEE ON THE LEFT COLUMN,
IDENTIFY INDEED THE SOLUTION
THAT WAS IN THE RIGHT COLUMN
THAT WAS IMPLEMENTED PRIOR TO
THE PATIENT CARE ROLL OUT.
SO FIRST FOR CONFUSION ABOUT
WHICH TEAM MEMBERS COULD CALL A
BRAIN CODE AND WOULD RESPOND AND
THEN THERE WAS EDUCATION ACROSS
THE DIFFERENT TEAMS TO CLARIFY
THAT.
THE SECOND ISSUE THAT THE CT
SCANNER WAS NOTIFIED BY CALLING
THE FRONT DESK OF CT, BUT
OBVIOUSLY THAT WOULD NOT BE
USEFUL AT NIGHT, SO THE PROCESS
WAS CHANGED TO PAGING THE
RADIOLOGY TECH ONCALL SO SOMEONE
WILL ALWAYS BE ABLE TO RESPOND
AND MOBILIZE THE CT SCANNER.
ANOTHER THING IS OBVIOUSLY
TREATMENT OF INCREASED
INTERCRANIAL PRESSURE IS VERY
IMPORTANT IN A NEUROLOGICAL
EMERGENCY, IT WAS NOTED DURING
THAT INSITU SIMULATION THAT
THERE WERE LACKS OF SPACE SO THE
CODE CAT WAS ARRANGED TO PROVIDE
FOR THAT.
SO IN THE END A LOT OF BEEN FIT
THERE.
SO IN CONCLUSION, HIGH RISK, LOW
VOLUME CARE REQUIRES EFFECTIVE
TEAM BASED CARE, SIMULATION
BASED PROFESSIONAL EDUCATION
ALLOWS FOR TEAM PRACTICE,
TREATING PREDICTED EMERGENCYING
AND THEIR OPPORTUNITIES FOR
FUTURE JUST IN TIME TRAINING OF
TEAMS FOR SCHEDULED ADMISSIONS
OF HIGH RISK LOW VOLUME CASES,
REALLY EXCITE FEDERAL WE CAN DO
THAT AND I WANT TO ACKNOWLEDGE
OUR AMAZING CRITICAL CARE
SIMULATION TEAM DEVELOPED
SCENARIOS AND DEBRIEFED TOGETHER
AND NOW WE HAVE RON GILL
SUPPORTING US WITH OPERATIONS,
NOW I WANT TO STOP AND PASS IT
ON TO DR. GOMEZ WHO WILL TALK
ABOUT SOME OF THE OTHER
IMPORTANT SIMULATION WORK GOING
ON AT THE CENTER.
>> THANK YOU DR. SEAM AND THE
LAST PART OF THIS PRESENTATION
IS ABOUT THE SIMULATION
INITIATIVES BUT BEFORE TALKING
ABOUT THOSE INITIATIVES I WOULD
LIKE TO SHARE WITH YOU THE
PROGRAM'S INITIATIVE WHICH IS
ADVANCE PATIENT CARE AT THE NIH
CLINICAL CENTER ESPECIALLY WITH
REGARDS TO ITS UNIQUE HIGH RISK,
LOW VOLUME CASE MAKES TO THE
INTEGRATION OF A
STATE-OF-THE-ART SIMULATION INTO
THE CONTINUUM OF TRAINING AND
EDUCATION FOR CLINICAL AND
ADMINISTRATIVE PROFESSIONALS.
OUR MISSION INCLUDES 1
CULMINATED CENTER AND PROGRAM
AVAILABLE AND ACCESSIBLE TO
EVERYONE, SUPPORT PROFESSIONAL
DEVELOPMENT, IMPROVE SYSTEMS AND
TEAM PERFORMANCE AND OF COURSE
SUPPORT A SAFER ENVIRONMENT FOR
FURTHER ENHANCING PATIENT
OUTCOMES.
SO WE HAVE 4 WORK STREAMS IN OUR
PROGRAM, THE TRANSLATIONAL
SIMULATION WORK STREAM WHICH
ESSENTIALLY TRAININGS ARE
DIRECTLY FOCUSED ON IMPROVING
HEALTHCARE PROCESSES ON
OUTCOMES, WE DO SYSTEM TESTING
PROCESS IMPROVEMENT AND SAFETY
ATHAT WILL SIS.
IN OUR CLINICAL WORK STREAM, WE
USE HEALTHCARE SIMULATION AS AN
EDUCATIONAL TOOL WHERE THE
PARTICIPANTS CAN PRACTICE
CLINICAL AND NONCLINICAL SKILLS
CREATING A SAFE ENVIRONMENT.
WE OFFER CENTER-BASED AND INSITU
SIMULATION, WE HAVE EDUCATION
AND FACULTY DEVELOPMENT PURPOSES
WITH EMPHASIS ON
INTERPROFESSIONAL COLLABORATION.
IN OUR--OUR INNOVATION WORK
STREAM, WE WORK WITH OTHER
DEPARTMENTS AND INSTITUTES TO
CREATE DIFFERENT SIMULATION
REALITIES THAT SERVE AS
EDUCATIONAL TOOLS FOR OUR
LEARNERS.
AND IN RESEARCH, WE HAVE FOCUSED
OUR ENERGY ON CREATING A STRONG
SIM DATABASE AND DEVELOPING OUR
METRICS AND ASSESSMENT TOOLS
THAT HELP US TO BUILD EVIDENCE.
SO LET ME SHOW SOME OF THOSE
EXAMPLES WITH YOU.
FOR TRANSLATIONAL SIMULATION,
THE GENE 1 PROMG ECTOMYOSINNINGS
SERVED FOR THE SIMULATION
PROGRAM IF YOU REMEMBER AS PART
OF THE NIH CLINICAL CENTER IN
2019, THE CEO DR. GILMAN INCLUDE
TD GENE THERAPY AS 1 RESEARCH
PRIORITY FOR THE HOSPITAL AND
THE AMBITIOUS PROJECT CAME WITH
MANY CHALLENGES LIKE TAKING CARE
OF YOUNGER AND SMALLER PEDIATRIC
PATIENTS SO IT HAS BEEN WORKING
ON THE CAPABILITIES NEEDED TO
RELIEVE THE JEEP THERAPY AT
TREATMENT AND ALSO KEEPING OUR
PATIENTS SAFE.
GENE THERAPY HAS PROVIDED
TREATMENT FOR UNTREATABLE
DISEASES LIKE THE TYPE 1
[INDISCERNIBLE] WHICH HAS RARE
RAPIDLY FATAL CANNED WHAT
DISORDER WITH LIFE EXPECTANCY OF
LESS THAN 3 YEARS OF AGE.
SO IN 2021 THE CLINICAL CENTER
RECEIVED 2 PATIENTS WITH THIS
MEDICAL CONDITION AND IN ORDER
TO BE READY FOR THEM WE DEVELOP
A SIMULATION BASED TRAINING TO
BE PREPARED FOR ANY
COMPLICATIONS RELATED TO GENE
THERAPY LIKE CARDIAC ARRHYTHMIA,
ANAFLACKSIS AND SEIZURES.
IN OUR SIMULATION INITIATIVES WE
HAVE THE NEW SCIENCE NURSING
EDUCATION, HERE'S 1 FOR 0 EMPLOY
AS YOU KNOW NEUROLOGICAL
EMERGENCIES REQUIRE IMMEDIATE
RECOGNITION AND TREATMENT TO
PREVENT LONG-TERM DISABILITY AND
DEATH.
TREATMENT IS TIME SENSITIVE AND
THE INITIAL MANAGEMENT INVOLVES
RAPID ASSESSMENT AND SUPPORTIVE
TREATMENT, HOWEVER, EVERY
ASSESSMENT CAN BE INTIMIDATING
AND SOMETIMES CLINICIANS DON'T
HAVE TIME TO COMPLETE A
NEUROLOGICAL ASSESSMENT.
SO WITH THE HELP OF A CRITICAL
DECISION AID TOOL DEVELOPED HERE
AT THE CLINICAL CENTER, WE
CREATED SIMULATION BASED
TRAINING WHERE THE PARTICIPANTS
HAVE THE OPPORTUNITY TO CONDUCT
THEIR ASSESSMENTS AND GAIN
CONFIDENCE IN CONDUCTING THEIR
ASSESSMENT AND IMPROVE PRACTICE
IN THE PROFESSIONAL
COLLABORATION.
SINCE MARCH WE HAVE TRAINED 177
PARTICIPANTS IN NEUROLOGICAL
EVENTS.
[INDISCERNIBLE] IS NOT A RARE
EVENT, YOU WILL FIND MULTIPLE
REPORTS OF THESE EVENTS ON THE
INTERNET AS CAN YOU SEE HERE.
AND THE FEDERAL AVIATION
ADMINISTRATION REGULATES THE
CONTENT OF THE EMERGENCY MEDICAL
EQUIPMENT, CAN YOU SEE THE LIST
HERE AND YOU CAN ALSO APPRECIATE
THAT EPINEPHRINE INJECTORS ARE
NOT PART OF THAT EMERGENCY
MEDICAL EQUIPMENT, SO WE HAD AN
IMMUNOLOGY AND IMAGING PROGRAM.
SOPHISTICATEDY WE CREATED
SCENARIOS FOR THE FELLOWS LIKE
AN ANAPHYLAXIS UNIT OR CBO
CHALLENGE AND REACTION TO
MEDICATIONS BUT WE ALSO CREATED
AN AIRPLANE ANAPHYLAXIS FOR THE
MOST OBJECTIVE IN THIS CASE,
BASICALLY THAT THE FELLOWS COULD
PRACTICE OUTSIDE OF CLINICAL
SETTINGS, WITH RESOURCES OR
LIMITED RESOURCES, AND ALSO FOR
EXAMPLE, USE TECHNOLOGY LIKE
CELL PHONES AND APPLICATIONS TO
CREATE OR TO TRANSLATE THOSE
CELL PHONES INTO MONITORS.
RADIOLOGY AND IMAGING SCIENCES
SIMULATION BASED TRAINING AS YOU
KNOW LIFE THREATENING
EMERGENCIES ARE RELATIVELY
INCOMMON IN THE RADIOLOGY
DEPARTMENT BUT WHEN ENCOUNTERED
REQUIRE TIMELY INTERVENTION, SO
RADIS IS SUPPORTED BY THE ICU
CODE BLUE AND RAPID RESPONSE
TEAM HOWEVER THERE IS A CRITICAL
PERIOD BETWEEN CARDIAC ARREST
CURING AND THE SUBSIDIARY QUEBT
IEE, AUDIENCE RIVAL OF
RESUSCITATION TEAM.
FOR THAT REASON WE DEVISED A
TEAM THAT INCLUDES RADIOLOGY IV
THERAPY, ADMINISTRATIVE PERSONAL
AND CARDIOLOGISTS AND WE CREATE
A SIMULATION BASED TRAINING
WHERE THEY HAVE THE OPPORTUNITY
TO PRACTICE ASSERTIVE
COMMUNICATION AND
INTERPROFESSIONAL COLLABORATION.
OF COURSE, THE CASE SCENARIOS
ARE COMMON MEDICAL EMERGENCIES
WITHIN THE RADIOLOGY DEPARTMENT
LIKE ANAPHYLAXIS IV
ADMINISTRATION AND VASAL
[INDISCERNIBLE].
IN THE INNOVATION AS YOU KNOW
ELECTRONIC HEALTH RECORDS
IMPROVE THE [INDISCERNIBLE] IN
SIMULATION BASED TRAININGS BUT
ALSO INCREASE THE ABILITY TO
RECOGNIZE AND COMMUNICATE
CRITICAL PATIENT SAFETY ISSUES,
BUILD INTO THE SIMULATED MEDICAL
RECORD SO WITH THE HELP OF THE
DEPARTMENT OF CLINICAL RESEARCH
INFORMATICS HERE AT THE CLINICAL
CENTER, WE CREATED ELECTRONIC
MEDICAL RECORDS FOR EVERY SINGLE
SIMULATED PATIENT.
SO THAT MEANS DURING THE
INTERPROFESSIONAL OR
PROFESSIONAL SIMULATIONS,
PARTICIPANTS HAVE OPPORTUNITY TO
SEE, OTHERS, RESULTS, X-RAYS AND
EKGs TO IMPROVE THE DECISION
MAKING PROCESS.
EMPATHY IT'S REALLY DIFFICULT TO
DEFINE AND HARD TO MEASURE BUT
WE ALL KNOW THAT EMPTHATETTIC
CARE IS FUNDAMENTAL IN HELT CARE
SETTINGS AND ASSOCIATED TO
POSITIVE OUTCOMES FOR CARE
WORKERS AND PATIENTS.
NO STANDARD CURRICULUM FOR
HEALTHCARE TRAINING CURRENTLY
EXISTS IN HEALTHCARE EDUCATION
AND BUILDING EVIDENCE IN EMPATHY
TRAINING HAS BEEN ELUSIVE FOR
MANY REASONS.
SO THE EVIDENCE OR THE BEST
EVIDENCE AVAILABLE SAYS THAT THE
LEARNERS SHOULD BE IN THE
PATIENT'S SHOES, SO WE NEED TO
ASK THE LEARNER TO ACT IN THE
ROLE OF THE PATIENT.
WITH THIS EVIDENCE AVAILABLE AND
WITH THE HELP OF THE PAIN AND
PALLIATIVE CARE SERVICE WE
CREATED A HUMAN AVATAR, THIS
HUMAN AVATAR INTERACTING IN A
REAL WORLD WITH REAL HUMANS SO
THAT GIVES THE FELLOWS THE
OPPORTUNITY TO EXPERIENCE A
PATIENT'S JOURNEY FROM THEIR
ARRIVAL THE AT NIH CENTER FOLLOW
THE END OF LIFE CONVERSATIONS.
IN SUMMARY THE SIMULATION
PROGRAM IS PREVING TO BE
ANENTIOUS SENTIAL TRAINING TOOL
THAT PREPARES CLINICAL SKILLS,
PREPARES TEAMS FOR MORE COMPLEX
CARE AND IMPROVES TEAM WORK AND
COMMUNICATION AND FUTURE
INITIATIVES WILL LOOK AT
OPPORTUNITIES BEYOND THE
TRADITIONAL SIMULATION TO
INCLUDE HEALTH SYSTEM
ADMINISTRATIVE SIMULATION,
OPERATIONAL TASKS, AND
COMMUNICATIONS.
A SPECIAL THANKS TO ALL THE NIH
CLINICIANS THAT HAVE BECOME
SIMULATION CHAMPIONS AND HELP US
TO ADVANCE THE PROGRAM WITHOUT
THEM THIS WOULD NOT BE POSSIBLE.
WHERE TO START?
IF YOU DON'T KNOW HOW TO DO
THESE TRAININGS, JUST REACH OUT
AND WE ARE IN THE INTERNET AND
WE WILL SUPPORT YOU TO DEVELOP
YOUR INITIATIVES.
THANK YOU.
>> FIRST OF ALL I WANT TO THANK
OW SPEAKERS DR. LOPRIEATO, AND
SEAMS AND GOMEZ, THANK YOU FOR
PROVIDING THE INFORMATION FOR
TRAINING, UNFORTUNATELY WE'RE AT
THE HOUR SO WE WILL NOT BE ABLE
TO TAKE ANY WRITTEN
QUESTIONS--TAKE ANY QUESTIONS
BUT IF ANY OF VIEWERS WOULD LIKE
TO SUBMIT QUESTIONS I WILL MAKE
SURE THEY GET SENT TO THE
APPROPRIATE SPEAKER.
THANKS FOR THIS OVERVIEW.
I THINK IT'S VERY IMPORTANT
ESPECIALLY WITH REGARDS TO THE
EVIDENCE OF HOW SIMULATION
TRAINING CAN IMPROVE ON OUTCOMES
AND TRAINING AND COMMUNICATION
AS WELL AS THE PROGRAMS THAT
HAVE BEEN IMPLEMENTED TO DATE
HERE AT THE CLINICAL CENTER, I
WANT TO THANK THE LEADERSHIP OF
DR. GOMEZ AND DR. SEAM FOR US,
THIS IS FOR THAT.
SO AGAIN, THANK YOU VERY MUCH
AND TO OUR VIEWING AUDIENCE,
THANK YOU FOR JOINING US AND WE
WILL SEE YOU NEXT WEEK AND I
WISH EVERYONE A GREAT AFTERNOON.
THANK YOU.
>> KD--SALLY THANK YOU.