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Theme: 10BB Simulation 2
Abstract Title: Development, Implementation and Assessment of a Longitudinal Simulation Curriculum for the Management of Medical Emergencies: The RAPID Training Program
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Authors

  • Vivian Obeso MD FACP
  • Ansley Splinter MD MACM FAAP
  • Rebecca Toonkel MD
  • Melissa Ward-Peterson MPH
  • Christine Dalton MD
  • Noel Hernandez MSN RN CHSE

Institution

  • Herbert Wertheim College of Medicine, Florida International University - United States of America
Background

•Responding appropriately to a patient in medical distress is an essential skill for medical students to acquire during training.

•The era of patient safety and development of milestones in GME has reignited discussion regarding whether medical students possess the skills expected on day one of residency.

•Simulation-based education (SBE) in medical curricula has been shown to increase confidence and improve ability in specific core skills.

                 Figure 1. Examples of Simulation-Based Education

                    

 

•The AAMC recently published the Core Entrustable Professional Activities for Entering Residency (EPAs), behaviors expected of all graduating medical students.

•One of the core EPAs is to recognize a patient requiring urgent or emergent care and initiate evaluation and management (EPA 10).

•Although students may take courses such as BLS and ACLS, or participate in transition courses, studies have demonstrated that without deliberate practice, repeated exposure, and feedback, these skills may not be retained.

•To make a decision that implies entrustment, a robust curriculum and assessment process must be in place.

•To our knowledge, no research has been done on the implementation of a longitudinal course spanning the four years of undergraduate medical training.

Summary of Work

•To address the need for a longitudinal approach to residency preparedness, our faculty developed the RAPID (Responding Appropriately to a Patient In Distress) training program, a simulation-based curriculum that fosters progressive learning and deliberate practice across all four years of undergraduate medical training.

•The RAPID training program was designed to teach and assess student performance in emergency situations at each level of training.

•One key component of the RAPID training program is training in effective communication, utilizing the SBAR framework.

 

Figure 2. SBAR Framework for Communication

•The overlap of competency in communication skills and patient safety is particularly important when responding to a patient experiencing a medical emergency. Such a scenario encompasses five of the AAMC’s newly released EPAs, including:

§EPA 6: Provide an oral presentation of a clinical encounter

§EPA 8: Give or receive a patient handover to transition care responsibility

§EPA 9: Collaborate as a member of an interprofessional team

§EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management

§EPA 13: Identify system failures and contribute to a culture of safety and improvement

            Figure 3. Conceptual Framework for the RAPID Curriculum

 

         

 

 

             Figure 4. RAPID Curriculum Implementation Plan

 

            

•Implementation is being carried out in a stepwise fashion.

•To investigate effectiveness, faculty will explore the hypothesis that repeated exposure through a longitudinal simulation emergency management curriculum will improve students’ knowledge, skills, retention, and level of confidence in the management of a medical emergency.

•To test this hypothesis, the following simulation research aims will be addressed:

      1.Evaluate students’ emergency management skills, specifically:

                 a)Retention of knowledge and skills throughout the medical school experience; and

                 b)Overall performance before and after program implementation.

      2.Evaluate and compare student confidence levels before and after program implementation.

      3.Evaluate the impact of pre-session computer learning modules, designed to improve

          interdisciplinary communication, on the simulation experience.

      4.Improve emergency management training assessment methodologies, including:

                 a)Enhancement of valid and reliable assessment tools; and

                 b)Improvement in methods for effective formative feedback to students.

Summary of Results

•The refinement of assessment tools will be guided by two established frameworks for the evaluation of training programs: Kirkpatrick’s hierarchy of evaluation and Messick’s framework for test validity.

•Data collection methods will include video recording, paper checklists, online survey software, and database software.

•Data analysis will be conducted using Stata.

•Descriptive and inferential statistics will be used to analyze results; analysis will be conducted within and between student cohorts.

Conclusion

•Preparing future doctors for emergency situations is crucial to improving patient safety outcomes.

•The importance of these skills is highlighted by efforts such as the AAMC Entrustable Professional Activities and the ACGME Milestones Project.

•Research needs to be done on the utility of emergency management courses within a standard curriculum.

•The RAPID training program will provide data on the success of such a program and will assess student competence in emergency situations before they enter residency.

References

1.Hall K, Schneider B,  Abercrombie S, Gravel Jr. J, Hoekzema G, Kozakowski S, Mazzone M, Shaffer T, Wieschaus M: Hitting the Ground Running: Medical Student Preparedness for Residency Training. Annals of Family Medicine 2011; 9: 375.

2.Dickson G, Chesser A, Woods N, Krug N, Kellerman R: Family Medicine Residency Program Director Expectations of Procedural Skills of Medical School Graduates. Family Medicine 2013; 45: 392-399.

3.Lypson M, Frohna J, Gruppen L, Wooliscroft J: Assessing Residents' Competencies at Baseline: Identifying the Gaps. Academic Medicine 2004; 79: 564-570.

4.Raymond M, Mee J, King A, Haist S, Winward M: What New Residents Do During Their Initial Months of Training. Academic Medicine 2011; 86: S59-S62.

5.AAMC. (2014). Core Entrustable Professional Activities for Entering Residency. Retrieved January 7, 2015 from www.aamc.org/cepaer

6.Rogers, P. L., Jacob, H., Thomas, E. A., Harwell, M., Willenkin, R. L., & Pinsky, M. R. (2000). Medical students can learn the basic application, analytic, evaluative, and psychomotor skills of critical care medicine. Critical Care Medicine, 28(2), 550-554.

7.Smith, C. M., Perkins, G. D., Bullock, I., & Bion, J. F. (2007). Undergraduate training in the care of the acutely ill patient: A literature review. Intensive Care Medicine, 33(5), 901-907.

8.Hamilton R (2005) Nurses' knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature. J Adv Nurs 51: 288-297.

9.Hazinski MF (2010) Highlights of the 2010 american heart association guidelines for CPR and ECC. Dallas, TX: American Heart Association.

10.Smith KK, Gilcreast D, Pierce K (2008) Evaluation of staff's retention of ACLS and BLS skills. Resuscitation 78: 59-65.

11.Leonard M, Graham S, Bonacum D. The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care. 2004;13(suppl 1):i85-i90.

12.Kirkpatrick, D.L. & Kirkpatrick, J.D. (2006). Evaluating Training Programs: The Four Levels. San Francisco, CA: Berrett-Koehler Publishers, Inc.

13.Kirkpatrick, D.L. & Kirkpatrick, J.D. (2007). Implementing the Four Levels: A Practical Guide for Effective Evaluation of Training Programs. San Francisco, CA: Berrett-Koehler Publishers, Inc.

14.Messick, S. (1995). Validity of Psychological Assessment: Validation of Inferences From Persons’ Responses and Performances as Scientific Inquiry Into Score Meaning. American Psychologist, 50(9), 741-749.

15.Messick, S. (1998). Test Validity: A Matter of Consequence. Social Indicators Research, 45, 35-44.

16.Association of American Medical Colleges. (2013). Teaching for Quality: Integrating Quality Improvement and Patient Safety Across the Continuum of Medical Education. Retrieved October 20, 2013 from https://www.aamc.org/initiatives/cei/te4q/

17.Nasca, T., Philibert, I., Brigham, T., & Flynn, T. (2012). The Next GME Accreditation System - Rationale and Benefits. The New England Journal of Medicine, 366, 1051-1056.

18.Carraccio, C., & Burke, A. (2010). Beyond Competencies and Milestones: Adding Meaning Through Context. Journal of Graduate Medical Education, 2(3), 419-422.

19.Green, M., Aagaard, E., Caverzagie, K., Chick, D., Holmboe, E., Kane, G., Smith, C., & Iobst, W. (2009). Charting the Road to Competence: Developmental Milestones for Internal Medicine Residency Training. Journal of Graduate Medical Education, 1(1), 5-20.

 

Background

 

 

 

Summary of Work
Summary of Results
Conclusion
References
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