Deborah Rooney's, PhD, talk at Mersin University in Turkey on October 27, 2015.

1. Simulation-based education: How
couldsimulationbeusedfortechnicalskills
developmentinthefuture
MersinŰniversitesi,FacultyofMedicine
MESEKOK
October27,2015
Deborah Rooney PhD
MEDICAL SCHOOL
UNIVERSITY
OF
MICHIGAN
Copyright 2015. All Rights Reserved.

2. Disclosures and conflicts of interest
• None

3. My Background

4. My Background

5. My Background
• Medical education since 1991
• Nine years in surgical education
• PhD in Educational Psychology
• Director of Education and Research, Clinical
Simulation Center, University of Michigan (UMCSC)

6. UM Clinical Simulation Center (UMCSC)

7. 231523142305
UMCSC Spaces

8. UMCSC Utilization

9. Today’s talk: Simulation-based
education
• Brief history of developments that impacted
simulation
• Current applications of simulation-based training for
technical skills
• Projected trends in simulation-based training

10. Simulation-based education is not
new

11. n = 3
n = 963
History of Simulation-based
Education

12. Dr. Gordon introduces “Harvey”
History of Simulation-based
Education

13. 1973 “Harvey”
1970s Standardized Pts
History of Simulation-based
Education

14. 1980-90s MIS training
1973 “Harvey”
1970s Std Pts
History of Simulation-based
Education

15. 1980-90s Computers
1973 “Harvey”
1970s Std Pts
1980-90s MIS
History of Simulation-based
Education

16. 1998 Standards
1973 “Harvey”
1970s Std Pts
1980-90s MIS
Computers
History of Simulation-based
Education

17. 2000 Error
1973 “Harvey”
1970s Std Pts
1980-90s MIS
Computers
1998 Standards
History of Simulation-based
Education

18. Development & refinement of best practices
• Invention and proof of concept of specific
simulators, skills curricula
• Development of practical tools to support
learning and assessment in complex settings
• Application of educational theories
History of SBE* for technical skills:
2000 to present
*SBE= Simulation-based Education

19. Educational Theory and Technical Skills:
Bloom
Bloom, based on Dave, R. (1967). Psychomotor domain. Berlin: International Conference of Educational Testing.
Higher order psychomotor skills
Lower order psychomotor skills
Watch instructor and repeat
(copy)
Complete task with verbal
instruction
Combine learned skills to
meet novel requirements
Apply automatic strategies
Perform with expertise
without assistance
Naturalization
Articulation
Precision
Manipulation
Imitation
GOAL

20. Frequency
Urgency (cost)
urgency
frequency
urgency
frequency
(CVC, code)( PE, IV)
Current Trends: technical skills
training

21. Address
Gap
Impact
Pt Care
Value
?
Current Trends: technical skills
training

22. Benefits of SBE for technical skills
training
Addresses the gap (improving KSA*)
• Lumbar puncture (LP) skills in the Neonatal Intensive Care Unit
(Shafer et al, 2013)
Improves patient outcomes
• Central venous catheter placement skills in the Medical Intensive
Care Unit
(Barsuk et al, 2009)
Decreases hospital costs
• Central line placement skills in the Medical Intensive Care Unit
(Cohen et al, 2010)
*KSA= knowledge, skills, attitude

23. Learning Goals:
• Improve documentation (knowledge)
• Decrease traumatic tap rate (skills)
• Improve confidence amongst residents
(attitude/affect)
Shafer S, Rooney D, Schumacher R, Chapman R, House J. Neonatal Lumbar Punctures: Bridging the Clinical
Gap. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9597
Addressing gaps: lumbar puncture in
NICU**Neonatal Intensive Care Unit

24. Intervention
• Pre-assessment
• Simulation-based Curriculum (blocked, deliberate practice)
• Post-assessment
Program Evaluation
• Compare pre- post measures (KSAs)
• knowledge (written test)
• performance assessment
(sim and clinical)
Shafer S, Rooney D, Schumacher R, Chapman R, House J. Neonatal Lumbar Punctures: Bridging the Clinical
Gap. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9597
Addressing gaps: lumbar puncture in
NICU

25. 0
0.5
1
1.5
2
2.5
3
Pre
Post
Addressing gaps: lumbar puncture in
NICU*

26. What about impact
to patient care?

27. Improves patient outcomes: Central
Venous Catheter (CVC) placement in MICU
Sim-based, mastery training central line placement skills
in Medical ICU (MICU);
• Presentation with contra/indications for CVC
• Video demonstration of CVC IJ placement
• One-on-one instructor & trainee practice with
feedback
• Pre-post training assessment
Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne DB. Simulation based mastery learning reduces complications
during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009 Oct;37(10):2697-701.

28. CVC placement in Medical
Intensive Care Unit (MICU)
Sim-based, mastery training improved
clinical measures;
• Fewer needle passes
• Fewer arterial punctures
• Fewer catheter adjustments
Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne DB. Simulation based mastery learning reduces complications
during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009 Oct;37(10):2697-701.

29. Cohen ER, Feinglass J, Barsuk JH, et al. Cost savings from reduced catheter-related bloodstream infection after simulation-based
education for residents in a medical intensive care unit. Simul Healthc. 2010 Apr;5(2):98-102.
Follow-up research compared pre-post Catheter-Related
Bloodstream Infections (CRBSI) and potential cost-
savings for the hospital
-Cohen and colleagues
CVC placement in Medical
Intensive Care Unit (MICU)

30. Cohen ER, Feinglass J, Barsuk JH, et al. Cost savings from reduced catheter-related bloodstream infection after simulation-based
education for residents in a medical intensive care unit. Simul Healthc. 2010 Apr;5(2):98-102.
4.2/100
MICU CVC CRBSI/adm.
0.42/100
MICU CVC CRBSI/ adm.
SBE CVC training improved infection
rates

31. • Training cost ~US$110,000 ( 319,000)
• Approximately 9.95 CRBSIs were prevented in MICU
patients/ CVCs in the year after intervention
• Each translated to US$82,000 ( 240,000) and 14
added hospital days
Cohen ER, Feinglass J, Barsuk JH, et al. Cost savings from reduced catheter-related bloodstream infection after simulation-based
education for residents in a medical intensive care unit. Simul Healthc. 2010 Apr;5(2):98-102.
2M
SBE CVC training reduced costs

32. What about the future?

33. Future Trends: technical skills
training
Frequency
Urgency (cost)
urgency
frequency
urgency
frequency
urgency
frequency
(CVC, code)
( Targeted learners)
( PE, IV)

34. Future trends: targeted
procedural training

35. -Tavlasoglu et al (Diyarbakir Military Medical Hospital)
Future trends: targeted
procedural training

36. Barsness KA, Rooney DM, Davis LM, O'Brien E. Evaluation of three sources of validity evidence for a laparoscopic duodenal atresia repair simulator.
J Laparoendosc Adv Surg Tech A. 2015 Mar;25(3):256-60.
Tai B, Rooney D, Stephenson F, Liao P, Sagher O, Shih A, Savastano LE. Development of 3D-printing built ventriculostomy placement simulator.
J Neurosurg. 2015 Jun 26:1-7.
Future trends: targeted
procedural training
Neurosurgery and Pediatric Surgery
• Very small trainee group
• Target procedural skills

37. Challenges associated with
SBE
• Cost
• Space
• Expertise
• Time (development and delivery)

38. • Decrease space requirements
• Decrease faculty time commitment
• Increase learner access
Addressing the challenges:
Future training targets technical skills

39. • Using available web-based curriculum on computer
• Self-directed training and
assessment
• Addresses knowledge,
skills, attitude
Future Training: Streamlining
technical skills training with technology

40. Future training targeting
technical skills: retinal exam
• Originally developed for residents, soon to be adapted by medical
students (n=170)
• 3 weeks to teach retinal exam
skills
• 30 minutes/session = 85
teaching hours
• Teaching commitment = 0

41. Future training targeting
technical skills: endoscopy
Residents;
• Family medicine
• IM-Gastroenterology
• Surgery
ü Self-directed learning
ü 24 hour access
ü Built-in assessment

42. and there’s more than technical
skills…

43. Future SBE targets: moving
beyond technical skills
• Communication and professionalism
• Patient safety & quality improvement
• More complex skills (decision-making)

44. Communication skills
Pediatric ICU (PICU)
“Bootcamp”
Trainees:
PICU fellows
Learning Goals:
Improve PICU fellows’ reflection/awareness of own communication skills
Improve fellows’ awareness of patient/families’ perceptions
Improve fellows’ communication skills with patients and families

45. Day 1
• Introductions
• Presentation of family’s story from parent/child
• Self-evaluation
Day 2
• Faculty/Parent-educator facilitated simulation
Ongoing Assessment & Evaluation
• 360° (nursing staff, faculty, patient/parent, trainee-self)
• On-unit assessment
Communication Bootcamp:
logistics

46. Communication Skills: third-year
medical students in Turkey

47. Conclusions

48. Thank you
Questions?
Deborah
Rooney,
PhD
dmrooney@med.umich.edu