the family medicine residency program & academic hospitalist program at southside hospital...
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The Family Medicine Residency Program & Academic Hospitalist Program at Southside Hospital NSLIJHS has been using simulation to train residents, medical students and faculty for several years. We have recently incorporated the use of Team Based Learning (TBL) in our simulation sessions. This combination has provided a tool for education in teamwork and patient safety while incorporating the six ACGME competencies.
DescriptionThe course consists of:• a pre-class reading of a topic,• an individual readiness assurance test
(IRAT) when they come to class • followed by a group readiness assurance
test (GRAT). The TBL activity is then facilitated after
which the teams take turns applying their knowledge in the simulation scenario (patient interaction).
Upon completion of the scenarios, the teams reconvene for debriefing, reflection (they watch themselves from the video) and further discussion of the topic.
Conclusions
Team-Based Learning & Simulation in Medical Education:
Promoting Patient Safety (2007-2010)
Tochi Iroku-Malize MD, MPH, SFHM Michael Delman MD, FACP
Southside Hospital, North Shore Long Island Jewish Health System
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Bibliography
Objectives:Patient safety initiatives via
Simulation 1. Introduce oneself to the patientMaking sure that patients are aware of the
members of their health care team for better flow of information.
2. Identification of the patient via two forms of ID
To reduce medical error, it is important to properly identify the patient being treated.
3. Washing hands before and after patient encounter
Improved adherence to hand hygiene (i.e. hand washing or use of alcohol-based hand rubs) has been shown to terminate outbreaks in health care facilities, to reduce transmission of antimicrobial resistant organisms and reduce overall infection rates.
3. Encourage patient’s active involvement in their care via communication with patient and/or family members
When the patient knows what to expect, he or she is more aware of possible errors and choices. They can also be an important source of information about potential adverse events and hazardous conditions. Davis D, O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A.
Impact of formal continuing medical education. Do conferences, workshops, rounds, and other traditional continuing education activities change physician behaviour or health care outcomes? JAMA 1999; 282: 867-874]
Institute of Medicine To Err Is Human: Building a Safer Health System,. National Academy of Sciences. (1999)
McGaghie WC, Siddall VJ, Mazmanian PE, Myers J; American College of Chest Physicians Health and Science Policy Committee.Article 1 : Chest. 2009 Mar;135(3 Suppl):62S-68S; “Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.”
Over 100 residents and students participated. A Classroom Engagement Survey was distributed to the participants with four subscales: Learner Participation, Learner Enjoyment of Class, Patient Safety Elements and Team Work Awareness. Anecdotally, the preliminary evaluations from the participants in the simulation combined with TBL sessions have been more positive than those of simulation alone. Adding the TBL portion to the simulation sessions helped to improve the RATS.
The foregoing data demonstrates that simulation use in graduate medical education is a useful tool for enhancing medical training. The data shows that the level of proficiency with regards to the 6 competencies improved after participation in the simulation sessions
Background
Evaluation
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2.4
2.5
2.6
2.7
2.8
2.9
3
Rating
So
loS
imu
lation
So
lo &
Rep
eat
Team
Sim
ulatio
n,
Lectu
re,
TB
L &
Team
Sim
Session Type
Classroom Engagement
Participation
Enjoyment
Patient Safety
Teamwork
PATIENT SAFETY INSTITUTE BASIC 5 RUBRIC
Program: ______________________________ Date: _______________ Participants: ___________________________ Rater: _________________
Critical elements
0 Does not
meet expectations
1 I ncomplete
expectations
2 Meets expectations
Comments/ Debrief
Score
I ntroduces self
□ No participants introduce
themselves to the patient
□ Not All participants
introduce themselves using Name and
Position/title
□ All participants introduce themselves to patient using
Name and
Position/Title
_ _ / 2
Washes Hands □ No participants washes their hands
□ Not all participants wash their hands
□ All participants wash their hands
__ / 2
Dons gloves before patient
care
□ No participants don gloves before
patient care
□ Not all participants don gloves before patient care
□ All participants don gloves before patient care
_ _ / 2
I dentifies patient
□ No participants identify the patient
□ Participants identified the
patient using wrong/ incomplete identifiers
□ Participants identify the patient
using the correct identifiers of name and
date of birth
_ _ / 2
I ncludes patient/ family
in communication
□ No participants communicate with
patient/ family
□ Participants inform patient/ family about plan of
care
□ Participants are fully engaged
with the patient and family answering any questions they have regarding plan of care
_ _ / 2
TOTAL SCORE __ / 10
Simulation Training &Team Based Learning-
Readiness Assessment Tests
30405060708090
100
7/2/09
7/9/09
7/16/09
7/23/09
7/30/09
8/6/09
8/13/09
8/20/09
8/27/09
9/3/09
9/10/09
9/17/09
9/24/09
10/1/09
10/8/09
10/15/09
10/22/09
10/29/09
Dates of Tests
Score (%) IRATGRAT
1
2
3
4
Score of Proficiency
Co
mm
un
ica
tion
Me
dic
al
Kn
ow
led
ge
Pro
fes
sio
na
lism
Pa
tien
t Ca
re
PB
LI
Sy
ste
ms
Ba
se
dP
rac
tice
Competencies
Simulation Training at SSH FMRPACGME Competencies
Pre-Simlab
Post-Simlab
0
1
2
3
4
5
Wa
sh
Ha
nd
s
Pre
-
En
co
un
ter
Fu
ll Ph
ys
ica
l
Fo
cu
se
d
Ph
ys
ica
l
Wa
sh
Ha
nd
s
Po
st-
En
co
un
ter
Simulation Training SSH FMRPPhysical Encounter
2007
2008
2009
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