WISERPeter M. Winter Institute for Simulation, Education & Research

UPMC University of PittsburghMedical Center

Annual Report Academic Year 2005-2006

Peter M. Winter Institute forSimulation, Education & Research

I hear and I forget. I see and I remember. I do and I under-I hear and I forget. I see and I remember. I do and I understand.Confucius Chinese philosopher & reformer (551 BC - 479 BC)

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Table of Contents

Mission Statement................................................................................................................1

Introduction..........................................................................................................................2

Growth and Development ....................................................................................................4

Curriculum Development.....................................................................................................6

Continuing Mission of Patient Safety ..................................................................................9

Leadership Transitions.......................................................................................................10

Faculty Recognition...........................................................................................................12

National Presentations .......................................................................................................14

Academic Presentations .....................................................................................................20

Current Project and Collaborations....................................................................................26

Funding ..............................................................................................................................28

News Archives from WISER.............................................................................................29

Appendix A: WISER Advisory Board Membership .........................................................32

Appendix B: WISER Faculty and Staff .............................................................................33

Appendix C: Academic Year 2005 -2006 WISER Course Listing....................................34

Appendix D: Current WISER Course Directors................................................................36

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Mission Statement

The Peter M. Winter Institute for Simulation Education and Research (WISER) is dedicated to healthcare education and educational research. The Institute will apply advanced instructional technology including the use of various forms of simulation as well as the University of Pittsburgh standards of excellence and professionalism to study the efficacy of educational training programs and their impact on learning and on clinical care. Objectives:

1. Create a safer environment for patients by using simulation and other state of the art educational technology in the training and assessment of the healthcare system professionals

2. Serve as a laboratory to research the use of simulation and other

advanced instructional technology in healthcare education and to publish the results

3. Develop and validate simulation based technology as a competency

assessment evaluation tool for healthcare professionals 4. Create simulation based education programs for primary education in

various domains of the healthcare delivery system

5. Contribute to the education and mentorship of future generations of healthcare system educators and education researchers interested in creating or evaluating simulation based teaching methodologies

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Introduction Academic year 2005 – 2006 has been an exciting year for WISER. There have been multiple areas of program expansion, remodeling of the institute, and participation in many academic activities locally, nationally and internationally. We have had a leadership change and continue to pursue areas of opportunity.

WISER has had a significant increase in the number of courses and number of students utilizing the institute for training, development, and research of education activities. We have had significant expansion in undergraduate classes in the schools of nursing and pharmacy. Courses including practicing healthcare providers such as Medical Emergency Team Training are conducted regularly involving nurses, physicians and respiratory therapist.

Faculty involved at WISER have been recognized for their commitment to education, innovation and teaching excellence. The number of faculty involved in the creation and teaching of courses at WISER continues to grow. We have established leaders in the major domains of users at WISER to mentor faculty members new to simulation. The results show exciting growth in a variety of programs.

In response to a more sophisticated consumer of simulation information, we have created a new series of modular based courses called Foundations of Simulation. This course series provides training and education to those who are in pursuit of knowledge necessary to the development simulation centers from planning, operations and curriculum development. The course has been extremely well received, and participants from all over the world continue to hail its success.

WISER continues to provide leadership to the simulation community. Dr. Mike DeVita, WISER’s Associate Director is this year’s program chairman for the annual meeting of the Society for Simulation in Healthcare. Tom Dongilli, John O’Donnell and myself are on the meeting’s planning committee. The new industry journal Simulations in Healthcare continues to thrive with Dr. DeVita as one of the associate editors, and Dr. Ake Grenvik and myself serving on the editorial board. Tom Dongilli is the Operations Track Chair.

In addition to expansion, and continued pioneering efforts in simulation, we have had a leadership change and reorganization of the WISER team. In December, 2005 John Schaefer, the Director of the Institute over ten years departed for opportunities in South Carolina. I had been serving as the Assistant Director for Emergency Medical Programs for eighteen months and was asked by Dr. John Williams to serve as the Interim Director until a national search could be conducted to identify a permanent director.

I was able to secure additional support from UPMC to appoint John O’Donnell as an Associate Director to lead the nursing based efforts. Dr. William McIvor accepted a position as an Associate Director for medical student activities. These accomplished educators will be available to assist and mentor those who wish to develop nursing and medical student based coursework.

All in all, it has been an exciting and productive year of change. We continue to thrive and carry on with our mission of creating programs to make a safer environment for patients and further investigate the uses of simulation in healthcare education and assessment. Please view this annual report to see some of the details of these exciting times for WISER.

Sincerely,

Paul E. Phrampus, MD FACEP

Interim Director, WISER Institute

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Growth and Development In the 2006 academic year (July 2005 – June 2006) WISER significantly increased the participation and utilization of the institute. There was a 31% increase in the number of students as compared to the prior academic year, with a total of 2,723 individuals enrolled in WISER courses. This represented a 19% increase in educational encounters to nearly 10,000. 165 instructors (19% increase) taught 1,167 classes. Overall, there were nearly 40,000 hours of educational time spent by students at WISER. As we are planning for next year it has become apparent that the coming year will continue or exceed this rate of growth. Table 1. Vital statistics from the 2006 academic year

2005 2006 Total Number of Classes 1,008 1,167 Total Number of Individual Students 2,085 2,723 Total Number of Educational Encounters 8,038 9,546 Total Number of Student Hours 33,497 39,574 Average Class Length in Hours 3.31 3.72 Total Number of Instructors 147 165

Figure 1. Utilization of WISER by Department

WISER Utilization By Department

ANES, 10.90%

CCM, 3.49%

CEM, 3.57%

EM, 3.20%

PHARM, 0.66%

SOM, 25.57%

SOM ANES, 3.64%SOM CCM, 5.13%

SOM EM, 1.50%

SON, 16.37%

SURG, 0.78%

UPMC, 18.09%

WISER, 7.10%

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Table 2. Utilization

Department Room Hours Utilization Anesthesiology 1,247.50 10.90% Critical Care Medicine 399.75 3.49% Center for Emergency Medicine 408.00 3.57% Emergency Medicine 366.50 3.20% Pharmacy 75.00 0.66% School of Medicine 2,926.00 25.57% School of Medicine Anesthesiology 416.25 3.64% School of Medicine Critical Care Medicine 586.75 5.13% School of Medicine Emergency Medicine 171.75 1.50% School of Nursing 1,873.50 16.37% Surgery 89.50 0.78% UPMC 2,069.50 18.09% WISER 812.50 7.10% Total 11,442.50 100.00%

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Curriculum Development

During the academic year, WISER added a number of new and innovative courses, many focusing on WISER’s mission of improving patient safety. The following are representative of new courses developed and offered at WISER from many different domains of healthcare. Difficult Airway Management Emergency Medicine – Community – Course Author Paul Phrampus, MD - Practicing Emergency Medicine Physicians learn and demonstrate competency in managing difficult airway situations utilizing the Emergency Medicine Difficult Airway Algorithm. Web based didactics and a hands-on skills review of less commonly used skills such as cricothyrotomy, LMA and Combitube, complement the use of real-time human simulation for this course immersing the participant in difficult airway management. First Five Minutes – Course Author Tom Dongilli - A precursor to the successful Crisis Team Training course that WISER hosts. The target audience is the floor nurse and is aimed at training the student to be effectively prepared immediately after a crisis is discovered, but prior to the crisis team arriving. Specific protocols are emphasized to prepare the patient and scene prior to the teams’ arrival. This course is conducted at the hospital to minimize the disruption to the nursing staff. Foundations Module I: Creating Your Simulation Center – Course Author Tom Dongilli - A course that provides the student with detailed information on how to establish a simulation center. Topics range from architectural design considerations to budgeting and funding sources. Students are led through a step by step process, with real world examples used to supplement the curriculum. Opportunities to address individual questions regarding students particular issues are provided throughout the class. Foundations Module II: Programming Your Laerdal SimMan™ – Course Author Tom Dongilli - By using practical examples, this two day course leads the novice SimMan operator from basic operation to intermediate level programming of scenarios using the Laerdal 3.1 operating system. This helps ensure that their simulation sessions are consistent and meet the goals and objectives of the intended teaching points they are trying to make. Hands-on programming examples are created with individual attention provided from expert instructors. Additional modules will be developed in the coming year, including advanced programming and tailored instruction focusing on healthcare specialties, such as nursing.

Introduction To Pediatric Critical Care Medicine – Course Author Melinda Fiedor, MD - A one month experience combining simulation based patient encounters, a longitudinal curriculum and actual patient experiences introduces the complexities of the Pediatric Critical Care Environment for the new fellow. In addition to the simulator experiences the fellows interact with seasoned veteran nurses from the pediatric critical care unit to gain rapid understanding of their new environment.

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Nursing Advanced Clinical Problem Solving – Course Author John O’Donnell, CRNA, MSN - This course focuses on the nursing management of the adult experiencing acute or complex illnesses with an alteration in multiple body systems. Principles of crisis intervention are integrated to create interactions for adult clients who have life threatening, physiological and possibly psychological problems. The student's ability to apply nursing processes using critical thinking is expanded through classroom and clinical activities. Collaboration with interdisciplinary health professionals in health promotion and restoration is fostered.

Obstetrics Crisis Team Training – Course Author Gabrielle Gosman, MD - This course is designed to promote patient safety by training obstetric teams to navigate patient crises effectively. The course trains obstetricians, anesthesia providers, nurses, and others to work together to deliver outstanding patient care in emergent situations.

Pediatric Critical Care Nursing – Course Author John O’Donnell, CRNA, MSN - This four day pediatric critical care nursing course focuses on cognitive and psychomotor skills in caring for Pediatric Intensive Care Unit (PICU) patients. The curriculum is divided into didactic and hands-on learning utilizing lectures, group discussion, and simulation. The focus of the course content is at the level of the novice pediatric critical care RN. Curriculum includes pathophysiology and nursing care of patients with shock, sepsis, immunosuppression, traumatic brain injury, diabetic ketoacidosis, ECMO, and respiratory care issues.

Pediatric Emergency Airway Management – Course Authors Erin Phrampus, MD and Noel Zuckerbraun, MD - This half day simulation based course with an accompanying web-based curriculum focuses on the management of the pediatric airway. The course was created for the practice of Pediatric Emergency Medicine and Pediatric Critical Care. The course focuses on the proper decision making and procedural skills when faced with a pediatric patient requiring airway management.

Preceptor Program – Course Authors Tom Dongilli and Christine Barton -This is a 1-2 day program, depending on the needs of the student, which offers the opportunity for simulation specialists or potential simulation specialists, to observe and learn how WISER Simulation Specialists function. Participants of this program spend time with members of the WISER simulation specialist team and have the opportunity to observe and learn how WISER manages such a busy facility.

Respiratory Therapy Immediate Life Support – Course Authors Ray Tuttle and Albert Augustine -This course provides the respiratory therapist with the essential knowledge and skills to manage adult patients in cardiopulmonary distress. It prepares the therapist for the role of cardiac arrest team member. Basic life support (BLS) is assessed and modifications specific to the provision of in-hospital BLS are emphasized. The teaching of airway and ventilation management, closed chest compressions and use of automated external defibrillators (AEDs) are prime objectives. Basic maneuvers with simple adjuncts (the skills and equipment that are most likely to be used by the airway assistant) are covered. The use of video recorded performances and debriefing allow immediate feedback to the participants.

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Respiratory Therapy Lung Recruitment – Course Authors Ray Tuttle and Albert Augustine - Lung recruitment is a strategy aimed at re-expanding collapsed alveoli, and then maintaining adequate PEEP to prevent 'de-recruitment'. This extensive course involves online instructional videos of the procedure with monitoring examples, written material and references to publications. Participants get hands on training utilizing simulation and ventilators in real world situations. They are instructed in techniques from basic setup to dealing with more advanced situations. The simulation sessions are video recorded so that the instructor and participant can effectively debrief.

Respiratory Therapy Mechanical Ventilation: Problem Solving and Troubleshooting – Course Authors Ray Tuttle and Albert Augustine - This course provides the Respiratory Therapist with the opportunity to apply critical thinking and problem solving to manage adult patients on mechanical ventilation, in a simulated Critical Care Unit. All participants are expected to have a fundamental understanding of mechanical ventilation including modes of ventilation. Basic principles of problem solving are presented. Steps for assessing and managing a patient in sudden distress and fighting the ventilator will be reviewed and practiced. The use of scenarios, video recorded performances and debriefing allow immediate feedback to the participants.

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Continuing Mission of Patient Safety WISER continues to play a key role in creating a safer environment for patients. We continue with a number of important quality improvement and patient safety programs implemented throughout the health system. Central Venous Cannulation Training – WISER continued in its patient safety mission with the Central Venous Cannulation course by training 90% of targeted incoming residents in this complex and vital procedure this year. A curriculum designed to make the placement of central lines a safer procedure with focus on infection control, recognition of complications as well as the use of ultrasound guidance for line placement is a well received program by participants. In addition, nearly 90% of all resident house staff has been trained at WISER since the program’s inception in 2003. WISER has expanded this program to include CRNAs and CRNPs as well. In total, over 500 individuals have participated in this course. It continues to be a cornerstone of WISER’s patient safety mission. Crisis Team Training – In academic year 2006, WISER further developed its outstanding Crisis Team Training course. By increasing the pool of instructors, WISER held over 40 classes and expanded the participating clinical areas to include Shadyside hospital. With funding from the Jewish Healthcare Foundation, Dr. Michael DeVita and the WISER Information Technology Team (IT) developed a novel debriefing tool that assists instructors in helping the students self evaluate their performance during simulated crises. This year the IT team will completely integrate the scoring system used in this course into SIMS, allowing task completion tracking of multiple team participants. WISER looks forward to continuing to expand this program, as there is significant interest both inside and outside of the health system in crisis team training. Difficult Airway Management – Anesthesiology – WISER continued the tradition of being the premier difficult airway management training center during this academic year. The course assumed new leadership with Dr. Joseph Quinlan being named course director. It continued to train all anesthesia residents with curriculum based on the American Society of Anesthesiologists difficult airway algorithm of each specialty. The difficult airway management research group, led by Dr. Quinlan, continued to work on a wide variety of research projects and presented many of their findings at the American Society of Anesthesiologists meeting in Las Vegas. Difficult Airway Management – Emergency Medicine –The department of Emergency Medicine continues to conduct courses in difficult airway management based on a curriculum designed for the practice of Emergency Medicine. All Emergency Medicine residents participate in the course initially during the PGY-I year, then receive annual refreshers there after. All faculty emergency physicians have been trained as part of a requirement for practice in the Presbyterian Emergency Department. This academic year a community practice version of the course was finalized. The course is directed by WISER’s Interim Director, Dr. Paul Phrampus.

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Leadership Transitions

As in any high performance organization leadership transitions and restructuring are an important part of growth and sustainment. WISER underwent a leadership transition when long time Director Dr. John Schaefer departed to assume an endowed chair position at the Medical University of South Carolina in Charleston, South Carolina.

Dr. Schaefer was an innovative, dedicated leader of WISER for more than one decade. Together with his staff, he led WISER to become one of the most advanced medical simulation center in the nation. WISER’s curriculum development and utilization of the internet for automatic data collection and immediate analysis remains unique and of outstanding importance for trainee feedback and publications. Dr. Schaefer accepted a position as Professor of Anesthesiology at the Medical University of South Carolina (MUSC) in Charleston with secondary appointments at the University of South Carolina in Columbia and the Clemson University in Greenville. He now serves as Director of Simulations with an endowed chair in the Coalition of University and Health Systems in Greenville, Columbia and Charleston. Dr. Schaefer has an endowed chair for Medical Simulation at the South Carolina Center for Quality Health Care and Patient Safety. Paul E. Phrampus, MD was appointed Interim Director of the Institute on December 27, 2005. Dr. Phrampus had been serving in the role of Assistant Director of Emergency Medical Programs for the Institute for the previous eighteen months. He has extensive experience in simulation activities and also has developed numerous simulation based training courses for Emergency Physicians and residents. He has also co-authored courses for the Stat Medivac Helicopter System owned by the Center for Emergency Medicine and is actively involved in simulation based training for pre-hospital care providers. He has lectured extensively on simulation based activities nationally and internationally as well as to military medical educators.

Tom Dongilli was named Director of Operations and Administration. Mr. Dongilli has been involved with WISER since its conception thirteen years ago. He has extensive experience operating, designing and assessing simulation based training facilities. He has been integral in simulation based training activities for the US Army, as well as the University of Pittsburgh and UPMC. He has lectured locally and nationally as well as conducted numerous workshops on simulation technology. In his new role at WISER, he is responsible for management of all day to day operations and administration. John Lutz was appointed the Director of Information Technology. Before becoming Director of IT, Mr. Lutz was the lead systems developer and software engineer for the Departments of Anesthesiology and Critical Care Medicine and WISER. Christine Barton has become the Coordinator of Simulation Services. Prior to her promotion, Mrs. Barton was the Senior Simulation Specialist at WISER and continues to be an integral part of the WISER team.

John O’Donnell, CRNA, MSN and Dr. William McIvor were named Associate Directors. Mr. O’Donnell was named Associate Director of the Nursing Programs and Dr. McIvor was named Associate Director of Medical Student Programs. There were also three

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additions to the WISER staff. The first of these was Joshua Franczyk who was brought on as a simulation specialist. Prior to coming to WISER, Mr. Franczyk worked as an anesthesia technologist in the operating room at United Hospital Center. Jewel McKinnon has joined the WISER team as the front receptionist. Ms. McKinnon is a graduate from the University of Pittsburgh School of Nursing. The other new member of the WISER team is Daniel Battista. Mr. Battista has an MBA in Human Resources/Business Leadership from Waynesburg College and is the Administrative Coordinator at WISER. The combined experience and new leadership team at WISER will ensure that the institute remains a state of the art simulation center serving the educational needs of the Schools of the University of Pittsburgh, the UPMC Health System and the Southwestern Pennsylvania healthcare community. They will continue an aggressive campaign to expand WISER's focus on simulation education research and educational programs designed to increase patient safety and enhance healthcare education.

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Faculty Recognition Part and parcel to the success of the Institute has to do with the excellence of the faculty that contributes their time, expertise and passion for education. Many of the involved faculty members have recently won accolades in recognition of their dedication. Two WISER Faculty Earn Prestigious Chancellor's Distinguished Teaching Award In January 2006 Richard Henker CRNA, PhD was awarded the prestigious Chancellor's Distinguished Teaching Award acknowledging his work in human simulation education, distance education, and international volunteerism. He was recognized for contributing to undergraduate and graduate nursing education. “The teaching mission of your department and school have been strengthened by your mentoring of new faculty, your extensive committee involvement, and your leadership role in curricular development that produced four new majors,” (Chancellor) Nordenberg wrote to Henker. Dr. Amy Seybert, Assistant Professor of Pharmacy and Therapeutics, is being honored by receiving the University of Pittsburgh Chancellor's Distinguished Teaching Award. In addition to being a superb classroom and experiential teacher, Dr. Seybert has combined scholarship with her innovations. Dr. Seybert incorporated the patient simulators at the WISER Center and has a manuscript in press about the work. She was honored at the Honors Convocation on February 24, 2006 and will again be honored at a reception later this year. She will have her name inscribed on a bronze plaque in the William Pitt Student Union, and will receive a grant to support her work. John M. O'Donnell honored as a 2006 University of Pittsburgh School of Nursing Distinguished Alumni On May 20th 2006, John M. O'Donnell (MSN '91) was honored as a 2006 University of Pittsburgh School of Nursing Distinguished Alumni. Mr. O’Donnell received the award at the University of Pittsburgh School of Nursing Alumni day. He was recognized as an extraordinary clinician, nurse educator and mentor. He earned a BSN at Carlow College (University), an MSN from Pitt’s nurse anesthesia program in 1991 and is currently a doctoral candidate in epidemiology at the Graduate School of Public Health, University of Pittsburgh. As Director of the nurse anesthesia program at the University of Pittsburgh School of Nursing for over 11 years, Mr. O’Donnell has provided expert leadership that has kept the program consistently ranked among the top ten programs in the country. His academic contributions have expanded the use of human simulation within the undergraduate and graduate programs, and he is the Associate Director of the University of Pittsburgh Winter Institute for Simulation, Education and Research.

John O’Donnell

Richard Henker and Amy Seybert

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Dr. Paul Rogers Receives Golden Apple Award Dr. Paul Rogers received the Golden Apple Award this past academic year for his exemplary teaching effort. The Golden Apple Award is an award that 4th year students give to a faculty member for their teaching efforts. Dr. Rogers use of simulation for his 4th year Critical Care Medicine course has made his course a popular one among his students. The students feel that the use of simulation along with standard teaching practices helps them in situations later on in their medical career. Drs. McIvor, Phrampus and Tisherman Honored by Medical School Three WISER faculty members Drs. William McIvor, Paul Phrampus and Samuel Tisherman were awarded the 2006 Clerkship Preceptor of the Year Award by the University Of Pittsburgh School Of Medicine. The three awardees were selected by a committee of faculty colleagues, medical students and medical school leadership honoring their commitment to the education of medical students. The awards were presented at the 2006 Annual Curriculum Colloquium held in May of 2006.

Dr. Phrampus

Dr. McIvor

Dr. Tisherman

Dr. Rogers

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National Presentations As a recognized pioneer and leader in simulation based education, WISER faculty and Staff continue to be invited to share the expertise and experience with other leaders of healthcare education as well as an advocate of safer patient environments to the public. WISER also maintains a leadership presence in many national organizations and meeting planning for simulation focused education activities. Dr. Phrampus Lectured at US Army's Annual 91W Combat Medic Educators Training Conference Dr. Paul Phrampus, Assistant Director of Emergency Medical Programs for WISER delivered an invited lecture entitled “Embedding the Simulator into an Education Program” to the US Army's Annual 91W Combat Medic Educators Training Conference in San Antonio, Texas. The 600 conference attendees are involved in the training and education of the Army’s combat field medics. WISER is involved in assisting the Army increase the efficiency of their simulation training program for combat medics by a closer integration of the simulation based education into the existing Army curriculum. The Army's 91 W program trains about 7,000 combat medics per year. WISER Faculty Conduct Workshops at 2005 Society for Airway Management Meeting Drs. Schaefer, Quinlan, Metro, Talarico, and Krohner participated in the 2005 Society for Airway Management meeting held in Washington, DC, September 16-18. The WISER faculty conducted a difficult airway management simulation workshop on Friday afternoon which was extremely well attended. Participants managed simulated airway scenarios and tested their ability to apply the ASA Difficult Airway Algorithm. The WISER faculty also conducted a workshop in basic fiberoptic bronchoscopy on Saturday afternoon. Both workshops are abbreviated versions of courses taught at WISER. Both workshops were very well received by the meeting participants. Dr. Phrampus Presents at Society for Airway Management Dr. Paul E. Phrampus attended the Society for Airway Management annual meeting in Washington DC. He presented two plenary sessions. The first focused on Development of an Airway Simulation Training Program for Pre-hospital care. He presented a second plenary session on development of a training program to utilize a checklist for error reduction in troubleshooting hypoxia in flight. Dr. Phrampus also participated as an instructor in a workshop session on pre-hospital airway management. This workshop gave participants the opportunity to manage the airway in environments and situations that they were not used to. Some examples included patient sitting up in a car, airway management of near drowning victims and trauma victims whose cervical spine cannot be manipulated

Dr. Phrampus

Dr. Phrampus

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International Meeting on Medical Simulation The meeting hosts many educational sessions along with a scientific session. WISER Associate Director Dr. Michael DeVita served as the Workshop Chairman on the Program Committee. 104 abstracts were accepted for presentation in three categories that included Education, Patient Safety and Technology and Simulation center operations.

WISER faculty presented seven poster presentations the 2006 International Meeting on Medical Simulation (now named the International Meeting on Simulation in Healthcare).

• Using Simulation Based Learning Systems to Train a Large Urban EMS Service in Difficult Airway Management-Thomas Dongilli, John J. Schaefer, MD, Ronald Roth, MD, Roy E. Cox, Jr., MEd, EMT-P, Douglas Garretson, BA, NREMT-P, Myron J. Rickens, EMT-P, Paul A. Sabol, EMT-P, Jeffery S. Pelkofer, Sr., BS, NREM-P, Mark E. Pinchalk, B.S., EMT-P and Anthony L. Shrader, EMT-P

• A Novel Debriefing Tool: Online Facilitator Guidance Package for Debriefing Team Training Using Simulation-Michael DeVita, MD., John Lutz, Nicolette Mininni and Wendy Grbach.

• The Use of Simulation Information Management System (SIMS) for data mining of simulation sessions-John Lutz, Kimberly Mitchell, John Schaefer, MD.

• Death During Simulation Training: Feedback from Trainees-Paul E. Phrampus, MD, Michele L. Dorfsman, MD, John S. Cole, MD.

• Functional Validity of Airway Techniques in Whole Task Human Simulation Using the Laerdal SimMan-Joseph Quinlan, MD and John J. Schaefer, MD.

• The BIG Shock-AED Trial for Non-Experienced Responders-Thomas Dongilli, Nicolette Mininni, Karen Stein, Michael DeVita, MD.

• Integration of Human Patient Simulation into a Comprehensive Standardized Patient OSCE-Mahoney J et al.

Dr. Michael DeVita was the Research Chair for the meeting, which saw a dramatic increase in the number of presentations from prior years. WISER’s research director, Dr. Ake Grenvik, served as one of the professors of the Poster Walk Rounds. Over 700 registrants participated from different medical specialties including nursing, respiratory therapy, emergency medical services and other simulation related fields. Exhibitors provided new information on their latest products in the rapidly expanding field of simulation technology. WISER continues to provide national leadership in simulation education. During this academic year the Society for Simulation in Healthcare launched its new peer reviewed journal "Simulation in Healthcare". Dr. DeVita is one of the four associate editors and Drs. Ake Grenvik and Paul Phrampus are members of the editorial board.

Tom Dongilli and Dr. Michael DeVita

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Tom Dongilli, Director of Operations and Administration of WISER led the Round Table Session on Simulation Center Operations. This session hosted over 120 people. WISER team member are also actively involved in the planning of the 2007 annual meeting. Dr. Michael DeVita was elected 2007 Conference Chair. Mr. Tom Dongilli will serve as the Chairman for the meetings Operations track, Dr. Paul Phrampus is chair of the roundtable sessions, and John O’Donnell is instrumental to the development of the nursing track. WISER Faculty Present Research Findings at the American Society of Anesthesiologists Annual Meeting. A team of faculty from WISER, led by Dr. Joseph Quinlan, presented on multiple subjects centered on difficult airway management for Anesthesiologists at the American Society of Anesthesiologist meeting in Atlanta.

• Retention of Difficult Airway Management Skills by Practicing Anesthesiologists - R.Romeo, MD, JJ Quinlan, MD, D Metro, MD, J Lutz, BS, and J Schaefer, MD.

• Difficult Airway Management Training of Board Certified Anesthesiologists Using Whole Task Simulation - John J. Schaefer, III, MD, Joseph J. Quinlan, MD, Mohamed I. Foraida, Ryan C. Romeo, MD, David G. Metro, MD

• Difficult Airway Management Using Human Dynamic Macrosimulation – Revisited- R Romeo, MD, JJ Quinlan, MD, D Metro, MD, J Talarico, DO, and J Schaefer MD.

• Can Demographic Data Predict Which Anesthesiologists are Competent Managers of the Difficult Airway? - DG Metro, MD, RC Romeo, MD, MI Foraida, MD, JJ Quinlan, MD and RG Krohner, MD.

• Whole Task Human Simulation Accurately Predicts Competent Managers of the Difficult Airway - DG Metro, MD, MI Foraida, MD, JJ Quinlan, MD, JS Schaefer, MD, and LM Zhang, MD.

• Validation of Whole Task Human Simulation to Measure Competency in Difficult Airway Management: Reproducibility of Repeated Testing - JF Talarico, MD, JJ Quinlan, MD, JS Schaefer, MD, MI Foraida, MD.

• Functional Validity of Airway Techniques in Whole Task Human Simulation Using the Laerdal SimMan- Joseph J. Quinlan, MD and John J. Schaefer, MD.

WISER Participates in the 16th Annual Asian Pacific Military Medicine Conference Dr. Paul E. Phrampus, Interim Director of WISER, along with John Lutz, Director of Information Technology represented WISER in presenting simulation based workshops at the Asian Pacific Military Medicine Conference in New Delhi, India March 26-29. Collaborating with faculty members from the University of Hawaii Simulation Center and faculty members from the US Army Combat Medic Training Program at Fort Sam Houston they were

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able to demonstrate the effectiveness of simulation based training. They were demonstrating the advanced capabilities of the Laerdal SimMan to delegates representing 22 nations form the Pacific Rim. Approximately 100 senior members of the Indian Armed Forces were involved in the sessions, which generated tremendous interest. 4th Annual Safar Symposium WISER Interim Director, Paul Phrampus, MD, assisted in the planning of the 4th Annual Peter Safar Symposium held at the University of Pittsburgh in June of 2006. The afternoon sessions were dedicated to simulation based education and were moderated by Drs. Paul Phrampus and Joseph Quinlan, the Director of the Difficult Airway Management Course for Anesthesiologists at WISER. Keynote speakers for the afternoon included Dr. Gerald Moses, the Director of the Medical Modeling and Simulation section of the Army’s Telemedicine and Advanced Technologies Research Center (TATRC) and Mark Scerbo, PhD, an Educational Psychologist from Old Dominion University in Norfolk, Virginia. There were also presentations from WISER faculty members David Metro, MD, Paul Rogers, MD, and John O’Donnell, CRNA, MSN, on various aspects of simulation based education programs focusing on nursing, medical student and resident education . WISER at 2006 ATA WISER participated at the 11th annual American Telemedicine Association (ATA) Conference at the San Diego Convention Center in conjunction with UPMC's Integrated Medical Information Technology System (IMITS) conference. Faculty and staff from WISER demonstrated the capabilities of simulation based education highlighting aspects of the WISER Simulation Information Management System (SIMS), and the Nursing Back Injury Prevention Project. WISER demonstrated the incorporation of simulators into the education process. Also featured was the interactive instructional game called Rapid Response Sim which was developed by SilverTree Media, a Pittsburgh Based computer game company. SilverTree worked with WISER faculty Michael Devita, MD to develop the game which is utilitized as a training tool in team training courses. Tremendous interest was generated regarding simulation based education and the potential applications for the healthcare community. WISER and SilverTree Media help Close 100,000 Lives Campaign WISER faculty and staff participated in the 2nd Annual International Summit on Redesigning Hospital Care organized by the Institute for Healthcare Improvement on June 12th, 2006 in Atlanta, GA. This meeting was the closing of the 100,000 Lives Campaign for Patient Safety. Two pre-conference workshops, conducted by WISER, featured the creation of an on-site simulation center with education and hands-on stations for participants.

Dr. Phrampus

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In the morning, a session entitled Using Simulation Based Education in Healthcare, evaluated the deployment of simulation based-training into the mainstream education of healthcare. The focus of the session was on patient safety at all levels, from students to practicing clinicians. The session was led by WISER’s Interim Director, Dr. Paul Phrampus. Multiple WISER faculty conducted workshop stations including John O’Donnell, CRNA, MSN, Associate Director of Nursing at WISER, Dr. Richard Wadas, Associate Course Director of the Emergency Medicine Difficult Airway Course at WISER, and WISER instructor Dr. Lillian Emlett. The afternoon session entitled Using Simulation in Nursing Education to Improve Safety was led by John O’Donnell, CRNA, MSN, and Associate Director for Nursing Programs at WISER. The session featured the presentation of simulation based education programs unique to the nursing domain that were created by O’Donnell and his team at WISER focusing on the area of Patient Safety. Participants learned about the mission of WISER and participated in various hands-on components of many of WISER’s courses including: Crisis Team Training, Difficult Airway Management, Central Venous Cannulation, Nursing Back Injury Prevention and many others. In conjunction with the Crisis Team demonstration, participants engaged in training on the game “Rapid Response Sim” which is used in team Crisis Team Training courses at WISER. O’Donnell was assisted by WISER instructors Beth Kuzminsky, RN, MSN, Claire Daday, RN and Dr. Wadas for the afternoon sessions. 3rd Annual Advanced Initiatives in Medical Simulation WISER participated in the 3rd Annual Advanced Initiatives in Medical Simulation (AIMS) Conference and Exhibition in May, 2006. AIMS is committed to bringing together various aspects of the healthcare simulation community including industry, military, government, research, and academia, to educate public policy makers, health care practitioners, and educators about the value of medical simulation in health care training. This year’s exhibition was supported by AIMS honorary co-chairs Senator Tom Harkin and Congressman J. Randy Forbes as well as 134 congressional co-hosts. WISER, in conjunction with UPMC’s Integrated Medical Information Technology System (IMITS), provided an overview of how an integrated healthcare simulation program can help drive patient safety through the combined use of curriculum, technology and simulation tools including mannequins and partial task trainers. During the exhibition, Tom Dongilli, WISER’s Director of Operations and Administration, shared his experience and deep knowledge of healthcare simulation and its impact with military leaders as well as members of the congressional staff.

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WISER Featured on NBC's Today Show Dr. Paul Phrampus and Tom Dongilli were featured on national television to educate the public on the commitment WISER has to patient safety and the concept of simulation in healthcare education. The WISER team, along with Katie Couric and Matt Lauer provided a scenario demonstration of caring for a trauma patient on live television as a segment on the Today Show on November 29, 2005.

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Academic Presentations In the past academic year, WISER continued to be one of the most prolific producers of presentations, lectures and posters in the healthcare simulation field. The topics ranged from AED trials for non-experienced responders to dealing with death during simulation training. We present the posters that have been presented by WISER staff and faculty throughout the past academic year. Copies of the abstracts are available on the WISER website, www.wiser.pitt.edu. A Novel Debriefing Tool: Online Facilitator Guidance Package for Debriefing Team Training Using Simulation-Michael DeVita, MD, John Lutz, Nicolette Mininni and Wendy Grbach. Crisis training (a form of crisis resource management training) focuses on helping ad hoc teams function together to attain group goals. A web-based interactive facilitator website that utilizes a checklist approach that allows competent (not expert) instructors to provide expert (not competent) debriefing by ensuring that they cover all teaching points, tasks and ask questions during the debriefing was developed. The web pages are designed in a way that they can be modified to be used with other courses taught at WISER. Using Simulation Based Learning Systems to Train a Large Urban EMS Service in Difficult Airway Management-Thomas Dongilli, John J. Schaefer, MD, Ronald Roth, MD, Roy E. Cox, Jr., M.Ed., EMT-P, Douglas Garretson, B.A., NREMT-P, Myron J. Rickens, EMT-P, Paul A. Sabol, EMT-P, Jeffery S. Pelkofer, Sr., B.S., NREM-P, Mark E. Pinchalk, B.S., EMT-P and Anthony L. Shrader, EMT-P. Using a combination of on-line curriculum, the City of Pittsburgh, Bureau of EMS Difficult Algorithm and simulation-based workshops; we were able to train and evaluate 174 City of Pittsburgh Paramedics in management of a variety of difficult airway scenarios. All of the training took place at the WISER. To maintain a high continuity of instruction, the paramedic instructors were guided by on-line curriculum that allowed for greater uniformity throughout the program. Using a combination of pre-course and post course surveys and simulation-based training exercises, evaluations of performance and attitudes of paramedics based on knowledge and technical skills in the Difficult Airway Management

WISER Presents Winning Abstract at 2006 International Meeting on Medical Simulation This abstract was presented at the Society for Medical Simulation held its annual meeting which took place at Sheraton Hotel and Marina in San Diego, CA January 14 - 17, 2006. Dr DeVita was awarded first prize in the Technology and Operations category for his abstract entitled "A Novel Debriefing Tool: Online Facilitator Guidance Package for Debriefing Team Training Using Simulation". His abstract was co-authored by WISER’s John Lutz, Director of Information Technology, and Crisis Team Course Instructors Nicolette Mininni and Wendy Grbach.

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was able to be obtained. This model was well received and demonstrated improvement in the paramedic’s knowledge of the difficult airway management algorithm. The Use of Simulation Information Management System (SIMS) for data mining of simulation sessions-John Lutz, Kimberly Mitchell, John Schaefer, MD. WISER has developed a web-based Simulation Information Management System (SIMS) that allows customized surveys, evaluations, and quizzes to be completed online by course participants. WISER, as part of its SIMS, has developed a Medical Simulation Educational Analysis Tool (MSEAT) to allow the online linking of these online forms to the XML (Extensible Markup Language) session data. Using this new tool, researchers at WISER were able to easily collect data regarding the simulation sessions recorded there. Death During Simulation Training: Feedback from Trainees-Paul E. Phrampus, MD, Michele L. Dorfsman, MD, John S. Cole, MD. During a medical simulation scenario the appropriate physiological response may be for the simulator to “die”. We queried groups of students participating in simulation based training programs about their perceptions of experiencing a simulated death. Quality assurance surveys were conducted between April and November, 2004 of 63 physicians and 175 Air Medical Crew members. Five-point Likert response questions were utilized to assess participant perceptions. Participants disagreed that simulation death was distracting to the learning environment and that a separate disclosure about the possibility of simulated death was necessary. Participants strongly disagreed that students in their respective fields should be exempted from simulated death and that experiencing simulated death would create a reluctance to participate in further simulation training. Functional Validity of Airway Techniques in Whole Task Human Simulation Using the Laerdal SimMan-Joseph Quinlan, MD and John J. Schaefer, MD. Whole task human simulation holds great promise as an evaluation and training tool in areas such as difficult airway management. However, one of the prerequistes for proving whole task simulation to be a reliable educational instrument in difficult airway management is to demonstrate that airway techniques are performed in a functionally valid way. The airway techniques suggested by the American Society of Anesthesiologists (ASA) Difficult Airway Algorithm were evaluated to be functionally valid on the Laerdal SimMan. Agreement as to functional validity of most techniques was in the very good to excellent range. The exceptions were the lighted stylet and cricothryrtomy, where agreement as to validity was good and fair, respectively. Seventeen physicians experienced in difficult airway management used a variety of techniques approved for use in the American Society of Anesthesiologists Difficult Airway Algorithm in the Laerdal SimMan and to rate the functional validity of those techniques compared with performing them in human patients. Participants were offered the opportunity to rate the validity of the lighted stylet, fiberoptic bronchoscope, Combitube, Laryngeal Mask Airway, Laryngeal Tube, intubating stylets (bougie), retrograde intubation, transtracheal jet ventilation, cricothyrotomy, and percutaneous cricothyrotomy. It was concluded that all airway techniques suggested within the ASA Difficult Airway Algorithm are functionally valid in the Laerdal SimMan

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The BIG Shock-AED Trial for Non-Experienced Responders-Thomas Dongilli, Nicolette Mininni, Karen Stein, Michael DeVita. UPMC established a task force of experts to evaluate and determine the feasibility of placing AEDs within the existing health system. Facilitators oriented participants to the environment and gave basic information that the victim was unresponsive and that the participant was asked to use the AED on the victim. All participants demonstrated the ability to use an AED without any training. Participants stated that they would use an AED if the opportunity arises. The Nursing Back Injury Prevention Project (N-BIPP)-A Pilot Study-John M. O’Donnell CRNA, MSN, Judith Bradle, Joseph S. Goode Jr. CRNA, MSN, Gail Wolf RN, DNS, FAAN, Edward Cook OTD/L, Dennia Martin OTD/L, Angela M. Moczan CPA, Claire Daday BS, MBA, Jennifer A. Fleegle-Vitsas SRNA, BSN, SuAnne Caccamese SRNA, BSN. The average age of a nurse is 48 years old and 80% are expected to have at least 1 significant back or musculoskeletal injury during their career. A study was conducted to see what the key barriers to safe and effective moves of patients were. A prospective educational intervention was conducted as a pilot study at the University of Pittsburgh and the University of Pittsburgh Medical Center. A 10 Point Protocol was developed that provided nurses with guidelines on the proper steps on moving a patient. Curricular Integration of Human Simulation Education Across Programs: SEGUE at the University of Pittsburgh School of Nursing-John O’Donnell CRNA, MSN, Richard Henker CRNA, PhD, Bettina Dixon CRNA, MSN, Helen Burns RN, PhD, Deborah White RN, PhD, Rose Hoffman RN, MSN, Sandy Sell CRNA, MSN, Nadine Englert RN, MSN. All courses using simulation were identified by faculty survey. Projection of future simulation activities and hours per student was performed. SEGUE (Simulation Effort in Graduate and Undergraduate Education) consulted with and assisted interested faculty with integration of content into courses. Total sim education hours increased 22X from 2002 to 2005 and 56.5% of students will participate in Simulation Modules in 2005. The feedback from both student and faculty has been highly positive. Evaluation of Problem Based Simulation Module: Graduate Nurse Anesthesia Student Learning and Attitudes Toward Human Simulation Education-Sandra Sell, MSN, CRNA, Julia Sullivan, RN, BSN, SRNA, Bettina Dixon, MSN, CRNA, Laura Palmer, MNEd, CRNA, Richard Henker, PhD, CRNA, and John O’Donnell, CRNA, MSN. This study was undertaken to determine if knowledge acquisition occurred with student participation in problem based simulation modules and if attitudes associated with simulation changed significantly with experience. First year anesthesia students enrolled in NURSAN 2720: Applied Physiology and Pathophysiology, participated in a day long problem based simulation session. After the first session was completed, each study subject completed a 22-item multiple choice pre-quiz and 16 item pre-attitudinal survey consisting of a 5 point Likert scale. After completing the debriefing of the final scenario, study subject completed a 22-item multiple choice pre-quiz and 16 item pre-attitudinal survey consisting of a 5 point Likert scale. It was found that students agreed that the simulation scenarios were realistic and were similar to actual clinical situations and students felt less anxious with simulation teaching by the end of the session.

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Quality Improvement Monitoring and Evaluation of a Course Enhancement Simulation Module-Sandra Sell, MSN, CRNA, Bettina Dixon MSN, CRNA, Richard Henker, PhD, CRNA, Laura Palmer, MNEd, CRNA, and John O’Donnell, CRNA, MSN. The purpose of the study is to implement a standardized quality improvement/evaluation method to assure that the simulation modules are realistic and that students acquire knowledge, skills and competence to manage patients in the clinical arena. Second year students enrolled in NURSAN 2750: Advanced Principles of Anesthesia III participated in a day long problem based simulation session that was offered for four consecutive days. The simulation intervention consisted of a series of patient scenarios designed to integrate course content from NURSAN 2750. Pre-course and post-course students were asked to complete a 16-item attitudinal survey consisting of a 5 point Likert scale. The findings were that problem based simulation module scenarios were realistic and students also indicated that this simulation module helped increase confidence in their practice and improved their skills and knowledge. Retention of Difficult Airway Management Skills by Practicing Anesthesiologists- R.Romeo, MD, JJ Quinlan, MD, D Metro, MD, J Lutz, BS, and J Schaefer, MD. A competency-based Difficult Airway Management (DAM) training course using human simulation was developed. It was hypothesized that an improvement in DAM skills would be retained over a subsequent 1-3 year period. Faculty that had tested 1-3 years ago were re-tested with four difficult airway scenarios that incorporated each part of the difficult airway algorithm. The faculty were rated as competent and non-competent and this was passed on the faculty passing all four scenarios. It was found that 16 of the 22 faculty passed all four scenarios. It was concluded that DAM training using human simulation appear to do well in terms of retention of difficult airway management skills. Difficult Airway Management Training of Board Certified Anesthesiologists Using Whole Task Simulation- John J. Schaefer, III, MD, Joseph J. Quinlan, MD, Mohamed I. Foraida, Ryan C. Romeo, MD, David G. Metro, MD. A competency-based whole task simulation program in Difficult Airway Management (DAM) was mandated for all clinical anesthesiology faculty due to the number of claims that were filed within the health system. A training course of 4 hours of web-based self didactic review and 8 hours of workshop training was conducted on 66 faculty subjects. The workshop consisted of a one hour lecture and the remaining seven hours were spent doing hands-on simulation based training. DAM performance evaluation included 4 simulation scenarios based on the 4 clinical endpoints of the ASA Difficult Airway Guidelines. The competency rate prior to the training was 27%, after training it was 92% on the first attempt and 100% after the second attempt. This study suggests that DAM can be systematically taught and that performance in applying this standard can be measured quantitatively through simulation. Difficult Airway Management Using Human Dynamic Macrosimulation – Revisited- R Romeo, MD, JJ Quinlan, MD, D Metro, MD, J Talarico, DO, and J Schaefer, MD. Two separate sets of data were collected from individuals that attending difficult airway management (DAM) full body microsimulations in 2003 and also in 2004. This data showed that anesthesiologists failed to appropriately manage the difficult airway in three different difficult airway scenarios. It was hypothesized that practicing anesthesiologists would not apply the ASA guidelines for the management of difficult airway in an

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environment that simulated the difficult airway. Six Laerdal SimMan full-scale human dynamic macrosimulators were available with an instructor at each station. Participants voluntarily took part in scenarios designed to mimic a difficult airway. There were three scenarios that were used and the participants randomly selected their testing station and were not aware of the pathway that was involved. They were rated pass or fail based on a set of criteria and if the criteria were not met and the patient still survived, they still failed. The results suggested that there is a deficiency in following the ASA Guidelines for managing a difficult airway, as well as unfamiliarity with certain basic airway techniques used in emergent pathway. Can Demographic Data Predict Which Anesthesiologists are Competent Managers of the Difficult Airway? - DG Metro, MD, RC Romeo, MD, MI Foraida, MD, JJ Quinlan, MD and RG Krohner, MD. A limited number of studies suggest that a significant proportion of practicing anesthesiologists do not follow the ASA Difficult Airway Algorithm and are then rendered not competent managers of the difficult airway. This study hypothesized that demographic factors would predict with anesthesiologists would be successful in the Difficult Airway Management (DAM) using human simulation. One hundred twenty four anesthesiologists participated in DAM workshops utilizing whole task microsimulation in 2003 and 2004. Each participant was asked to fill out demographic sheet asking questions about anesthesia experience, practice and opinions regarding the DAM. Participants took part in scenarios that were designed to mimic difficult airways that may be encountered in an operating room. There were three scenarios that were used and participants rated pass/fail on the non-emergent pathway and in three ways on the emergent pathway. The performance in the scenarios was then correlated with the demographic data obtained. It was found that the overall failure rate for non-emergent pathways were 14% and 82% respectively. Failures rates were consistently low for non-emergent pathway and consistently high for the two emergent pathways. Experience in anesthesia, faculty status, and self-evaluation of competence do not predict overall competency in DAM, although experience does play a role in success in managing scenarios in the non-emergent pathway. This suggests that all anesthesiologists, regardless of demographics or perceived level of competence, may benefit from DAM training. Whole Task Human Simulation Accurately Predicts Competent Managers of the Difficult Airway- DG Metro, MD, MI Foraida, MD, JJ Quinlan, MD, JS Schaefer, MD, and LM Zhang, MD. Whole task human simulation is a tool that has been used to try to evaluate competence in difficult airway management (DAM), but the validity of many characteristics of whole task human simulation remains unproven. One such characteristic is predictive validity. Two groups were defined a priori: “experts” and “novices”. “Experts” were faculty anesthesiologists who taught DAM to faculty and residents, and “novices” were CA-1 residents in their fourth month of training. Subjects participated in four difficult airway scenarios which all used SimMan® human dynamic macrosimulators. Scenarios replicated the four arms of the ASA Difficult Airway Algorithm. Participants were labeled competent if they successfully passed all four scenarios by following the ASA Difficult Airway Algorithm. By testing “experts” who are competent and “novices” who are not, it was able to be shown that a statistically significant difference in performance and very good sensitivity, specificity, and positive and negative predictive values.

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Validation of Whole Task Human Simulation to Measure Competency in Difficult Airway Management: Reproducibility of Repeated Testing- JF Talarico, MD, JJ Quinlan, MD, JS Schaefer, MD, MI Foraida, MD. Whole task human simulation has not been fully validated as a measure of difficult airway competency and this study focuses on the reproduction of results using novices and experts. Novices were considered to be CA-1 residents and experts were faculty who taught the difficult airway course. All subjects were tested on four different difficult airway scenarios, using whole task human simulation. Each scenario corresponded with one of the four main pathways of the algorithm: awake, non-emergent, emergent/non-surgical, and emergent/surgical. Successful completion was determined by the ability of the participant to follow the ASA difficult airway algorithm, and secure a definitive airway within the allotted time. Participants who properly managed all four scenarios were determined to be competent. Reproducibility of results among those determined to be difficult airway experts was excellent. Reproducibility of results among those deemed novices were fair. The results indicate that measurement of competency in managing the difficult airway using whole task human simulation is reproducible across a wide spectrum of expected abilities. Functional Validity of Airway Techniques in Whole Task Human Simulation Using the Laerdal SimMan- Joseph J. Quinlan, MD and John J. Schaefer, MD. It was hypothesized that the airway techniques suggested for use by the American Society of Anesthesiologists Difficult Airway Algorithm would be evaluated to be functionally valid in the Laerdal SimMan. 17 physicians experienced in difficult airway management to use a variety of techniques approved for use in the American Society of Anesthesiologists Difficult Airway Algorithm in the Laerdal SimMan and to rate the functional validity of those techniques compared with performing them in human patients. Participants were asked to rate the validity of several tools as well as encourage to rate only those techniques that they felt comfortable performing in human patients in their daily practice. Participants rated individual techniques as valid or not valid. De-identified data was collected using a web-based application on a laptop computer in a fashion that blinded the authors to the decisions made by participants. All techniques tested were rated valid. Agreement as to functional validity of most techniques was in the very good to excellent range. The exceptions were the lighted stylet and cricothyrotomy, where agreement as to validity was substantial and good, respectively. It was concluded that airway techniques suggested within the ASA Difficult Airway Algorithm are functionally valid in the Laerdal SimMan.

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Current Project and Collaborations In addition to the operations of the main WISER facility in Oakland, WISER faculty and staff are involved in the operations and planning of many strategic projects. Projects ranging from creating satellite centers in the health system, identifying and supporting collaborative academic partners to assisting the military with simulation based training efforts are ongoing. The United States Army In academic year 2006 WISER continued to develop the collaboration with the Combat Medic Training Program at Ft. Sam Houston (FSH). WISER, along with the leadership of FSH and the Telemedicine and Advanced Technologies Research Center (TATRC) proposed a research project to measure the retention of skills of combat medics. The project will collaborate with the National Training Center at Ft. Irwin in California as well as the University of Hawaii in addition to Ft. Sam Houston. ISMETT WISER has been significantly involved with the development of a satellite simulation center at the L’Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) in Palermo, Italy. Though a generous grant through the Fiandaca Foundation, ISMETT has identified facility space, leadership and instructors and has started to develop course curriculum. WISER has been involved in the development, lending its expertise in all aspects of the center development from facility design to creation of their web site (hosted on SIMS), to development of course curriculum and training of the center’s leadership staff. The center is scheduled to open in the fall of 2006. University of Hawaii WISER continued and expanded its collaboration with the University of Hawaii this year. UPMC has had an ongoing relationship with the University of Hawaii through the Innovative Medical & Information Technologies (IMTS) Center of UPMC. The University of Hawaii recently created its own simulation center, named SimTiki. SimTiki will utilize WISER’s Simulation Information Management System (SIMS) to run its facility, deliver course materials and aid in research projects. As preliminary pilot courses have proven to be extremely successful, SimTiki is scheduled to officially open in the beginning of the 2007. WISER looks forward to a rich and rewarding collaborative relationship with this new center in the coming years.

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SilverTree WISER worked with a South Side based company SilverTree Media who developed the Rapid Response Sim multiplayer networked simulation game. The game allows a group of health care professionals to interact in a virtual world in which there is a crisis with a patient. The game was created as part of the curriculum development for the Crisis Team Training Course taught at WISER. The game has been successfully integrated into the course which runs at WISER on the regular basis, training healthcare professional across the UPMC health system. WISER will continue to work with SilverTree and others to explore the effectiveness of cutting edge technology for the training of health care professionals. CCM Video WISER continues to be a major draw in recruitment to the University of Pittsburgh Health System and UPMC. As part of this effort WISER recently worked with the Critical Care Medicine Department in creating a recruitment video for prospective fellows. Various techniques were highlighted, from central venous cannulation to difficult airway management. Interviews with faculty and students showcased the many positive aspects of WISER on medical training. WISER McKeesport WISER continues to maintain a presence at UPMC McKeesport and the operation of a satellite training facility to offer easy access to some of WISER’s courses. Plans are underway to expand the McKeesport Satellite to a 4000 sq foot center to accommodate an increasing need for course offerings and expansion of WISER programs throughout the health system.

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Funding Funding is the life blood of any organization. WISER is an institute within the Department of Anesthesiology of the University of Pittsburgh. Funding comes from the Department as well as the University of Pittsburgh Medical Center (UPMC) and several other sources, including tuition charged for some of WISER’s courses.

WISER continues to obtain funding through multiple sources. These sources include the Asmund S. Laerdal Foundation for Acute Medicine Inc., congressional funds for work performed at Fort Sam, Houston (91Whiskey Combat Medic Program), University of Pittsburgh, Department of Anesthesiology, University of Pittsburgh Medical Center (UPMC) and Schools of Medicine and Nursing. Through multiple collaborations and expansions of programs, WISER anticipates that it will continue to be well funded in the coming years.

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News Archives from WISER Throughout the year various newsworthy items are presented on the WISER web site home page located at http://www.wiser.pitt.edu. Current news events are present as well as access to the archive is provided on the site. The following list is a consolidated list as major new events from the archives that are not otherwise covered in this annual report.

Dr. Grenvik Retiring from the Laerdal Foundation Board After 25 years of service, Ake Grenvik, MD, PhD, on July 1, 2005, retired from the Board of the Laerdal Foundation for Acute Medicine in Stavanger, Norway. This is the largest private Norwegian foundation supporting research, teaching and simulation in medical education. From a relatively small start in 1980 with NK 10 M in funding, the Foundation has grown to a size of NK 250 M, i.e. approx. US $40 M. Over the 25 years, some 1,400 projects have been awarded grants worldwide with an average amount of $10,000. Numerous seed money type grants have benefited University of Pittsburgh Critical Care fellows and junior faculty members. Major grants have also been awarded to prominent research and teaching institutions, including both SCRR (repetitious support over many years, since the late Dr. Safar founded his International Resuscitation Research Center, which has continued during Dr. Kochanek's leadership) and WISER (a 3 year establishment support of $1 M which together with matching local funds made it possible to create one of the largest and best simulation centers in the world.) Laerdal's New SimBaby Introduced at WISER On July 1, 2005, the new Pediatric CCM Fellows began their training by simulation of critical conditions in infants as programmed on SimBaby. This new Laerdal simulator has been developed in close collaboration with Dr. John Schaefer and his associates at the Peter M. Winter Institute for Simulation Education and Research (WISER). Dr. Melinda Fiedor, who serves as associate director of pediatric simulation, is leading this new training program, featured in the July 31, 2005 edition of Pittsburgh Post-Gazette and also broadcast by the local TV channel. Dr. Ake Grenvik Presented Medical Grand Rounds in Morgantown Ake Grenvik, MD, PhD was invited as the 2005 Sakarba V. Dedhia Visiting Professor by the West Virginia University School of Medicine in Morgantown to deliver Medical Grand Rounds on "The Development of CCM" on November 11, 2005. During his visit to WVU, he also lectured to the Division of Pulmonary and Critical Care Medicine on "Simulation in Medicine."

Ake Grenvik, MD, PhD

Dr. Melinda Fiedor

Ake Grenvik, MD, PhD

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SIMS On February 13, 2006 WISER implemented the new version of the Simulation Information Management System (SIMS). This was the culmination of approximately a years worth of work from the IT team and leadership at WISER. Significant improvements to the usability, reliability, security and data extraction were made. Working in conjunction with UPMC’s Diversified Services Incorporated (DSI) division, the team transferred the WISER web site to new servers located in DSI’s state of the art facility. All previous data captured in the old version of SIMS was transferred to the new database system. The new system allows other centers to use the same servers, code and database and yet maintain their own content, look and users. The new SIMS will allow significant research collaboration in the future with simulation centers throughout the world. John O'Donnell Honored Speaker at AANA Assembly John O'Donnell, CRNA, MSN, Associate Director, Nursing Programs at WISER was invited by the program committee to lecture at the February 2006 annual convention of the American Association of Nurse Anesthetists National Assembly of School Faculty. He addressed education technology and simulation in nursing with his presentation, entitled “Technology in Teaching: PowerPoint, SimMan, and the Land of Oz: Is that a yellow-brick or megabyte road we are following?” The AANA National Assembly is the main forum for Nurse Anesthesia Educator networking and mentoring in the world to which John O'Donnell made a most significant contribution.

John O'Donnell, CRNA, MSN, Associate Director,

Nursing Programs

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Tours WISER continued to demonstrate its capabilities this past academic year to many different groups from around the world including fellow academic institutions seeking mentorship in simulation center operations, high school students, industry leaders, politicians, military officials as well as UPMC and University of Pittsburgh dignitaries. Some of the people that have visited WISER within the past year:

• Congressman Larry Brown, Las Vegas Nevada • Max King-President of the Heinz Endowment • Pennsylvania State Representative Tony DeLuca • Representatives from the Jewish Healthcare Foundation • Assistant Professor Dr. Hanada of Hirosaki University and Assistant Professor Dr.

KiKuchi of Dokkyo University

WISER also continued to tour potential medical students as well as Anesthesiology and Emergency Medicine Residents and SRNA applicants. There were a total of 108 applicant tours totaling over 1,600 individuals. Based upon responses from surveys conducted after the tours, WISER continues to be a significant attraction for potential students, residents and faculty.

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Appendix A: WISER Advisory Board Membership John Williams (Chair) Safar Professor and Chairman Marion Ball Vice President Clinical Informatics Strategies Adjunct Professor Johns Hopkins School of Nursing and Health Sciences Charles Brindis Assistant Professor Anesthesiology Elizabeth Concordia President/CEO UPMC Presbyterian Shadyside Thomas Dongilli Director of Operations, Peter M. Winter Institute for Simulation, Education and Research Jacqueline Dunbar-Jacob Dean, School of Nursing Professor, Nursing, Epidemiology and Occupational Therapy-School of Nursing Mitchell Fink Chairman Critical Care Medicine Ake Grenvik Distinguished Service Professor of Critical Care Medicine Steven Kanter Vice Dean School of Medicine

Patrick Kochanek Professor, Critical Care Medicine Director, Safar Center for Resuscitation Research Alan Lesgold Dean, School of Education William McIvor Assistant Professor, Anesthesiology Tamra Merryman Vice President Center of Quality Improvement Paul Paris Professor Chairman Department of Emergency Medicine Paul Phrampus Assistant Professor Emergency Medicine Interim Director, Peter M. Winter Institute for Simulation, Education and Research William Shaffner Associate Council, Legal Department University of Pittsburgh Medical Center Richard Simmons Distinguished Service Professor of Surgery Medical Director, University of Pittsburgh Medical Center Peter Winter Professor Emeritus Consultant Anesthesiology

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Appendix B: WISER Faculty and Staff Executive Leadership Paul Phrampus, MD Interim Director phrampuspe@upmc.edu Michael DeVita, MD Associate Director devitam@upmc.edu Ake Grenvik, MD, PhD Research Director grenvika@ccm.upmc.edu Thomas Dongilli Operations Director dongata@upmc.edu John Lutz Director of Information Technology lutzjw@upmc.edu John O’Donnell, CRNA, MSN Associate Director, Nursing Programs jod01@pitt.edu William McIvor, MD Associate Director, Medical Student Program mcivorwr@upmc.edu Administration Daniel Battista, MBA Administrative Coordinator battistads@upmc.edu Jewel McKinnon, BSN Receptionist mckinnonjl2@upmc.edu

Operations Christine Barton Coordinator of Simulation Services bartoncm@upmc.edu Jon Mazur Simulation Specialist mazurjf@upmc.edu Joshua Franczyk Simulation Specialist franczykjd@upmc.edu Project Managers Elizabeth Sanchez Project Manager-External Relationships sanchezec@upmc.edu Aimee Smith Project Manager-Curriculum Development smital4@upmc.edu Information Technology Benjamin Hosler Lead Systems Analyst hoslbj@upmc.edu Kimberly Mitchell Application Coordinator-QA Lead mitchellks@upmc.edu Michael Smochek Curriculum Application Developer smochekmt@upmc.edu Craig Deuink Data Application Developer dejucw@upmc.edu Max Leake Multimedia Application Developer leakemw@upmc.edu

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Appendix C: Academic Year 2005 -2006 WISER Course Listing

Department NAME of Course

Anesthesiology Anesthesia Crisis Leadership Training Resident & SRNA

CA-1 Introduction to Anesthesiology Simulation

Difficult Airway Management Anesthesiology Faculty

Difficult Airway Management Anesthesiology Residents

Difficult Airway Management Training Program CME

Anesthesia Residents Fiberoptic Bronchoscopy

Fiberoptic Bronchoscopy Training Program CME

Research: Validation of the Optimal Single-Provider Facemask Ventilation

CCM Critical Care Medicine Fellows Orientation

Difficult Airway Management Critical Care Medicine Fellows

Fiberoptic Bronchoscopy Critical Care Medicine Fellows

Introduction to Pediatric Critical Care Medicine

MISC Training - Critical Care Medicine

MISC Training - Pediatric

CEM Air Medical Crew Training

EM Difficult Airway Management Emergency Medicine - Community

Difficult Airway Management Emergency Medicine Residents

MISC Training - Emergency Medicine

Pediatrics – Div of Emerg Med Pediatric Emergency Airway Management

Pharmacy Pharm 5216: Pharmacotherapy of Cardiovascular Disease - Dysrhythmia

Pharm 5221: Introduction to Critical Care

School of Medicine

2nd Year Medical Student Clinical Procedures Course: Adult Basic Airway Management

Combined Ambulatory Medicine & Peds Clerkship

MISC Training - Medical Students

Organized Structured Clinical Exam: Clinical Competency Assessment

Organized Structured Clinical Exam: Clinical Skills Assessment

Organized Structured Clinical Exam: Clinical Skills Assessment: Physical Diagnosis II

School of Medicine - Anesthesiology 2nd Year Medical Student Anesthesiology Basic Monitoring

3rd Year Medical Student Day 1: Airway Management During Intravenous Induction of General Endotracheal Anesthesia

3rd Year Medical Student Day 2: Intravenous Induction of General Endotracheal Anesthesia

3rd Year Medical Student Day 3: Anesthesia for Emergency Exploratory Laparotomy

3rd Year Medical Student Day 4: Perioperative Crises

3rd Year Medical Student Anesthesia EKG Recognition

4th Year Medical Student Anesthesiology Advanced Airway Management

4th Year Medical Student Anesthesiology for Neurosurgery

4th Year Medical Student Anesthesiology for Obstetrics

4th Year Medical Student Anesthesiology TURP

School of Medicine - CCM 3rd Year Medical Student Critical Care Medicine

4th Year Medical Student Critical Care Medicine

School of Medicine - EM 4th Year Medical Student Emergency Medicine Clerkship

School of Nursing MISC Training - School of Nursing

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Department NAME of Course

NUR 0080 - Foundations of Nursing Practice I

NUR 1050: Nursing Care of Mothers, Newborns, and Families

NUR 1052 Nursing Care of Children and Families

NUR 1120 - Advanced Nursing Management of the Adult with Acute/Complex Health Problems

NUR 1121 - Nursing Advanced Clinical Problem Solving

NUR 1710 - Nursing Advanced Cardio-Pulmonary

Nursing Fast Track Back

NURSAN 2720: Problem Based Simulation - Integration of Course Content

NURSAN 2740 - Problem Based, Integration of Course Content

NURSAN 2740 - SRNA Double Lumen Tube / Jet Ventilation

NURSAN 2740 - SRNA Invasive Monitoring/Central Line Placement

NURSAN 2750: Course Content Integration and Simulation

NURSAN 2750: Difficult Airway Workshop

NURSAN 2750: Trauma Rounds

NURSAN 2760: Critical Event Management/ACRM

Surgery Surgical Advanced Crisis Leadership Training

UPMC Crisis Team Training

Crisis Team Training - McKeesport

Central Venous Cannulation Training

Difficult Airway Management for Pre-Hospital Care Providers

MISC Training - Respiratory Therapy

MISC Training - SDY - Hillman

Nursing Back Injury Prevention Project (N-BIPP)

Obstetric Crisis Team Training

Pediatric Critical Care Nursing

Respiratory Therapy Mini-BAL

WISER Advanced Cardiac Life Support (CME)

Basic Life Support Certification (Adult and Pediatric)

Design, Development and Operation of Medical Simulation Centers Registration

Creating and Implementing a Simulation Learning System and Custom SimMan Programming and Advanced Techniques

Foundations of Simulation in Healthcare: Module 1 Creating Your Simulation Center

Foundations of Simulation in Healthcare: Module 2 Programming Your Laerdal SimMan

Medical Simulation Course Facilitator Training

WISER Preceptor Program

36

Appendix D: Current WISER Course Directors

DIRECTOR Department COURSE

Barton,Christine WISER Advanced Cardiac Life Support (CME) Basic Life Support Certification (Adult and Pediatric) Medical Simulation Course Facilitator Training

Blazeck,Alice Nursing NUR 0080 - Foundations of Nursing Practice I

Campbell,Patricia School of Medicine Combined Ambulatory Medicine & Peds Clerkship Organized Structured Clinical Exam: Clinical Competency Assessment Organized Structured Clinical Exam: Clinical Skills Assessment Organized Structured Clinical Exam: Clinical Skills Assessment: Physical Diagnosis II

DeVita,Michael Critical Care Medicine Crisis Team Training

Dongilli,Thomas WISER Foundations of Simulation in Healthcare: Module 1 Creating Your Simulation Center

Foundations of Simulation in Healthcare: Module 2 Programming Your Laerdal SimMan Medical Simulation Course Facilitator Training WISER Preceptor Program

Dunmire,Susan Emergency Medicine 4th Year Medical Student Emergency Medicine Clerkship

Fiedor,Melinda Pediatrics Introduction to Pediatric Critical Care Medicine Pediatric Critical Care Nursing

Fioravanti,Marie Nursing NUR 1120 - Advanced Nursing Management of the Adult with Acute/Complex Health Problems

Gosman,Gabriella Obstetrics Obstetric Crisis Team Training

Hoffmann,Rose Nursing Nursing Fast Track Back

Libman,Shelley Nursing NUR 1052 Nursing Care of Children and Families

McIvor,William Anesthesiology 2nd Year Medical Student Clinical Procedures Course: Adult Basic Airway Management

3rd Year Medical Student Day 1: Airway Management During Intravenous Induction of General Endotracheal Anesthesia

3rd Year Medical Student Day 2: Intravenous Induction of General Endotracheal Anesthesia 3rd Year Medical Student Day 3: Anesthesia for Emergency Exploratory Laparotomy 3rd Year Medical Student Day 4: Perioperative Crises 4th Year Medical Student Anesthesiology Advanced Airway Management 4th Year Medical Student Anesthesiology for Neurosurgery 4th Year Medical Student Anesthesiology for Obstetrics 4th Year Medical Student Anesthesiology TURP CA-1 Introduction to Anesthesiology Simulation

Metro,David Anesthesiology CA-1 Introduction to Anesthesiology Simulation

Mohr,Michael Anesthesiology Central Venous Cannulation Training

Murray,Andrew Anesthesiology Anesthesia Crisis Leadership Training Resident & SRNA Anesthesia Residents Fiberoptic Bronchoscopy

O'Donnell,John Nursing NUR 1050: Nursing Care of Mothers, Newborns, and Families NUR 1052 Nursing Care of Children and Families NURSAN 2760: Critical Event Management/ACRM Nursing Back Injury Prevention Project (N-BIPP) Nursing Fast Track Back

Phrampus, Erin Ped – Div of Emer Med Pediatric Emergency Airway Management

Phrampus,Paul Emergency Medicine Air Medical Crew Training Difficult Airway Management Emergency Medicine - Community Difficult Airway Management Emergency Medicine Residents

37

DIRECTOR Department COURSE

Difficult Airway Management for Pre-Hospital Care Providers

Quinlan, Joseph Anesthesiology Difficult Airway Management Anesthesiology Faculty Difficult Airway Management Anesthesiology Residents Difficult Airway Management Training Program CME Fiberoptic Bronchoscopy Training Program CME

Rogers,Paul Critical Care Medicine 3rd Year Medical Student Critical Care Medicine 4th Year Medical Student Critical Care Medicine Critical Care Medicine Fellows Orientation

Romeo,Ryan Anesthesiology 2nd Year Medical Student Anesthesiology Basic Monitoring

Sell,Sandy Nursing NURSAN 2720: Problem Based Simulation - Integration of Course Content NURSAN 2740 - Problem Based, Integration of Course Content NURSAN 2740 - SRNA Double Lumen Tube / Jet Ventilation NURSAN 2740 - SRNA Invasive Monitoring/Central Line Placement NURSAN 2750: Course Content Integration and Simulation NURSAN 2750: Difficult Airway Workshop NURSAN 2750: Trauma Rounds NURSAN 2760: Critical Event Management/ACRM

Seybert,Amy Pharmacy Pharm 5216: Pharmacotherapy of Cardiovascular Disease - Dysrhythmia Pharm 5221: Introduction to Critical Care

Tasota,Frederick Nursing NUR 1710 - Nursing Advanced Cardio-Pulmonary

Tisherman,Samuel Surgery Surgical Advanced Crisis Leadership Training

Tuttle,Raymond Respiratory Therapy Respiratory Therapy Mini-BAL Respiratory Therapy Immediate Life Support Respiratory Therapy Mechanical Ventilation: Problem Solving and Troubleshooting Respiratory Therapy Lung Recruitment

Venkataraman,Ramesh Critical Care Medicine Difficult Airway Management Critical Care Medicine Fellows Fiberoptic Bronchoscopy Critical Care Medicine Fellows

White,Deborah Nursing NUR 1050: Nursing Care of Mothers, Newborns, and Families

Zewe,Gretchen Nursing NUR 1121 - Nursing Advanced Clinical Problem Solving

Zuckerbraun, Noel Peds – Div of Emer Med Pediatric Emergency Airway Management

The Peter M. Winter Institute for Simulation, Education & Research

http://www.wiser.pitt.edu