telesimulation script template
TRANSCRIPT
Case Details
SECTION I: SCENARIO DEMOGRAPHICS
SECTION II: SCENARIO DEVELOPERS
SECTION III: CURRICULUM INTEGRATION
Scenario Title: Let’s Get the Pads On This Guy! (A case of V-Tach & Cardioversion)
Date of Development: 9/22/2020
Target Learning Group: Participants Telesimulation Conference Workshop
Scenario Developer(s): Jonathan St George, Nada Ray
Affiliations/Institution(s): Weill Cornell Medicine, School of Visual Arts
Contact E-mail (optional): [email protected]
Learning Goals & Objectives
Educational Goal: 1. Teach the basic principles of videography to enhance the translation of simulation-based knowledge into the digital space for the purposes of remote learning.
CRM Objectives: 1. Work with team using the current remote environment and equipment to create a telesimulation that effectively translates the test case’s medical objectives and teaching goals.
Medical Objectives:
1. Identify unstable V-Tach.2. Successfully perform synchronized cardioversion.
SECTION IV: SCENARIO SCRIPT
Case Summary: Brief Summary of Case Progression and Major Events
Background. A patient with recent cardiac bypass surgery is recovering in the hospital when he complains of palpitations and dizziness. The nurse sees that he is pale and confused and decides to put him on the monitor, get an EKG and call the care team. On arrival the care team notes the patient to have a heart rate over 200 bpm, hypotensive, pale and confused. After unstable ventricular tachycardia is identified by the team, the crash cart is brought to the bedside the defibrillator pads are placed on the patient’s chest and synchronized cardioversion is performed with a return to normal sinus rhythm and improvement of the patient.
A. Clinical Vignette: To Read Aloud at Beginning of CaseHi, I’m glad you’re here! The patient is a 63 year old man who’s recovering from a CABG ten days ago. He’e been doing great post-op, but he just started saying his heart was racing, then he got pale and dizzy and a little confused so I put him on the monitor and got an EKG and called you.
B. Scenario, Cast & Realism
Patient: Computerized Mannequin
Realism:
Select most important dimension(s)
Conceptual
Mannequin SIM Man 3G
Physical
Standardized Patient
Emotional/Experiential
Hybrid Other:
Task Trainer N/A
Confederate(s) RN in the room
C. Required Monitors
Monitor Leads/Wires
Oxygen Saturation Monitor Central Venous Line
SECTION V: PATIENT DATA AND BASELINE STATE
NIBP Cuff Defibrillator With Pads Capnography
Arterial Line Other:
D. Required SIM EquipmentStretcher Crash cart Zoll-R defibrillator with pads
E. Required Filming Equipment
Lighting Audio Cameras Accessories Other
Natural (overhead)
Multidirectional microphone Webcam #1 IV pole
Overhead lighting (night) iPhone OSMO Mobile
F. MoulageIn hospital gown, occasional moaning, eyes open occasionally, non-verbal.
G. Approximate Timing
Set-Up: Scenario: 2-3 min Debriefing: 20 min
A. Patient Profile and History
Patient Name: John Carter Age: 63 Weight: 80Kg
Gender: M F Code Status: Full Code
Chief Complaint: My heart is racing
Past Medical History: HTN, CAD
Allergies: NKDA Surgical: s/p CABG (POD10)
Social History: no smoking, occasional alcohol, no illicit drugs
Family History: Non contributory
SECTION VI: SCENARIO PROGRESSION & SHOOTING SCRIPT
B. Baseline Simulator State and Physical Exam
No Monitor Display Monitor On - No Data Displayed Monitor on - Data Displayed
HR: 220 BP: 70/40 RR: 30/min by BVM
O2SAT: 89%
Rhythm: V-Tach T: 36.9oC Glucose: 90 mmol/L
GCS: 10
General Status: Lethargic, incoherent groaning occasionally
CNS: GCS 10
HEENT: Normal
CVS: Rapid and thready
RESP: Bilateral chest wall rise with rapid shallow breathing
ABDO: NT, ND, no scars
GU: Normal
MSK: Normal, no calf swelling. SKIN Pale, clammy
Shot# Time Patient Camera Learner Actions Modifiers/Triggers
1 00:01
Rhythm: V-TachHR: 220 bpmBP: 70/40 mmHgRR: 30/minO2SAT: 89%Confused
Camera #1 Webcam on poleWide/StaticTrigger: None
Gets history from RN
Modifiers NoneTriggersVital signsEKG
2 00:30
Rhythm: V-TachHR: 220 bpmBP: 70/40 mmHgRR: 30/minO2SAT: 89%Confused
Camera #2 iPhone/OSMO 3Active/Tight ViewTrigger: RN hands EKG to Learner(moves in to view EKG)
Gets handed EKG
Modifiers If doesn’t identify v-tach RN promptsTriggersVital signsEKG
301:00 - 02:30
Rhythm: V-TachHR: 220 bpmBP: 70/40 mmHgRR: 30/minO2SAT: 89%Confused
Camera #1 Wide/StaticTrigger: Learner moves to crash cart
1. Brings crash cart and defibrillator to bedside
2. Places pads on patient
Modifiers If doesn’t identify v-tach RN promptsTriggersVital signsEKG
401:00 - 02:30
Rhythm: V-TachHR: 220 bpmBP: 70/40 mmHgRR: 30/minO2SAT: 89%Confused
Camera #2 iPhone/OSMO 3Active/Tight ViewTrigger: learner moves to defibrillator(view of defibrillator screen for synchronized cardioversion)
1. Brings crash cart and defibrillator to bedside
2. Place pads on patient
Modifiers If doesn’t identify v-tach RN promptsTriggersVital signsEKG
5 03:00
Rhythm: NSRHR: 78 bpmBP: 115/73 mmHgRR: 20/minO2SAT: 96%Less confused
Camera #2 iPhone/OSMO 3(moves out slowly toward camera #1)
Prepare for debrief
END OF CASE
Shooting Choreography Shot Notes
Sketch of SIM with camera locations and shots
SECTION VII: SUPPORTING DOCS, LAB RESULTS & MULTIMEDIA Images (ECGs, CXRs, etc.)
SECTION VIII: DEBRIEFING GUIDE General Debriefing Plan
Individual With Group With Video Without Video
Objectives
Educational Goal: 1. Understand how to set up multiple cameras via ZOOM 2. Understand basics of videography (lighting, audio, cameras) 3. Understand the basics of choreography integration into SIM
Medical Objectives: Use key principles of filmmaking and videography to enhance the ability of telesimulation to translate medical knowledge to the next generation of medical learners.
Sample Questions for Debriefing How well did the education goals of this simulation translate into the digital space?
How might they be improved?
What might be the future direction you would take this telesimulation
Required Critical ActionsUnderstand the basic Set-up to connect multiple cameras to a platform like ZOOM
Demonstrate effective use of basic principles of lighting, audio, camera angles and choreography
Successfully outline a filming script that translates the learning objectives of this case scenario
Capture the EKG findings for remote learners
Demonstrate the key steps of synchronized cardioversion for remote learners