The Family Medicine Residency Program & Academic Hospitalist Program at Southside Hospital NSLIJHS has been using simulation to train residents, medical students and faculty for several years. We have recently incorporated the use of Team Based Learning (TBL) in our simulation sessions. This combination has provided a tool for education in teamwork and patient safety while incorporating the six ACGME competencies.

DescriptionThe course consists of:• a pre-class reading of a topic,• an individual readiness assurance test

(IRAT) when they come to class • followed by a group readiness assurance

test (GRAT). The TBL activity is then facilitated after

which the teams take turns applying their knowledge in the simulation scenario (patient interaction).

Upon completion of the scenarios, the teams reconvene for debriefing, reflection (they watch themselves from the video) and further discussion of the topic.

Conclusions

Team-Based Learning & Simulation in Medical Education:

Promoting Patient Safety (2007-2010)

Tochi Iroku-Malize MD, MPH, SFHM Michael Delman MD, FACP

Southside Hospital, North Shore Long Island Jewish Health System

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Bibliography

Objectives:Patient safety initiatives via

Simulation 1. Introduce oneself to the patientMaking sure that patients are aware of the

members of their health care team for better flow of information.

2. Identification of the patient via two forms of ID

To reduce medical error, it is important to properly identify the patient being treated.

3. Washing hands before and after patient encounter

Improved adherence to hand hygiene (i.e. hand washing or use of alcohol-based hand rubs) has been shown to terminate outbreaks in health care facilities, to reduce transmission of antimicrobial resistant organisms and reduce overall infection rates.

3. Encourage patient’s active involvement in their care via communication with patient and/or family members

When the patient knows what to expect, he or she is more aware of possible errors and choices. They can also be an important source of information about potential adverse events and hazardous conditions. Davis D, O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A.

Impact of formal continuing medical education. Do conferences, workshops, rounds, and other traditional continuing education activities change physician behaviour or health care outcomes? JAMA 1999; 282: 867-874]

Institute of Medicine To Err Is Human: Building a Safer Health System,. National Academy of Sciences. (1999)

McGaghie WC, Siddall VJ, Mazmanian PE, Myers J; American College of Chest Physicians Health and Science Policy Committee.Article 1 : Chest. 2009 Mar;135(3 Suppl):62S-68S; “Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.”

Over 100 residents and students participated. A Classroom Engagement Survey was distributed to the participants with four subscales: Learner Participation, Learner Enjoyment of Class, Patient Safety Elements and Team Work Awareness. Anecdotally, the preliminary evaluations from the participants in the simulation combined with TBL sessions have been more positive than those of simulation alone. Adding the TBL portion to the simulation sessions helped to improve the RATS.

The foregoing data demonstrates that simulation use in graduate medical education is a useful tool for enhancing medical training. The data shows that the level of proficiency with regards to the 6 competencies improved after participation in the simulation sessions

Background

Evaluation

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2.4

2.5

2.6

2.7

2.8

2.9

3

Rating

So

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imu

lation

So

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Rep

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Team

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Lectu

re,

TB

L &

Team

Sim

Session Type

Classroom Engagement

Participation

Enjoyment

Patient Safety

Teamwork

PATIENT SAFETY INSTITUTE BASIC 5 RUBRIC

Program: ______________________________ Date: _______________ Participants: ___________________________ Rater: _________________

Critical elements

0 Does not

meet expectations

1 I ncomplete

expectations

2 Meets expectations

Comments/ Debrief

Score

I ntroduces self

□ No participants introduce

themselves to the patient

□ Not All participants

introduce themselves using Name and

Position/title

□ All participants introduce themselves to patient using

Name and

Position/Title

_ _ / 2

Washes Hands □ No participants washes their hands

□ Not all participants wash their hands

□ All participants wash their hands

__ / 2

Dons gloves before patient

care

□ No participants don gloves before

patient care

□ Not all participants don gloves before patient care

□ All participants don gloves before patient care

_ _ / 2

I dentifies patient

□ No participants identify the patient

□ Participants identified the

patient using wrong/ incomplete identifiers

□ Participants identify the patient

using the correct identifiers of name and

date of birth

_ _ / 2

I ncludes patient/ family

in communication

□ No participants communicate with

patient/ family

□ Participants inform patient/ family about plan of

care

□ Participants are fully engaged

with the patient and family answering any questions they have regarding plan of care

_ _ / 2

TOTAL SCORE __ / 10

Simulation Training &Team Based Learning-

Readiness Assessment Tests

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100

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8/27/09

9/3/09

9/10/09

9/17/09

9/24/09

10/1/09

10/8/09

10/15/09

10/22/09

10/29/09

Dates of Tests

Score (%) IRATGRAT

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Score of Proficiency

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Competencies

Simulation Training at SSH FMRPACGME Competencies

Pre-Simlab

Post-Simlab

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5

Wa

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Simulation Training SSH FMRPPhysical Encounter

2007

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2009