Presentation given at HPSN 2011 titled: Simulation-Based Resuscitation - Team Leadership

1. Simula'on-­‐Based
Resuscita'on:
Team
Leadership
Eric
B.
Bauman,
PhD
RN,
Paramedic
Ka'e
White,
MD
Copyright
2011
E.
B.
Bauman
&
K.
White
All
Rights
Reserved

2. Disclosures
&
Affilia'ons
Ka'e
White
is
a
Staff
Physician
at
Wm.
S.
Middleton
Veterans'
Memorial
Hospital
and
a
Clinical
Instructor
at
the
University
of
Wisconsin
School
of
Medicine
and
Public
Health.
Dr.
White
is
also
a
Hospitalist
at
the
Stoughton
Hospital
and
hold
the
'tle
of
associate
with
Clinical
Playground,
LLC.

3. Disclosures
&
Affilia'ons
Eric
B.
Bauman
is
the
founding
and
managing
member
of
Clinical
Playground,
LLC.
Dr.
Bauman
is
a
special
event
staff
nurse
for
the
University
of
Wisconsin
Department
of
Athle'cs’
and
a
Paramedic/
Firefighter
for
the
Town
of
Madison
Fire
Department
and
a
Paramedic
for
the
City
of
Middleton
Department
of
EMS.

4. IRB
Approval
This
study
was
granted
an
Exemp&on
by
the
Health
Sciences
Internal
Review
Board
at
the
University
of
Wisconsin
-­‐
Madison

5. Needs
Assessment
• Leadership
and
Crisis
Management
Skills
in
VA
Hospital
related
Cardiac
Resuscita'on
– The
PGY2
Medicine
Residents
from
the
University
of
Wisconsin
School
of
Medicine
&
Public
Health
are
responsible
for
leading
a
mul'-­‐professional
code-­‐blue
team
– Residents
have
varied
experience
with
cardiac
resuscita'on
• All
have
current
ACLS
Training
• Few
if
any
have
any
Team
Leadership
experience
or
training

6. Iden'fying
Cogni've
and
Behavioral
Deficit
• Anecdotally:
Based
on
Ka'e’s
experience
as
Chief
Resident
and
when
mentoring
junior
residents
• Empirically:
Based
on
the
literature
and
our
pretest
ques'onnaire
Bauman,
2007

7. Medical
Educa'on
Literature
In
a
study
of
Internal
Medicine
Residents
(Hayes,
et
al,
2007)
• 49.3%
felt
inadequately
trained
to
lead
a
cardiac
arrest
• 50.3%
felt
that
standard
ACLS
training
did
not
provide
necessary
team
leadership
skills
related
to
resuscita'on
• 40%
indicated
they
received
no
addi'onal
training
related
to
resuscita'on
beyond
a
standard
ACLS
course
• 52.15%
felt
prepared
to
lead
a
cardiac
resuscita'on
-­‐
55.3%
worried
they
made
errors
• Residents
felt
unsupervised
-­‐
No
backup
• Post
event
debriefing/feedback
was
lacking
This
was
very
consistent
of
the
PGY2
Medicine
Class
working
as
Medical
Officers
of
the
Day

8. Hypothesis
Simula'on
can
be
effec've
for
increasing
resident
comfort
with
ACLS
algorithms
and
resuscita'on
leadership
roles,
while
decreasing
anxiety
related
to
cardiac
resuscita'on
management.

9. Workshop
Objec'ves
• Residents
will
demonstrate
the
ability
to
apply
knowledge
of
ACLS
protocols
in
a
high
fidelity
simulated
case-­‐based
sehng
with
emphasis
on
the
first
10
minutes
of
the
event
including
diagnosis
of
the
rhythm
and
underlying
process,
primary
survey,
and
ini'al
algorithm
selec'on
• Residents
will
demonstrate
team
leadership
and
team
member
skills
and
be
able
to
describe
the
importance
of
delega'on
of
tasks,
func'onal
team
dynamics,
and
role
ownership
• Residents
will
express
improved
confidence
with
code
team
leadership
and
decreased
anxiety
about
managing
code
situa'ons
• Residents
will
become
aware
of
the
strengths
and
weaknesses
of
simula'on
as
a
learning
tool.

10. Study
Objec'ves
• Increase
comfort
level
related
to
using
ACLS
Algorithms
• Use
Simula'on-­‐Based
Educa'onal
Interven'on
to
decrease
anxiety
associated
with
MOD
Role
• Increase
perceived
comfort
level
with
code
leadership
• Increase
par'cipant
comfort
level
associated
with
simula'on-­‐based
learning
environment

11. The
theore'cal
Framework
Based
Fink’s
Taxonomy
:
Theore'cal
Framework
that
was
already
in
place
to
guide
educa'onal
interven'ons
and
resident
curricula
in
the
Department
of
Medicine
Fink,
D.
L.
,2003

12. Learning
How
to
Learn:
Founda'onal
Knowledge:
• Becoming
a
beier
Student
Understanding
and
remembering
•
Informa'on
•
Inquiring
about
a
subject
•
Ideas
•
Self-­‐direc'ng
learners
Caring:
Developing
new
Applica'on
•
Feelings
•
Skills
• Interests
• Values
Fink’s
Taxonomy
•
Thinking:
Cri'cal,
Crea've,
&
Prac'cal
Thinking
•
Managing
projects
Human
Dimension:
Learning
Integra'on:
Connec'ng
about
•
Ideas
•
Oneself
• People
•
Others
• Realms
of
life

13. Our
Pretest/
Pre-­‐Interven'on
Data
n=24
1-­‐5
Likert
Scale
Mean
Value
is
Reported
• Comfort
with
ACLS
Algorithms
2.8
• Comfort
with
Leadership
with
Acute
Ward
Situa'on
2.68
• Level
of
Anxiety
in
MOD
Role
4.08
(High
Anxiety
Level)
• Comfort
with
Simula'on
as
a
Learning
Tool
3.52
www.pamelaheath.com/Cartoons4.htm

14. Curriculum
Development
• Establish
Objec'ves
• This
goes
beyond
a
desire
to
use
the
simulator
• Iden'fy
and
target
our
learners
• Those
rounding
out
their
PGY1
Year
• Storyboard
Scenarios
that
meet
interven'on
objec'ves
(Backfill
and
Narra've)
• This
is
the
way
it
would
look
in
the
VA
• Write/Repurpose
and
test
scenarios

15. Clovis
Nov.
2009
Timeline
Dec
1,
2009
Feb.
2010
Clovis
June
2010
July
2009
Ka'e
has
Baby
Tested
Scenarios
Ka'e
comes
for
Dec.
29,
2009
tour
of
the
Ka'e
and
Baby
(Maggie)
comes
to
Simlab
May
14,
2010
Simlab
Storyboard
Narra'ves
&
Backfill
2nd
of
4
Workshops
Nov
2009
June
14,
2010
Project
Incep'on
January,
2010
4nd
of
4
Workshops
Target
Learners
Planning
con'nues
Iden'fy
Outlined
workshop
Agenda
Objec'ves
June
7th,
2010
March
5,
2010
3nd
of
4
Workshops
First
of
4
Workshops

16. The
Agenda
• 7
Residents
per
workshop
• 3
Facilitators
per
workshop
– Educator,
Aiending,
Chief
Resident
• 2.5
Hours
– Icebreaker
Games
focusing
on
team
dynamics
and
leadership
– Review
of
concepts
of
Crisis
Resource
Management
(Gaba
et
al,
2001)
– Scenarios
with
Debriefing
(2
per
Session)
– Wrap
Up
(Surveys
and
Feedback)

17. Environment
• Icebreaker
Games
focusing
on
team
dynamics
and
leadership
Classroom
• Review
of
concepts
of
Crisis
Resource
Management
Wrap
Up
Classroom
• Scenarios
with
Debriefing
(2
per
Session)
Simula'on
Laboratory
• Wrap
Up
(Surveys
and
Feedback)
Classroom
www.pamelaheath.com/Cartoons4.htm

18. The
Scenarios
• Based
previous
research
focusing
on
resuscita'on
and
crisis
management
(Bauman,
2007)
–
Two
Scenarios:
Pulseless
VT
and
ACS
• Well
known
algorithms
but
s'll
had
cri'cal
thinking
components
– Learners
“entered”
authen'c
designed
experience
scenarios
without
defined
roles
(Squire,
2006
)

19. Video
Review
of
Sessions
• Chief
Resident,
Department
of
Medicine
Educators,
Aiending
Staff
Physician
• Provided
Wriien
feedback
to
all
par'cipants
• Opportunity
for
one-­‐on-­‐one
mee'ng
with
Chief
Resident
and/or
Aiending

20. What
were
they
looking
for?
• Each
evaluator
was
assigned
to
one
or
two
residents
to
watch
through
each
videotaped
session
• Evaluators
observa'ons’
were
compared
and
reconciled
so
that
consistent
feedback
could
be
provided
to
each
par'cipant
• All
par'cipants
were
provided
with
wriien
feedback
whether
or
not
they
self
selected
into
a
leadership
or
followership
role.

21. Examples
• Level
of
Par'cipa'on
• Communica'on
Style:
Closed
Loop
technique,
asser'veness,
appropriateness
• Leadership
orienta'on/posi'on
in
the
room
• Ability
of
leader
to
effec'vely
delegate
• Decision
Making
ability
Gaba
et
al,
2001
Squire,
Giovaneio,
DeVane,
&
Durga,
2005

22. Our
Post-­‐test/Post-­‐Interven'on
Data
n=24
1-­‐5
Likert
Scale
Mean
Value
is
Reported
• Comfort
with
ACLS
Algorithms
3.38
• Comfort
with
Leadership
with
Acute
Ward
Situa'on
3.44
• Level
of
Anxiety
in
MOD
Role
3.7
(Decrease
in
anxiety)
• Comfort
with
Simula'on
as
a
Learning
Tool
4.26
*All
results
were
sta's'cally
significant

23. Resident
Comfort
Level
Survey
Results
1
0.8
0.6
Change
in
Resident
Survey
Ra;ngs
0.4
0.2
0
-­‐0.2
-­‐0.4
-­‐0.6
Comfort
with
ACLS
Comfort
with
code
team
Anxiety
about
code
team
Comfort
with
simula'on
Protocol
leadership
leadership
as
a
learning
tool
Change
in
Survey
Score
0.58
0.76
-­‐0.38
0.88
Denotes a statistically significant change from pre- to post-workshop.

25. Limita'ons
• Time
Constraints
– Release
from
clinical
responsibili'es
– Lab
Scheduling
– No
everyone
was
able
to
play
the
role
of
leader
• Primary
feedback
comment
from
par'cipants
• Resident
buy-­‐in
of
the
created
environment
– Suspension
of
Disbelief
– More
orienta'on
'me
– More
Integra'on
of
Simula'on
into
Resident
Training
www.pamelaheath.com/Cartoons4.htm

26. Final
Thoughts
• Importance
of
theore'cal
framework
when
designing
curricula
and
research
projects
• Importance
of
objec've-­‐
based
curriculum
design
• Knowing
our
learners
program
expecta'ons
• Effec'vely
targe'ng
your
audience
R.
Kyle

27. References
Bauman,
E.
(2007).
High
fidelity
simula'on
in
healthcare.
Ph.D.
disserta'on,
The
University
of
Wisconsin-­‐Madison,
United
States.
Disserta'ons
&
Thesis
@
CIC
Ins'tu'ons
database.
(Publica'on
no.
AAT
3294196)
Fink,
D.
L.
(2003)
Crea%ng
Significant
Learning
Experiences.
San
Francisco
Jossy-­‐Bass
Gaba,
D.
M.,
Howard,
S.
K.,
Fish,
K.,
Smith,
B.,
&
Sowb,
Y.
(2001).
Simula'on-­‐based
training
in
anesthesia
crisis
resource
management
(ACRM):
A
decade
of
experience.
Simula%on
&
Gaming,
32(2),
175-­‐193.
Hayes,
H.W.,
Rhee,
A.,
Detsky,
E.,
LeBlanc,
V.R.,
and
Wax,
R.S.
(2007).
Residents
feel
unprepared
and
unsupervised
as
leaders
of
cardiac
arrest
teams
in
teaching
hospitals:
A
survey
of
internal
medicine
residents.
Cri%cal
Care
Medicine
35(7),
1668-­‐1672.
Squire,
K.
(2006).
From
content
to
context:
Videogames
as
designed
experience.
Educa'onal
Researcher.
35(8),
19-­‐29.
Squire,
K.,
Giovaneio,
L.,
DeVane,
B,.
&
Durga,
S.
(2005).
From
users
to
designers:
Building
a
self-­‐organizing
game-­‐based
learning
environment.
Technology
Trends,
49
(5),
34-­‐42.