UPMC Critical Care

Developing Educational ObjectivesAn objective is a statement of purposeThey describe specifically what the learner is tolearnThis includes three domainsCognitive – intellect “brain / the knowing”Affective – values “heart / the feeling”Psychomotor – skills “hands / the doing” Exemplary Care Cutting-edge Research World-class Education

Sample Educational ObjectivesBe able to manage unresponsive patientsORCheck for pulse immediately, check bloodglucose, inquire about opiate use, administer40ug narcan, provide bag-mask ventilation ifairway not protected Exemplary Care Cutting-edge Research World-class Education

Sample Educational ObjectivesManages respiratory distressORCheck respiratory rate, place pulse oximeter,start 100% non-rebreather, call for rapid responseteam Exemplary Care Cutting-edge Research World-class Education

Exemplary Care Cutting-edge Research World-class Education

Feedback DefinitionMethod of controlling a ”system” by reinsertinginto the system the results of its performanceProviding the learner with specific informationabout their performance to reinforce or changebehaviorFormative (qualitative feedback)Summative (educational outcomes) Exemplary Care Cutting-edge Research World-class Education

Feedback Timing and SettingEstablished during orientation that feedback willbe provided immediately following assessmentWill be provided dailyShould be an expected part of the learningexperience Exemplary Care Cutting-edge Research World-class Education

Without FeedbackIn surveys one of the most frequently citeddeficiencies of an educational program is the lackof feedbackFailure to effectively evaluate performanceConcern it will lead to an unpleasant emotional responseMay damage learner-teacher relationshipMistakes go uncorrectedGood performance goes unreinforcedStudents generate their own feedback byattacking importance to unintended clues Exemplary Care Cutting-edge Research World-class Education

Exemplary Care Cutting-edge Research World-class Education

Exemplary Care Cutting-edge Research World-class Education

“I hear, and I forgetI see, and I rememberI do, and I understand”-Confucius Exemplary Care Cutting-edge Research World-class Education

Simulation for Critical Care EducationSimulation “Any training device that duplicatesartificially the conditions likely to be encounteredin an operation” – Webster’sLow TechPartial task TrainersSimulated patientsComputer basedRealistic patient simulators Exemplary Care Cutting-edge Research World-class Education

Partial Task Trainer Exemplary Care Cutting-edge Research World-class Education

Whole Body SimulationIs an efficient means of teaching a large group oftraineesAllows trainees to experience rare, lifethreateningconditionsAllows trainees to make medical errors withoutharmful consequences to patientsEnables faculty to provide feedbackPermits trainees to repeat performances untileducational objectives are mastered Exemplary Care Cutting-edge Research World-class Education

SimulationCircumplex Model of EmotionFeldman-Barrett, 1998, “A Circumplex Model of Affect,"Journal of Personality and Social Psychology Exemplary Care Cutting-edge Research World-class Education

Fourth Year CCM ClerkshipDr Paul Rogers Exemplary Care Cutting-edge Research World-class Education

ACLS Guidelines Exemplary Care Cutting-edge Research World-class Education

Exemplary Care Cutting-edge Research World-class Education

Exemplary Care Cutting-edge Research World-class Education

Simulation SessionsRespiratory DistressPulseless RythymsAcute Coronary SyndromeStable and Unstable supraventricular arrhythmiasSeptic ShockAnaphylaxisStatus EpilepticusHypertensive crisis Exemplary Care Cutting-edge Research World-class Education

Simulation Exemplary Care Cutting-edge Research World-class Education

Simulation Exemplary Care Cutting-edge Research World-class Education

Simulation Exemplary Care Cutting-edge Research World-class Education

Simulation Exemplary Care Cutting-edge Research World-class Education

Computer Based SimulationSimulation-based Approaches to Graduate MedicalEducation: Mechanical Ventilation SAGE-MVFirst step in micro-simulation based technologyProvides current ventilator settings and waveformsIdentifies goals of therapyAllows goal directed titration of therapyDescribes any adverse outcomesStores success ratesExplores cognitive processing and allows for self-directed learning Exemplary Care Cutting-edge Research World-class Education

Initial presentation of standardized patient case Exemplary Care Cutting-edge Research World-class Education

Oops– bad choice Exemplary Care Cutting-edge Research World-class Education

Interventions have corrected pH Exemplary Care Cutting-edge Research World-class Education

Interventions have corrected pH and SaO2 Exemplary Care Cutting-edge Research World-class Education

Acidosis, hypoxia, and hypotension repaired:Learner commits to settings Exemplary Care Cutting-edge Research World-class Education

New virtual patient is immediately presented Exemplary Care Cutting-edge Research World-class Education

Figure 1: Following simulation based training, practitioners solved a standardized panelof patients with fewer attempts (Panel A) and similar to increased success (panel B),suggesting increased efficiency Exemplary Care Cutting-edge Research World-class Education

Figure 6: Following simulation based training, practitioners implemented significantlymore complex patterns of adjustment at each change in ventilator settings. Panel A:“Complexity” is simply the average number of parameters changed at each step. PanelB: “Weighted complexity” is the sum of setting changes at each intervention, with eachsetting change weighted by the number of outcome parameters that are affected by thatsetting. For example, frequency can affect minute ventilation, plateau pressure,oxygenation, minute ventilation, and mean arterial pressure; changes in FiO2 only affectoxygenation. Practitioners qualitatively changed their patterns of practice. Exemplary Care Cutting-edge Research World-class Education

Future of Critical Care SimulationMeasurement Tool for Core CompetenciesOsteopathic Philosophy and Osteopathic ManipulativeMedicineMedical KnowledgePatient CareInterpersonal and Communication SkillsProfessionalismPractice Based Learning and ImprovementSystems-Based Practice Exemplary Care Cutting-edge Research World-class Education

Future of Critical Care SimulationMeasurement Tool for CertificationMeasurement Tool for Re-CertificationImprove Patient Safety and Outcomes Exemplary Care Cutting-edge Research World-class Education

Questions Exemplary Care Cutting-edge Research World-class Education