Simulation competency course is a first
Simulation competency course is a first
It’s the first of its kind: a course in difficult airway management using mannequin simulations that is required for all practicing emergency physicians at the University of Pittsburgh Medical Center, says Paul Phrampus, MD, FACEP, director of the course, assistant professor of emergency medicine in the department of emergency medicine, and assistant director of the Peter M. Winter Institute for Simulation, Education, and Research (WISER).
"It is a course designed for competency assessment of a practicing emergency physician’s ability to manage critical airway situations," he explains. It includes a four-hour online pre-course curriculum and participation in the simulation center for eight hours.
The training involves a battery of scenarios, Phrampus explains. "It might range from a simple, straightforward scenario to a patient in severe respiratory distress," he says. "It could involve the placement of a breathing tube where everything goes fine to a complicated traumatic patient with a neck injury where you are unable to place a breathing tube and have to perform a surgical cricothyroidotomy to save the patient’s life."
The physicians are assessed every step of the way, says Phrampus. "The results of the program are recorded [via video], and then the participant is debriefed immediately after, with best practice guidelines included in the review," he explains.
This ability to review performance via videotape is common in many other industries, but it has not been prevalent in medicine, notes Paul Barach, MD, MPH, director of The University of Miami/Jackson Memorial Hospital Center for Patient Safety in Miami. The traditional approach to learning in medicine has been the "see one, do one" approach, Barach says. But this is not how many other professionals learn. "In the sports environment, you have an opportunity to review the videos of your performance, but we have not really had that in health care," he says.
At UPMC, depending on the performance review, the ED physician may or may not be finished with his or her assessment. "If their performance is below standard, they get debriefed, and then they do it again," says Phrampus. Sometimes, he says, the error can be as simple as omitting one element of treatment. "During the debriefing, the error is corrected, and we find them another scenario that is similar," he says. "If they mess up more than three scenarios, they have to come back another day."
Every single faculty member at the University of Pittsburgh Medical Center has been through this course, says Phrampus.
Why was difficult airway management chosen for a first-of-its-kind course? It is an extremely high-risk, low-volume situation, Phrampus says.
"The risk is as high as it is for anything we do, but the actual number of times a practicing emergency physician encounters it is quite infrequent; but when it happens, it hits you like a truck," he says. Also, the outcomes often are catastrophic, and the medical legal settlements astronomically high, Phrampus says. "Eighty-five percent of these cases, if not managed correctly, end in brain damage or death," he says.
Sources/Resource
For more information on re-engineering an ED, contact:
- Paul Barach, MD, MPH, Director, Center for Patient Safety, University of Miami School of Medicine, Jackson Memorial Hospital, 1611 NW 12th Ave., North Wing 109, Miami, FL 33136. Phone: (305) 585-8364. Fax: (305) 585-8359. E-mail: [email protected].
- Paul Phrampus, MD, FACEP, Assistant Professor of Emergency Medicine, University of Pittsburgh Department of Emergency Medicine; Assistant Director, Peter M. Winter Institute for Simulation, Education, and Research, Pittsburgh. Phone: (412) 648-6073. E-mail: [email protected]. Institute web site: www.wiser.pitt.edu.
- Abdul M. Memon, MD, FACP, FRCP(C), FACEP, Chief, Emergency Services Medical Director, Emergency Care Center, Jackson Memorial Hospital; Associate Professor Medicine, Emergency Medicine, University of Miami School of Medicine, both in Miami. Phone: (305) 585-6913. Fax: (305) 585-0000. E-mail: [email protected].
SimMedical is planning its first releases in June. Initially it will be providing courses on emergency medicine as well as anesthesia physician courses in difficult airway management, central venous cannulation, and conscious sedation, and nursing courses in critical care orientation, accreditation competencies, and conscious sedation for nursing. In addition, it will offer a comprehensive Learning Management Software system called SIMS (Simulation Information Management System) that provides scheduling, delivery of pre-course curriculum, warehousing of data, and a learning portfolio for students and faculty. Fee structures are primarily based on the number of courses an institution needs and the number of seats in a particular course. For more information, contact:
- SimMedical, 230 McKee Place, Suite 400, Pittsburgh, PA 15213. Phone: (412) 647-6341. E-mail: [email protected]. Web: www.simmedical.com.
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