Simulation in healthcare : journal of the Society for Simulation in Healthcare
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In medicine, standard setting methodologies have been developed for both selected-response and performance-based assessments. For simulation-based tasks, research efforts have been directed primarily at assessments that incorporate standardized patients. Mannequin-based evaluations often demand complex, time-sensitive, hierarchically ordered, sequential actions that are difficult to evaluate and score. Moreover, collecting reliable proficiency judgments, necessary to estimate meaningful cut points, can be challenging. The purpose of this investigation was to explore whether expert judgments obtained using an examinee-centered standard setting method that was previously validated for standardized patient-based assessments could be used to set defensible standards for acute-care, mannequin-based scenarios. ⋯ An examinee-centered approach, using aggregate expert judgments of audio-video performances, was suitable for setting standards on most acute-care, mannequin-based scenarios. It is necessary, however, to have valid scores for the chosen scenarios and to sample performances across the ability spectrum.
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Obstetric crises are unexpected and random. Traditionally, medical training for these acute events has included lectures combined with arbitrary clinical experiences. This educational paradigm has inherent limitations. During actual crises insufficient time exists for discussion and analysis of patient care. Our objective was to create a simulation program to fill this experiential gap. ⋯ Simulated obstetric crises training offers the opportunity for educators to identify specific performance deficits of their residents and the subsequent development of teaching modules to address these weaknesses.
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Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. ⋯ A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.
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There is a paucity of literature pertaining to the role and techniques of moulage for creating high-fidelity medical simulations. As part of an Intensive Care Crisis Event Management Course, simulation of an extensive torso burn was desired. The aim of the moulage was to enhance the realism of the scenario but additionally to enable a chest wall escharotomy to be performed. ⋯ In the case of the chest wall burn model, moulage was used as more than a visual realism enhancing strategy-it served as an educational tool in its own right, permitting demonstration of a procedure performed infrequently outside the walls of major burns centers.
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Although a traditional simulation laboratory may have excellent installed audio/visual capabilities, often large classes overwhelm the limited space in the laboratory. With minimal monetary investment, it is possible to create a portable audio/visual stand from an old IV pole. ⋯ The modified IV pole is a cost-effective and portable solution to limited space or the need for audio/visual capabilities outside of a simulation laboratory. The familiarity of an IV pole in a clinical setting reduces the visual disturbance of relocated audio/visual equipment in a room previously void of such instrumentation.