Demonstration of High‐fidelity Simulation Team Training for Emergency Medicine

Abstract

Abstract. Emergency medicine (EM) presents many cognitive, social, and systems challenges to practitioners. Coordination and communication under stress between and among individuals and teams representing a number of disciplines are critical for optimal care of the patient. The specialty is characterized by uncertainty, complexity, rapidly shifting priorities, a dependence on teamwork, and elements common to other risky domains such as perioperative medicine and aviation. High-fidelity simulators have had a long tradition in aviation, and in the past few years have begun to have a significant impact in anesthesiology. A national, multicenter research program to document the costs of teamwork failures in EM and provide a remedy in the form of an Emergency Team Coordination Course has developed to the point that high-fidelity medical simulators will be added to the hands-on training portion of the course. This paper describes an evolving collaborative effort by members of the Center for Medical Simulation, the Harvard Emergency Medicine Division, and the MedTeams program to design, demonstrate, and refine a high-fidelity EM simulation course to improve EM clinician performance, increase patient safety, and decrease liability. The main objectives of the paper are: 1) to present detailed specifications of tools and techniques for high-fidelity medical simulation; 2) to share the results of a proof-of-concept EM simulation workshop introducing multiple mannequin/ three-patient scenarios; and 3) to focus on teamwork applications. The authors hope to engage the EM community in a wide-ranging discussion and handson exploration of these methods. Key words: patient safety; performance; teamwork; team training; emergency medicine; simulation. ACADEMIC EMER- GENCY MEDICINE 1999; 6:312 -323 T HE PRACTICE of emergency medicine (EM) presents many cognitive, social, and systems challenges to clinicians and administrators. Education of emergency physicians (EPs) must optimally include training to manage the self, team, and environment under difficult conditions. Naturalistic decision making (NDM) is a growing school of thought that has led to greater understanding of how skilled people solve complex problems in the actual contexts in which tasks must be carried out. Job performance in EM can be characterized as consisting of the eight task and setting factors that serve as a framework for the NDM movement (Table 1).

Prospective Randomized Crossover Study of Simulation vs. Didactics for Teaching Medical Students the Assessment and Management of Critically Ill Patients

“…Patient SIM has spread from anesthesiology to other disciplines such as internal medicine, pediatrics, neonatology, radiology, trauma, nursing, emergency medical services/disaster medicine, and emergency medicine (EM) (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Although SIM-based training makes intuitive sense and has shown benefit in other fields such as aviation, the evidence to support its effectiveness in medicine is limited.…”

Human Simulation in Emergency Medicine Training: A Model Curriculum

“…24 One of the biggest strengths of this tech- nology is the ability to train residents to work well in a team by practicing and debriefing about teamwork in these patient care scenarios. 9 The realism of the simulator places real stress and time pressure on the teams, which is critical for training them to function in an actual crisis or critical care situation. 16 Medical Knowledge.…”

“…18,25 Problems are presented to the residents that are poorly defined and changing, and the residents must investigate, analyze, and apply their knowledge and skills to care for the patient. 9 During debriefing sessions, gaps in medical knowledge are identified from resident performance in the session. These gaps are addressed by a brief focused didactic session or through resident follow-up and self-education.…”

“…Suggestions for improving the realism of EM simulations include: actors playing family members; using actual radiographs, electrocardiograms, and lab reports; minimal instructor input during simulation; multiple patient encounters; interruptions such as nursing questions and pages; and replicating exactly the physical working environment, chart, and equipment. 9 Following the conclusion of the simulation, debriefing occurs in a separate room and involves reviewing a videotape of the encounter with discussion by the participants. The debriefing is facilitated by the instructor but is primarily run by the participants.…”

“…8 Emergency medicine has many cognitive and systems similarities to anesthesia, which suggests that simulation training is likely to benefit EM residents. 9 Advantages of simulation include: the ability to practice invasive skills without risk to patients, exposure to uncommon clinical situations, mistakes can be allowed to reach their natural conclusions, identical scenarios can be presented to multiple groups, actual medical equipment is used, interpersonal skills are realistically modeled, and recording of the situation is possible without patient consent. 10 Students perceive the realism of modern simulators to be high, [11][12][13] and the pattern of errors recorded by participants is similar to that in actual practice.…”