MedEdPORTAL (Apr 2013)
Covering All Bases: A Simulated, Longitudinal Case-Based Approach to Teaching Critical Care Fellows
Abstract
Abstract Introduction Any method to enhance patient care and safety is of great significance to those putting their trust in physicians charged with caring for the ill. Simulation is an effective tool for teaching the complexities of caring for critically ill patients because it allows for the development of the cognitive skills necessary to quickly analyze a situation and intervene in a timely manner to avoid patient harm. This resource describes the approach to a multistage didactic for training critical care fellows using simulation on typical scenarios encountered in the intensive care unit (ICU). Methods The resource comprises seven sessions, each one building upon events encountered in the prior session. The patient in the case, given the severity of her/his condition at the time of admission, would be expected to respond poorly to treatment and have a multitude of complications while being cared for in the ICU. Each session consists of a 25-minute practical part and a 25-minute debriefing. In addition to the trainees, a faculty facilitator, embedded nurse educator (at the bedside to convey information and implement orders), and simulator technician (to monitor the manikin and adjust settings accordingly) are necessary to complete the endeavor. The curriculum is best implemented via monthly sessions and completed over a 7-month period. Results This curriculum has been in place at our medical center for 3 years and has been well received by trainees and facilitators. It was originally implemented in July 2010 with first-year critical care fellows. During the first year of its use, fellows found engaging in the situation easier with each passing month and actually commented on the reality of each session. In July 2011, the case was again used, with minor adjustments based upon feedback from the initial group, including changes to the patient's physiology, laboratory data, and feedback mechanisms to further enhance the learning experience. In July 2012, a third pair of fellows participated in these learning sessions, and the process evolved to incorporate multiple-choice questions for each session (as a mode of objectively testing learners' understanding) plus assigned reading prior to each session. Discussion The simulation format promotes a learning-centered environment encouraging trainees to actively engage in their education and allowing teachers to adjust the educational experience to better address trainees' learning needs. We continue to refine this curriculum based on trainee feedback. The latest iteration has the trainees take on more responsibility, reinforcing the active learning approach the curriculum embraces. In the future, we plan to start collecting data from trainees' pre- and postcurriculum performances in the ICU to better evaluate the effectiveness of this resource.
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