Simulation Training – Optimizing Outcomes through Simulation
University of Kansas, Internal Medicine Residency Program
Our internal medicine residents are fortunate to have access to a variety of simulation opportunities throughout their residency training. This experiential learning enables our residents to apply their knowledge to a simulated, concrete experience, reflect on the encounter and then refine their future performance. As so elegantly stated by our team in the Zamierowski Institute for Experiential Learning, "by taking new knowledge and skills 'for a test drive' through experiential learning, our residents can integrate complex concepts, adapt medical knowledge to nuanced cases, learn from mistakes, and generate new ideas for improving patient care."
The following is a snapshot of our current, but quickly expanding, simulation opportunities:
End of life discussion: A simulation experience designed to allow residents to practice therapeutic support, compassionate end of life care, and assess spiritual needs of patients and their family. This skill correlates clinically with our rotations on palliative care consults, inpatient oncology, and in the intensive care units.
Code status discussion: These simulation experiences teach physicians the communication skills required to conduct an effective code status discussion that focuses on key elements for informed decision making and goals of care. These two simulations are performed in a real world environment with actors, medical supplies, and an advanced manikin, "Barney."
Code Blue Session 1: Successful and organized code blue scenarios are something that every medical center strives to achieve. This simulation experience provides the learner the chance to practice every skill in a code blue including: CPR, monitoring central pulses, respiratory management, medication administration, interpreting ECG tracer strips, and recording events. Simulations are performed on advanced manikins with the ability to inject medications, check for pulses, and secure advanced airway. This interprofessional simulation is performed in conjunction with the code blue team nurses from the ICUs.
Code Blue Session 2: As a physician, code blue team members look to you to be the leader of the resuscitation efforts. This simulation trains physicians on how to clearly identify yourself as the code leader, communicate with every member of the code blue team, and issue all medical and resuscitative orders including medications with closed loop communication. This interprofessional simulation is performed with respiratory therapists, acute progressive care nurses and code blue team nurses at our institution.
Central Venous Catheter Training: This in-depth experience provides residents the opportunity to efficiently train in ultrasound-guided central venous catheterizations. The training walks the learner through obtaining informed consent, aseptic technique, ultrasound technique, and placement of an internal jugular central venous catheter under the guidance of trained pulmonary and critical care physicians. After completion of this, the physician performs the entire procedure alone, followed by one-on-one feedback to maximize the learning experience.
Hypotension/Rapid response training: Hypotension is one of the most common clinical scenarios in a tertiary medical center, and this simulation experience teaches how to apply the basics of fluid resuscitation and the role of different vasopressors. The rapid response team is an integral part of identifying, evaluating, and treating patients whose condition is declining. This opportunity teaches the learner the different team members of the rapid response, available tests, and how to transition care to the ICU.
Tachyarrhythmia: This workshop starts with a review of the evaluation and treatment of tachyarrhythmias including EKG review, brief clinical scenarios on a manikin, and practicing cardioverting patients, when appropriate.
Airway: This workshop introduces residents to different oxygen delivery devices, appropriate bag-valve-mask techniques and equipment involved in intubation.
Ventilator: This workshop involves interactive cases, as well as equipment familiarity with regards to different ventilator modes and how to make appropriate changes.
Bradyarrhythmia: This workshop starts with a review of the evaluation and treatment of bradyarrhythmias including EKG review, brief clinical scenarios on a manikin, and practicing pacing patients, when appropriate.
Development of simulations and further workshops is ongoing. Many of our simulations take place in the Zamierowski Institute for Experiential Learning (ZIEL). To learn more about this innovative venture visit http://www.kumc.edu/ziel.html.