Institutional culture is hard to change. That truism is illustrated no more clearly than in the area of patient-based medical
training. The model of "see one, do one, teach one" still persists in many training settings. Not surprisingly, this training methodology has drawbacks for both students and patients. The quality of training is only as good as the quality of that first or second experience. And patients suffer an unnecessarily high frequency of adverse outcomes at the hands of inexperienced trainees.
HRET, in collaboration with the University of Colorado Health Sciences Center, Geisinger Medical Center, and Medical Simulation Corporation, is conducting a project that will assess the use of clinical simulations in training health care providers to conduct left heart catheterization and coronary angiography and in evaluating knowledge, procedural skill, and clinical decision-making.
The primary objectives of this project are:
- To assess the impact of a simulation-based teaching paradigm, compared to a traditional patient-based standard, for cardiovascular trainees.
- To demonstrate and evaluate medical simulation as a tool for improving education and practice, enhancing patient safety, and increasing an understanding of evidence-based clinical practice guidelines.
- To improve clinical skills and promote patient safety-directed behavior, specifically with regard to individual provider performance, team performance, and recognition and management of adverse events in the cardiac catheterization laboratory.
The purpose of this project is to demonstrate, evaluate and disseminate an innovative education and training program for health care providers using medical simulation to enhance knowledge about patient safety practices and to promote a positive safety environment.
Funding: Agency for Healthcare Research and Quality
Partners: The University of Colorado Health Sciences Center, Geisinger Medical Center, and Medical Simulation Corporation |
In simulation-based training, clinician trainees learn new skills by practicing on a human “patient simulator”—a computerized manikin that simulates the physiological responses of a living patient according to various medical scenarios.
The most obvious advantage of clinical simulations over traditional patient-based training is that clinicians learn skills through “hands-on experience” without risking harm to real patients. Simulation-based training also provides trainees with a broad range of learning experiences, including the treatment of uncommon conditions unlikely to be encountered in traditional patient-based training.
For this project, cardiovascular trainees in Colorado and Pennsylvania are undergoing pre-testing, training, and post-training assessment. Both control and intervention subjects receive a uniform didactic curriculum. Control subjects experience training in a patient-based setting, whereas study subjects receive 6 hours of training on a cardiac simulator, practicing on 10 simulated cases. Post-training assessments for all subjects are conducted using the catheterization simulators.
The project is also exploring simulation as a tool in training experienced, practicing physicians, nurses, and technicians, both individually and in teams. Individual practitioners go through pre-training and post-training assessments after using the simulator to measure improvement in risk assessment, knowledge of evidence-based practice, and patient safety topics. Practicing teams of invasive cardiologists, nurses and technicians undergo team training focusing on patient safety, recognition of complications, crisis management, communication, and teamwork. Pre-training and post-training assessment data is captured for each team. Data analysis is underway, and results are anticipated in Spring 2005.
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