Assessing and Enhancing Clinical Competency with

Simulation

Norbert WernerNorbert Werner

City of Edmonton Emergency Medical ServicesCity of Edmonton Emergency Medical Services

EMS Program DevelopmentEMS Program Development

Norbert.Werner@Edmonton.caNorbert.Werner@Edmonton.ca

The painful post-lunch lecture!!The painful post-lunch lecture!!

Presentation Objectives:Presentation Objectives:

At the end of this brief session, you will be able to:At the end of this brief session, you will be able to:

1. Appreciate the need and importance of assessing 1. Appreciate the need and importance of assessing competency in your staff.competency in your staff.

2. Discuss a few benefits of full-scale medical 2. Discuss a few benefits of full-scale medical simulation and its potential to enhance clinical simulation and its potential to enhance clinical competency.competency.

3. Apply several innovative and practical tools regarding 3. Apply several innovative and practical tools regarding simulation that can be used in your workplace.simulation that can be used in your workplace.

Important QuestionsImportant Questions

How do we produce a competent student?How do we produce a competent student?

How well prepared are our graduates and future How well prepared are our graduates and future employees?employees?

Are there ways to supplement the clinical Are there ways to supplement the clinical practicum experience?practicum experience?

As employers and educators, how do we As employers and educators, how do we maintain and enhance clinical competency in our maintain and enhance clinical competency in our staff and students?staff and students?

CMA Conjoint AccreditationCMA Conjoint Accreditation

Goal: Goal: To ensure that educational programs enable To ensure that educational programs enable

their students to their students to acquireacquire the knowledge, skills, the knowledge, skills, and attitudes to function as a and attitudes to function as a competentcompetent health health practitioner for the benefit of all Canadians.practitioner for the benefit of all Canadians.

What happens after graduation?What happens after graduation?

What about 1, 5, or 25 years after graduation?What about 1, 5, or 25 years after graduation?

Simulation...Simulation...

……is simply a tool.is simply a tool.

Aviation IndustryAviation Industry

Purpose of Simulation:Purpose of Simulation: To prevent error and To prevent error and

deathdeath

Accelerates your Accelerates your experiential learning experiential learning curve.curve.

Mastery of knowledge Mastery of knowledge or skill in safe or skill in safe environmentenvironment

Ideal Learning EnvironmentIdeal Learning Environment

Clinical CareClinical Care Corrections during Corrections during

performanceperformance

Others point out errorsOthers point out errors

Others tell you how you Others tell you how you performedperformed

You move on to the You move on to the next clinical tasknext clinical task

SimulationSimulation Consequences of Consequences of

decisions seendecisions seen

You realize/prioritize You realize/prioritize errorserrors

You observe how you You observe how you performedperformed

You repeat the You repeat the challengechallenge

University of Calgary Study:University of Calgary Study:PI: Dr. Rob Hall BSc, MDPI: Dr. Rob Hall BSc, MD

Study QuestionStudy Question

HUMAN PATIENTSIMULATOR(SIM group)

versusOPERATING ROOM (OR group)

University of Calgary Study:University of Calgary Study:Overall Intubation Success RateOverall Intubation Success Rate

87.8 84.8

0

20

40

60

80

100

Success Rate %

SIMOR

Difference of 3.0%

ImplicationsImplications

Paramedic students should be trained ETI on a Paramedic students should be trained ETI on a patient simulator prior to the OR rotationpatient simulator prior to the OR rotation

Improved airway trainingImproved airway training Reduce OR time Reduce OR time

Simulator training should not entirely replace the Simulator training should not entirely replace the OR experience OR experience

Medical Control Guidelines Medical Control Guidelines Continuing Education ProgramContinuing Education Program

Purpose:Purpose: Continuous trainingContinuous training

Maintenance and Maintenance and enhancement of skill-enhancement of skill-sets and knowledgesets and knowledge

Proactive, regular Proactive, regular face-to-face needs face-to-face needs assessmentassessment

Medical Control Guidelines Medical Control Guidelines Continuing Education ProgramContinuing Education Program

Part A:Part A: Quarterly con-ed Quarterly con-ed

modulemodule

Topic based on one Topic based on one or two MCG’sor two MCG’s

Topic driven by staffTopic driven by staff

Interactive designInteractive design

Medical Control Guidelines Medical Control Guidelines Continuing Education ProgramContinuing Education Program

Part B:Part B: Simulation educational Simulation educational

session for all staffsession for all staff

No fore-warning/ No fore-warning/ random selectionrandom selection

Simulator or live Simulator or live standardized patientstandardized patient

Debriefing timeDebriefing time

What Makes Simulation What Makes Simulation Successful?Successful?

The 6 R’s:The 6 R’s:

RReal timeeal time

RReal environmenteal environment

RReal peopleeal people

RReal actionseal actions

RReal drugseal drugs

RReal stresseal stress

Most importantly….Real fun!!Most importantly….Real fun!!

Debriefing Session:

Debriefing Session:

Create a safe, non-threatening environmentCreate a safe, non-threatening environment

Encourage experiential learningEncourage experiential learning

Encourage feedback and self-evaluationEncourage feedback and self-evaluation

Allow the participant to vent, affirm, or redeem Allow the participant to vent, affirm, or redeem their performancetheir performance

Debriefing Session:

What What NOTNOT to do! to do!

Instead, encourage Instead, encourage student-driven student-driven learning and learning and discoverydiscovery

Assessment of Students Assessment of Students PerformancePerformance

Two categories for evaluationTwo categories for evaluation::

1. Team behaviors1. Team behaviors

2. Critical actions2. Critical actions

Debriefing session includesDebriefing session includes:: Reviewing key learning objectivesReviewing key learning objectives Individually-targeted trainingIndividually-targeted training Addressing everyone’s unique needsAddressing everyone’s unique needs

Cardiac Arrest SimulationCardiac Arrest Simulation

Is Simulation Worth the Effort?Is Simulation Worth the Effort?

Three “feel good” stories:Three “feel good” stories:

1. Junior crew: difficult airway/GSW1. Junior crew: difficult airway/GSW

2. Cricothyrotomy success2. Cricothyrotomy success

3. Cardiac dysrhythmia patient3. Cardiac dysrhythmia patient

Questions to Ask OurselvesQuestions to Ask Ourselves

Do we encourage lifelong learning in our Do we encourage lifelong learning in our students/staff? Is training a priority?students/staff? Is training a priority?

As educators and employers, do we offer safe, As educators and employers, do we offer safe, non-threatening opportunities for remediation non-threatening opportunities for remediation and enhancement of competency?and enhancement of competency?

As an educator or clinical preceptor, how do I As an educator or clinical preceptor, how do I currently maintain my own competency?currently maintain my own competency?

SummarySummary

Assessing clinical competency of staff Assessing clinical competency of staff needs to be a priority.needs to be a priority.

Simulation and other forms of technology Simulation and other forms of technology can enhance competency of students can enhance competency of students and employees.and employees.

Simulation can supplement or “fill the Simulation can supplement or “fill the gaps” in the clinical education that you gaps” in the clinical education that you currently offer your staff and students.currently offer your staff and students.

Thank you!!Thank you!!