Improved Patient Safety By Comprehensive Simulation-Based Training in Cardiac Surgery
AHRQ's 2012 Annual Conference Slide Presentation
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Slide 1
Improved Patient Safety By Comprehensive Simulation-Based Training in Cardiac Surgery
AHRQ 2012 Annual Conference September 10, 2012
Richard H. Feins, MD
Professor of Surgery
University of North Carolina at Chapel Hill
Chapel Hill, NC
Slide 2
Disclosures
- Equity interest in KindHeart, Inc., a company developed to maximize the use of simulators in surgical and medical education. This does not include any simulators used in the AHRQ grant.
- Donations of instruments and sutures have been made in support of the AHRQ grant by Teleflex, Inc.
Slide 3
Improved Patient Safety By Comprehensive Simulation-Based Training in Cardiac Surgery
AHRQ 2012 Annual Conference September 10, 2012
Richard H. Feins, MD
Professor of Surgery
University of North Carolina at Chapel Hill
Chapel Hill, NC
Slide 4
Changes Negatively Impacting the Apprentice Model 2012
- Loss of the ward services.
- Faculty priority change from teaching surgery to doing surgery.
- Increase in number of married residents.
- Decrease in amount of time allowed in hospital.
Slide 5
Problems with Patient Care Model of Surgical Education
The apprentice model curriculum depends almost exclusively on what happens to walk through the door for its clinical experience.
Slide 6
Problems with Patient Care Model of Surgical Education
"with good judgment coming from experience and experience, unfortunately, coming from bad judgment"
Dr. Scott Hultman
University of North Carolina at Chapel Hill
Slide 7
Problems with Patient Care Model of Surgical Education
We violate the basic principle by which people become masters of a skill—
DELIBERATE PRACTICE
Slide 8
K. Anders Ericsson, PhD
Image: A photograph of K. Anders Ericsson, PhD, is shown.
Slide 9
Characteristics of Deliberate Practice
- Focused.
- Carried out over extended periods of time.
- Guided by an experienced coach.
- Identifies errors and concentrates on procedures directed at eliminating those errors.
- Constantly moves out of the trainees comfort zone.
- Has a consistent means of evaluating the level of performance.
Slide 10
Characteristics of Deliberate Practice
- Not "play."
- Not reimbursed.
- May not be fun.
Slide 11
Problems with Patient Care Model of Surgical Education
No ability to actually TRAIN surgeons in how to handle adverse events.
Slide 12
American Board of Thoracic Surgery Case Requirements—2012
Congenital Heart: 10
Adult valves: 50
Myocardial Revasc: 80
Conduit harvest: 1
Aortic procedures: 10
Arrhythmia surgery: 5
Transplant/VAD: 10
Slide 13
Comprehensive Simulation Based Training
Slide 14
Image: A photograph of a heart exposed during surgery is shown.
Slide 15
Improved Patient Safety by Simulator Based Training in Cardiac Surgery
AHRQ Grant # 1R18HS020451-01
Slide 16
Cardiac Surgery Simulation ConsortiumCardiac Surgery Simulation Consortium
- University of North Carolina at Chapel Hill (PI).
- Massachusetts General Hospital.
- Johns Hopkins University.
- Vanderbilt University.
- University of Rochester.
- Mayo Clinic.
- Stanford University.
- University of Washington.
Slide 17
Deliberate Practice Component Task Training
Slide 18
Schema for Simulation Based Training in Cardiac Surgery
- Determine the operative procedures to be addressed.
- Break each down into smaller component tasks.
- Create a comprehensive syllabus for simulation based training for each of the component tasks for each procedure.
- Create "component task simulators" to allow for training in the component tasks using deliberate practice.
- Combine the component tasks mastered into the whole procedure.
- Use deliberate practice to master the whole procedure.
- Assess (using OSATS/ 5 point Likert tools) and video record each part of the process.
Slide 19
AHRQ Grant Simulation Modules
Basic Procedures:
- Cardiopulmonary Bypass (CPB).
- Coronary Artery Bypass Grafting (CABG).
- Aortic Valve Replacement (AVR).
Slide 20
AHRQ Grant Simulation Modules
Significant Adverse Events:
- Air Embolism (AE).
- Acute Intra-operative Aortic Dissection (AIAD).
- Sudden Deterioration of Cardiac Function (SDCF).
Slide 21
Image: A chart shows the following process: Procedure or Adverse Event → Component Task(s) → Procedure or Adverse Event.
Slide 22
Image: The title page of the Simulation Syllabus for AHRQ Grant No. R18 HS20451-01, Improved Patient Safety by Simulator Based Training in Cardiac Surgery, is shown.
Slide 23
Improved Patient Safety by Simulator Based Training in Cardiac Surgery
AHRQ Grant # 1R18HS020451-01
Simulation Syllabus for Each Week of Training:
- Overview.
- Goals and Objectives.
- Teaching Plan.
- Simulator(s) Set-up.
- Conduct of Simulation.
- Assessment Tools.
Slide 24
Image: The title page of the Cardiopulmonary Bypass (CPB) Module for AHRQ Grant No. R18 HS20451-01, Improved Patient Safety by Simulator Based Training in Cardiac Surgery, is shown.
Slide 25
Image: The schedule of the seven-week CPB training program is shown. Weeks 1-4 address the Fundamentals of CPB. Weeks 5-7 address Full CPB on Ramphal Simulator.
Slide 26
Image: The objectives and teaching plan of the CPB training program are outlined.
Slide 27
Image: The Set-up of the Aortic Cannulation Simulation model outlined.
Slide 28
Image: The VACF Form is shown. The section headings—1. Atrial/Bi-caval site, 2. Needle angles, 3. Bite, and 4. Spacing—are highlighted.
Slide 29
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Slide 30
Image: A line graph shows estimated marginal means of MEASURE_1.
Slide 31
Acute Intra-operative Aortic Dissection (AIAD)
Slide 32
Image: The title page of the Acute Intra-operative Aortic Dissection (AIAD) module for AHRQ Grant No. R18 HS20451-01, Improved Patient Safety by Simulator Based Training in Cardiac Surgery, is shown.
Slide 33
Image: The schedule of the five-week AIAD training program is shown.
Slide 34
Image: The protocols for aortic dissection are shown.
Slide 35
Image: A section of the protocols for aortic dissection addressing procedures to deal with inability to flow arterial cannula are circled.
Slide 36
Image: A section of the protocols for aortic dissection on surgical steps to take for groin femoral artery cannulation are circled.
Slide 37
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Slide 38
Improved Patient Safety by Simulator Based Training in Cardiac Surgery AHRQ Grant # 1R18HS020451-01
Year 1
- 16 Residents participating.
- Over 11,000 data points recorded.
- Over 120 individual simulation hours per resident.
- Over 2000 total simulation hours.
- Component task simulators for all component tasks.
- 210 page comprehensive curriculum syllabus written.
- Extensive video library recorded.
