Minutes 09.22.05

Minutes 09.22.05

University of Virginia School of  Medicine
Curriculum Committee

Surgery Conference Room, 4:00 p.m.                       

Present (underlined) were: Reid Adams, Eve BargmannDaniel Becker, Robert Bloodgood,  Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair),  Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson,  Anthony DeBenedet, Sixtine ValdelievreDebra Reed (secretary) 

  1. Human Patient Simulation.  (Marcus Martin)  Dr. Martin provided an update on the Life-Saving Techniques Workshop added to the UVA Medical School Curriculum and an overview of the emerging utilization of simulation in medical education.   The Life-Saving Techniques workshop accommodates 36-40 students at one time and occurs four times per year at the present time.

    The objectives of the Life Saving Techniques workshop are to:
                Recognize common life threats
                Prioritize actions
                Utilize resources appropriately
                Take immediate critical actions
                Understand other important actions needed to effectively manage the patients
                Introduce life saving techniques

    The Learning Module Includes:
                Seven simulated cases
                Discussion of common life threats for each case
                Discussion of immediate critical actions for each case
                Discussion of other actions for each case
                Outline of basic management principles
                List of common emergency life saving procedures
                Video of thoracotomy technique
                Video of cricothyroidotomy technique

    Dr. Martin gave a brief history of the Development of Mannequin Simulators for Clinical Education.

    Advantages of use of the HPS include:
                Patient safety:  practice without risk
                Early exposure and competence
                Education on demand
                Standardization of curriculum
                Mitigate time and chance
                Efficiency in a new era:  acceleration of the experience curve
                Problem based learning/teaching by the case method
                Bring the cases to life

    Patient Care Simulation Examples
                Acute myocardial infarction/thrombolic drug use
                Obstructed airway/cricothyrotomy
                Ventricular fibrillation/cardiac arrest
                Acute Shortness of breath:  congestive heart failure, pulmonary embolus, asthma
                Shock:  septic, cardiogenic, hypovolemic
                Resuscitation of multiple patients, mass casualties due to trauma
                Weapons of mass destruction, chemical terrorism

    Students show statistically significant improvement in quality of team behaviors and reduction in the clinical error rate and improvement in attitudes towards teamwork through simulation training.

    Uses of HPS:

    ACGME Competencies
    Board Certifications and Re-certifications
    Undergraduate (Med Schools)
    Nursing Schools

    Paramedic Training
    Lay Public Education
    Disaster Preparedness

    Student evaluation of the course has been positive with each of the six stations receiving the following scores:

    Please rate each station:  1=Poor, 2=Fair, 3=Average, 4=Good, 5=Excellent
          S1-Chest tube and DPL:  4.58
          S2-Airway Intubation:  4.66
          S3-Cricothyrotomy:  4.52 
          S4-IV/IO Access:  4.54
          S5-Advanced Airway Skills:  4.61
          S6-ECS Demo in ER:  4.79

    Life Saving Techniques Graph 2

    Student perception of their own skill level:
    Life Saving Techniques Graph

    Dr. Martin noted that there are many types of simulators available:

    Human Patient Simulator (HPS)
    Emergency Care Simulator (ECS)
    Cardiac Cath Sim
    Endoscopy Sim
    Bronchoscopy Sim
    Ultrasound Sim
    Peds Sim
    Baby Sim
    Surgical Sim (Laparoscopy)     

    Airway Simulator
    Central Cath Sim
    TraumaMan SimMan
    Endovascular Skills Sim
    Anesthesia Delivery Sim
    Resuscitation Drug Recognition System
    Pelvic Exam Sim
    Dysrhythmia Generator Sims     

    At present, finding rooms to accommodate the Life Saving Techniques sessions is very difficult and much time spent setting up and removing the equipment from various rooms.   The new medical education building will have a permanent site for the Simulation and LSL Center which should alleviate this problem. Funding for permanent staff to maintain and operate the equipment must also be found.

    Dr. Martin, when asked if he had a preference for the day of the week that the LST workshops occur, replied that Friday might be preferable because of the decreased volume in the ER on that day.

    Dr. Martin also noted that once there is a permanent facility for the HPS, workshops can be expanded to include disaster preparedness, pediatric patients, as well as many other topics.

Donald J. Innes