Authors | Institution | |
Anita Sarmah1 Agnes Ryzynski2 Susan DeSousa2 Mabel Choi1 Fahad Alam1 Vanessa Percival1 Isabella Devito3 |
Department of Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada Sunnybrook Canadian Simulation Centre, Toronto, Canada 3Department of Anesthesia, Mount Sinai Hospital, Toronto Canada |
|
|||||||
Upping the ante: Introduction of innovative educational tools to undergraduate medical students 2nd simulation session |
At University of Toronto, 260 3rd year medical students rotate sequentially through the Simulation centre on day 2 of 10 during core Anesthesia rotation. The day consists of part task and high fidelity simulation highlighting team and resuscitation skills. Student feedback consistently requested more simulation time to reinforce their learning.
Following an adopted “Flipped Classroom” approach, time was created for a second simulation with end goal to reinforce learning, entitled “Exit Simulation”.
To “up the ante” we introduced Innovative tools rarely used in Undergraduate medicine. Course objectives were mapped to clinical areas where Anaesthetists care for patients: Preoperative, Intraoperative and Postoperative.
Preoperative scenario
Students perform a real time assessment of a standardized patient. The group is subdivided into two groups. Each group must develop a management plan and risk stratify patient’s co-morbidities. Groups re-join and pitch their management plans to each other. Team must decide on one plan without hybridizing.
Intraoperative scenario
Students are required to manage an intraoperative crisis. Roles are assigned to reflect a working operating room. Concept of mental practice pre-simulation is introduced.
Physical barriers to communication are created by the use of surgical drapes and addition of cognitive loads (such as cutting “S”’s with laparoscopic equipment).
Postoperative scenario
Involves the assessment and mgt of pain and crisis in the PACU setting. SAGAT stops are utilized.
Learner Feedback
Preoperative: “Very realistic patient and co-morbidities”; “Great to have the opportunity to think through our own patient plan”.
Intraoperative: “Good introduction to intra-operative communication. I will remember some valuable lessons”; “visualization before simulation was helpful exercise”; “I enjoyed thinking through case before it started, I will use this in future”
Postoperative: “Taught me to avoid fixating on a problem”; “Reinforced our learning”
Impact
Exit Simulation day consistently ranks highly. Students have commented that the use of mental imagery is transferable across other specialties during clerkship; and the modified SAGAT highlights the impact of fixation error. We are excited about the launch of our new Undergraduate Anesthesia curriculum after our initial positive feedback and anticipate that this additional simulation day helps “close the loop” on their core rotation
Rotation Evaluation
“The rotation was a good educational experience"
Challenges/ Opportunities
•Needs many facilitators
•Opportunity opened up with RT professional and educational leader
•“I believe this has been a great collaboration and wonderful learning opportunity for the RT students. I would be happy to have them continue to participate”
Take home Message
The innovational tools used here have potential application across all specialties
Thank you to the Globe and Mail for cataloguing the day at the Canadian Simulation Centre, Sunnybrook Health Sciences Centre.
1. Abstract presented at AMEE 2012 Abstract Book 9G1
2. Med Ed 2008;42:607-12
3. Qual Saf Health Care. 2004 October; 13(Suppl 1): i65-i71