Robotic Simulation in Medical Emergency Care Training

Christine Werner PhD, PA-C, RD
Saint Louis University (SLU)
Department of Physician Assistant Education (DPAE)
St. Louis, Missouri
Education Innovation
Session: 1058
Purpose of this study was to determine whether
medical emergency care (MEC) simulation
training improves students’ sense of confidence
and preparedness in assisting with:
Trauma cases
Cardiac codes
Medically unstable patients
Emergency department setting
Robotic Simulation at SLU
History of the Curriculum
2003 – 2008
School of Medicine and Air Force collaboration
Created a 2 week trauma care training program for
active duty personnel:
“C-STARS” – Center for Sustainment of Trauma & Readiness Skills
Air Force, Air Force Reserve, Air National Guard,
physicians, nurses and medics
PA students provided limited opportunity into the
trauma lab
History of the Curriculum Continued
2009
Partnership between SLU, Air Force and School of
Medicine
One of three corporative program in U.S.
Space allocated for a full time simulation laboratory
SLU healthcare students
SLU hospital employees
C-STARS - separate location
Figures of the SLU
Simulation Laboratory
One full time technician
Scheduling
Training
Operation
One “trauma” suite
Adjacent video room
Cardiac monitor
Crash cart
Defibrillator
Ventilator
TV monitor
Case presentation
Radiographs
Laboratory results
Figures of the High-Fidelity Mannequin
Ears:
can leak blood/spinal fluid
Neck:
trachea with realistic
anatomical landmarks
Pulses:
pulses can be palpated at:
• Carotids
• Radials
• Brachials
• Femorals
• Dorsalispedis
Gender:
transferable
Limbs:
transferable
Eyes:
blink and automatically
responds to light stimuli
Mouth:
speaks, tongue can swell,
airway can close
Thorax:
-heart sounds
• regular
• irregular
• arrhythmias
-Lungs
• breath sounds
• create pneumothorax
Medical Emergency Care (MEC)
Cardiology Module
Emergency Medicine
Essentials course
Clerkship
Traditional clerkship preparation
Basic Life Support (BLS)
Advanced Cardiac Life Support (ACLS)
Task trainer chest thoracostomy lab
Task trainer central line placement lab
2009 - present
Enhanced MEC simulation training curriculum
reflective of course/rotation evaluations:
Intimidation factor of “ED” setting especially if 1st rotation
Lack of confidence
Lack of preparedness
Assisting with cardiac codes
Hesitation towards working with the
team to stable trauma/ medically
unstable patients
MEC Curriculum
Educational competencies:
Basic Life Support (BLS) Protocol
Advanced Cardiac Life Support (ACLS) Protocol
Primary trauma survey
Secondary trauma Survey
Clinical competencies:
Focused physical examination
Critical decision making
Accuracy of stabilization plan
Team communication skills
MEC Curriculum continued..
Didactic Year
Cardiology and EM courses
Introduction to the lab:
Equipment
Mannequin
Airway management
Oxygen masks
Intubation devices
Ventilator protocol
Chest tube thoracostomy
Log roll
Safety measures
Expected /unexpected
physical findings
Breath sounds
Cardiac sounds
Cardiac rhythms
Other organ/system
findings
Practice as a team
MEC Curriculum continued..
Didactic and Clinical Year
Faculty-guided video debriefing
Practicum
Immediate feedback
Teams of 4-5 students
Done in both didactic and
20 min to stabilize patient
clinical year curriculum
Initial assessment BLS
Self reflection
Primary survey
Strengths
Secondary survey
Areas to improve
Accuracy of plan
Team effort
Communication skills
Communication
Professional conduct
Evaluation of MEC training curriculum
Methods
Two consecutive classes (2011, 2012)
Qualtrics survey
Anonymous responses
Five point Likert scale
Strongly Agree – Agree – Neutral – Disagree – Strongly
Disagree
Five questions
Comments
Descriptive statistics
SAS 9.3
Surveyed after emergency medicine rotation
Evaluation of
MEC training curriculum
Survey Components
Statements of Beliefs
Q 1 - MEC training helped prepare me for their Emergency
Medicine (EM) Rotation.
Q 2 - Various procedures/survey practice prepared me to
assist with trauma cases/codes.
Q 3 - MEC training helped improve my confidence and
communication skills with EM preceptors.
Q 4 - MEC training increased interest in EM.
Q 5 - ACLS certification prior to MEC training helped prepare me to
assist with codes/care of unstable patients.
Evaluation of MEC training curriculum:
Results
Q 1 - Preparation for EM rotation
Q 2 – Confident in conducting procedures/primary and secondary surveys
Q 3 – Improved confidence/communication skills
Q 4 - Increased interested in EM
Q 5 - ACLS certification prepared with code assist/care of the unstable patient
Evaluation of MEC
training curriculum
Results
Response rate: 72.5%
Majority of responses (classes combined)
Strongly Agreed or Agreed
Q 1 - Preparation for EM rotation (89%)
Q 2 – Confident in conducting procedures/surveys (88%)
Q 3 – Improved confidence/communication skills (92%)
Q 4 - Increased interested in EM (90%)
Q 5 - ACLS certification (92%)
Evaluation of MEC
training curriculum
Student comments
Training was fantastic
Trained on more things than I was able to do in EM
rotation but this will help in the job setting
Felt I made great strides with the combo of didactic
MEC training, then the EM rotation
Didactic prep was a plus to feel prepared in EM
More practice, more time, more training in trauma lab
Robotic Simulation in Medical
Emergency Care Training
Conclusion
MEC training using robotic simulation prior to
clinical rotations:
Improved students’ confidence
Preparedness
Function as a team member for EM events.
Overall demonstrate usefulness of robotic
medical simulation in MEC education.
Acknowledgments
Saint Louis University School of Medicine
Medical Simulation Laboratory
Wesley Q Burch, EMT, Education Specialist
Anthony J Scalzo, MD, FAAP, FACMT
Saint Louis University
Doisy College of Health Sciences
Patrick Kelly, PhD, Statistician
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