Tuckamore - Faculty of Medicine

 Tuckamore
Simulation Research Collaborative
DECEMBER 2014
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It’s almost the holidays for most, and all of us here at the Tuckamore Simulation Research Collaborative are reflecting and thinking of you, our partners, and the ways you have been there for us during this inaugural year. Your growing support and involvement means a lot. SUMMARY BLOG: Every practice is a simulation: Lots to learn from our coaches (H. Carnahan and P. Benoit) E-­‐Resource: Where to publish: A list of journals that publish simulation related research Chop Shop: High school student’s recipe for a gel block model for simulation training of ultrasound skills. Next chop shop date will be set for January 2015 (TBA) Workshops: Last workshop date February 6, 2015. New for 2015 will be our Certificate Program (http://www.med.mun.ca/TSRC/WhatWeDo/Workshops/Certificate-­‐Program.aspx)! Suggested Readings: Two recent articles; one example of longitudinal research and one a review of where we are with simulation. and ANALOG BLOG http://tuckamoreamonth.blogspot.ca Every practice is a simulation: Lots to learn from our coaches By Heather Carnahan, Dean and Professor, School of Human Kinetics and Recreation, Memorial University & Peter Benoit, Head Coach, Sea-­‐Hawks Men’s Basketball, Memorial University In the School of Human Kinetics and Recreation at Memorial University, kinesiology researchers and coaches from Sea-­‐Hawks Athletics are working together to understand how to optimize performance in high stakes MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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game situations. For example, as part of a post-­‐game debriefing session, our coaches have been using SportsCode video analysis software to identify good performances as well as errors in team execution. SportsCode also allows our coaches to provide individualized feedback to players. Both positive and negative clips can be brought together to help players recognize the errors they are producing consistently, and to validate to the players through video demonstration, the coaches verbal feedback. This video review takes place under the supervision of the coach, and virtually, where athletes can download their edited videos to engage in their own analysis of their performances. We are currently collaborating on a program of research to understand how the errors generated during practice are related to the errors generated during game situations. Why is this relevant to the health professions education community? There is emerging literature on the importance of coaching in health professions education. There is also a longstanding literature on coaching best practices within the sports community. There is much that can be learned from sport coaches ranging from how they develop talent, facilitate group dynamics, apply theories of motor learning to skill development, to training individuals and teams to achieve optimal levels of performance in high stakes situations. While some learning takes place on game day, much of the athlete’s learning takes place during practice. While the language of simulation is not often used in the sports context, during practice, simulations of game play are executed and feedback is provided, using technology such as SportscCode. Our research into how this feedback is best delivered, and how it relates to performance in the game or “real life” situation should have application to the type of training taking place in the simulation centre where health professionals are trained. It is hoped that a dialogue between the sports and health professions domains will be opened. We have much to learn from each other. Reflections By Adam Dubrowski We have chosen to publish the two blogs (by Simon Reynolds and this one) side by side as they look at identical issues, but through two entirely different lenses. What Peter and Heather bring to the conversation is the beautiful fusion of applied research and education practice. Coaches working with the researchers using state of the art technology to enhance our understanding of how humans learn complex skills, as well as how to improve the Sea-­‐Hawk’s record. Both blogs draw parallels between sports derived coaching methods and heath professions education. I would only add that these parallels extend far into any space where human performance is of key importance: from operating a crane, to flying a helicopter, to steering an ROV, to performing in the operating room. MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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E-­‐RESOURCE We have made significant advances in compiling e-­‐resources for you. On our website, you can find links to most relevant journals and conferences that deal with issues related to simulation and education. http://www.med.mun.ca/TSRC/Who-­‐we-­‐are-­‐.aspx As a result of the discussions we had during our last workshop about where to publish, we have decided to pull together a list of journals that publish simulation in health professions education. Although this list considers medical and nursing focused journals separately, it does not list any medical-­‐division/specialty specific journals. This list does not offer any other simulation and modeling (S&M) journals such as those where simulation is used in engineering, aviation and marine contexts. Again, if you see gaps please let us know. Medical focus Medical Education Impact Factor: 3.617 http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291365-­‐2923 Academic Medicine Impact Factor: 3.468 http://journals.lww.com/academicmedicine/pages/default.aspx Advances in Health Sciences Education: Theory and Practice Impact Factor: 2.705 http://www.springer.com/education+%26+language/journal/10459 Medical Teacher Impact Factor: 2.045 http://www.medicalteacher.org Medical Education Online Impact Factor: 1.68 http://med-­‐ed-­‐online.net/index.php/meo/article/view/25771/html MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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Simulation in Healthcare Impact Factor: 1.593 http://journals.lww.com/simulationinhealthcare/pages/aboutthejournal.aspx BMJ Medical Education http://www.bmj.com/specialties/medical-­‐education New in 2014 from the BMJ family: BMJ Simulation & Technology Enhanced Learning http://stel.bmj.com/ “BMJ Simulation & Technology Enhanced Learning focuses on the use of simulation and innovative technology as an educational method or intervention for professionals in all areas of health and social care education, workforce development and quality of care. The journal seeks to contribute to research, innovation and knowledge translation for practitioners, teachers, students and leaders in all health and social care professions who wish to improve clinical outcomes, patient experience, and safety.” Nursing focus Clinical Simulation in Nursing Impact Factor; 1.145 www.nursingsimulation.org/ Journal of Nursing Education Impact Factor: 1.13 http://www.healio.com/nursing/journals/jne International Journal of Nursing Education Scholarship Impact Factor; 1.079 http://www.degruyter.com/view/j/ijnes Nursing Education Perspectives Impact Factor; 1.06 http://www.nln.org/nlnjournal/ MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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CHOP SHOP One day this week, Andrew Smith came to my office and we talked about the fact that low-­‐tech, low-­‐cost simulation does not receive as much attention as the bells and whistles of computerized models. Coincidentally, preparing for an upcoming high-­‐school science fair, one of our partner’s daughter (Dr. Mohamed Sheheta, Faculty of Engineering) presented on the topic of low-­‐tech, low-­‐cost solutions to the development of simulators to teach ultrasound skills. This topic is very timely considering our work with development of simulation-­‐augmented education in Haiti and for our own remote north. In this issue of the newsletter we decided to give you 2 such recipes. Low-­‐cost homemade gel block for ultrasound training Author: Dina Shehata (High school Student) Context: Ultrasound is a valuable tool being increasingly integrated into a multitude of different disciplines of clinical medicine. Point of Care Ultrasound (PoCUS) improves patient safety when used to guide procedures such as central line placement, paracentesis, and thoracentesis. Training residents to be proficient in ultrasound needle guidance predominantly relies on the use of commercial phantoms or gel blocks. These simulators range in cost from $100-­‐5000 per unit and facilitate a defined number of needle-­‐sticks. Home-­‐
made phantoms are inexpensive ($5-­‐10 per block) and have been cited in the literature as being of good quality. Provided are recipes and preparation instructions for 2 such models. Homemade “thick” gel block (Figure 1) This recipe is based on the link on YouTube: https://www.youtube.com/watch?v=u9_1md1f-­‐NM&feature=youtu.be&noredirect=1 Ingredients •
Gelatin •
One mixing bowl •
Metamucil (sugar-­‐free) MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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Measuring cup 2 Tupperware containers of the same size (I used a 7 ½ x 4 ¾ x 2 ⅞ inch containers) 2 water pipes with different outer diameters (¾ inch pipe and 7/16 inch pipe) Spade drill bits that correspond with the water pipes Drill Cloth soaked in cooking oil Any preservative (I used 70% isopropyl alcohol) Hot water Hand mixer Spoon and sieve •
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Preparation 1.
Take one of your Tupperware containers and drill two different sized holes on the left and right faces of the containers. Have each hole line up with the hole of the same size on the opposite sides of the containers. Note that these two holes will be made with the drill bits that are the same size as your water pipes. 2.
Place the two water pipes in their corresponding holes through the container from end to end. 3.
Then lubricate the pipes with your oil-­‐soaked cloth so that they would be easier to take out later. 4.
Take your mixing bowl and in it put 180 grams of gelatin powder, 1000 milliliters of water, 60 milliliters of preservative and 2 tablespoons of Metamucil. 5.
Use the hand mixer for about 1-­‐2 minutes and make sure all the powder dissolves. 6.
Using the sieve remove the air bubbles and debris from the surface. 7.
Pour liquid into container then place it in the refrigerator for around 3-­‐4 hours. 8.
Once the model is firm, remove the pipes but be a bit cautious as to not move them around too much so they won’t ruin the block. 9.
Put the model in a new plastic container. 10. While it is in the container fill the two holes of the model with water. Remove all excess air by tilting the container then pushing down on the model and squeezing the air out and refill until the vessel is full. Make sure there are no air bubbles. MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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Figure 1. Top panel: representation of commercially available “expensive” and home-­‐made gel blocks. Middle panel: ultrasound images produced using the homemade blocks. Bottom panel: ultrasound images produced using the Blue phantom, commercially available and expensive blocks Homemade ”thin” gel block This recipe is based on the link on YouTube: https://www.youtube.com/watch?v=ypw8vjZ2DN0 MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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Ingredients: •
Gelatin •
Two different sized plastic tubes (I used a ¼ inch plastic tube and ¾ inch plastic tube) •
Measuring cup •
Measuring spoons •
Whisk •
Tupperware container at least 2-­‐3 inches in height (I used a 7 ½ x 4 ¾ x 2 ⅞ inch container) •
Non-­‐stick spray or cooking oil •
Pot •
Paperclips or staples Preparation NOTE: There will be two different layers two this block. Bottom Layer: 1.
Put 250cc water into a pot and boil until you see little bubbles coming out the bottom of the pot. 2.
Gently stir in 21 grams of gelatin. 3.
Whisk rapidly so you won’t get clumps of gelatin. 4.
Once the gelatin is added and dissolved, add in one tablespoon of Metamucil all the while still whisking. 5.
Pour the mixture into your container and then place in your fridge for about an hour 6.
Take your plastic tubes and tie off the ends with some string or knot them. Then fill them up with water and tie off or knot the top. Make sure that they are not leaking water. If they are leaking, something I did was to set fire to each end and mold them shut while they are still hot and are able to be easily shaped. 7.
Take your container out of the fridge and put the plastic tubes on top of the mold. They should be a few cm away from each other. In order to secure Penrose Drain, I used paper clips and bent them into the shape of staples and tacked down the Penrose Drain. Top Layer: Note: This layer will actually be thicker than the bottom layer. 1.
Put 425cc of water into a pot and make it boil until once again there are little bubbles reaching the surface of the water. 2.
Mix in 35 grams gelatin and whisk it. Make sure it has dissolved and there are no clumps before adding in 1.5 tablespoons of Metamucil. Mix until completely smooth. 3.
To make sure there are no clumps you can use a tissue as a sift to take out all clumps. 4.
Let this mixture cool for about 20-­‐25 minutes before pouring it onto the 1st layer. Every 5 minutes go and stir it to prevent clumps and so it can cool evenly. 5.
Then pour mixture onto 1st layer and then take the whole thing and place it in the refrigerator for about two hours. 6.
When you take it out you’ll notice that it is not completely solidified but it is still pretty firm. 7.
Take a dull knife to go around the edges and the model should easily fall out. MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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Put the mold on wax paper, wrap the model, put the whole thing in a Ziploc bag and place it in the fridge overnight. After that it will be ready for use. WORKSHOPS LAST WORKSHOP (in this series) Workshop 6: February 6th, 2015 WRITING A FUNDING PROPOSAL NEW FOR 2015: TUCKAMORE SIMULATION RESEARCH CERTIFICATE PROGRAM We would like to thank all of you who have attended elements of the inaugural workshop series. Although there is still one more workshop on February 6, 2015, you have provided us with feedback and comments, which we can use to improve the series to be more suitable for working professionals and augment your scholarly work. Consequently, the original workshop series have been re-­‐done completely and complemented with a flexible, milestone-­‐based curriculum. Together, the workshops (now referred to as the bootcamp) and the milestones are designed to offer individualized support and mentorship to take your research projects from conception to a peer-­‐reviewed paper. The first pilot cohort will start as early as May 11, 2015! For more information visit our website: http://www.med.mun.ca/TSRC/WhatWeDo/Workshops/Certificate-­‐
Program.aspx. If you have comments of ideas for improvement do not hesitate to contact us. SUGGESTED READINGS CLARKE, S., HORECZKO, T., CARLISLE, M., BARTON, J., NG, V., AL-­‐SOMALI, S., BAIR, A.. Emergency medicine resident crisis resource management ability: a simulation-­‐based longitudinal study. Medical Education Online, North America, 19, dec. 2014. Available at: <http://med-­‐ed-­‐online.net/index.php/meo/article/view/25771>. QAYUMI K, PACHEV G, ZHENG B, ZIV A, KOVAL V, BADIEI S, CHENG A. Status of simulation in health care education: an international survey. Adv Med Educ Pract. 2014 Nov 28;5:457-­‐67. MEMORIAL UNIVERSITY OF NEWFOUNDLAND
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Our partners Faculty of Medicine (Medical Education Scholarship Centre), Clinical Learning and Simulation Centre, NorFam (Labrador), Centre for Collaborative Health Professions Education, Aboriginal Health Institute, Schools of Nursing, HKR and Pharmacy, Marine Institute, Grenfell Campus (Western Regional School of Nursing) MEMORIAL UNIVERSITY OF NEWFOUNDLAND