Patient Safety and Simulation Initiatives
Simulation is utilized to implement patient safety initiatives. A Moderate Sedation Course is taught using a simulation exercise that highlights pitfalls and rescue techniques for patients undergoing moderate sedation. Nursing utilizes simulation exercises to demonstrate potential errors with IV pump management and other high-risk areas for medical error.
As a highlight of UF education week, teams of residents and nurses from across the institution compete against one another in high fidelity hybrid simulation scenarios emphasizing teamwork and communication skills.
Resuscitation and Crisis Resource Management
The UFCOM-Jacksonville emergency medicine residency program and the UF Health Jacksonville emergency nursing staff perform quarterly resuscitation training events aimed at junior physicians and nurses new to the resuscitation area. Heavy emphasis is placed on crisis resource management and teamwork and communication skill training, along with critical patient care case management and just-in-time training for new procedures, equipment, and algorithms. Debriefing allows the moderators to focus on critical events and provide feedback based on goals and objectives created for each scenario.
In addition, the Cardiovascular Intensive Care Unit (CVICU) nursing staff and cardiothoracic surgery train with post-op scenarios that require immediate action and coordinated team response. Both nursing and physician leadership contribute to the scenario development and debriefing.
The emergency medicine residency program at the UFCOM-Jacksonville utilizes CSESaR for both presentation and simulation experiences as part of the program's didactic curriculum. The training is aimed at incorporating all six core competencies. Faculty, Pediatric Emergency Medicine (PEM) fellows, residents, and medical students participate regularly in simulation exercises. In addition, EM nursing participate in team training exercises. Lecture, case-based, and educational gaming/interactive presentations comprise approximately 67% of the scheduled, synchronous educational presentations with much of this performed in CSESaR. Simulation exercises that correlate with these educational activities account for the other 33% of the curriculum. Adult and pediatric simulations occur with resident involvement utilizing high-fidelity simulation, role-play, standardized patients, and hybrid simulations. Task trainers and cadaveric labs are used for procedural competency training. The residency regularly collaborates with hospice educators and chaplains for “delivery of bad news” training. Mass casualty incident training provides residents exposure to disaster training in a full size emergency department. Goals, objectives, and debriefing evaluations are available electronically. The events and debriefings are captured and stored on CSESaR's B-line recording solution for future review.
All internal medicine residents participate in on going training within CSESaR as part of their morning report curriculum at least twice monthly. Brief cases are prepared by the chief residents and individual residents are selected for participation and assigned various roles. Code team training is provided for first and second year residents utilizing high fidelity simulators with video debriefing. The residents also train on task trainers for central lines, lumbar puncture and intubations. The simulation education curriculum gives faculty a venue for evaluating and providing directed feedback in several of the core competencies, including patient care, medical knowledge, communication, practice based learning, and professionalism.
The neurology residents are involved in simulation training in a number of areas. The residents and stroke/cerebrovascular disease fellow participate in “breaking bad news” simulations. During these events, training and competency in interpersonal and communication skills (ICS) and systems-based practice (SBP) are provided and assessed. Scenario based simulations with trained actors as patients and caregivers are utilized with real patient care scenarios. Residents receive immediate feedback on the core competencies of professionalism, ISC and SBP skills from faculty evaluators. The simulation training is gradually expanding due to positive resident feedback and the success of the initial programs.
Obstetrics and Gynecology
Faculty-directed obstetrics training incorporates both resident and medical student education. Residents at all levels of training are confronted with challenging birthing scenarios that enhance understanding and retention. Specific infrequently performed but high-risk procedures are routinely taught so that providers are able to master critical techniques that impact outcomes in the delivery room.
Residents also utilize task trainers and cadavers to advance skills in laparoscopic surgery techniques. Due to the nationally recognized advanced simulation education currently in place, CSESaR has been chosen as an initial American Congress of Obsetrics and Gynecology (ACOG) simulation training site.
Orthopaedic surgery utilizes simulation workshops to address educational objectives in areas of training such as spine anatomy and techniques. The workshops are designed to train and evaluate performance in the core competencies. Using cadaveric stations and supplemental “sawbones” stations, multiple scenarios including percutaneous vertebral biopsy and kyphoplasty, anterior and posterior cervical instrumentation, dissection of anatomy and exposure for laminectomy and bone graft harvest, performance of laminectomy, and lumbar pedicle screw instrumentation are performed. Evaluations of resident performance in PGY specific tasks recorded in the simulation center are included in resident learning portfolios.
The department has performed educational research in regard to the competency of “practice based learning” to find most effective ways to train complex techniques. The conclusion showed that mentored education produces less technical errors and improved scores on knowledge base testing.
Several core surgical courses and skill labs are supported by the simulation center.
These courses include the Fundamental Critical Care Support Course, a two-day comprehensive course addressing fundamental management principles for the first 24 hours of critical care. All surgical residents take this course yearly in addition to respiratory therapists, nurses, physician extenders and other interested department housestaff.
The Fundamentals of Laparoscopic Surgery (FLS) training is also administered and partly supported through CSESaR. FLS is a comprehensive web-based education module that includes a hands-on skills training component and assessment tool designed to teach the physiology, fundamental knowledge, and technical skills required in basic laparoscopic surgery. The FLS Test measures cognitive knowledge, case/problem management skills and manual dexterity. All surgical residents participate in this required yearly training. The FLS program content has been endorsed by the American College of Surgeons (ACS) and is a joint educational offering of SAGES and ACS. We are the only center in NE Florida to offer this.
CSESaR further provides support and resources for the American College of Surgeons/Association of Program Directors Surgery Surgical Skills Curriculum that is presented as an ongoing surgical resident training course. The curriculum has been carefully structured and designed by content experts to enhance resident training through reproducible simulations, with verification of proficiency before operative experience.
School for the Medical Arts
The UF Center for Simulation Education and Safety Research (CSESaR) is currently involved in the “School for the Medical Arts” (SoMA). With $24.8M in funding from the Duval County School System and the U.S. Department of Education, SoMA will become a grade 6 to 12, full high school Magnet program in the U.S. with a medical focus. With the funding, new structures will be built at the site and the enrollment at the school will be doubled. The importance of this for simulation is the role CSESaR played in getting this grant and the role it expects play in the program.
The program includes substantial simulation training at CSESaR—traditional hands-on simulation, as well as cutting-edge virtual reality and hybrid scenarios. It is expected that students will graduate from high school with basic life support certification (BLS) and associate nursing credentials. The vision is that this program will encourage these young students to enter college with the ultimate goal of seeking advanced medical degrees.
This is not intended to be just a local CSESaR effort. CSESaR will encourage cooperative efforts among medical schools and simulation centers in the U.S. and around the world to support similar efforts.
Disaster Medical Assistant Team (DMAT)