A Graduatte Level Immersive-Simulattion Program for Teaching and Assessing Fundamental Skills in Entry Level Clinical Perfusionists.

Background: The clinical perfusionist is a member of the open-heart-surgery team and responsible for operating the life support equipment that replaces the function of the patient\u27s heart and lungs and arrests and restarts the patient\u27s heart in the course of a Cardiopulmonary Bypass (CPB) procedure. In the perfusionists scope of practice, the consequence of unskilled actions, inaccurate understanding or delayed decision making may result in significant patient morbidity or even death. Historically, perfusion students have learned and practiced their skills within a clinical preceptorship program in which an experienced clinician allows the novice student to operate the life support equipment under their direct supervision and consultation. While there is clinical evidence from numerous surgical specialties which establishes that learning curve associated errors have a negative effect on patient outcomes, this has not been researched for clinical perfusionists. Despite this evidence gap, the professions leaders have been instrumental in driving educational innovation and the development of medical simulation models that may reduce the patient\u27s exposure to learning curve associated morbidity by developing competence with high-risk clinical skills prior to patient contact. The purpose of this research is to develop, validate and apply novel medical simulation techniques and technologies to the preparation of entry level clinical perfusionists and demonstrate pre-clinical competence with the fundamental perfusion skills.Methods and Results: To inform the development of a skills curriculum we conducted two national surveys using online survey tools. Through these surveys we validated a list of fundamental skills, and the deconstructed sub-elements involved in the conduct of these skills. Additionally, we identified the typical ranges of physiologic and technical parameters that clinicians maintain during clinical procedures. With this foundational benchmark data we validated the performance of a simulated patient to establish that the patient surrogate generates data that is substantially similar to the physiologic and technical data that a perfusionist would manage during a live clinical procedure. This validated simulation technology was then incorporated into a high-fidelity simulation suite and applied to an innovative immersive curriculum which included hands on repetitive practice, live and video supported self, peer and expert observation and feedback as well as a battery of high-stakes assessments. The validity and fidelity of the simulated experience was established through analysis of over 800 opinions generated over 10 years by novice and expert perfusionists after performing simulated cases. Finally, the efficacy of the simulation curriculum was assessed by comparing our simulation trained students to a national pool of their peers from other schools and expert clinicians. Through this process we generated the first measurements of the typical learning curve for the fundamental skills of CPB, the first estimates of error rates for students navigating the learning curve and the first benchmark measures of competent performance in a simulated environment. This data establishes that students learning in traditional clinical training programs conduct three-fold more errors than experts and will have approximately 99 high-risk patient encounters prior to developing competence with fundamental skills. By comparison, simulation trained students demonstrated competence with fundamental skills that was similar to the experts with almost no high-risk patient encounters. Discussion: The implications to patient safety are clearly implied. These studies establish that there is a high level of agreement among clinicians regarding the skills that are necessary to operate perfusion equipment and that realistic simulation environments can be designed and applied to the development of student\u27s fundamental perfusion skills without exposing patients to the threat of students learning curve associated errors. This data may catalyze a larger national dialog regarding Entrustable Professional Activities for perfusionists and influence national accreditation standards for educational programs

Oral Paper SP63. Learner Centred Communication Masterclasses

Background HYMS 3rd and 4th Year MB ChB students frequently encountered communication challenges on clinical placements, despite extensive communication skills teaching in the first two (university based) years of the course. PresentationCompulsory Communication Masterclasses were introduced for 3rd and 4th year students to provide an opportunity for them to address Communication and Professionalism challenges they have encountered on clinical placement. The student-centred Masterclasses are led by Primary /Secondary Care clinicians working with experienced Simulated Patients. They provide an opportunity for students to role play Communication/Professionalism challenges and receive feedback from their peers, Simulated Patient and tutor to help identify strategies for dealing with similar challenges in their future career. Evaluation Students are required to complete an online evaluation which includes descriptive and Likert scale feedback. Students give consistently positive feedback on these sessions, and highlight appreciating the opportunity to reflect and learn from clinician tutors about real-life communication/ professionalism challenges. This student evaluation informs Staff Development Masterclasses for tutors, tutored by faculty and run similarly to the Student Communication Masterclasses. These provide an opportunity to address challenges that tutors have encountered when tutoring Masterclasses and ensure that tutors deliver a consistently high quality student-learning experience

Roundtable RT06. Clinical Reasoning skills: Something that can be taught or just a matter of seeing lots of patients?

There is considerable literature regarding the complex nature of clinical reasoning for clinicians. Norman (2005) stated “there is no such thing as clinical reasoning - there is no best way through a problem. The more one studies the clinical expert, the more one marvels at the complex and multidimensional components of knowledge and skill that he brings to bear on the problem, and the amazing adaptability he must possess to achieve the goals of effective care”.For novices to become experts they need extensive deliberate practice to facilitate the availability of conceptual knowledge and add to their storehouse of already solved problems (Norman 2005).The authors are aware that previously students learnt how to reason clinically by clerking lots of patients and constructing lists of likely differential diagnoses. Students were repeatedly interrogated by doctors to justify their differential diagnoses. Changes in working time directives and increased shift working mean that students are less likely to have to justify their thinking on several occasions to the same doctor who then helps them develop their reasoning skills.Today’s students face further challenges, as modern medical curricula generally focus on delivering clinical experience in system-specific rotations leaving students unable to organise information effectively when patients present with complex, multisystem illnesses. A limitation of systems based curricula is that it does not encourage the development of clinical reasoning skills.There is now extensive literature regarding the need to explicitly teach clinical reasoning skills to students in addition to them having lots of practice in clerking patients and then constructing lists of the most likely differential diagnoses.Delegates at this round table discussion will be encouraged to debate whether they believe that students can be explicitly taught clinical reasoning skills or whether it is just a case of ‘seeing lots of patients’

Oral Paper S26 - What are students frightened of?

Background Despite extensive consistent integrated early clinical experience at HYMS, students have often been noted to struggle in making the transition from the largely University-based Phase I (2 years) to immersion in the clinically-based Phase II. Tutors report student difficulties in adopting an appropriate attitude to learning in this environment; some are noted to respond to this by minimising the time spent on the wards with obvious consequences for their experience and education. Presentation A new “Core Clinical Skills and Professional Expectations” course, lasting 2 weeks was introduced in August 2014 for students making this transition. This block aimed to address many areas which students have been noted to struggle with, including professionalism and development of clinical diagnostic reasoning and skills for independent learning. Evaluation Students were asked to identify their own fears and anxieties about moving into the clinical environment. All students completed a brief survey at both the beginning and the end of this two week period which included identification of their own sources of anxiety in approaching immersion in the clinical environment. Results of this survey are presented and discussed with implications for clinical teaching

Workshop 13. Clinical Diagnostic Reasoning: Equipping students with peer instruction skills to work together in developing their diagnostic reasoning

Workshop Format An introductory presentation covering best evidence in current medical education literature regarding development of diagnostic clinical reasoning skills for undergraduate students Small group work focusing on clinical tutor- identified real case scenarios to enable delegates to identify teaching and learning approaches to help undergraduate students to develop diagnostic reasoning skills. This will include consideration of facilitation of peer-peer approaches for development of clinical reasoning skills A closing plenary will include • DVD demonstrating the authors’ approach to facilitation of skills development in this area • Further discussion about the student-led approach • Reflection on incorporating novel approaches in delegates` own curriculum and teaching sessions • Presentation of the authors student “pocket guide” hand-out • Questions/Answers/Sharing best practice. Workshop Submissions Objectives To consider clinical tutor-identified, specific, student cognitive-processing difficulties in clinical diagnostic reasoning in contemporary systems based curricula. o consider specific challenges for students in developing their own clinical reasoning skills, following a transition from university to clinical teaching environments. To aid development of students` ability to consider their own clinical reasoning skills and facilitate development of these skills in their colleagues To share best practice with colleagues To discuss the authors` example of curricular innovation in this area Intended audience Tutors responsible for delivering clinical skills/ clinical reasoning teaching in undergraduate training

The application of innovative virtual world technologies to enhance healthcare education

The World Wide Web has evolved leading to the development of three- dimensional virtual worlds. These are online, accessible environments through which a user may engage, communicate and interact via their digital self, known as their avatar. These virtual worlds offer the opportunity for further content to be generated in order to provide new environments and simulations. This research work explores the potential of virtual worlds in providing an educational platform for healthcare professionals. In order to establish this, the effectiveness of a virtual world environment was determined through the use of a custom-built virtual world operating theatre, which was utilised to train operating theatre novices in preparation for the real-life environment. Following the application of a virtual world environment, this research explored the development of a virtual patient scenario for training healthcare professionals. The virtual patient scenario focused on the management of adverse events associated with medical infusion devices with a nurse user group assessing the simulation face validity. The next step was to devise a methodology to develop a series of immersive virtual patients. This involved the use of allied web technologies to produce a robust, reproducible method of 3D virtual patient generation. Three virtual patients were constructed, with distinct surgical pathologies at three levels of increasing complexity. Subsequently the face, content and construct validity of the virtual patients was established to differentiate surgeons of different training grades. Finally the virtual patients were utilised to emulate real clinical situations, in which handoff of patient information occurred. The virtual patients were used to establish if the quality of handoff impacted on the subsequent patient management in a simulated setting. Overall this research has demonstrated the efficacy of virtual world environments and simulations in providing an alternative educational platform for healthcare professionals.Open Acces