Q: Do you think this is the wave of the future?
A: Absolutely. And as the Accreditation Council for Graduate Medical Education promulgates new rules that limit the hours trainees can work, it’s going to be incumbent on training programs to be creative in providing equal or near-equal experience in a much shorter time. Simulation can help fill that bill.
Q: You created a crisis-management simulation course for IM residents. How did that come about?
A: When we have a crisis like a code blue, I witnessed the chaos that ensued. I thought some of the paltry resuscitation rate could be due to the fact there was no meaningful communication in that scenario.
Using full-scale mannequins, I put nurses and residents into those types of situations and videotaped what ensued. Frequently we saw the same chaos we see in reality, and many rather basic, commonsensical concepts went out the window.
Q: Can you offer an example?
A: A big one is situational awareness. If the head of the gurney is in a seated position, that’s not a conducive way to do chest compressions. If the side rails of the bed are up, you can lower them so you aren’t reaching over them. Was a team leader assigned or were roles delegated? These aren’t novel concepts, but when faced with a crisis, everybody tends to focus on their own thing. In a crisis, you need to break those silos down and operate as a team.
Q: How effective is the training?
A: After the first scenario, we show the video and debrief them for 10 or 15 minutes, keying in on some behaviors that can be employed in a crisis. Then we expose them to a different crisis scenario immediately thereafter. Often we see an immediate change in their behavior.
Q: You developed a curriculum through which residents are taught in a standardized manner how to perform invasive bedside procedures. How does it work?
A: They have 12 hours of hands-on instruction using fluid-filled, ultrasound-capable mannequins. A faculty attending teaches these procedures. We took it a step further and made a four-week rotation as a mandatory component of the residency program. They carry a beeper, and any service within the hospital can call the procedure team to do one of the procedures on which they were already trained.
Q: How successful is the effort?
A: This is the beginning of our fifth year, and we’ve been called more than 4,000 times to do procedures on hospitalized patients. We’ve published our curriculum. We’ve shown a significant improvement in knowledge, technical skills, and confidence level, and we have data we’re going to publish later this year that shows our complication rates are better than complication rates that are published elsewhere.
Q: What is your biggest professional reward?
A: The ability to impact the next generation. With the procedural training alone, we have just trained our 1,000th person. Each one of them is going to take care of thousands of patients in their professional careers. That’s an expansive influence.
Q: What is your biggest professional challenge?
A: The culture of medicine. It is infused with hundreds of years of tradition and, at times, it feels like trying to move a mountain. It may take a generation to do it, but there will come a time—at least within the field of patient safety—when more people are attuned to it and understand the concepts really are lifesaving. That doesn’t happen as fast as I would like it to, but if we keep plugging away one year at a time, we will be able to make an impact.