Emergency Medicine Residency Education – Adult Simulation

Simulation ManikinRecognizing the importance of experiential learning, efforts have been put forth to simulate various medical diseases and processes. We employ different levels of fidelity with regard to simulators from simple task trainers to more advanced high-fidelity patient simulators. Our sessions can concentrate on certain disease processes with an emphasis on their recognition and treatment. We also use simulation to work on teamwork and system based issues with the Emergency Department nurses and staff with in-situ sessions in the Emergency Department covering such topics as resuscitation and STEMI care. These sessions typically occur each month.

Emergency Medicine Residency Education – Pediatric Simulation

EM Pediatrics SimulationThe Emergency Medicine Simulation program devotes a great deal of energy and time to educate residents in the management of pediatric emergencies through the use of high fidelity simulation. There are scenarios presented every other month as part of educational themes for pediatric conference days. These are designed to add practical experiences for residents that allow them to apply the day's didactics in a high fidelity simulation scenario. These scenarios are regularly conducted in a multi-disciplinary context that includes our nursing staff in both the scenario and debrief. We also participate and deliver scenarios designed for inpatient settings to augment the resuscitation skills of pediatric residents who may encounter any number of acute presentations on inpatient ward services. We feel Pediatric Emergency Simulation is an area of expertise for the group that we are able to bring to our on campus and off campus learners.

OHSU School of Medicine, Med Student Simulation:

Simulation EquipmentThe Introduction to Patient Simulation course is OHSU's first simulation-based elective for second year medical students. This course is designed to act as a bridge between the non-clinical and clinical years of medical school, linking patient symptoms, exam findings, and management plans to students' basic science knowledge of anatomy, pathophysiology, and pharmacology. Each of the eight hour-long sessions highlights a cardinal presentation. By linking these diagnoses to a common symptom—such as shortness of breath—students are able to compare and contrast their patient's story and physical exam findings to the patients they have seen in prior sessions. This reinforces the critical exam findings, how these are explained by the pathophysiology of their disease process, and differences in management. Through this longitudinal experience, learners begin to build 'illness scripts', problem representations that help clinicians organize their knowledge of various disease processes into framework that enhances diagnostic reasoning. Our hope is that these preclinical simulated experiences will anchor the students' basic science knowledge in 'real life' patient encounters, and encourage a learning model whereby our students will compare and contrast the presentation and management of multiple disease processes simultaneously when they reach their clerkships.

Trauma Simulation

The effects of patient care in situations where multiple health teams are working together create a complex environment. Teamwork and communication skills are highlighted in the care of these patients. In order to practice these skills, the Trauma Surgery and Emergency Medicine teams take part in joint simulated trainings in a simulation theatre using a high-fidelity simulator. These scenarios begin with the arrival of EMS through to an ultimate disposition. Both departments have noted improved teamwork, role definition, and communication as a result.

STEMI simulation

The rapid recognition and treatment of patients suffering ST-elevated myocardial infarction (STEMI) is incredibly important for this time-critical condition. The use of pre-hospital EKGs and identification of STEMIs prior to arrival has worked to decrease the door-to-balloon time (D2B). In contrast, patients arriving to the ED in private vehicles can have increased D2B times. In order to work on this issue, we planned and put on an in-situ STEMI simulation beginning with the arrival of a patient with chest pain with his family, the identification of an anterior STEMI in the ED, the activation of the catheterization laboratory, communication to cardiology, and ultimate transfer of the patient for PCI. Efforts are being put forth to repeat and practice such scenarios to help decrease the D2B times. This activity coincided with the site visit from the Society for Chest Pain Centers which resulted in OHSU garnering accreditation as a Chest Pain Center.

Pediatric Mock Codes - Doernbecher Children's Hospital

Pediatric Mock Codes are monthly multidisciplinary learning opportunities utilizing simulated patients in actual clinical environments. This is a collaborative venture between the Doernbecher Pediatric Intensivits, Hospitalists, NICU team, and Pediatric emergency medicine teams. Each mock code involves the Senior pediatric resident as the code leader, unit nursing staff, and other pediatric residents to fill assigned roles. When appropriate, the Pediatric Transport team (PANDA), who is also part of the pediatric code team, is utilized to assist with more realistic organizational code simulation. Achievement of stated medical knowledge objectives is documented using a skills checklist. Cognitive awareness is assessed utilizing the Behavioral Basement Tool. Feedback is provided via video taped review of the team's performance and multidisciplinary discussion.