The Use of Dramatic Simulation in Patient Safety Education or “Doc-U-Drama”

1. The Use of Dramatic Simulation in Patient Safety Educationor “Doc-U-Drama” Margaret Kirkegaard, MD, MPH

2. Outline of Workshop • History of Doc-U-Drama • Description of Doc-U-Drama • Educational Rationale for Doc-U-Drama • Evaluation data • How to try Doc-U-Drama yourself • Doc-U-Drama with participants

3. History of Doc-U-Drama • Result of previous failure • Built on realization that our medical education system produces highly autonomous, perfectionistic residents who are inherently refractory to talking about medical errors: “no trust” • Goal is to open brains to the concept of systems theory and medical errors

4. Description of Doc-U-Drama • Scripts dramatizing real adverse events • Performed by learners • Followed by discussion • Usually starts with trying to assign blame then moves to recognition of complexity

5. Educational Rationale for Doc-U-Drama • Focuses on communication • Drama-based education techniques • Standardized patients • Simulation training, clinical (ACLS) and other high-tech industries

6. Safety and Communication • Overfocus on Content in healthcare • CPOE • Abbreviations • Computerized sign-outs

7. Safety and Communication • Underfocus on Context and Process • Hierarchy • Interpersonal conflict • Role ambiguity • Lack of training • Fragmented communication

8. Drama-based education • Used to teach about complex doctor and patient relationship issues • Engages the “players” • “Real” but anonymous • Evidence that it promotes empathy and attitude change

9. Standardized patients AAMC Report, May 1998 • 97% of all schools report using in some capacity • 80% of all schools use to teach doctor-patient communication skills • Focuses on individual doctor-pt communication rather than complex communication networks

10. Doc-U-Drama Evaluation • 69 total evaluations • Completed in four different settings

11. Feedback • “Fun!”  • “Great! Now how do we fix it?”  • “I worked on the pt safety committee at a major medical center. This was a really good lecture. The examples were very realistic. A couple were similar to incidents we had. Thank you.”

12. SA % A % N % D% SD% Doc-U-Drama is an effective way to learn about medical errors. 39 56 4 0 0 Doc-U-Drama is an effective way to see medical errors from the viewpoint of all the people involved. 45 51 3 1 0 Doc-U-Drama creates an emotionally comfortable environment in which to explore medical errors. 48 49 3 0 0 Doc-U-Drama is more effective than didactic presentations for learning about patient safety. 49 35 14 1 0 Doc-U-Drama effectively illustrates the complexities of our health care system. 46 45 9 0 0

13. Benefits of Doc-U-Drama • Emotionally safe • Explores complexity and communication patterns • Explores multiple perspectives • Fun, relaxed • Requires no prep time from participants

14. Doc-U-Drama Format • 60 minutes to 3 hours • Classroom or conference room • Can use simple props or signs • 10-40 participants • Medical students, PA students, attendings, residents (JF has worked with interdisciplinary groups)

15. Doc-U-Drama Format • Brief introduction: IOM report • Discussion about why this is a “hard topic” • Bad apples vs swiss cheese demo • Doc-U-Drama • Discussions shifting from “bad apples” to “swiss cheese” • Include remediation techniques • One page handout or PDA memo

16. Doc-U-Drama Focuses • Engaging or joining with learner: “This is hard stuff” (Marine technique) • Use group facilitation to promote learning • Eg: That’s an interesting idea, does anyone else have a different opinion?” • Promote “swiss cheese thinking”

17. Conclusion • No real outcomes data • Fun, high energy • Use and adapt scripts • Create own scripts (JF found script writing to be an interdisciplinary pt safety learning exercise)