Forskning i færdighedstræning og simulation Nationalt lektor seminar 2011 Doris Østergaard, DIMS

1. Forskning i færdighedstræning og simulation Nationalt lektor seminar 2011Doris Østergaard, DIMS

2. Oversigt • Hvad er problemet? • Hvilke initiativer • Hvad er opgaven? • Hvordan løser vi opgaven?

3. Patientsikkerhed • Theoretical foundation • Human factors perspective – human error (Reason J, 1990) • Retrospektive studier har vist at fejl i kirurgi ofte skyldes utilstrækkelig kommunikation og samarbejde (1) • Prospektive studier har vist at dårligt samarbejde øger risikoen for komplikationer (2) • Teamtræning forbedrer kommunikation og samarbejde i operationsteamet (3) • Gawande A et al. Analysis of errors reported by surgeons at three teaching hospitals. Surg 2003; 133:614-621 • Mazzocco K et al. Surgical team behaviours and patient outcomes. Am J Surg 2009; 197:678-685 • Spanager L, Rosenberg J, Østergaard D. Kirurger har også behov for ikke-tekniske færdigheder. Ugesk for Læger. I trykken.

4. Hvorfor færdigheds - eller simulationsbaseret træning? • Træne i kontekst og dermed øge patientsikkerheden • Omsætning af teori til praksis • Patienten “skades” ikke • Trygge omstændigheder • Kompleksiteten kan kontrolleres • Fejl er tilladt (gentagelse er mulig) • Erfaring med sjældne,kritiske hændelser • Team træning muligt • Bygger på voksenlæringsprincipper (reflektion) • Give mulighed for at træne – balancen mellem antal patienter og antal uddannelselsøgende

5. Challenges • Research in the use of simulation technology is still in its infancy • Provide assurances that simulation complement/substitute clinical experience • Improve the quality and safety of patients • Publications • The state of medical educational research is comparable with medical research 20 years ago • Identified priorities for medical educational research (Fincher et al. Acad Med 2010) • Systematic reviews, task forces etc. (Bond et al Acad Med 2007, Gurusamy et al. Br J Surg 2008, Issenberg et al. Med Teacher 2005, Gaghie et al Med Edu 2010, Stefanidis Surg Clin North An 2010)

6. Few published journal articles on the effectiveness of high-fidelity simulations have been performed with enough quality and rigour to yield useful results. Only 5% of research publications in this field (31/670) meet or exceed the minimum quality standards.

7. www.bemecollaboration.org • / • about • BEME review 4 Features and uses of high-fidelity medical simulations that lead to effective learning: Barry Issenberg et al.sttarting a review • shed reviews • Providing feedback (47%) • Repetitive practice (39%) • Curriculum integration (25%) • Range of difficulty • Capture clinical variation • Controlled environment • Individualised learning • Defined outcomes • Simulator validity (3%)ctivities

8. Deliberate Practice & Mastery Learning • Skill Acquisition & Maintenance • Transfer to Practice • Educational & Professional Context • Rigorous Outcome Measurement • Non-technical Skills & Team Training • Role of Instructor

9. 4 Tracks each with Educational and Evaluation Sub-groups • Individual/Cognitive Expertise • Group Expertise • Technical Expertise • Systems Expertise

10. Consensus Statements and Recommendations from the 14th Ottawa Conference May 2010 • 6 ‘theme’ groups identified by organizing committee • Criteria for a good assessment • Technology-based assessment • Performance assessment • Assessment of professionalism • Assessment for selection for healthcare professions and specialty training • Research in assessment

11. 2010 Utstein Summit on Simulation-based Research Copenhagen, June 2010 24 simulation research experts from 8 countries

12. Ian Curran James Gordon Roger Kneebone Paul Phrampus Jette L. Sørensen Barry Issenberg Jack Boulet Vicki LeBlanc Vinay Nadkarni Georges Savoldelli Dimitrios Stefanidis Doris Østergaard Participants • Betsy Hunt • Pamela Jeffries • Nikki Maran • Eldar Søreide • Rachel Yudkowsky • Peter Dieckmann • Steven Howard • Bill McGaghie • Stephen Sollid • Amitai Ziv • Jacob Rosenberg • Charlotte Ringsted

13. Utstein type Meeting in Copenhagen June 2010 • The goal of the meeting was to • Identify the state of the art educational simulation based research • Identify the future directions and headline topics and research questions • Identify key methodological issues • Provide recommendations of what to include in research papers Grant from the Laerdal Foundation

14. Future Research areas in Simulation • Guidelines for reporting research on simulation • Instructional design • Designing and planning • Science of learning • Systems considerations • Faculty – the selection, the role and training programs • Outcome measures • Translational research • Identification of researchable problems • Framing general research questions • Identify conceptual and theoretical frameworks

15. Translation to Clinical Setting

16. The relatively weaker factors, where there are most improvements to make Which factors influence chances of resuscitation ? « All breakthrough, no follow through NIH Implementation Research Conference Jan 2009

17. “…meaningfully contributing to discussions of ‘Why did it work?’ or ‘Why didn’t it work’ can go a long way towards …prompting previously unthought ways of dealing with inherently difficult issues.”

18. “…Regehr’s article is a call to move away from research that is intended to prove the effectiveness of our educational endeavours and towards research that aims to understand the complexity inherent in those activities.” K. Eva

19. CLINICAL ENVIRONMENT Patients Identify learning need Reapply skill Review Continue Clinicalsupervision Tutor support Simulatorbasedpractice Further practice as needed Simulators SIMULATED ENVIRONMENT

20. January 20-22, 2011 – New Orleans Opening Remarks & Summit Overview

21. FocusAreas Human Factors Studies Human Factors Tools SummativeAssessment FormativeAssessment SystemDevelopm. OutcomeStudies Research Reporting Team Learning IndividualLearning Research With / On Simulation

22. Research – how to do it?

23. Bordage and Dawson, Med Education 2003 • ”The research question is the keystone of the entire • Enterprise, followed by the selection of an optimal study • design and the control of possible confounding variables. • No study is perfect. The researchers must constantly • weigh advantages and disadvantages and select • the most scientifically sound and feasible alternatives”

24. States an independent variable Learner’s level of training Number of practice hours Feedback present (or not) States an outcome Speed to complete simulation Errors in completing the simulation Errors in real clinical task McGaghie et al from IMSH 2008 States a direction of outcome “….will be greater than…..” “….will show a positive relationship “….a greater proportion of learners will….” States subjects in the study Medical students Post graduate/staff Teams Good Research Question

25. Research in medical education • Research is about inquiry into general problems, phenomena, and mechanisms of learning, teaching, training, education • Research in medical education is neither about solving concrete, local problemsnor about providing universal solution Regehr ME 2010

26. Research approaches • Medical education is a complex phenomenon operating in a complex system • Multiple research approaches are warranted • An overview model – “The cycle of research” • Campbell et al, BMJ 2000. Framework for design and evaluation of complex interventions to improve health. • Cook et al, Med Educ 2008. Description, justification and clarification: a framework for classifying the purposes of research in medical education. • Bordage, Med Educ 2009. Conceptual frameworks to illuminate and magnify • ++++ Ringsted 2010

27. The cycle of research Justifying Experimental studies Observational studies Conceptual theoretical framework Modelling Predicting Exploratory studies Translational studies Implementing Ringsted 2010

28. JAMA. 2007;298(9):1002-1009 • MERSQI – 10 item measure of medical education research study quality • MERSQI scores independently associated with • Previous publications by 1st author • Study funding ≥ $20,000 USD (↑ scores w/ ↑ funds)

29. The future - collaboration • The role of the different societies • Bringing multi professional researches together – establishing teams across disciplines and professions • Multi-centre studies – increase power • Funding