Charles E. Schmidt College of Medicine
Florida Atlantic University
777 Glades Road
Boca Raton, FL 33431
Each case based learning exercise is developed by first describing the health state changes that would normally occur in a patient. This scenario algorithm follows all realistic health state changes and allows the trainers to vary the patient response based upon the participant's treatment or the pathophysiological responses caused by the disease or injury. Next detailed Learning Objectives are derived from the exercise, including baseline and advanced topics. The scenario is expanded by including patient background and history, which the participant will derive directly from the patient or from their chart. Details from additional lab test and results for the entire course of the scenario are created to respond to the expected requests from the medical staff. The use of ventilation therapy (oxygen regulators and ventilators) is available for each case as required. Additional equipment such as an electrocardiogram or Foley Catheters are included and tested with the scenario. The scenario scene is created, which may include Moulage, the art of adding makeup or blood or fluid lines to the patient for realism. We test the scenarios to develop a smooth flow, as well as the creation of the instructor note set creating a patient personality profile to focus questions and attention to proposed changes in the patient condition. Finally, we include both appropriate and inappropriate drug treatment protocols to assure that anticipated responses are correct. Detailed checklists are prepared, in concert with the case, for the Facilitators and Preceptors to follow and assess the performance of their participants.
Among the reasons this project is justified are:
1) To replicate this facility in Hospitals or other healthcare settings would require dedicated hospital space (loss of revenue bed potential), specifically designed for simulation training (outfitting costs), as well as the cost of high fidelity equipment, the hiring of, at least, two FTE positions to staff the Center, and the development of specific scenarios to replicate the Hospital protocols. Each station at the FAU Centers is capable of handling between four and six participants for optimal training. Our Centers have the ability to replicate cases that might take months or years to occur in the normal hospital clinical environment. These cases can be created and repeated for consistency and preparation. The result will be reduced morbidity rates and improved patient outcomes.
2) FAU has two identical Training Centers, one at the Boca Raton Campus in the Research Par and a second facility on the grounds of St. Mary's Hospital at the Palm Healthcare Pavilion on 45th Street West Palm Beach. These facilities provide an easier access to the Southern area hospitals and the Northern area as well. FAU has staffed the simulation center with professionals with backgrounds in Medicine, Nursing, Emergency Response Services, and technology. Our staff of physicians includes Cardiologists, Internal Medicine, Trauma and General surgery, Pediatrics, and Anesthesia. The Center is also staffed with experienced personnel that have developed and executed extended medical, disaster and emergency training and remediation.
3) The FAU Centers provides state of the art training facilities for Hospital staff to practice interdisciplinary communication essential to improve patient care and treatment and insure the highest level of patient safety, including Pre-hospital, Hospital, and Post-Hospital based personnel. By providing video and audio capture of the sessions in real time, the participants have documented capture of their activities which is essential in aiding the debriefing of the participants. The Centers can pre-record the sessions utilizing preceptors from FAU using standard protocols, so the participants have a model to compare and contrast their own performance.
The FAU simulation Center uses the latest High Fedility mannequens to actively engage and train our medical students starting in the very first semester through the fourth year of their medical education. The simulation center has been inculcated into the curriculum, and this is expected to increase with the addition of the new Clinical Skills Training Center that will be adjacent to the Boca Raton Simulation Facility. The medical students are exposed to case based learning throughout their medical training. In the Simulation Centers, the initial focus is on “Critical Thinking Methodology”. From the first interaction with the simulation center, the students are taught to think through a broad range of potential differential diagnosis, and then narrow their diagnosis based on information and evidence from history and physical examinations. In this manner, we reinforce the teaching concepts throughout the curriculum. At the FAUSC, we may have the students ascertain the condition of their patient through a thorough focused physical examination, requiring the turning of their patient and a complete head to toes examination to determine root cause of a patient condition. The patients respond in real time, giving the students the sense of realism in responding to patient treatment. If they prescribe the wrong dosage or amount of medication, the mannequin patients will respond accordingly and they learn firsthand about the impact of incorrect medication. The mannequin patients respond interactively with the students, as the exercise is managed remotely from outside the room. The exercises are videotaped and provided as a debriefing and memory record for the students. The students utilize these recordings to perform self-assessments and peer evaluations to identify issues with their own performance.
The Centers are used to expose the students to complex assessment on the mannequins. They utilize venipuncture trainers to learn to draw blood. Suturing techniques are taught using skin pads and appropriate medical equipment. They utilize the Intubation Heads to learn intubation protocols. They learn to practice physical examinations and assessments on rectal, pelvic, breast and testicular skill trainers. They learn cardiac sounds through the use of the Heart Sound “HARVEY” Simulator. They are exposed to advanced medical cases such as Cardiology, Pulmonary, Infectious Disease and Renal Disorders at the Simulation Centers. These detailed cases focus on key learning objectives and teachable moments during hands on case based learning with the mannequins.
The typical evidence based scenario is developed in conjunction with a Program Director for the particular discipline. The objective of the simulation scenario is to use the scenario as a vehicle to bring together all of the elements of their didactic and self-directed learning experiences. The scenario is developed by outlining the learning objectives, primary and secondary that the Director wants to emphasize. The scenario describes the environment, mannequin setup, any props or Moulage (makeup) required to make the patient seem more realistic (insertion of a pacemaker with scar and bandage covering), diagnostic studies (CBC, ECG, Chest x-ray, 12 lead, BMP, etc), medications that the patient had been taking and any distracters (socks covering foot ulcer, stage 3 sacral decubitus covered by patients shorts). The scenario then includes the physical pertinent positives, vitals including heart and lung sounds as appropriate. The Preceptors have a chart that assist their leading the medical students through possible etiologies and differential diagnosis. We map out the flow of potential patient changes, including those with positive and negative results, depending upon the diagnosis, or treatment provided by the students. We then can reset the case flow and restart the scenario and provide the correct treatment with the corresponding expected results. The scenario plan includes specifics for the debriefing and has the key objectives or take away points that the students need to review before the conclusion of the case. The cases contain facilitator (directors of the case from outside of the simulation room providing the voice and system responses for the mannequins) notes and key words or phrases to respond to medical student queries.
Each Training Session that is offered is comprised of hands on scenarios, followed by a debriefing session, led by Hospital supervisors or proctors. Each scenario is evidence based matching institutional/learner objectives needs which may include focusing on heart sounds, breath sounds, intubation or respiratory therapy and patient psychosocial needs. Prior to the start of all the cases, FAU presents an introductory examination of the Human Mannequin Simulators so that the nurses become familiar with their vital signs and responses. Prior to the start of the cases, the nurses may be given charts that relate to the specific patients to which they will respond. The Training Sessions can be a single session attended by a group of nurses from the same practice area, or may comprise a series of Training sessions over a period of weeks, focusing on different aspects of the same practice area (e.g. Telemetry, Medical Surgical, Emergency Room, Critical Care, Labor & Delivery, etc). The following table represents a sample of some of the cases the Simulation Center has already created:
Pediatric/Pediatric Intensive Care
Telemetry - Med/Surg
Each incoming class of residents will receive BLS/ACLS/PALS(as appropriate) training at our training centers. In addition, we have teamed with St. Mary’s Hospital and also provide ATLS training as appropriate. The FAU Simulation Center utilizes a baseline assessment program to identify areas of potential focused education for each class of residents. As part of this assessment, the FAUSC developed clinical stations utilizing customizable, Rectal, rhythm identification and Heart Sound “HARVEY” Simulators to present various clinical findings for a patient. The Residents are required to describe the diagnosis and prescribe the next steps in treatment. The Residents answer multiple choice questions regarding each simulated patient. In addition, FAU created numerous distinct cases and each PGY 1 - 3 performs an assessment and treats their patient on an individual participant basis. Various simulation methods and scenario combinations are used. For example:
Additional training for residency programs have been created to match other disciplines. Currently our training includes both our Internal Medicine and Surgical Residency’s, and we are preparing for our Emergency Department residents in the 2017. We currently have cases written for Cardiology, Pulmonary, Infectious Disease, Renal and Multi-system Failure, Shock and Stroke, Pediatrics, Labor and Delivery and neonatal conditions. We have skill training for surgery, with the inclusion of sonogram and ultrasound guided central line placements and “box” trainers for laparoscopic skills enhancement. In addition, we are preparing to integrate the minimally invasive surgical stations with our full body mannequins to simulate an operating theatre environment and duplicate emergent conditions during surgery.
The responsibilities of Medical Reserve Corps (MRC) volunteers vary, depending on the nature of the needs in the community. MRC volunteers consist of active or retired healthcare professionals who are unaffiliated with a hospital or institution and want to volunteer their services in the event of a disaster or national emergency and assist with public initiatives and ongoing community health outreach and education efforts. Major emergencies can overwhelm the capabilities of first responders, particularly during the first 12 to 72 hours. Medical and other health volunteers can provide an important "surge" capacity during this critical period. They also can augment medical staff shortages at local medical and emergency facilities. In short, communities often need medically trained individuals and others to fill in the gaps in their emergency response plans and to improve their response capabilities overall. MRC volunteers also strengthen the overall health of Americans by participating in general public health initiatives such as flu vaccination clinics and diabetes detection programs. The U.S. Surgeon General has outlined his priorities for the health of individuals and the nation as a whole. With an overarching goal to improve health literacy, he encourages MRC volunteers to work toward increasing disease and injury prevention, eliminating health disparities, and improving public health preparedness.
The Program has been designed to simulate emergency conditions in an effort to provide advanced training to professionals during an Emergency. These events may be related to disaster conditions caused by natural or manmade events. Emergency medical, trauma, biological, nuclear and chemical agents can be replicated in our Center. The scenarios will duplicate real events and facilitate analysis of the chain of patient safety and treatment procedures, while creating the illusion of real-life drama, both under normal and disaster circumstances.
The following is the outline for the course: