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Innovative Problem Based High Fidelity Simulation to Teach Higher-level Problem Solving Strategies

Tuesday, May 15
11:00 - 12:30
Location: Neptune 1&2

Context: : Due to variable anatomic and physiologic characteristics, critically-ill patients with congenital heart disease may manifest illness in an unconventional manner and require rapid intervention tailored to their unique pathophysiology. Clinicians in training often struggle with efficient and effective response to deterioration of cardiac patients due to their unique disease processes and lack of exposure to individual congenital cardiac pathologies. Problem and simulator-based learning (PSBL) have been shown to be effective tools to develop critical thinking in bedside providers. We hypothesized that PSBL will lead to improved critical thinking for trainees in pediatric cardiac critical care (PCCC).

Description: : Thirty-six, half-hourly PSBL sessions involving the pediatric critical care, cardiology and neonatology fellows and advanced practice providers were performed from 04/2016 till 10/2017. To enhance the discussion and teaching we purposefully grouped higher level learners (fellows and instructors), instead of traditional multidisciplinary approach. Few examples of scenarios taught are 1. Management of hypoxemia in single ventricle physiology (pre and post-operative); 2. Management of post-operative arrhythmia with hands on use of temporary pacemaker; 3. Management of hypoxemia in transposition physiology; 4. Management of shock in post-cardiopulmonary bypass patients; 5. Management of cardiogenic shock in patients with acute and chronic heart failure; 6. Management of emergencies in patients supported with mechanical circulatory devices. No scenario was repeated over 6 months period. Participants evaluated each session for preparedness, content presentation, self reported improvement in knowledge and facilitation of safe learning environment.

Observation/Evaluation: : These 36 sessions were attended by 102 participants during the aforementioned period. On a scale of 1-5 (reflecting categories from very poor to excellent), on average each session was as 4.99 for preparedness, 4.70 for content presentation, 4.96 for improvement in knowledge and 4.97 for facilitating safe learning environment. Participants especially appreciated the hands-on and interactive nature of sessions and requested for frequent sessions.

Discussion: : PSBL is an effective and innovative method to teach core concepts related to PCCC physiology and can help develop critical thinking in PCCC trainees. The hands-on approach, ability to think through the disease process and getting instantaneous feedback on thought process, in a safe and relaxed environment distinguishes this unique approach from traditional didactic teaching. Assimilating learners from different background help share knowledge and wisdom, with hope of improved bedside response working in a multidisciplinary team in clinical situation. In future we intend to create a library of cases encompassing various PCCC emergencies with teaching objectives and supplementing material enabling other simulation practitioners’ teaching repertoire.





Parag Jain, MD, FAAP

Assistant Professor
Texas Children's Hospital and Baylor College of Medicine
Houston, Texas

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Mubasheer Ahmed, MD

Assistant Professor
Texas Children's Hospital and Baylor College of Medicine

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Justin Elhoff, MD

Assitant Professor
Texas Children's Hospital and Baylor College of Medicine

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Aarti C. Bavare, MD, MPH

Assistant Professor
Baylor College of Medicine

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Send Email for Ulrich Strauch


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