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Kainth R. Dynamic Plus-Delta: an agile debriefing approach centred around variable participant, faculty and contextual factors. Adv Simul (Lond) 2021; 6:35. [PMID: 34620251 PMCID: PMC8496135 DOI: 10.1186/s41077-021-00185-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/04/2021] [Indexed: 12/29/2022] Open
Abstract
The current coronavirus pandemic has necessitated rapid intensive care infrastructure expansion with corresponding demand for training healthcare staff. At the NHS Nightingale Hospital, London, the staff underwent a training programme prior to entering the clinical environment with simulation being a core component. This paper describes the rationale for choosing an initial debriefing model which evolved overtime to consider multiple contextual factors: demands of the clinical environment, the diverse participants and their learning needs, the variable experience of faculty, and the dynamic nature of available debriefing time. The new approach, termed here as the Dynamic Plus-Delta model, blends the traditional Plus-Delta approach with specific dynamic elements which considers the unique demands of rapidly training large number of staff. We outline the core features of this model and detail specific considerations around psychological safety. This debriefing approach can be used in similar simulation intervention settings where rapid training of participants is required with multiple and varying contextual factors.
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Affiliation(s)
- Ranjev Kainth
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Simulation and Interactive Learning (SaIL) Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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2
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D'Orta I, Herrmann FR, Giannakopoulos P. Determinants of Revolving Door in an Acute Psychiatric Ward for Prison Inmates. Front Psychiatry 2021; 12:626773. [PMID: 33935830 PMCID: PMC8081974 DOI: 10.3389/fpsyt.2021.626773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Among the different types of heavy use of mental health services, frequent inpatient admission in acute care units of individuals unable to return to their usual environment refers to as revolving-door (RD). RD in prisoners is related to increased violence (acted and supported) and suicidal recidivism. We explored the determinants of RD in 200 inmates from the Swiss-French speaking areas who were admitted to the sole acute psychiatric care unit for all of the Swiss-French counties, located in Geneva. The Cuzick's test for trend across ordered groups, Kruskal-Wallis test and oneway ANOVA were used to compare demographic and clinical variables between single (one admission, N = 100), frequent (3-7, N = 69) and RD (more than 8, N = 31) during a 12 months period. In addition, univariate and multivariable ordered logistic regression modes were built to examine the determinants of RD. The sample included 27 women (mean age: 31.2 years) and 173 men (34.5 years) who were admitted during the period 2014-2019. The vast majority were single (65%) with low level of education (<6 years, 78%). Suicidal behavior was the more frequent reason for admission (57%). Psychiatric history was positive in 77.5% of cases and in 54.5% of cases there was at least one episode of inpatient psychiatric care. The more frequent ICD-10 psychiatric diagnosis in the last admission were psychotic disorder (38%), personality disorder (29.5%) and adjustment disorder (19.5%). In contrast, depressive episodes (7%) and bipolar disorder (4.5%) were rare. Group comparison showed that the presence of court-ordered treatments, suicidal behavior, personality and psychotic disorders was associated with significantly increased frequency of RD use. In univariate models, the same factors were positively associated with RD, the highest odds ratio being found for court-ordered treatments (5.77) and personality disorders (2.14). In contrast, the diagnosis of adjustment disorders was related to decreased RD use (OR 0.25). Court-ordered treatments and personality disorders were the only factors to predict RD in multivariable regression models. These findings suggest that acute psychiatric care in these patients did not depend of environmental stressors but rather represents the expression of a long-lasting vulnerability related to their psychological profile and criminal status.
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Affiliation(s)
- Isabella D'Orta
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - François R. Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
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3
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Pezel T, Coisne A, Bonnet G, Martins RP, Adjedj J, Bière L, Lattuca B, Turpeau S, Popovic B, Ivanes F, Lafitte S, Deharo JC, Bernard A. Simulation-based training in cardiology: State-of-the-art review from the French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology. Arch Cardiovasc Dis 2021; 114:73-84. [PMID: 33419690 DOI: 10.1016/j.acvd.2020.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
In our healthcare system, mindful of patient safety and the reduction of medical errors, simulation-based training has emerged as the cornerstone of medical education, allowing quality training in complete safety for patients. Initiated by anaesthesiologists, this teaching mode effectively allows a gradual transfer of learning, and has become an essential tool in cardiology teaching. Cardiologists are embracing simulation to master complex techniques in interventional cardiology, to manage crisis situations and unusual complications and to develop medical teamwork. Simulation methods in cardiology include high-fidelity simulators, clinical scenarios, serious games, hybrid simulation and virtual reality. Simulation involves all fields of cardiology: transoesophageal echocardiography, cardiac catheterization, coronary angioplasty and electrophysiology. Beyond purely technical issues, simulation can also enhance communication skills, by using standardized patients, and can improve the management of situations related to the announcement of serious diseases. In this review of recent literature, we present existing simulation modalities, their applications in different fields of cardiology and their advantages and limitations. Finally, we detail the growing role for simulation in the teaching of medical students following the recent legal obligation to use simulation to evaluate medical students in France.
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Affiliation(s)
- Théo Pezel
- Department of Cardiology, Lariboisiere Hospital, AP-HP, Inserm UMRS 942, University of Paris, 75010 Paris, France; Division of Cardiology, Johns Hopkins University, MD 21287-0409 Baltimore, USA; Ilumens Simulation Department, Paris Diderot University, 75010 Paris, France; French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France
| | - Augustin Coisne
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiovascular Explorations and Echocardiography-Heart Valve Clinic, CHU de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000 Lille, France
| | - Guillaume Bonnet
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Paris, PARCC, INSERM, 75015 Paris, France; Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Raphael P Martins
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Rennes, CHU de Rennes, INSERM, LTSI-UMR 1099, 35000 Rennes, France
| | - Julien Adjedj
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Arnault Tzanck Institute, 06700 Saint-Laurent-du-Var, France
| | - Loïc Bière
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Service de Cardiologie, CHU de Angers, Université Angers, 49100 Angers, France
| | - Benoit Lattuca
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Stéphanie Turpeau
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Pôle Cardiologie, Angiologie, Néphrologie, Endocrinologie, Centre Hospitalier d'Avignon, 84000 Avignon, France
| | - Batric Popovic
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiology, CHRU de Nancy, Université de Lorraine, 54000 Nancy, France
| | - Fabrice Ivanes
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Tours University, 37000 Tours, France; Cardiology Department, Tours University Hospital, 37000 Tours, France
| | - Stéphane Lafitte
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Jean Claude Deharo
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Service de cardiologie, hôpital de la Timone, 33000 Marseille, France
| | - Anne Bernard
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Tours University, 37000 Tours, France; Cardiology Department, Tours University Hospital, 37000 Tours, France.
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4
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Hager K, St Hill C, Prunuske J, Swanoski M, Anderson G, Lutfiyya MN. Development of an interprofessional and interdisciplinary collaborative research practice for clinical faculty. J Interprof Care 2016; 30:265-7. [PMID: 26934068 PMCID: PMC4819843 DOI: 10.3109/13561820.2015.1092951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 07/24/2015] [Accepted: 09/08/2015] [Indexed: 11/13/2022]
Abstract
This article describes an interprofessional collaborative research practice fellowship designed to foster the research skills of clinical faculty. The year-long fellowship was grounded in big data analysis and the triangle of informatics--knowledge, information, and data. Fellows were selected to include diverse perspectives, training, and knowledge but had limited experience in team science or being a member of an interprofessional research team. The underlying philosophy of the fellowship was experiential learning. Protected time and formal mentorship were necessary factors for developing the interprofessional research practice and the skills to participate in an interprofessional research team. We believe that this innovative interprofessional faculty research fellowship is a viable option for supporting scholarly activity and research collaboration. The findings could inform interprofessional clinical practice and be implemented for patient care. Engagement in interprofessional collaborative research and incorporation of the perspectives, knowledge and expertise of multiple professions, is a model to de silo knowledge creation.
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Affiliation(s)
- Keri Hager
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, Duluth, Minnesota, USA
| | - Catherine St Hill
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jacob Prunuske
- Department of Family Medicine and Community Health, University of Minnesota, Duluth, Minnesota, USA
| | - Michael Swanoski
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Grant Anderson
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, Duluth, Minnesota, USA
| | - May Nawal Lutfiyya
- National Center for Interprofessional Practice and Education, University of Minnesota, Minneapolis, Minnesota, USA
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Gardner AK, Lachapelle K, Pozner CN, Sullivan ME, Sutherland D, Scott DJ, Sillin L, Sachdeva AK. Expanding simulation-based education through institution-wide initiatives: A blueprint for success. Surgery 2015; 158:1403-7. [PMID: 26013982 DOI: 10.1016/j.surg.2015.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Consortium of American College of Surgeons Accredited Education Institutes (ACS-AEIs) was created to promote patient safety through the use of simulation, develop innovative education and training, advance technologies, identify best practices, and encourage research and collaboration. METHODS During the seventh annual meeting of the consortium, leaders from across the consortium who have developed institution-wide simulation centers were invited to participate in a panel to discuss their experiences and the lessons learned. CONCLUSION These discussions resulted in definition of 5 key areas that need to be addressed effectively to support efforts of the ACS-AEIs.
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Affiliation(s)
- Aimee K Gardner
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
| | - Kevin Lachapelle
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Charles N Pozner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maura E Sullivan
- Department of Surgery, University of Southern California, Los Angeles, CA
| | | | - Daniel J Scott
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Lelan Sillin
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
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O'Brien BC, Irby DM. Enacting the Carnegie Foundation call for reform of medical school and residency. TEACHING AND LEARNING IN MEDICINE 2013; 25 Suppl 1:S1-S8. [PMID: 24246101 DOI: 10.1080/10401334.2013.842915] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
On the 100th anniversary of the Flexner Report, the Carnegie Foundation for the Advancement of Teaching published a new study of medical education. This study, titled Educating Physicians: A Call for Reform of Medical Schools and Residency Programs, contained four primary recommendations intended to stimulate innovation and improvement in medical education. In this article, the authors examined the ways others have applied the four recommendations from Educating Physicians within and beyond medical education. In their review of 246 publications citing the Carnegie work, they found that the recommendation for integration was addressed most frequently, often through descriptions of integration of curricular content in undergraduate medical education. The recommendation to focus on professional identity formation was the second most frequently addressed, followed by standardization and individualization, then inquiry, innovation, and improvement. The publications related to these latter three recommendations tended to be conceptual rather than descriptive or empirical. Publications spanned the continuum of medical education (from medical school to residency to physicians in practice) and even into other fields, but undergraduate medical education received the most attention. The authors discuss common themes among the citing publications and highlight opportunities for further discussion and innovation. Many exciting developments have occurred in medical education and beyond since the publication of Educating Physicians in 2010. Thus far, most of the publications citing the Carnegie recommendations describe incremental changes in medical education, particularly in the area of integration. Some of the conceptual work around these recommendations, coupled with a variety of external factors such as changes in health care and accreditation systems, suggests the potential for changes that are more transformative in nature.
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MESH Headings
- Curriculum/standards
- Curriculum/trends
- Diffusion of Innovation
- Education, Medical, Graduate/standards
- Education, Medical, Graduate/trends
- Education, Medical, Undergraduate/standards
- Education, Medical, Undergraduate/trends
- Humans
- Internship and Residency/standards
- Internship and Residency/trends
- Models, Educational
- Professional Competence/standards
- Quality Improvement
- Schools, Medical/organization & administration
- United States
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Affiliation(s)
- Bridget C O'Brien
- a Office of Research and Development in Medical Education , University of California , San Francisco , California , USA
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