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Gross IT, Clapper TC, Ramachandra G, Thomas A, Ades A, Walsh B, Kreuzer F, Elkin R, Wagner M, Whitfill T, Chang TP, Duff JP, Deutsch ES, Loellgen RM, Palaganas JC, Fayyaz J, Kessler D, Calhoun AW. Setting an Agenda: Results of a Consensus Process on Research Directions in Distance Simulation. Simul Healthc 2023; 18:100-107. [PMID: 36989108 DOI: 10.1097/sih.0000000000000663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic forced rapid implementation and refinement of distance simulation methodologies in which participants and/or facilitators are not physically colocated. A review of the distance simulation literature showed that heterogeneity in many areas (including nomenclature, methodology, and outcomes) limited the ability to identify best practice. In April 2020, the Healthcare Distance Simulation Collaboration was formed with the goal of addressing these issues. The aim of this study was to identify future research priorities in the field of distance simulation using data derived from this summit. METHODS This study analyzed textual data gathered during the consensus process conducted at the inaugural Healthcare Distance Simulation Summit to explore participant perceptions of the most pressing research questions regarding distance simulation. Participants discussed education and patient safety standards, simulation facilitators and barriers, and research priorities. Data were qualitatively analyzed using an explicitly constructivist thematic analysis approach, resulting in the creation of a theoretical framework. RESULTS Our sample included 302 participants who represented 29 countries. We identified 42 codes clustered within 4 themes concerning key areas in which further research into distance simulation is needed: (1) safety and acceptability, (2) educational/foundational considerations, (3) impact, and (4) areas of ongoing exploration. Within each theme, pertinent research questions were identified and categorized. CONCLUSIONS Distance simulation presents several challenges and opportunities. Research around best practices, including educational foundation and psychological safety, are especially important as is the need to determine outcomes and long-term effects of this emerging field.
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Affiliation(s)
- Isabel T Gross
- From the Department of Pediatrics (I.T.G., T.W.), Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT; Weill Cornell Medicine NewYork-Presbyterian Simulation Center (T.C.C.), Weill Cornell Medical College, New York, NY; Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad, India; Division of Pediatric Emergency Medicine (A.T.), Department of Pediatrics, Seattle Children's Hospital, Seattle, WA; Division of Neonatology (A.A.), Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Pediatric Emergency Medicine (B.W.), Department of Pediatrics, Boston University School of Medicine, Boston, MA; Faculty of Medicine (F.K.), Ludwig-Maximilians-University Munich, Munich, Germany; Department of Emergency Medicine (R.E., D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY; Division of Neonatology (M.W.), Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria; Department of Emergency Medicine (T.W.), Yale University School of Medicine, New Haven, CT; Division of Emergency Medicine (T.P.C.), Department of Medical Education, Children's Hospital Los Angeles & Keck School of Medicine at University of Southern California, Los Angeles, CA; Division of Pediatric Critical Care Medicine (J.P.D.), Department of Pediatrics, University of Alberta, Edmonton, Canada; Department of Anesthesiology and Critical Care Medicine (E.S.D.), Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatric Emergency Medicine (R.M.L.), Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Anesthesia, Critical Care, and Pain Medicine (J.C.P.), Harvard Medical School, Boston, MA; Department of Pediatric Emergency Medicine (J.F.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics (A.W.C.), University of Louisville and Norton Children's Hospital, Louisville, KY
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Thyagarajan S, Ramachandra G, Jamalpuri V, Calhoun AW, Nadkarni V, Deutsch ES. Simulathon 2020: Integrating Simulation Period Prevalence Methodology Into the COVID-19 Disaster Management Cycle in India. Simul Healthc 2022; 17:183-191. [PMID: 34405824 PMCID: PMC9169606 DOI: 10.1097/sih.0000000000000601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SUMMARY STATEMENT The disaster management cycle is an accepted model that encompasses preparation for and recovery from large-scale disasters. Over the past decade, India's Pediatric Simulation Training and Research Society has developed a national-scale simulation delivery platform, termed the Simulathon , with a period prevalence methodology that integrates with core aspects of this model. As an exemplar of the effectiveness of this approach, we describe the development, implementation, and outcomes of the 2020 Simulathon, conducted from April 20 to May 20 in response to the nascent COVID-19 pandemic disaster. We conclude by discussing how aspects of the COVID-19 Simulathon enabled us to address key aspects of the disaster management cycle, as well as challenges that we encountered. We present a roadmap by which other simulation programs in low- and middle-income countries could enact a similar process.
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Affiliation(s)
- Sujatha Thyagarajan
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Geethanjali Ramachandra
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Vijayanand Jamalpuri
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Aaron W. Calhoun
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Vinay Nadkarni
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ellen S. Deutsch
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Patterson MD, Deutsch ES. Simulation to improve patient care. Implement Sci 2022. [DOI: 10.4324/9781003109945-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Deutsch ES, Malekzadeh S, Schmalbach CE. Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation. Otolaryngol Head Neck Surg 2021; 166:23-34. [PMID: 34003066 DOI: 10.1177/01945998211013314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Simulation training has taken a prominent role in otolaryngology-head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.
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Affiliation(s)
- Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Cecelia E Schmalbach
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Ramachandra G, Deutsch ES, Nadkarni VM. A Road Map for Simulation Based Medical Students Training in Pediatrics: Preparing the Next Generation of Doctors. Indian Pediatr 2020; 57:950-956. [PMID: 33089810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Current Medical training in India is generally didactic and pedagogical, and often does not systematically prepare newly graduated doctors to be competent, confident and compassionate. After much deliberation, the Medical Council of India (MCI) has recently introduced a new outcome-driven curriculum for undergraduate medical student training with specific milestones and an emphasis on simulation-based learning and guided reflection. Simulation-based education and debriefing (guided reflection) has transformed medical training in many countries by accelerating learning curves, improving team skills and behavior, and enhancing provider confidence and competence. In this article, we provide a broad framework and roadmap suggesting how simulation-based education might be incorporated and contextualized by undergraduate medical institutions, especially for pediatric training, using local resources to achieve the goals of the new MCI competency-based and simulation-enhanced undergraduate curriculum.
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Affiliation(s)
- Geethanjali Ramachandra
- Krishna Institute of Medical Science Secunderabad, Telangana, India and Pediatric Simulation Training and Research Society (PediSTARS), India. Correspondence to: Dr Geethanjali Ramachandra, Department of Pediatric Intensive Care, Krishna Institute of Medical Science, Minister Road, Secunderabad 500 003, Telangana, India.
| | - Ellen S Deutsch
- Pediatric Simulation Training and Research Society (PediSTARS), India and Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, USA
| | - Vinay M Nadkarni
- Pediatric Simulation Training and Research Society (PediSTARS), India; and Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, USA
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Faucett EA, Wolter NE, Balakrishnan K, Ishman SL, Mehta D, Parikh S, Nguyen LHP, Preciado D, Rutter MJ, Prager JD, Green GE, Pransky SM, Elluru R, Husein M, Roy S, Johnson KE, Friedberg J, Johnson RF, Bauman NM, Myer CM, Deutsch ES, Gantwerker EA, Willging JP, Hart CK, Chun RH, Lam DJ, Ida JB, Manoukian JJ, White DR, Sidell DR, Wootten CT, Inglis AF, Derkay CS, Zalzal G, Molter DW, Ludemann JP, Choi S, Schraff S, Myer CM, Cotton RT, Vijayasekaran S, Zdanski CJ, El-Hakim H, Shah UK, Soma MA, Smith ME, Thompson DM, Javia LR, Zur KB, Sobol SE, Hartnick CJ, Rahbar R, Vaccani JP, Hartley B, Daniel SJ, Jacobs IN, Richter GT, de Alarcon A, Bromwich MA, Propst EJ. Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus. Laryngoscope 2020; 131:1168-1174. [PMID: 33034397 DOI: 10.1002/lary.29126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. STUDY DESIGN Blinded modified Delphi consensus process. SETTING Tertiary care center. METHODS A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. RESULTS The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. CONCLUSIONS It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. LEVEL OF EVIDENCE 5. Laryngoscope, 131:1168-1174, 2021.
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Affiliation(s)
- Erynne A Faucett
- Division of Otolaryngology, Head and Neck Surgery, Phoenix Children's Hospital, Department of Child Health, University of Arizona, Tucson, Arizona, U.S.A.,College of Medicine, Department of Otolaryngology, Mayo College of Medicine and Science, Phoenix, Arizona, U.S.A
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Karthik Balakrishnan
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Stacey L Ishman
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Deepak Mehta
- Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Sanjay Parikh
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Diego Preciado
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - Michael J Rutter
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Jeremy D Prager
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Glenn E Green
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - Seth M Pransky
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, U.S.A
| | - Ravi Elluru
- Division of Otolaryngology, Dayton Children's Hospital, Dayton, Ohio, U.S.A
| | - Murad Husein
- Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Soham Roy
- Department of Otorhinolaryngology, University of Texas at Houston McGovern Medical School, Houston, Texas, U.S.A
| | - Kaalan E Johnson
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jacob Friedberg
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Romaine F Johnson
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Nancy M Bauman
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - Charles M Myer
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Eric A Gantwerker
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - J Paul Willging
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin-Milwaukee Campus, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Derek J Lam
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, Oregon, U.S.A
| | - Jonathan B Ida
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - John J Manoukian
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - David R White
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Christopher T Wootten
- Division of Otolaryngology, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, U.S.A
| | - Andrew F Inglis
- Division of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Craig S Derkay
- Department of Otolaryngology - Head and Neck Surgery Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, Washington, District of Columbia, U.S.A
| | - David W Molter
- Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, U.S.A
| | - Jeffrey P Ludemann
- Pediatric Otolaryngology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, Arizona, U.S.A
| | - Charles M Myer
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Robin T Cotton
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Head and Neck Surgery, Perth Children's Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Hamdy El-Hakim
- Division of Pediatric Surgery and Otolaryngology - Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Udayan K Shah
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, U.S.A
| | - Marlene A Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Marshall E Smith
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Dana M Thompson
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Luv Ram Javia
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Karen B Zur
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Steven E Sobol
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School Boston, Boston, Massachusetts, U.S.A
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jean-Philippe Vaccani
- Division of Otolaryngology, Department of Surgery, CHEO, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hartley
- Department of Otolaryngology, Great Ormond Street Hospital, London, United Kingdom
| | - Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Ian N Jacobs
- Division of Otolaryngology, The Children's Hospital of Philadelphia, Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Gresham T Richter
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| | - Alessandro de Alarcon
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, Ohio, U.S.A
| | - Matthew A Bromwich
- Division of Otolaryngology, Department of Surgery, CHEO, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Malloy KM, Lieu JEC, Cervenka BP, Deutsch ES, Malekzadeh S. Regionalization of ORL Boot Camps: Report of the Society of University Otolaryngologists Task Force. Laryngoscope 2020; 131:737-743. [PMID: 32857421 DOI: 10.1002/lary.29052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/17/2020] [Accepted: 07/31/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Simulation-based boot camps have emerged as timely vehicles to help novice residents develop the skills needed to manage medical emergencies. Geographically regional boot camps provide opportunities for interaction between residents and faculty from multiple otolaryngology programs. The Society of University Otolaryngologists (SUO) Boot Camp Task Force investigated the concept of regional access to otolaryngology boot camps with the goal of making more regional boot camps available for otolaryngology residents across the United States. STUDY DESIGN Interviews. METHODS The SUO Boot Camp Task Force assessed regional access to otolaryngology boot camps with a focus on geographic distribution, curricular content, and finances. Boot camp directors were contacted by email and telephone and interviewed to elicit information on all these areas. RESULTS Data were available from 10 known regional simulation-based boot camps designed for novice residents. Individual boot camps included from 12 to 30 residents and 10 to 50 faculty members. Curricula included both technical (ie, procedural) and non-technical (eg, communication, leadership) skills for individuals and teams. Content was heavily weighted toward a variety of airway problems and management techniques, although various conditions involving hemorrhage, and airway fires were also addressed. Funding and expense structures had the greatest variability. CONCLUSIONS Considerable variability was identified among the known regional boot camps in terms of numbers of participants and finances, but fewer differences in curriculum. Geographic opportunity for 9 to 10 new boot camps was identified. The SUO Task Force recommends that a consensus be developed for several individual skill and teamwork scenario objectives to be included in each boot camp. Laryngoscope, 131:737-743, 2021.
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Affiliation(s)
- Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Judith E C Lieu
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Brian P Cervenka
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
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Daly Guris RJ, Elliott EM, Doshi A, Singh D, Widmeier K, Deutsch ES, Nadkarni VM, Jackson KR, Subramanyam R, Fiadjoe JE, Gurnaney HG. Systems-focused simulation to prepare for COVID-19 intraoperative emergencies. Paediatr Anaesth 2020; 30:947-950. [PMID: 32683765 PMCID: PMC7404905 DOI: 10.1111/pan.13971] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/27/2020] [Accepted: 07/13/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Rodrigo J. Daly Guris
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of Philadelphia and University of PennsylvaniaPhiladelphiaPAUSA
| | - Elizabeth M. Elliott
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of Philadelphia and University of PennsylvaniaPhiladelphiaPAUSA
| | - Anushree Doshi
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of Philadelphia and University of PennsylvaniaPhiladelphiaPAUSA
| | - Devika Singh
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of Philadelphia and University of PennsylvaniaPhiladelphiaPAUSA
| | - Keith Widmeier
- Center for Simulation, Advanced Education, and InnovationChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Ellen S. Deutsch
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of Philadelphia and University of PennsylvaniaPhiladelphiaPAUSA
| | - Vinay M. Nadkarni
- Departments of Anesthesiology and Critical Medicine, and PediatricsChildren's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | - Rajeev Subramanyam
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of Philadelphia and University of PennsylvaniaPhiladelphiaPAUSA
| | - John E. Fiadjoe
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of Philadelphia and University of PennsylvaniaPhiladelphiaPAUSA
| | - Harshad G. Gurnaney
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of Philadelphia and University of PennsylvaniaPhiladelphiaPAUSA
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9
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Wiet GJ, Deutsch ES, Malekzadeh S, Onwuka AJ, Callender NW, Seidman MD, Fried MP. SimTube: A National Simulation Training and Research Project. Otolaryngol Head Neck Surg 2020; 163:522-530. [PMID: 32450737 DOI: 10.1177/0194599820920833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the feasibility and impact of a simulation training program for myringotomy and tube (M&T) placement. STUDY DESIGN Prospective randomized controlled. SETTING Multi-institutional. SUBJECTS AND METHODS An M&T simulator was used to assess the impact of simulation training vs no simulation training on the rate of achieving competency. Novice trainees were assessed using posttest simulator Objective Structured Assessment of Technical Skills (OSATS) scores, OSATS score for initial intraoperative tube insertion, and number of procedures to obtain competency. The effect of simulation training was analyzed using χ2 tests, Wilcoxon-Mann-Whitney tests, and Cox proportional hazards regression. RESULTS A total of 101 residents and 105 raters from 65 institutions were enrolled; however, just 63 residents had sufficient data to be analyzed due to substantial breaches in protocol. There was no difference in simulator pretest scores between intervention and control groups; however, the intervention group had better OSATS global scores on the simulator (17.4 vs 13.7, P = .0003) and OSATS task scores on the simulator (4.5 vs 3.6, P = .02). No difference in OSATS scores was observed during initial live surgery rating (P = .73 and P = .41). OSATS scores were predictive of the rate at which residents achieved competence in performing myringotomy; however, the intervention was not associated with subsequent OSATS scores during live surgeries (P = .44 and P = .91) or the rate of achieving competence (P = .16). CONCLUSIONS A multi-institutional simulation study is feasible. Novices trained using the M&T simulator achieved higher scores on simulator but not initial intraoperative OSATS, and they did not reach competency sooner than those not trained on the simulator.
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Affiliation(s)
- Gregory J Wiet
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Amanda J Onwuka
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Michael D Seidman
- AdventHealth Medical Group, Otolaryngology-Head & Neck Surgery, Celebration, Florida, USA.,Department of Otolaryngology Head and Neck Surgery, University of Central Florida, Orlando, Florida, USA.,Department of Otolaryngology Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Marvin P Fried
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York, USA
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10
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Propst EJ, Wolter NE, Ishman SL, Balakrishnan K, Deonarain AR, Mehta D, Zalzal G, Pransky SM, Roy S, Myer CM, Torre M, Johnson RF, Ludemann JP, Derkay CS, Chun RH, Hong P, Molter DW, Prager JD, Nguyen LHP, Rutter MJ, Myer CM, Zur KB, Sidell DR, Johnson LB, Cotton RT, Hart CK, Willging JP, Zdanski CJ, Manoukian JJ, Lam DJ, Bauman NM, Gantwerker EA, Husein M, Inglis AF, Green GE, Javia LR, Schraff S, Soma MA, Deutsch ES, Sobol SE, Ida JB, Choi S, Uwiera TC, Shah UK, White DR, Wootten CT, El-Hakim H, Bromwich MA, Richter GT, Vijayasekaran S, Smith ME, Vaccani JP, Hartnick CJ, Faucett EA. Competency-Based Assessment Tool for Pediatric Tracheotomy: International Modified Delphi Consensus. Laryngoscope 2019; 130:2700-2707. [PMID: 31821571 DOI: 10.1002/lary.28461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/08/2019] [Accepted: 11/21/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Create a competency-based assessment tool for pediatric tracheotomy. STUDY DESIGN Blinded, modified, Delphi consensus process. METHODS Using the REDCap database, a list of 31 potential items was circulated to 65 expert surgeons who perform pediatric tracheotomy. In the first round, items were rated as "keep" or "remove," and comments were incorporated. In the second round, experts were asked to rate the importance of each item on a seven-point Likert scale. Consensus criteria were determined a priori with a goal of 7 to 25 final items. RESULTS The first round achieved a response rate of 39/65 (60.0%), and returned questionnaires were 99.5% complete. All items were rated as "keep," and 137 comments were incorporated. In the second round, 30 task-specific and seven previously validated global rating items were distributed, and the response rate was 44/65 (67.7%), with returned questionnaires being 99.3% complete. Of the Task-Specific Items, 13 reached consensus, 10 were near consensus, and 7 did not achieve consensus. For the 7 previously validated global rating items, 5 reached consensus and two were near consensus. CONCLUSIONS It is feasible to reach consensus on the important steps involved in pediatric tracheotomy using a modified Delphi consensus process. These items can now be considered to create a competency-based assessment tool for pediatric tracheotomy. Such a tool will hopefully allow trainees to focus on the important aspects of this procedure and help teaching programs standardize how they evaluate trainees during this procedure. LEVEL OF EVIDENCE 5 Laryngoscope, 130:2700-2707, 2020.
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Affiliation(s)
- Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Karthik Balakrishnan
- Department of Otolaryngology and Mayo Children's Center, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, U.S.A
| | - Ashley R Deonarain
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Deepak Mehta
- Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, DC, U.S.A
| | - Seth M Pransky
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, U.S.A
| | - Soham Roy
- Department of Otorhinolaryngology, University of Texas at Houston McGovern Medical School, Houston, Texas, U.S.A
| | - Charles M Myer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Michele Torre
- Airway Unit, Scientific Institute for Research and Healthcare, Giannina Gaslini Institute, Genoa, Italy
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jeffrey P Ludemann
- Pediatric Otolaryngology, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin-Milwaukee Campus, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Paul Hong
- Division of Otolaryngology, Dalhousie University, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - David W Molter
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jeremy D Prager
- Department of Pediatric Otolaryngology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, U.S.A
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael J Rutter
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Charles M Myer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Karen B Zur
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A
| | - Liane B Johnson
- Division of Otolaryngology, Dalhousie University, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - Robin T Cotton
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - J Paul Willging
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Carlton J Zdanski
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - John J Manoukian
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, Oregon, U.S.A
| | - Nancy M Bauman
- Department of Otolaryngology, Children's National Health System, Division of Otolaryngology, George Washington University Washington, DC, U.S.A
| | - Eric A Gantwerker
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Murad Husein
- Department of Otolaryngology-Head and Neck Surgery, Victoria Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrew F Inglis
- Division of Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Glenn E Green
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - Luv Ram Javia
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, Arizona, U.S.A
| | - Marlene A Soma
- Department of Pediatric Otolaryngology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Steven E Sobol
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | - Jonathan B Ida
- Division of Pediatric Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Trina C Uwiera
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Udayan K Shah
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, U.S.A
| | - David R White
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Hamdy El-Hakim
- Divisions of Pediatric Surgery and Otolaryngology-Head and Neck Surgery, Departments of Surgery and Pediatrics, The Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Matthew A Bromwich
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Gresham T Richter
- Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| | - Shyan Vijayasekaran
- Department of Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, University of Western Australia, Nedlands, Western Australia, Australia
| | - Marshall E Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Jean-Philippe Vaccani
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Erynne A Faucett
- Department of Pediatric Otolaryngology, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
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11
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Maa T, Scherzer DJ, Harwayne-Gidansky I, Capua T, Kessler DO, Trainor JL, Jani P, Damazo B, Abulebda K, Diaz MCG, Sharara-Chami R, Srinivasan S, Zurca AD, Deutsch ES, Hunt EA, Auerbach M. Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study. J Allergy Clin Immunol Pract 2019; 8:1239-1246.e3. [PMID: 31770652 DOI: 10.1016/j.jaip.2019.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported. OBJECTIVE To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. METHODS A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected. RESULTS Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid. CONCLUSIONS A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites.
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Affiliation(s)
- Tensing Maa
- Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio.
| | - Daniel J Scherzer
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Ilana Harwayne-Gidansky
- Division of Pediatric Critical Care Medicine, Stony Brook Children's Hospital, Stony Brook, NY
| | - Tali Capua
- Pediatric Emergency Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David O Kessler
- Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Jennifer L Trainor
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Priti Jani
- Department of Pediatrics, Section of Critical Care Medicine, Comer Children's Hospital, University of Chicago, Chicago, Ill
| | | | - Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Ind
| | - Maria Carmen G Diaz
- Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del
| | - Rana Sharara-Chami
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Sushant Srinivasan
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Adrian D Zurca
- Division of Pediatric Critical Care Medicine, Penn State College of Medicine, Hershey, Pa
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pa
| | - Elizabeth A Hunt
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Health Informatics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Marc Auerbach
- Departments of Pediatrics and Emergency Medicine, Yale University, New Haven, Conn
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12
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Abstract
Anesthesiologists and otolaryngologists share the airway in an elegant ballet that requires communication, collaboration, and mutual respect. This article addresses principles to prevent or manage challenging conditions such as airway fires, anatomically difficult airways, and post-tonsillectomy hemorrhage. Discussion includes rationales for the use of simulation and resilience engineering principles to achieve the safest patient care.
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Affiliation(s)
- Ellen S Deutsch
- Anesthesiology and Critical Care, Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Room 9NW9329, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Tracey Straker
- Department of Anesthesiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, 110 East 210th Street, 4th Floor Silver Zone, Bronx, NY 10467, USA
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13
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Browne AM, Deutsch ES, Corwin K, Davis DH, Teets JM, Apkon M. An IDEA: Safety Training to Improve Critical Thinking by Individuals and Teams. Am J Med Qual 2019; 34:569-576. [PMID: 30739459 DOI: 10.1177/1062860618820687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Errors in thinking contribute to harm, delays in diagnosis, incorrect treatments, or failures to recognize clinical changes. Models of cognition are useful in understanding error occurrence and avoidance. Intra-team conflict can represent failures in joint cognitive processing. The authors developed training focused on recognizing and managing cognitive bias and resolving conflicts. The program provides context and introduces models of cognition, concepts of bias, team cognition, conflict resolution, and 2 tools. "IDEA" incorporates 4 de-biasing strategies: Identify assumptions; Don't assume correctness; Explore expectations; Assess alternatives. "TLA" presents strategies for resolving conflicts: Tell your thoughts; Listen actively, and Ask questions. A total of 4941 care providers participated in training using didactic presentations, group discussion, and simulation. Learners rated training effectiveness at 4.68 on a scale of 1 to 5 (5 as optimum) and perceived improvement in recognizing or managing errors. Nonphysician caregivers reported greatest improvement. Training to improve critical thinking is feasible, well received, and effective.
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Affiliation(s)
| | - Ellen S Deutsch
- The Children's Hospital of Philadelphia, Philadelphia, PA.,Pennsylvania Patient Safety Authority and ECRI Institute, Plymouth Meeting, PA
| | | | - Daniela H Davis
- The Children's Hospital of Philadelphia, Philadelphia, PA.,University of Pennsylvania, Philadelphia, PA
| | | | - Michael Apkon
- The Hospital for Sick Children, Toronto, ON, Canada.,The University of Toronto School of Medicine, Toronto, ON, Canada
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14
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Deutsch ES, Patterson MD. Simulation Saves the Day (and Patient). Otolaryngol Clin North Am 2018; 52:115-121. [PMID: 30249446 DOI: 10.1016/j.otc.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgeons can use simulation to improve the safety of the systems they work within, around, because of, and despite. Health care is a complex adaptive system that can never be completely knowable; simulation can expose aspects of patient care delivery that are not necessarily evident prospectively, during planning, or retrospectively, during investigations or audits. The constraints of patient care processes and adaptive capacity of health care providers may become most evident during simulations conducted "in situ" using real teams and real equipment, in actual patient care locations.
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Affiliation(s)
- Ellen S Deutsch
- Pennsylvania Patient Safety Authority, 333 Market Street, Harrisburg, PA 17101, USA; ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA; Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Mary D Patterson
- Department of Emergency Medicine, Center for Experiential Learning and Simulation, University of Florida, 1104 Newell Drive, Suite 445, Gainesville, FL 32610, USA
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15
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Deutsch ES, Yonash RA, Martin DE, Atkins JH, Arnold TV, Hunt CM. Wrong-site nerve blocks: A systematic literature review to guide principles for prevention. J Clin Anesth 2018; 46:101-111. [DOI: 10.1016/j.jclinane.2017.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/05/2017] [Accepted: 12/09/2017] [Indexed: 10/17/2022]
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16
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Deutsch ES. Staying Well in a Sea of Harm. Otolaryngol Head Neck Surg 2018. [PMID: 29533701 DOI: 10.1177/0194599818764409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physician psychological wellness is an emergent outcome resulting from dynamic interactions among complex conditions. We may enhance opportunities for physician wellness by applying principles developed to improve another emergent outcome: patient safety. The Safety I approach to patient safety focuses on "what went wrong" and considers humans a liability. Safety II is a powerful complementary approach that focuses on "what went right" and values human creativity. These contrasting perspectives are described in the context of patient safety, but the underlying principles have relevance for physician psychological wellness. We can create conditions that interfere with wellness and conditions that support wellness. We can learn from exploring and reinforcing successes and improving routine processes; together, these approaches may have a greater cumulative positive impact than just addressing problems. In addition to learning from failures, there is much we can learn from success.
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Affiliation(s)
- Ellen S Deutsch
- 1 Pennsylvania Patient Safety Authority, Harrisburg, Pennsylvania, USA.,2 ECRI Institute, Plymouth Meeting, Pennsylvania, USA.,3 Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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17
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Weintraub AY, Deutsch ES, Hales RL, Buchanan NA, Rock WL, Rehman MA. Using High-Technology Simulators to Prepare Anesthesia Providers Before Implementation of a New Electronic Health Record Module: A Technical Report. Anesth Analg 2017; 124:1815-1819. [PMID: 28207594 DOI: 10.1213/ane.0000000000001775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Learning to use a new electronic anesthesia information management system can be challenging. Documenting anesthetic events, medication administration, and airway management in an unfamiliar system while simultaneously caring for a patient with the vigilance required for safe anesthesia can be distracting and risky. This technical report describes a vendor-agnostic approach to training using a high-technology manikin in a simulated clinical scenario. Training was feasible and valued by participants but required a combination of electronic and manual components. Further exploration may reveal simulated patient care training that provides the greatest benefit to participants as well as feedback to inform electronic health record improvements.
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Affiliation(s)
- Ari Y Weintraub
- From the Departments of *Anesthesiology and Critical Care Medicine; ‡Center for Simulation, Advanced Education and Innovation; §Biomedical Engineering, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and †ECRI Institute, Plymouth Meeting, Pennsylvania
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Abstract
Attempts to understand and improve health care delivery often focus on the characteristics of the patient and the characteristics of the health care providers, but larger systems surround and integrate with patients and providers. Components of health care delivery systems can support or interfere with efforts to provide optimal health care. Simulation in situ, involving real teams participating in simulations in real care settings, can be used to identify latent safety threats and improve the work environment while simultaneously supporting participant learning. Thoughtful planning and skilled debriefing are essential.
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Affiliation(s)
- James A Kearney
- Pennsylvania Hospital, University of Pennsylvania Health System, Perelman School of Medicine at the University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Pennsylvania Patient Safety Authority, Harrisburg, PA, USA; ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA.
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Deutsch ES, Dong Y, Halamek LP, Rosen MA, Taekman JM, Rice J. Leveraging Health Care Simulation Technology for Human Factors Research: Closing the Gap Between Lab and Bedside. Hum Factors 2016; 58:1082-1095. [PMID: 27268996 DOI: 10.1177/0018720816650781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We describe health care simulation, designed primarily for training, and provide examples of how human factors experts can collaborate with health care professionals and simulationists-experts in the design and implementation of simulation-to use contemporary simulation to improve health care delivery. BACKGROUND The need-and the opportunity-to apply human factors expertise in efforts to achieve improved health outcomes has never been greater. Health care is a complex adaptive system, and simulation is an effective and flexible tool that can be used by human factors experts to better understand and improve individual, team, and system performance within health care. METHOD Expert opinion is presented, based on a panel delivered during the 2014 Human Factors and Ergonomics Society Health Care Symposium. RESULTS Diverse simulators, physically or virtually representing humans or human organs, and simulation applications in education, research, and systems analysis that may be of use to human factors experts are presented. Examples of simulation designed to improve individual, team, and system performance are provided, as are applications in computational modeling, research, and lifelong learning. CONCLUSION The adoption or adaptation of current and future training and assessment simulation technologies and facilities provides opportunities for human factors research and engineering, with benefits for health care safety, quality, resilience, and efficiency. APPLICATION Human factors experts, health care providers, and simulationists can use contemporary simulation equipment and techniques to study and improve health care delivery.
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Affiliation(s)
| | - Yue Dong
- Mayo Clinic, Rochester, Minnesota
| | | | | | | | - John Rice
- Children's Hospital of Philadelphia, PennsylvaniaMayo Clinic, Rochester, MinnesotaStanford University, Palo Alto, CaliforniaJohns Hopkins University, Baltimore, MarylandDuke University, Durham, North CarolinaSociety for Simulation in Healthcare, Norfolk, Virginia
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Woo JA, Malekzadeh S, Malloy KM, Deutsch ES. Are All Manikins Created Equal? A Pilot Study of Simulator Upper Airway Anatomic Fidelity. Otolaryngol Head Neck Surg 2016; 156:1154-1157. [PMID: 28566046 DOI: 10.1177/0194599816674658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluates the anatomic fidelity of several commercially available pediatric and adult manikins, including airway task trainers, which could be used in aerodigestive procedure training. Twenty-three experienced otolaryngologists assessed the aerodigestive anatomy of 5 adult and 5 pediatric manikins in a passive state, using rigid and flexible endoscopy. Anatomic fidelity was rated on a 5-point scale for the following: nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, trachea, esophagus, and neck. Mean scores and standard deviations were tabulated for each manikin at each anatomic site. Ratings by survey participants demonstrated variation in the anatomic fidelity of the aerodigestive tract in a range of manikins. Radar chart display of the results allows comparison of manikin fidelity by anatomic site. Differences in scores may allow instructors to select manikins with the best anatomic fidelity for specific educational purposes, and they may contribute to recommendations to improve future manikin design.
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Affiliation(s)
- Jennifer A Woo
- 1 Georgetown University School of Medicine, Washington, DC, USA
| | - Sonya Malekzadeh
- 1 Georgetown University School of Medicine, Washington, DC, USA.,2 Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Kelly M Malloy
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen S Deutsch
- 4 Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Deutsch ES, Dixit D, Curry J, Malloy K, Christenson T, Robinson B, Cognetti D. Management of Aerodigestive Tract Foreign Bodies: Innovative Teaching Concepts. Ann Otol Rhinol Laryngol 2016; 116:319-23. [PMID: 17561758 DOI: 10.1177/000348940711600501] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We discuss a method to provide medical education in bronchoesophagology by using high-fidelity patient simulation manikins. Methods: A sophisticated, life-sized infant manikin with realistic anatomic, physiologic, and hemodynamic responses to interventions was programmed to simulate endobronchial foreign body lodgment by blocking ventilation of one lung and manifesting audible stridor, asymmetric chest wall motion, and decreased oxygen saturation. Results: Otolaryngology residents participated in simulation exercises incorporating the cognitive and technical skills necessary for successful airway endoscopy, including technical proficiency and teamwork, to learn to coordinate endoscopy and ventilation and manage laryngospasm. Rather than relying on instructor description, the participants responded directly to the manikin. This sense of realism stimulated participants to rehearse to improve provider performance and patient safety. Simulation provided an agenda determined by the needs of the learners, exploration without direct risk to patients, immediate feedback, and objective documentation. Conclusions: Rapidly evolving medical simulation technologies support activated, effective adult learning; they will play an increasing role in medical education.
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Affiliation(s)
- Ellen S Deutsch
- Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19899, USA
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Cabrera CE, Deutsch ES, Eppes S, Lawless S, Cook S, O'Reilly RC, Reilly JS. Increased incidence of head and neck abscesses in children. Otolaryngol Head Neck Surg 2016; 136:176-81. [PMID: 17275535 DOI: 10.1016/j.otohns.2006.09.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 09/07/2006] [Indexed: 11/21/2022]
Abstract
Objective To describe increasing incidence and changing microbiology of head and neck abscesses in children admitted to the hospital during the first quarters of 2000 through 2003. Study Design and Setting Retrospective data warehouse review identified 89 children less than 19 years of age admitted to a tertiary care pediatric hospital during the first quarters of 2000 through 2003 for suspicion of head and neck abscess involving the neck, face, and peritonsillar, retropharyngeal, and parapharyngeal spaces; and for orbital and intracranial complications of acute sinusitis. Outcome Measures Outcome measures included the incidence of infection admissions and description of infection location and microbiology, calculated by χ2 technique. Results The incidence of infections increased in 2003. The greatest increase was in neck abscesses and complications of acute sinusitis. Conclusions The increase in group A strep infections may be related to its biologic properties. Significance Group A strep remains a significant cause of head and neck infections in children.
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Affiliation(s)
- Cristina E Cabrera
- Department of Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE 19899, USA
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Ambardekar AP, Singh D, Lockman JL, Rodgers DL, Hales RL, Gurnaney HG, Nathan A, Deutsch ES. Pediatric anesthesiology fellow education: is a simulation-based boot camp feasible and valuable? Paediatr Anaesth 2016; 26:481-7. [PMID: 26948074 DOI: 10.1111/pan.12865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pediatric anesthesiologists must manage crises in neonates and children with timely responses and limited margin for error. Teaching the range of relevant skills during a 12-month fellowship is challenging. An experiential simulation-based curriculum can augment acquisition of knowledge and skills. OBJECTIVES To develop a simulation-based boot camp (BC) for novice pediatric anesthesiology fellows and assess learner perceptions of BC activities. We hypothesize that BC is feasible, not too basic, and well received by fellows. METHODS Skills stations, team-based in situ simulations, and group discussions of complex cases were designed. Stations were evaluated by anonymous survey; fellows rated usefulness in improving knowledge, self-confidence, technical skill, and clinical performance using a Likert scale (1 strongly disagree to 5 strongly agree). They were also asked if stations were too basic or too short. Median and interquartile range (IQR) data were calculated and noted as median (IQR). RESULTS Fellows reported the difficult airway station and simulated scenarios improved knowledge, self-confidence, technical skill, and clinical performance. They disagreed that stations were too basic or too short with exception of the difficult airway session, which was too short [4 (4-3)]. Fellows believed the central line station improved knowledge [4 (4-3)], technical skills [4 (4-4)], self-confidence [4 (4-3)], and clinical performance [4 (4-3)]; scores trended toward neutral likely because the station was perceived as too basic [3.5 (4-3)]. An interactive session on epinephrine and intraosseous lines was valued. Complicated case discussion was of educational value [4 (5-4)], the varied opinions of faculty were helpful [4 (5-4)], and the session was neither too basic [2 (2-2)] nor too short [2 (2-2)]. CONCLUSION A simulation-based BC for pediatric anesthesiology fellows was feasible, perceived to improve confidence, knowledge, technical skills, and clinical performance, and was not too basic.
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Affiliation(s)
- Aditee P Ambardekar
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Devika Singh
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David L Rodgers
- Clinical Simulation Center, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Roberta L Hales
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Harshad G Gurnaney
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aruna Nathan
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ellen S Deutsch
- Pennsylvania Patient Safety Authority and ECRI Institute, Harrisburg, PA, USA.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Minter RM, Amos KD, Bentz ML, Blair PG, Brandt C, D'Cunha J, Davis E, Delman KA, Deutsch ES, Divino C, Kingsley D, Klingensmith M, Meterissian S, Sachdeva AK, Terhune K, Termuhlen PM, Mullan PB. Transition to surgical residency: a multi-institutional study of perceived intern preparedness and the effect of a formal residency preparatory course in the fourth year of medical school. Acad Med 2015; 90:1116-1124. [PMID: 25785673 DOI: 10.1097/acm.0000000000000680] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To evaluate interns' perceived preparedness for defined surgical residency responsibilities and to determine whether fourth-year medical school (M4) preparatory courses ("bootcamps") facilitate transition to internship. METHOD The authors conducted a multi-institutional, mixed-methods study (June 2009) evaluating interns from 11 U.S. and Canadian surgery residency programs. Interns completed structured surveys and answered open-ended reflective questions about their preparedness for their surgery internship. Analyses include t tests comparing ratings of interns who had and had not participated in formal internship preparation programs. The authors calculated Cohen d for effect size and used grounded theory to identify themes in the interns' reflections. RESULTS Of 221 eligible interns, 158 (71.5%) participated. Interns self-reported only moderate preparation for most defined care responsibilities in the medical knowledge and patient care domains but, overall, felt well prepared in the professionalism, interpersonal communication, practice-based learning, and systems-based practice domains. Interns who participated in M4 preparatory curricula had higher self-assessed ratings of surgical technical skills, professionalism, interpersonal communication skills, and overall preparation, at statistically significant levels (P < .05) with medium effect sizes. Themes identified in interns' characterizations of their greatest internship challenges included anxiety or lack of preparation related to performance of technical skills or procedures, managing simultaneous demands, being first responders for critically ill patients, clinical management of predictable postoperative conditions, and difficult communications. CONCLUSIONS Entering surgical residency, interns report not feeling prepared to fulfill common clinical and professional responsibilities. As M4 curricula may enhance preparation, programs facilitating transition to residency should be developed and evaluated.
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Affiliation(s)
- Rebecca M Minter
- R.M. Minter is associate chair of education and associate program director, Department of Surgery, associate professor and chief, Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, and associate professor, Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan. K.D. Amos was, at the time of this research, associate professor, Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina. M.L. Bentz is professor and chairman, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin. P. Gabler Blair is associate director, Division of Education, American College of Surgeons, Chicago, Illinois. C. Brandt is the chair and Richard B. Fratianne MD Professor of Surgery, Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. J. D'Cunha was, at the time of this research, associate program director, Division of Thoracic and Foregut Surgery, and assistant professor, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, and is now associate professor and associate director of lung transplantation, associate program director of thoracic surgery, and vice chairman, Academic Affairs, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. E. Davis is education research associate, Division of Education, American College of Surgeons, Chicago, Illinois. K.A. Delman is associate professor, Department of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia. E.S. Deutsch is physician, Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children, Wilmington, Delaware. C. Divino is professor and chief, Division of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. D. Kingsley is assistant professor, Department of Surgery, University of New Mexico School
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Deutsch ES, Wiet GJ, Seidman M, Hussey HM, Malekzadeh S, Fried MP. Simulation Activity in Otolaryngology Residencies. Otolaryngol Head Neck Surg 2015; 153:193-201. [PMID: 26019133 DOI: 10.1177/0194599815584598] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 04/08/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. STUDY DESIGN Web-based survey. SETTING US otolaryngology residency training programs. SUBJECTS AND METHODS An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. RESULTS Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. CONCLUSION Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs.
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Affiliation(s)
- Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory J Wiet
- Department of Otolaryngology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Michael Seidman
- Department of Otolaryngology-Head and Neck Surgery; Henry Ford Health System, Detroit, Michigan, USA
| | - Heather M Hussey
- Department of Research and Quality Improvement, American Academy of Otolaryngology Head and Neck Surgery, Alexandria, Virginia, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery; MedStar Georgetown University Hospital, Washington, DC, USA
| | - Marvin P Fried
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Deutsch ES, Wiet GJ, Cornett MP, Malekzadeh S, Fried MP, Seidman MD, Hussey H. Simulation Activity in Otolaryngology Residencies. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: (1) Determine simulation resources available within United States otolaryngology training institutions. (2) Determine current involvement in simulation within otolaryngology training programs. (3) Gauge interest in advancing simulation for training and assessment. Methods: A voluntary survey was sent to 104 program directors. The introduction provided a broad definition of simulation. Responses were collected between March 21 and April 5, 2013. Descriptive results are presented. Results: Responses were received for 43 (41%) of the surveys. A total of 39 of 43 respondents (91%) have a simulation center or program at their institution. A total of 34 of 43 respondents (79%) have onsite simulation, 32 (74%) have models, manikins, or other devices, and 25 (58%) have staff resources within their institution. A total of 8 of 43 respondents (19%) have extensive, 26 (60%) have limited, and 8 (19%) have no otolaryngology simulation activity at their institution. The most common applications of simulation within otolaryngology are emergency management (23 of 43 respondents; 53%) and otology (21 of 43; 49%). All 31 respondents use simulation for clinical training (100%), 11 (33%) for proficiency, and 7 for mastery (21%). Three of 36 (22%) use extensive, 12 (33%) limited, and 21 (58%) no simulation in research. None of 34 use simulation for otolaryngology credentialing, although 2 (6%) use simulation for advanced cardiac life support credentialing. A total of 31 of 37 respondents (84%) are interested in participating in multicenter trials of simulation initiatives. Conclusions: Simulation resources are widely available in otolaryngology training institutions. Survey respondents report limited but widespread participation in simulation activity, and widespread interest in participating in simulation trials.
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Deutsch ES, Seagull FJ, Johnson KE, Malloy KM, Eibling DE. Can Simulation and Human Factors Improve Systems and Safety? Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Program Description: Our expertise and skill are essential, but not sufficient, for optimal patient outcomes. We work with teams and we work within systems with variable functionality. How can we make sure our team works together effectively? How can we improve the systems within which we work? An expert panel will describe how we can use simulation and the science of human factors to improve the processes, the equipment, and even the spaces in which we work. Examples address emergency response teams, airway carts, and electronic health records. Our keynote speaker, F. Jacob Seagull, PhD, is an expert in human factors applications in health care. Educational Objectives: (1) Understand how simulation can be used to improve health care delivery systems and safety. (2) Understand how human factors principles can be applied to improve health care delivery systems and safety.
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Malekzadeh S, Deutsch ES, Malloy KM. Simulation-based otorhinolaryngology emergencies boot camp: Part 2: Special skills using task trainers. Laryngoscope 2014; 124:1566-9. [DOI: 10.1002/lary.24571] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 10/15/2013] [Accepted: 11/13/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery; MedStar Georgetown University Hospital; Washington DC
| | - Ellen S. Deutsch
- Department of Anesthesia and Critical Care; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania
| | - Kelly M. Malloy
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health System; Ann Arbor Michigan U.S.A
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Malloy KM, Malekzadeh S, Deutsch ES. Simulation-based otorhinolaryngology emergencies boot camp: Part 1: Curriculum design and airway skills. Laryngoscope 2014; 124:1562-5. [DOI: 10.1002/lary.24572] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 10/14/2013] [Accepted: 11/13/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Kelly M. Malloy
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health System; Ann Arbor Michigan
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery; MedStar Georgetown University Hospital; Washington DC
| | - Ellen S. Deutsch
- Department of Anesthesia and Critical Care; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania U.S.A
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Deutsch ES, Malloy KM, Malekzadeh S. Simulation-based otorhinolaryngology emergencies boot camp: Part 3: Complex teamwork scenarios and conclusions. Laryngoscope 2014; 124:1570-2. [PMID: 24375442 DOI: 10.1002/lary.24570] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 10/15/2013] [Accepted: 11/12/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Ellen S Deutsch
- Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Zapanta PE, Adler J, Constant J, Malekzadeh S, Deutsch ES, Fung K, Malloy KM. The Junior Resident’s Perspective of Learning in a Simulation-Based Otolaryngology Boot Camp. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813496044a39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: 1) Determine what residents experience in an otolaryngology boot camp (OBC). 2) Understand how the individual resident’s background influences learning. Methods: Using a qualitative phenomenological approach, investigators interviewed 36 junior otolaryngology residents who had participated in a one-day simulation-based OBC. The residents attended camps in Washington, DC (July 2012), or in London, Ontario (September 2012). A semi-structured interview of each resident was recorded and transcribed. Using Moustakaa’ss analysis, the interviews were broken up into codes and clusters to create a codebook. To ensure trustworthiness of the qualitative data, investigators used upfront debriefing, investigator triangulation, epoche, reciprocal coding of transcripts, member checks, and thick, rich description. Results: Five learning themes emerged during OBC: 1) Residents aim to gain knowledge and experience to positively affect their performance and patient outcomes. 2) Prior clinical experience and OBC’s realistic scenarios influenced resident learning. 3) The residents valued their development of leadership and teamwork. 4) Residents actively learn by synthesis and application of their knowledge. 5) The faculty plays a critical role in the boot camp. Conclusions: The Accreditation Council for Graduate Medical Education (ACGME) has specific core requirements to improve resident performance and competency. To address this, innovative otolaryngology faculty has developed specialty specific boot camps, and quantitative research has documented the learners’ performance gains. Using the residents’ own words, this qualitative research study shows how residents learn and why residents benefit from attending a simulation-based otolaryngology boot camp. This research will help us better understand our learners and how we can improve their learning experience.
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Sardesai MG, Whipple M, Weaver EM, Deutsch ES, Kim S. Optimize Patient Education for Patient Satisfaction. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813493390a29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Program Description: This miniseminar will discuss various modalities for providing patient education in otolaryngology practice, highlighting some evidence, relevant educational concepts, and otolaryngologists’ experiences. Patient education is a critical component of patient-centered care in today’s outcomes-focused environment, in which patients obtain information from various educational media, and in which patient satisfaction is an increasingly-emphasized metric. Speakers will use combinations of literature evidence, educational theory, and critical, reflective “How I do it” descriptions to highlight different approaches to patient education. Short overview didactic sessions will be followed by a panel discussion with input from the audience. Educational Objectives: 1) Describe selected relevant concepts in medical education, and apply these in developing strategies for patient education; summarize the literature evidence for written materials in patient education. 2) Interpret techniques for use of seminars and simulation for patient education, and recognize their benefits and limitations. 3) Consider when educating medical staff and trainees is best to provide patient education.
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Deutsch ES, Fried MP, Wiet GJ, Amin MR, Malekzadeh S, Ishman SL, Wang E. From Simulation to Surgery: Making It Real. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813493390a19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Program Description: Does learning on a simulator really help surgeons operate better? Can learning or directed practice on a simulator contribute to faster or better skill acquisition? What are the advantages and disadvantages of virtual, high tech, or home-made simulators? How do I get started? A panel of experts will provide examples from otology, sinus, and airway surgery; and describe their experiences, recommendations, and visions for the future. Dr. Fried: virtual sinus surgery; Dr. Wiet: virtual temporal bone surgery; Dr. Amin: simulation for office-based procedures; Dr. Malekzadeh: make it yourself; Dr. Ishman: how do we assess competency? Dr. Wang: return on investment. Educational Objectives: 1) Describe how simulators can be used to develop or improve surgical skills. 2) Compare the advantages of different types of simulators. 3) Use a competency-based assessment tool.
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Deutsch ES, Orioles A, Kreicher K, Malloy KM, Rodgers DL. A qualitative analysis of faculty motivation to participate in otolaryngology simulation boot camps. Laryngoscope 2013; 123:890-7. [PMID: 23417846 DOI: 10.1002/lary.23965] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 10/17/2012] [Accepted: 12/10/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize factors that motivate faculty to participate in Simulation-Based Boot Camps (SBBC); to assess whether prior exposure to Simulation-Based Medical Education (SBME) or duration (years) of faculty practice affects this motivation. STUDY DESIGN Qualitative content analysis of semi-structured interviews of faculty. METHODS Interviews of 35 (56%) of 62 eligible faculty including demographic questions, and scripted, open-ended questions addressing motivation. Interviews were recorded, transcribed, de-identified, coded and analyzed using qualitative analysis software. Demographic characteristics were described. Emerging response categories were organized into themes contributing to both satisfaction and dissatisfaction. RESULTS Three major themes of faculty motivation emerged: enjoyment of teaching and camaraderie; benefits to residents, patients and themselves; and opportunities to learn or improve their own patient care and teaching techniques. Expense, and time away from work and family, were identified as challenges. Faculty with many versus few years in practice revealed a greater interest in diversity of teaching experiences and techniques. Comparison of faculty with extensive versus limited simulation experience yielded similar motivations. CONCLUSION Enjoyment of teaching; benefits to all participants; and opportunities for self-improvement emerged as themes of faculty motivation to participate in SBBC. SBBC have unique characteristics which provide an opportunity to facilitate teaching experiences that motivate faculty.
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Affiliation(s)
- Ellen S Deutsch
- Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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Griswold S, Ponnuru S, Nishisaki A, Szyld D, Davenport M, Deutsch ES, Nadkarni V. The emerging role of simulation education to achieve patient safety: translating deliberate practice and debriefing to save lives. Pediatr Clin North Am 2012; 59:1329-40. [PMID: 23116529 DOI: 10.1016/j.pcl.2012.09.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Simulation-based educational processes are emerging as key tools for assessing and improving patient safety. Multidisciplinary or interprofessional simulation training can be used to optimize crew resource management and safe communication principles. There is good evidence that simulation training improves self-confidence, knowledge, and individual and team performance on manikins. Emerging evidence supports that procedural simulation, deliberate practice, and debriefing can also improve operational performance in clinical settings and can result in safer patient and population/system outcomes in selected settings. This article highlights emerging evidence that shows how simulation-based interventions and education contribute to safer, more efficient systems of care that save lives.
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Affiliation(s)
- Sharon Griswold
- Department of Emergency Medicine, Simulation Center, Drexel University College of Medicine, Philadelphia, PA 19102, USA
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Ishman SL, Benke JR, Johnson KE, Zur KB, Jacobs IN, Thorne MC, Brown DJ, Lin SY, Bhatti N, Deutsch ES. Blinded Evaluation of Interrater Reliability of an Operative Competency Assessment Tool for Direct Laryngoscopy and Rigid Bronchoscopy. ACTA ACUST UNITED AC 2012; 138:916-22. [DOI: 10.1001/2013.jamaoto.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Objective To conduct a systematic review of published articles that describe simulators that could be used in otolaryngology for education, skill acquisition, and/or skill improvement. Data Sources Ovid and Embase databases searched July 14, 2011. Review Methods Three hundred fifty-three abstracts were independently reviewed by both authors, then 154 eligible articles were reviewed by both authors, and 95 articles were categorized by organ system (eg, otologic); type of simulator (eg, physical, virtual); whether the simulator was a prototype, could be purchased, or was constructed; validation; and level of learning assessment. Discrepancies were resolved by re-review and discussion. Results In addition to 11 overview articles, 28 articles described 16 otology simulators, most of which are virtual and prototypes. Ninteen articles described 10 sinus/rhinology simulators; most are virtual surgery simulators and prototypes. Eight articles described 8 oral cavity simulators, and 8 articles described neck simulators. Seventeen articles described 13 bronchoscopy simulators; several are full-body high-technology manikins adapted from other purposes. Five articles described eclectic simulators, including some for learning nontechnical and teamwork skills. Half of the simulators have been validated. Learning levels were often not assessed or assessment was limited to the learners’ perceptions. Conclusion A wide variety of simulators are available or under development. Lack of unified validation concepts and limited descriptions restricted our ability to assess model characteristics, availability, and validation. Simulators are emerging as powerful tools to facilitate learning; this review may provide a platform for discussion and refinement of the information reported and analyzed in evaluating simulators.
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Affiliation(s)
- Luv Javia
- Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Department of Otorhinolaryngology/Head and Neck Surgery, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ellen S. Deutsch
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Woodson GE, Burns JA, Deutsch ES, Dailey SH, Jabbour N, Amin MR. Simulators for Endoscopic Airway Surgery: Current and Future. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812449008a53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Woo JA, Malekzadeh S, Malloy KM, Deutsch ES. Comparing Mannequin Upper Airway Anatomic Fidelity. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451426a25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Evaluate the anatomic fidelity of pediatric and adult mannequins commonly used in upper airway procedure training. Develop assessment criteria for future anatomic fidelity studies conducted among otolaryngologists and other airway specialists. Method: Experienced otolaryngologists assessed the anatomic fidelity of 8 mannequins (lettered A-H) in a passive state (eg, no electronic augmentation), using rigid and flexible endoscopy and a 5-point rating scale (5 = best). Ratings of the nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, trachea, esophagus, and neck are displayed in a “spidergram.” Results: Eleven faculty otolaryngologists evaluated the realism of upper airway passive anatomic fidelity of 3 adult and 5 pediatric mannequins, during a 1-day course. Mean scores and standard deviations were tabulated for each mannequin at each anatomic site, and displayed in “spidergrams.” Differences in scores allow comparison of mannequin anatomic fidelity by site (maximum range, 2.8 for nasopharynx) and by mannequin (maximum range, 2.1). Because of the small number of responses in this pilot study, mannequins are deidentified. Conclusion: Ratings by survey participants demonstrated variation in the anatomic fidelity of a range of commercially available mannequins. Spidergram display of the results may allow instructors to select mannequins with the best anatomic fidelity for their specific educational purposes and may contribute to recommendations for improving mannequin fidelity.
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Deutsch ES, Blevins NH, Shapiro JA, Malekzadeh S, Reickert C. Simulation: Disruptive Innovation and Our Quest to Excel. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812449008a30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Simulation is revolutionizing medical education, certification, and ongoing professional development. Simulation encompasses a variety of technologies as well as nontechnical approaches to improve individual psychomotor skills, group effectiveness, and systems processes, all without direct risk to patients. Simulation-enhanced learning experiences, addressing learning objectives based on the needs of the individual or the group and following the principles of adult education, can be used to ensure consistent and comprehensive learning opportunities, thereby creatively complementing didactic and clinical learning experiences. Pockets of simulation expertise are already present in the field of otolaryngology; more will develop as these exciting and important innovations blossom.
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Affiliation(s)
- Ellen S. Deutsch
- Center for Simulation, Advanced Education, and Innovation, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Malekzadeh S, Malloy KM, Chu EE, Tompkins J, Battista A, Deutsch ES. ORL emergencies boot camp: Using simulation to onboard residents. Laryngoscope 2011; 121:2114-21. [DOI: 10.1002/lary.22146] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/08/2011] [Indexed: 11/07/2022]
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Deutsch ES. Tracheostomy: pediatric considerations. Respir Care 2010; 55:1082-1090. [PMID: 20667156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Pediatric patients for whom tracheotomy is a consideration have different anatomy, medical conditions, and prognoses than adults; even the tracheotomy tubes are different. Indications for pediatric tracheotomy generally include bypassing airway obstruction, providing access for prolonged mechanical ventilation, and facilitating tracheobronchial toilet. Subglottic stenosis is an important indication for tracheotomy in children; its etiology, prevention, and alternative options for management are presented. Discussion includes the benefits, risks, impact on families, techniques for tracheotomy tube changes, and alternatives to tracheotomy, with illustrative photographs and diagrams.
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Affiliation(s)
- Ellen S Deutsch
- Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, 8NW100, Philadelphia, PA 19104, USA.
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Deutsch ES, Dailey S, Darzi A, Blevins N, Fried MP, Malloy KM. Standing on Shoulders of Dummies: Simulation education 2009. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB, Granieri E, Hapner ER, Kimball CE, Krouse HJ, McMurray JS, Medina S, O'Brien K, Ouellette DR, Messinger-Rapport BJ, Stachler RJ, Strode S, Thompson DM, Stemple JC, Willging JP, Cowley T, McCoy S, Bernad PG, Patel MM. Clinical Practice Guideline: Hoarseness (Dysphonia). Otolaryngol Head Neck Surg 2009; 141:S1-S31. [DOI: 10.1016/j.otohns.2009.06.744] [Citation(s) in RCA: 203] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 06/26/2009] [Indexed: 12/27/2022]
Abstract
Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers. Results The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
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Deutsch ES, Christenson T, Curry J, Hossain J, Zur K, Jacobs I. Multimodality Education for Airway Endoscopy Skill Development. Ann Otol Rhinol Laryngol 2009; 118:81-6. [DOI: 10.1177/000348940911800201] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Airway endoscopy is a difficult skill to master. A unique practicum was designed to help otolaryngology residents develop endoscopy skills. The learning modalities included lectures, an animal laboratory, high-fidelity manikins, virtual bronchoscopy simulation, and standardized patients. This study compares the relative subjective value of these learning modalities for skill development and realism. Methods: Participants used a Likert scale (1 = disagree to 5 = agree) and open responses to anonymously rate the efficacy of 5 learning modalities for teaching airway management, endoscopy skills, and clinical leadership and for providing a realistic experience. Results: The results in 2007 were uniformly positive, with mean scores for every category and modality greater than 4 for developing cognitive, psychomotor, and affective skills; managing normal and abnormal conditions; preventing and managing complications; improving endoscopy skills; understanding team process; and experiencing overall and manual “feel” realism. In 2008, the participants were encouraged to more critically evaluate the course. The ratings demonstrated statistically significant differences between the mean scores for 4 of the 9 evaluation categories in 2007 and all 9 categories in 2008. Conclusions: Specific learning modalities (eg, lecture, animal laboratory, high-fidelity manikin, virtual bronchoscopy, standardized patient) were perceived to have different values for teaching airway management, developing endoscopy skills, teaching clinical leadership, and providing a realistic experience. We propose that these learning modalities can be used in a complementary manner.
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Deutsch ES, Satava RM, Fried MP, Stredney D, Sachdeva AK. Is It Real, or Is It Simulated? Innovations in ORL Education. Otolaryngol Head Neck Surg 2008. [DOI: 10.1016/j.otohns.2008.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deutsch ES, Ziv A, Healy GB, Sachdeva AK, Fried MP, Blevins NH, Wiet G. Miniseminar: Innovation in ORL Education: Will Dummies Make Us Smarter? Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Penetrating middle ear injury can result in hearing loss, vertigo, and facial nerve injury. We describe the cases of 2 children with penetrating trauma to the right ear that resulted in ossicular chain disruption; one injury was caused by cotton-tipped swabs and the other by a wooden matchstick. Symptoms in both children included hearing loss and otalgia; in addition, one child experienced ataxia and the other vertigo. Physical examination in both cases revealed a perforation in the posterosuperior quadrant of the tympanic membrane and visible ossicles. Audiometry identified a moderate conductive hearing loss in one child and a mild sensorineural hearing loss in the other. Both children underwent middle ear exploration and reduction of a subluxed stapes. We discuss the diagnosis, causes, and management of penetrating middle ear trauma. To reduce the morbidity associated with these traumas, otologic surgeons should act promptly and be versatile in choosing methods of repairing ossicular chain injuries.
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Affiliation(s)
- Michael C. Neuenschwander
- From the Division of Pediatric Otolaryngology, Department of Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, Del., and the Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia
| | - Ellen S. Deutsch
- From the Division of Pediatric Otolaryngology, Department of Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, Del., and the Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia
| | - Anthony Cornetta
- From the Division of Pediatric Otolaryngology, Department of Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, Del., and the Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia
| | - Thomas O. Willcox
- From the Division of Pediatric Otolaryngology, Department of Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, Del., and the Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia
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