A Simulation-Based Mastery Learning Approach to Ventricular Assist Device Self-Management: The SimVAD Study

Abstract

Background Care of ventricular assist devices (VADs) requires meticulous self-management skills by patients and caregivers to enhance competence and prevent adverse events. Simulation-based mastery learning (SBML) is a clinical educational model that uses mannequins to train healthcare providers to a high standard and has been shown to reduce patient complications. SBML has not been used to train patients or caregivers to mastery on required skills. This abstract describes the multidisciplinary development of an innovative patient-centered, VAD self-management SBML curriculum. Methods We completed multidisciplinary, semi-structured interviews with 11 physicians, 7 VAD coordinators, 16 patients and 12 caregivers to identify important factors in VAD self-management. From these responses, we created a device-specific SBML training curriculum. SBML curricula include pretests followed by deliberate practice (repetitive, focused skills practice with expert feedback) on a mannequin. After practice, participants must meet or exceed a minimum passing standard (MPS) on posttests. To set MPSs on posttests for our SBML curriculum, we convened an expert panel of 6 physicians, 6 VAD coordinators, 6 patients and 6 caregivers and used the Mastery Angoff standard setting method. Results Interviews identified critical factors for inclusion in the curriculum: critical learning content (e.g., medications, controller and dressing changes) and training modalities such as wearable simulators, educational videos, emergency checklists and refresher training sessions. We created educational videos on controller changes, dressing changes, and abnormal driveline sites. Emergency checklists were created to help reinforce knowledge of alarms and VAD-related items needed for travel. We created checklists for controller and dressing changes, and changing power sources for scoring pre and post skills exams. We also developed a post training written exam which included key knowledge components. The MPS, per expert panel, for the skills exams ranged from 94–99% items correct while the written exam was 96% items correct. One, three, and 12-month follow-up skills assessments were subsequently created. Conclusions This is the first patient-centered VAD self-management curriculum to be created utilizing a powerful educational modality (SBML) and multidisciplinary feedback. We are currently engaged in a pilot trial (SimVAD) of the SBML curriculum to assess knowledge, skills acquisition and health related outcomes. Download : Download high-res image (90KB) Download : Download full-size image