Board 123 - Program Innovations Abstract Simulation-Based Training Manual for Internal Medicine Residents (Submission #375)

Abstract

Introduction/Background Historically, medical training programs have relied on classroom teaching and hands-on training by expert physicians. Work hour restrictions have decreased the amount of time medical students and doctors in training spend with attending physicians. This shift has stimulated the growth of innovative and time effective alternatives in education. Additionally, the impact of patient discomfort and associated complications of procedures ‘practiced’ on live patients has come under closer scrutiny. Safety and quality measures have made us question the old Methods of learning. Medical simulators have been at the forefront of the change in approach to training medical students and doctors. They provide a safe environment in which procedures can be repeatedly practiced without compromising patient safety. Numerous studies have shown this to be an effective and often superior method of learning to didactic lectures followed by traditional hands-on expert training. Today most large medical training centers, hospitals and medical schools possess medical simulation facilities. Medical simulators include a variety of devices from task trainers to full body high fidelity manikins. The latter provides a fully immersive experience and can be programmed to provide a wide array of clinical scenarios. They provide immediate learning opportunities since they obviate the need to wait for real life cases. This is of particular importance given the reduced patient volume resulting from work hour restrictions. Studies have shown that simulator trained physicians outperform non-simulator trained counterparts in real life situations. They complete procedures faster and with fewer complications and have greater confidence in dealing with the ‘deteriorating’ patient. Medical simulation has played a significant role in the education of Mayo Clinic Arizona internal medicine residents since 2011. A simulation-based curriculum is used by Chief Medicine Residents to augment didactic morning report sessions. As usage of this curriculum grows, more robust research will assist in the future development of this innovative and essential teaching tool. Methods Chief Medicine Residents at Mayo Clinic Arizona collectively endeavored to increase hands-on medical training by incorporating simulation-based teaching sessions into the traditional morning report time period. Since 2011 the repertoire of scenarios has been passed down from graduating to beginning chiefs without any standardization of style or format. We compiled a series of twenty scenarios with variable learning objectives and levels of complexity. Most scenarios involve clinically deteriorating patients that would typically be managed by hospital internists. Each scenario follows a standardized format and includes learning objectives, setting and background patient information, personnel, scripts, simulator settings, diagnostics, critical action list and simulation responses to interventions. Expectations for resident performance are outlined in the "critical action list" that lends itself to effectively monitoring and documenting trainees’ progress. This compilation is ideal for use by all internal medicine programs with simulation-based training facilities. A description of the Mayo Clinic Arizona mannequin capabilities and a guide to debriefing are included in the text. Results: Conclusion Work hour restrictions, as well as safety and quality measures have impacted traditional hands-on training for internal medicine residents. Mayo Clinic Arizona Chief Medicine Residents use medical simulation training sessions to augment traditional didactic morning reports and to provide simulated hands-on experience of managing clinically deteriorating patients. Our compilation of these scenarios is now in press for publication in both print and electronic versions, with plans for distribution and use as an educational and research tool. Disclosures None.