Board 500- Technology Innovations Abstract Clinical Map as a Design Tool for Simulation Scenarios

Abstract

Introduction/Background We reported Scenario Maker as a novel tool for making a training scenario at IMSH 2012. Scenario Maker has a structure of a clinical map (CM) with changeable elements. New scenarios can be produced by selecting elements from pull-down menus in cells of Scenario Maker. We have developed Scenario Maker to adapt to more complicated scenarios. In this paper, we report how to design training scenarios for ACEC (Advanced Coma Evaluation and Care) as half a day course for training initial managements for impaired consciousness caused by various pathologies. Methods A CM has a tabular form, representing a clinical pathway, consisting of a frame and elements. The horizontal axis of the frame shows the steps of an algorithm, and the vertical axis shows a medical situation in which various medical practices are performed such as physical and physiological examinations, blood/urinary examinations, imaging tests, and treatments. The elements represent symptoms, specific examinations and their Results, treatments or conditions, such as anisocoria, 12-lead electrocardiography, atrial fibrillation, or oxygen mask at 6 L/min. Besides, functions of a human simulator can be added to the vertical axis. The following shows three steps through which we made a derivative scenario of ACEC from an original one; 1) First, we described an original scenario in a text. The scenario showed an initial management for a patient with impaired consciousness caused by a certain pathology and proceeded along the ACEC algorithm consisting of primary survey for resuscitation, secondary survey for emergencies and tertiary survey for specialized fields. We focused the primary survey which contained Airway, Breathing, Circulation, Disability of central nervous system, Epilepsy, Fever and Freeze (abnormal temperature), abnormal level of blood Glucose, Hydrogen (acidosis), and Ions (abnormal levels of blood electrolytes); 2) Next, we transformed the original scenario written in a text into a CM by arranging elements of practices in the CM frame; 3) Then, we replaced the elements in the original CM with different elements according to other pathologies. In this manner, we made one original and four derivative scenarios of ACEC: 1) status epileptics (original); 2) Non-convulsive status epileptics (NCSE); 3) heat stroke; 4) septic encephalopathy; and 5) diabetic ketoacidosis (DKA). We held the first ACEC course with 20 trainees consisting of medical staffs. All of trainees enriched their understandings for pathologies and their treatments by comparing different points among the five CMs, and were satisfied with the first ACEC training course. Results: Conclusion A clinical map enables instructors to design an original scenario of training an initial treatment for a patient with impaired consciousness and its derivatives easily if an algorithm of the treatment is defined and a medical situation is fixed.