Board 228 - Program Innovations Abstract High Stakes, Non-technical Skills Curriculum Using Simulation (Submission #1206)

Introduction/Background The education of future emergency and critical care healthcare providers focuses on teaching the medical management of a variety of low frequency, high complexity critical situations. This education, however, often fails to address the leadership and interpersonal skills necessary to be effective in complicated high stakes situations. Patient safety research has demonstrated that the majority of adverse events stems from failures in team communication, situational awareness, resource utilization and leadership; further demonstrating the need for educating clinicians on these non-technical skills (NTS). This proposed curriculum, using crisis resource management (CRM) and NTS techniques from both aviation and anesthesiology as models, is designed to address these less tangible but critical skills. Methods This curriculum consists of four 90 minute sessions that will take the place of traditional didactic lectures given to emergency and critical care healthcare providers. The conceptual framework used to guide this curriculum is based on Ericsson’s theory on expertise, which suggests that to acquire expert level performance, one must engage in deliberate practice focused on improving some aspect of performance. In this regard, NTS are introduced to the learners, modeled using a video of expert performance and then the learners are allowed to practice the skills in various simulated clinical scenarios. At the beginning of each session, a short 10 minute powerpoint presentation will introduce the NTS principles at the first session and subsequently remind the learners of the NTS principles at the additional sessions. An expert video demonstrating these techniques in the management of a patient in a simulated clinical scenario will be shown at the first session to give the learners an expert model to try to emulate. Then, during each session, teams of learners will be asked to participate in a different simulated clinical scenario. Each scenario will involve both medical management of a patient in addition to NTS. A debriefing session immediately following the scenario will provide feedback on both the medical management in the case and the NTS demonstrated during the scenario. Then the learners will be allowed to repeat the same scenario using comments from the debriefing session to refine their NTS and facilitate retention of those skills. Results: Conclusion This curriculum introduces NTS to emergency and critical care healthcare providers and uses high fidelity simulation as a method to practice and refine these skills. Educating future healthcare providers on NTS may help prevent adverse events by facilitating effective leadership and communication skills. References 1. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains.Academic Medicine 2004; 79(10):S70-S81. 2. Gaba DM, Howard SK, Fish KJ, Smth BE, Sowb YA. Simulation based training in anesthesia crisis resource management (ACRM): a decade of experience. Simulation & Gaming. 2001; 32(2):175-93. 3. Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH. Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med. 1992; 63:763-70. 4. Kohn L, Corrigan J, Donaldson J. To err is human: building a safer health system. Washington (DC): National Academy Press; 1999. 5. McLaughlin S, Doezema D, Sklar D. Human simulation in emergency medicine training: a model curriculum. Acad Emerg Med2002; 9:1310-1318. 6. Morey J, Simon R, Jay G, Wears R, Salisbury M, Dukes K, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation Results of the MedTeams project. Health Services Research 2002; 37(6):1553-;81. 7. Risser D, Rice M, Salisbury M, Simon R, Jay G, Berns S, MedTeams Consortium. The potential for improved teamwork to reduce medical errors in the emergency department. Annals of Emergency Medicine 1999; 34(3):373-;83. 8. Small S, Wuerz R, Simon R, Shapiro N, Conn A, Setnik G. Demonstration of high-fidelity simulation team training for emergency medicine. Academic Emergency Medicine 1999; 6:312-;323. 9. Williamson J, Webb R, Sellen A, et al. Human failure: an analysis of 2000 incident reports. Anesthesia Intensive Care 1993; 21:678-;83. Disclosures None.