Aha!: Taking on the myth that simulated surprise enhances learning

Monteiro, Sandra; Sibbald Matthew

Objective: To discuss a recurring education problem of the high fidelity simulation myth. In the current instantiation, educators erroneously believe that trainees benefit from authentic uncertainty and surprise in simulation-based training. We explore the origins of this myth within experiential learning and social constructivism theories and propose an evidence-based solution of transparent and guided instruction in simulation.
Background: Constructivist theories highlight meaning making as the benefit of inquiry and discovery learning strategies. Inappropriate translation of this epistemology into an element of curriculum design, creates unfortunate unintended consequences. We propose that the translation of constructivist theories of learning within simulation-based education has resulted in a pervasive myth that scenarios must introduce realistic tension or surprises to encourage exploration and insightful problem solving.
Discussion: We argue that this myth is masquerading as experiential learning. We first interpret our experiences and observations of simulation-based education through our expertise in education science and curriculum design. We offer anecdotal evidence along with a review of selected literature to establish the presence of this previously undetected myth. We then propose directions for future research and education development.

Rapid cycle deliberate practice versus traditional simulation to improve resident performance in obstetrical emergencies

Pascoal, Erica; Mueller, Valerie; Morais, Michelle

Introduction: Rapid Cycle Deliberate Practice (RCDP) is a novel simulation strategy that is increasing in popularity in medical education. This simulation method contrasts traditional post-simulation debriefing styles in that clinical scenarios are paused and corrective feedback is provided in the moment before a scenario resumes. When an objective is met, a new cycle begins with more difficult tasks until participants acquire the desired skill. RCDP has been shown to be effective and superior to traditional simulation in improving medical learners’ performance in rare emergency scenarios in some studies. This method has been studied in the setting of pediatric and neonatal resuscitation and adult emergency medicine, however its use in obstetrics has not yet been studied. The Obstetrics and Gynecology program at McMaster University will be implementing and studying an RCDP simulation with a goal to improve resident skills in forceps assisted vaginal delivery, as this is an emergent obstetrical skill that is not often encountered in daily practice. The aim of this project is to determine the feasibility of implementing an RCDP simulation in an obstetrical residency program, and to study its effectiveness in improving residents’ immediate performance and skill retention as compared to traditional simulation methods.

Methods: Simulations will begin in the 2020-2021 educational year. A simulation using RCDP principles is being developed for a forceps-assisted vaginal delivery scenario. Residents across all years will be invited to participate and randomized to either RCDP or traditional simulation. Performance will be evaluated using a predetermined performance checklist that is being developed based on the best practices of local experts and objectives of training outlined by the Royal College of Physicians and Surgeons of Canada. Retention of knowledge/skills will be assessed by having residents repeat the simulation six months later. Residents will provide qualitative and quantitative feedback via an anonymous survey on their experience.

Results: This study is a work in progress and therefore no results are yet available.

Conclusion: The RCDP simulation technique is a novel method that has not yet been studied in obstetrics. This study seeks to understand its feasibility and effectiveness in comparison to traditional simulation, in teaching emergent obstetrical skills and improving skill retention.

Inter-professional Table Top Simulation

Van Alstine, Rebecca

The Table-top Simulation project is an inter-professional endeavour that takes place on the McMaster Clinical Teaching Unit at Grand River Hospital, Kitchener. It involves the "table-top" discussion of simulated cases relevant to the learners, nursing staff, ward administration, pharmacists, and other Allied health members who attend. Practically, each session is one hour and occurs on the ward teaching room at lunch hour. Cases focus on the ward management of unstable patients and discussion involves real-time case review, where a nurse, medical student and resident are assigned to the case and "solve" it together.
Items of interest for this study are both quantitative and qualitative. Ward metrics, including ICU calls, ICU transfers and deaths were measured pre-study and will then be reassessed post-study. Evaluations are gathered after each session for qualitative feedback and direction as to future topics. The primary goal of this study is to improve the care we provide to unstable (or potentially unstable) patients on our ward. We hope this will be accomplished through ongoing inter-professional educational initiatives.

Understanding the knowledge-to-practice continuum in the care of children and youth with autism and related neurodevelopmental disorders in the Emergency Department setting

Bhatti, Iqra; Nihal, Maleeha; Leung, James; Zubairi, Mohammad

Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder (NDD) characterized by impairments in social communication skills and patterns of restricted/repetitive behaviors. Children with ASD and related NDDs make more frequent visits to the emergency department (ED) than those without ASD/NDDs.  Caring for these children acutely is particularly challenging as they often experience difficulties communicating their symptoms and adhering to acute medical procedures, while also presenting with increased anxiety, irritability, self-injury, and aggression. These challenges translate into well-described gaps in care in ED settings. When surveyed, acute care health professionals report lack of knowledge and training in managing children with ASD/NDDs. Importantly, parents and caregivers also report that problems they encountered could have been avoided if healthcare providers had more experience in caring for individuals with ASD/NDDs. The aim of our study is to begin exploring and identifying the factors affecting the curricula and clinical exposures in order to understand and manage ASD and related NDDs in an ED setting. In phase one, we will develop a survey to identify learning needs and challenges among this patient population targeting health professionals at a tertiary Pediatric ED including physicians, nurses, social workers and child life specialists. Responses from this survey will guide phase two, which will utilize interviews with a grounded theory approach to construct a model of ideal care for children with ASD and related NDDs in an acute setting.  Finally, in phase three, we will conduct simulation-building exercises to address care gaps, focusing on quality improvement.

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