Data Collection Forms SS



Advanced Cardiac Life Support Checklists for Simulation-based Education

Background:

The following checklists are used at Northwestern University as assessment tools for internal medicine residents in Advanced Cardiac Life Support (ACLS). The checklists are part of a mastery learning program in ACLS for second-year internal medicine residents. Each resident has already completed a traditional American Heart Association (AHA) ACLS course, but is also required to complete the simulation-based training program.

The checklists assess resident performance in 6 common ACLS events. These are: ventricular fibrillation, pulseless electrical activity, supraventricular tachycardia, symptomatic bradycardia and ventricular tachycardia. Checklists were developed for each procedure using the AHA ACLS 2005 guidelines1 and rigorous step-by-step procedures.2

The checklists have been used in our program to assess the competencies of medical knowledge and patient care. They could also be used to teach and assess teamwork and communication/leadership.

The checklists were designed to be used with a full-body human patient simulator. These models allow realistic responses to medications and are compatible with defibrillator and pacemaker equipment. Additionally, practice time for chest compressions and airway management skills are important components of the curriculum.

Timeline and Content of Simulation Program

In our program, 40 internal medicine residents participate in 5 sessions in the simulator center in the fall of the PGY2 year. These are divided into testing sessions (2) and teaching sessions (3). The first session is a pretest in which the resident is asked to lead a clinical response to 6 simulated ACLS scenarios. Each scenario contains a brief clinical history and has a defined endpoint. The resident’s performance is assessed by the examiner on the skills checklist for each scenario. Examinees are not allowed to refer to the checklists or other written materials during pre or posttest assessments.

After pretest, residents attend 3 2-hour teaching sessions in groups of 4. The first session is reserved for deliberate practice of pulseless arrhythmias. The second session is reserved for deliberate practice of tachycardias. The third practice session is reserved for deliberate practice of the bradycardia scenario and review. Activities in each session are focused, standardized, and accompanied by specific feedback from the instructor.3

Checklists are available for review during teaching sessions. In addition to specific ACLS procedures and skills, intubation, airway management and chest compressions are important components of the curriculum. During team based ACLS care practice sessions, residents rotate through 4 roles. These are: team leader, chest compressor, airway manager, and nurse. Residents rotate so that each participant has the opportunity to practice the set of skills associated with each role.

After the educational sessions, residents return to the simulator center individually for posttesting. Residents must meet or exceed a minimum passing score (MPS) for each ACLS scenario. If a resident does not meet the MPS for 1 or more scenarios, they are referred back to the simulator center for more deliberate practice.

Sample Schedule:

July-August – pretesting of residents

Sept-October – teaching sessions for residents

November-December – posttesting of residents

Details regarding development and effectiveness of the ACLS curriculum are available in prior published reports.4-8 These include a randomized trial of simulation training4, standard setting and development of the MPS5, use of simulation training for mastery learning of ACLS procedures,6 documentation of skill retention 14 months after training 7 and a dramatic improvement in actual ACLS patient care after simulator-based training.8

Equipment needed:

-Human Patient Simulator

-Cardiac Monitor

-Defibrillator/AED

-Pacemaker

-Prefilled syringes to administer medications named in ACLS algorithms

-Intubation equipment

-Airway management supplies (oxygen tank, nasal cannula, mask)

Participants in the educational program:

|Session |Time |Content |Participants |

|1 |July- August |Pretest |1 Resident |

| | | |1 Simulator center staff* |

| | | |1 Faculty+ |

| | | |1 Examiner‡ |

|2 |September-October |Teaching: pulseless arrhythmias |4 Residents |

| | | |1 Simulator center staff* |

| | | |1 Faculty+ |

|3 | |Teaching: tachycardias | |

|4 | |Teaching: bradycardia & review | |

|5 |November-December |Posttest |1 Resident |

| | | |1 Simulator center staff* |

| | | |1 Faculty+ |

| | | |1 Examiner‡ |

*Simulator staff operate the simulator and provide a voice for the simulated patient. Staff are located behind a one-way mirror at our facility and can see the scenario and simulator but are not visible to the learners.

+Faculty facilitate testing sessions by carrying out tasks as assigned by the examinee. Faculty provide direction and feedback during teaching sessions.

‡Examiner scores each resident on the checklists.

Abbreviations used in the Checklists:

1) 6H/5T is an abbreviation for reversible causes or contributing factors to pulseless arrythmias.1 The six “H’s” are: hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypoglycemia and hypothermia. The five “T’s” are: toxins, tamponade (cardiac), tension pneumothorax, thrombosis (coronary or pulmonary) and trauma.

2) Monitored/Non Monitored. At the beginning of the case scenario, the patient is on a cardiac monitor (monitored) or is not on a monitor (non-monitored). Timing of telemetry monitoring is important for the assessment of each clinical scenario.

References

1. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005; 112. Available at: . Accessed 6/15/2008.

2. Stufflebeam DL. The Checklists Development Checklist. Western Michigan

University Evaluation Center, July 2000. Available at . Accessed 12/15/2005.

3. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad. Med. 2004;79:S70-S81.

4. Wayne DB, Butter J, Siddall VJ, Fudala M, Lindquist L, Feinglass J, Wade

LD, McGaghie WC. Simulation-based training of internal medicine residents

in advanced cardiac life support protocols: a randomized trial. Teaching and Learning in Medicine. 2005;17:202-208.

5. Wayne DB, Fudala MJ, Butter J, Siddall VJ, Feinglass J, Wade LD, McGaghie

WC. Comparison of two standard-setting methods for advanced cardiac life

support training. Academic Medicine. 2005;80(10 Suppl):S63-S66.

6. Wayne DB, Butter J, Siddall VJ, Fudala MJ, Wade LD, Feinglass J, McGaghie

WC. Mastery learning of advanced cardiac life support skills by internal medicine using simulation technology and deliberate practice. Journal of General Internal Medicine. 2006;21:251-6.

7. Wayne DB, Siddall VJ, Butter J, Fudala MJ, Wade LD, Feinglass J, McGaghie

WC. A longitudinal study of internal medicine residents’ retention of advanced

cardiac support life skills. Academic Medicine. 2006;81(10 Suppl):S9-S12

8. Wayne DB, Didwania A, Fudala M, Barsuk JH, Feinglass J, McGaghie WC.

Simulation-based education improves quality of care during advanced cardiac

life support events: a case control study. Chest. 2008;133:56-61.

Data Collection Forms Advanced Cardiac Life Support Simulation Program

Study # ____________________

Date ______________ Evaluator ________________________________

Ventricular Fibrillation/Pulseless : Persistent / Refractory

Skill Key: A = Done Correctly B = Done Incorrectly C = Not Done

|Check responsiveness |A |B |C |

|Get Help |A |B |C |

|Open airway, LOOK, LISTEN, FEEL |A |B |C |

|Give 2 rescue breaths |A |B |C |

|Check for a pulse ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download