Experiential learning and deliberate practice in organ donation: development and implementation of an in-situ simulation-based program for ICU trainees
CCCF ePoster library. Brunette V. Oct 27, 2015; 114770; P91
Dre Veronique Brunette
Dre Veronique Brunette
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Abstract
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P91


Topic: Education Science


Experiential learning and deliberate practice in organ donation: development and implementation of an in-situ simulation-based program for ICU trainees



Veronique Brunette, A. Lagace, I. Ortega, P. Marsolais

Intensive Care, Hopital du Sacre-Coeur de Montreal, Montreal, Canada | Intensive Care, Hospital du Sacre-Coeur de Montreal, Montreal, Canada | Intensive Care, Hopital du Sacre-Coeur de Montreal, Montreal, Canada | Intensive Care, Hopital du Sacre-Coeur de Montreal, Montreal, Canada

Introduction: Caring for potential organ donor is now a major part of critical care practice. The process of end-of life care is often very delicate in that context and the clinical management itself relies on specific knowledge and skills. Even with a large flow of patients (average 50 donor/year) trainees in our center are not systematically exposed to the care of these patients and their families. With simulation-based education, we now have the opportunity to expose them to the organ donation process, have them learn and practice the skills needed in a safe environment without any harm for patients and their families. Until now, we are not aware of any published simulation-based education in organ donation for ICU trainees. The aim of this work is to describe the development and the implementation of the pilot phase of a simulation-based program for trainees rotating in the ICUs of a level-1 trauma center in Montreal.

Objectives:

The goal of our program is to teach trainees the different aspects of organ donation with an experiential learning modality. At the end of the program, trainees will be able to identify potential organ donors, perform the appropriate neurological clinical examination for neurological determination of death, manage frequent clinical events, demonstrate specific communication strategies and skills when discussing organ donation with family members and have increase awareness and knowledge about donation after cardiocirculatory death.



Methods:

Based on those learning objectives, four 15 minutes simulation scenarios were designed by a group of content experts and health professions educators (see related material). To increase engagement of participants, we decided to perform the simulations in-situ (i.e. in the real ICU setting); to use a high technology mannequin and embedded simulation personnel (ESP) (ex: nurse or respiratory therapist) for the clinical management scenarios; and to use standardized family members (SFM) for communication scenarios. Between July 2014 and May 2015, all scenarios were tested with senior residents or critical care fellows. A 5 minutes briefing and a 30 minutes debriefing was performed before and after each session. The debriefing used a 3-phases model (reactions, analysis, take-aways) and video-replay was available if needed). Didactic teaching via mini-lectures or small group discussions was also part of the debriefing for some of the scenarios. The goal of this pilot phase was to assess feasibility, to identify potential problems with the flow of the scenarios and to get feedback from the participants. The full program will be implemented in the fall of 2015 in engage trainee from different levels (4th year medical students, residents and fellows).



Results:

At the end of each debriefing session, we conducted a 10-minute focus group with everyone who was part of the development and testing process. The program was well received and all participants were engaged. Themes that emerged were: benefit of simulation to practice (instead of only reading about organ donation), the need for this kind of learning experience and the importance of realism. Challenges that we faced were mostly about scheduling and time needed to set-up the in-situ environment with equipment and audio-video devices. We also had difficulty finding available ESP in the unit at the moment we needed them.



Conclusion:

This pilot phase allowed us to test our scenarios and identify need for improvement. We will implement the full program in the fall of 2015 for all the trainees rotating in our ICUs. We will also introduce a pre-post intervention knowledge questionnaire and post-intervention surveys about confidence and general appreciation of the simulation experience.



References: Mcgaghie, W. C., Issenberg, S. B., Petrusa, E. R., & Scalese, R. J. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education, 44(1), 50–63. doi:10.1111/j.1365-2923.2009.03547.x

Mcgaghie, W. C., Issenberg, S. B., Cohen, E. R., Barsuk, J. H., & Wayne, D. B. (2011). Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence. Academic Medicine, 86(6), 706–711. doi:10.1097/ACM.0b013e318217e119

Wood, C., Buss, C., Buttery, A., & Gardiner, D. (2012). Evaluation of deceased donation simulation. Journal of the Intensive Care Society, 13(2), 107-114.

Coles et al. (2013. Simulation-based training in deceased organ donor management improves confidence levels of specialist nurses in organ donation (a united kingdom experience). Organs, Tissues & Cells, 16, 33-36.

Quebec Transplant, Neurologic determination of death; available at: http://www.transplantquebec.ca/sites/default/files/leg-for-001a_v1.pdf

Quebec Transplant, Organ Donor assessment and management guidelines, available at : http://www.transplantquebec.ca/sites/default/files/eva-gui-001a_v2.pdf

Shemie, S. D. (2006). La prise en charge des donneurs d'organes au Canada : recommandations du forum Optimiser le maintien du donneur afin d‘accroitre le nombre d’organes admissibles pour la transplantation. Canadian Medical Association Journal, 174(6), SF14–SF32. doi:10.1503/cmaj.060252


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