A Simulation Curriculum for Management of Trauma and Surgical Critical Care Patients.
BACKGROUND
Expectations continue to rise for residency programs to provide integrated simulation training to address clinical competence. How to implement such training sustainably remains a challenge. We developed a compact module for first-year surgery residents integrating theory with practice in high-fidelity simulations, to reinforce the preparedness and confidence of junior residents in their ability to manage common emergent patient care scenarios in trauma and critical care surgery.


METHODS
The 3-day module features a combination of simulated patient encounters using standardized patients and electronic manikins, didactic sessions, and hands-on training. Manikin-based scenarios developed in-house were used to teach trauma and critical care management concepts and skills. Separate scenarios in collaboration with the regional organ donation program addressed communication in difficult situations such as brain death. Didactic material based on contemporary evidence, as well as skills stations, was developed to complement the scenarios. Residents were surveyed before and after training on their confidence in meeting the 14 learning objectives of the curriculum on a 5-point Likert scale.


RESULTS
Data from 15 residents who underwent this training show an overall improvement in confidence across all learning objectives defined for the module, with confidence scores before to after training improving significantly from 2.8 (σ = 0.85, median = 3) to 3.9 (σ = 0.87, median = 4) of 5, p < 0.001. Although female residents reported higher posttraining confidence scores compared with male residents (average 4.2 female vs 3.8 male, p = 0.002), there were no other significant differences in confidence scores or changes to scores owing to resident sex or program status (categorical or preliminary).


CONCLUSIONS
We successfully implemented a multimodal simulation-based curriculum that provides skills training integrated with the clinical context of managing trauma and critical care patients, simultaneously addressing a range of clinical competencies. Results to date show consistent improvement in residents' confidence in meeting learning objectives. Development of the curriculum continues for sustainability, as well as measures to embed objective evaluations of resident competence.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Kiyoyuki.Miyasaka@uphs.upenn.edu.
Kiyoyuki W
KW
Miyasaka
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Niels D
ND
Martin
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Jose L
JL
Pascual
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Joseph
J
Buchholz
Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada; Arnold and Blema Steinberg Medical Simulation Centre, Faculty of Medicine, McGill University, Montreal, Canada.
Rajesh
R
Aggarwal
D003422:Critical Care; D003479:Curriculum; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010561:Personnel Staffing and Scheduling; D000066908:Simulation Training / Q000191:economics / Q000379:methods; D014947:Wounds and Injuries / Q000601:surgery*
Interpersonal and Communication Skills; Patient Care, Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; education; residency; simulation; standardized patient; surgery