An Innovative Method of Teaching Advanced Cardiac-Life Support, or Why Cosmic Osmo May Someday Save Your Life. David W. Wormuth, MD Department of Surgery, SUNY Health Science Center at Syracuse, Syracuse NY 13210 Abstract A demonstration and discussion of the effectiveness of an animated and interactive simulation of cardiac andlor respiratory arrest with tools to allow the user to reverse the fatal course of events. The simulation is designed to reinforce and teach the American Heart Association's course in Advanced Cardiac Life Support (ACLS)[1J. Using an animated interactive simulation allows the student to rehearse various critical events without assembling all the components typically used in the ACLS course "MegaCode." The simulation is written in a commercial authoring shell made by Authorware, Inc, and currently runs on an Apple Macintosh II platform. Cosmic Osmo (Activision) is an animated and interactive exploration game based in Hypercard that allows the user to explore and control the game by clicking on various switchs, buttons, objects, even telephones. The interactive spirit of this program has been carried over to the ACLS tutorial.
Materials & Methods The simulation is written in Authorware Inc's, (Minneapolis, Minnesota) Authorware Professional version 1.5.2 and currently runs on the Apple Macintosh II platform. Authorware also runs on several other platforms (including MS-DOS). A color monitor is used to reproduce as closely as possible the color cues a physician uses in emergency situations (reaching for the mustard box of bicarbonate, the pink box of lidocaine, the blue and white box of epinephrine, or the purple box of atropine). In addition, positional cues are reinforced (in our institution these drugs are always in the second drawer from the top, while intubation supplies are in the third drawer from the top). This familiarity with the code cart, reduces the time needed to search for an item in the confusion of the code.
new skills for several days to a few weeks, but without constant reinforcement, these skills quickly lapse into the realm of "I used to know how to do that." Experience at our medical school has shown that the traditional model requires approximately two examinations before students begin to feel comfortable with actually managing a real cardiac arrest.
This simulation is intended to allow those students to practice anytime they want to brush up on their skills. By providing a stage where they control all the actions, the students are required to manage the code without subtle prompting available at real codes or at testing sessions. In addition, the computer is a very objective test monitor and can report back to the students areas where their skills were weak, or where they may have forgotten the appropriate algorithm sequence. The animation and interaction are important in the exercise because they tend to reinforce the actual carrying out of individual steps in managing a cardiac arrest. The student must activate and order the assembled personnel to initiate bag-mouth breathing or the patient maintains his current respiratory state or appropriately declines in status. Animation and interaction also reinforce knowledge of where common items are stored and how one must act in real situations to achieve a result. For instance, to give lidocaine to the patient, the student clicks on the second drawer of the code cart which pops open to show him a selection of medications. A quick search locates lidocaine which is drawn into a syringe when the box is clicked on. At random intervals, the student is asked to supply the correct dose and appropriate routes ( IV,. intracardiac, transtracheal, endotracheal tube, etc ) of the medication selected. This serves to demonstrate the students mastering of ACLS pharmaceuticals. Finally, the student drags the syringe over to the route desired and gives the drug.
Discussion Although the current version of the program is limited to ACLS simulations, the techniques, software, and teaching style used in this simulation can also be applied to several other algorithm based medical events. Such courses as the American College of Surgeons' Advanced Trauma Life Support[2] are also being
The traditional means of teaching medical students and other medical personnel the skills and practice of ACLS has been didactic lecture combined with limited opportunities to have actual practice experiences before being tested and certified to have competence in these skills. Very often, the students are very adequate at these 0195-4210/91/$5.00 C 1992 AMIA, Inc.
evaluated for similar simulations.
864
References 1. American Heart Association, Textbook of Advanced Cardiac Life Support, 1987.
2. Committee on Trauma, American College of Surgeons, Advanced Trauma Life Support Student Manual, 1989.
865
Materials & Methods The simulation is written in Authorware Inc's, (Minneapolis, Minnesota) Authorware Professional version 1.5.2 and currently runs on the Apple Macintosh II platform. Authorware also runs on several other platforms (including MS-DOS). A color monitor is used to reproduce as closely as possible the color cues a physician uses in emergency situations (reaching for the mustard box of bicarbonate, the pink box of lidocaine, the blue and white box of epinephrine, or the purple box of atropine). In addition, positional cues are reinforced (in our institution these drugs are always in the second drawer from the top, while intubation supplies are in the third drawer from the top). This familiarity with the code cart, reduces the time needed to search for an item in the confusion of the code.
new skills for several days to a few weeks, but without constant reinforcement, these skills quickly lapse into the realm of "I used to know how to do that." Experience at our medical school has shown that the traditional model requires approximately two examinations before students begin to feel comfortable with actually managing a real cardiac arrest.
This simulation is intended to allow those students to practice anytime they want to brush up on their skills. By providing a stage where they control all the actions, the students are required to manage the code without subtle prompting available at real codes or at testing sessions. In addition, the computer is a very objective test monitor and can report back to the students areas where their skills were weak, or where they may have forgotten the appropriate algorithm sequence. The animation and interaction are important in the exercise because they tend to reinforce the actual carrying out of individual steps in managing a cardiac arrest. The student must activate and order the assembled personnel to initiate bag-mouth breathing or the patient maintains his current respiratory state or appropriately declines in status. Animation and interaction also reinforce knowledge of where common items are stored and how one must act in real situations to achieve a result. For instance, to give lidocaine to the patient, the student clicks on the second drawer of the code cart which pops open to show him a selection of medications. A quick search locates lidocaine which is drawn into a syringe when the box is clicked on. At random intervals, the student is asked to supply the correct dose and appropriate routes ( IV,. intracardiac, transtracheal, endotracheal tube, etc ) of the medication selected. This serves to demonstrate the students mastering of ACLS pharmaceuticals. Finally, the student drags the syringe over to the route desired and gives the drug.
Discussion Although the current version of the program is limited to ACLS simulations, the techniques, software, and teaching style used in this simulation can also be applied to several other algorithm based medical events. Such courses as the American College of Surgeons' Advanced Trauma Life Support[2] are also being
The traditional means of teaching medical students and other medical personnel the skills and practice of ACLS has been didactic lecture combined with limited opportunities to have actual practice experiences before being tested and certified to have competence in these skills. Very often, the students are very adequate at these 0195-4210/91/$5.00 C 1992 AMIA, Inc.
evaluated for similar simulations.
864
References 1. American Heart Association, Textbook of Advanced Cardiac Life Support, 1987.
2. Committee on Trauma, American College of Surgeons, Advanced Trauma Life Support Student Manual, 1989.
865
