Resuscitation 85 (2013) e23
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Rapid sequence simulation training Sir, Simulation has arguably revolutionized medical education within the last 20 years. This is nowhere more evident than in critical care and emergency medicine, where simulation-based training (SBT) has become the gold standard in many centers worldwide. Among others, advantages of SBT over traditional training methodologies are: (i) deliberate, risk-free practice, (ii) repeatability of training experiences, (iii) learner centered training, (iv) deconstruction of complex tasks into manageable learning objectives, and (v) objective feedback.1,2 A number of trials have shown that SBT leads to improved clinical practice and patient health.3,4 Hence, simulation has been recommended by current resuscitation guidelines.5 However, despite the growing body of evidence suggesting that SBT is associated with increased resuscitation performance and patient outcomes, optimal applications of SBT and most effective course formats have yet to be determined.5 Therefore, we want to report on a novel course concept featuring simulation as cornerstone of advanced life support (ALS) training. Rapid sequence simulation training (RSST) is characterized by a three-phased incremental structure. During the first five simulation sessions, each lasting for two minutes, basic skills such as emergency assessment, oxygen therapy and patient monitoring are practiced. In addition, these introductory trainings aim at establishing familiarity with simulators and equipment. The second five training sequences – three minutes of duration each – focus on high-quality cardiopulmonary resuscitation (CPR), ECG interpretation, defibrillation and electrical cardioversion. CPR drugs, advanced airway management procedures such as endotracheal intubation and placement of supraglottic airway devices, basic communication and leadership skills constitute learning objectives of the third course part, which is divided in five four-minute simulation sessions. After each training, team positions and leadership duties change. Every simulation sequence is followed by 120 s of structured debriefing focusing on respective learning objectives. Including three ten-minute breaks, RSST requires just 105 min of course time. Traditional ALS training utilizes multiple sequences of 10–15 min each, followed by lengthy debriefings of about the same duration. Although we do not dispute the value of feedback at all, extensive debriefing at times overwhelms trainees and may lead to a loss of focus. Targeted and short feedback, on the other hand, which has been employed as part of RSST, may keep trainees more focused and susceptive and enables quick performance corrections during subsequent practice attempts. From an educational perspective, RSST utilizes deliberate, repeated practice, task centered feedback and one of the major strengths of simulation, which is the adaptability of training complexity to learners’ needs.
0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.10.019
During the last ten months, we have put RSST into practice at our medical school as part of compulsory and elective courses for undergraduate students and postgraduate faculty, and trainees’ satisfaction has been impressive. Participants especially valued the pre-defined course structure, the training intensity and clear, unequivocal communication of learning objectives prior to each of the 15 training sessions. As a next step we will perform a comparative, performance-based study of traditional ALS courses versus RSST, as this novel simulation-based course concept will ultimately have to prove its educational value through rigorous scientific investigation. Conflict of interest statement Lukas P. Mileder works part-time as instructor at the Clinical Skills Center, Medical University of Graz. Both authors have developed the present course concept and declare that there is no real or perceived conflict of interest associated with this article. References 1. Perkins GD. Simulation in resuscitation training. Resuscitation 2007;73:202–11. 2. Ilgen JS, Sherbino J, Cook DA. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis. Acad Emerg Med 2013;20:117–27. 3. Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case–control study. Chest 2008;133:56–61. 4. Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Crit Care Med 2011;12:33–8. 5. Soar J, Monsieurs KG, Ballance JH, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Resuscitation 2010;81:1434–44.
Lukas P. Mileder ∗ Clinical Skills Center, Medical University of Graz, Austria Thomas Wegscheider a,b Clinical Skills Center, Medical University of Graz, Austria b Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Austria a
∗ Corresponding author at: Clinical Skills Center, Medical University of Graz, Auenbruggerplatz 33, 8036 Graz, Austria. E-mail address: [email protected] (L.P. Mileder)
20 October 2013
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Rapid sequence simulation training Sir, Simulation has arguably revolutionized medical education within the last 20 years. This is nowhere more evident than in critical care and emergency medicine, where simulation-based training (SBT) has become the gold standard in many centers worldwide. Among others, advantages of SBT over traditional training methodologies are: (i) deliberate, risk-free practice, (ii) repeatability of training experiences, (iii) learner centered training, (iv) deconstruction of complex tasks into manageable learning objectives, and (v) objective feedback.1,2 A number of trials have shown that SBT leads to improved clinical practice and patient health.3,4 Hence, simulation has been recommended by current resuscitation guidelines.5 However, despite the growing body of evidence suggesting that SBT is associated with increased resuscitation performance and patient outcomes, optimal applications of SBT and most effective course formats have yet to be determined.5 Therefore, we want to report on a novel course concept featuring simulation as cornerstone of advanced life support (ALS) training. Rapid sequence simulation training (RSST) is characterized by a three-phased incremental structure. During the first five simulation sessions, each lasting for two minutes, basic skills such as emergency assessment, oxygen therapy and patient monitoring are practiced. In addition, these introductory trainings aim at establishing familiarity with simulators and equipment. The second five training sequences – three minutes of duration each – focus on high-quality cardiopulmonary resuscitation (CPR), ECG interpretation, defibrillation and electrical cardioversion. CPR drugs, advanced airway management procedures such as endotracheal intubation and placement of supraglottic airway devices, basic communication and leadership skills constitute learning objectives of the third course part, which is divided in five four-minute simulation sessions. After each training, team positions and leadership duties change. Every simulation sequence is followed by 120 s of structured debriefing focusing on respective learning objectives. Including three ten-minute breaks, RSST requires just 105 min of course time. Traditional ALS training utilizes multiple sequences of 10–15 min each, followed by lengthy debriefings of about the same duration. Although we do not dispute the value of feedback at all, extensive debriefing at times overwhelms trainees and may lead to a loss of focus. Targeted and short feedback, on the other hand, which has been employed as part of RSST, may keep trainees more focused and susceptive and enables quick performance corrections during subsequent practice attempts. From an educational perspective, RSST utilizes deliberate, repeated practice, task centered feedback and one of the major strengths of simulation, which is the adaptability of training complexity to learners’ needs.
0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.10.019
During the last ten months, we have put RSST into practice at our medical school as part of compulsory and elective courses for undergraduate students and postgraduate faculty, and trainees’ satisfaction has been impressive. Participants especially valued the pre-defined course structure, the training intensity and clear, unequivocal communication of learning objectives prior to each of the 15 training sessions. As a next step we will perform a comparative, performance-based study of traditional ALS courses versus RSST, as this novel simulation-based course concept will ultimately have to prove its educational value through rigorous scientific investigation. Conflict of interest statement Lukas P. Mileder works part-time as instructor at the Clinical Skills Center, Medical University of Graz. Both authors have developed the present course concept and declare that there is no real or perceived conflict of interest associated with this article. References 1. Perkins GD. Simulation in resuscitation training. Resuscitation 2007;73:202–11. 2. Ilgen JS, Sherbino J, Cook DA. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis. Acad Emerg Med 2013;20:117–27. 3. Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case–control study. Chest 2008;133:56–61. 4. Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Crit Care Med 2011;12:33–8. 5. Soar J, Monsieurs KG, Ballance JH, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Resuscitation 2010;81:1434–44.
Lukas P. Mileder ∗ Clinical Skills Center, Medical University of Graz, Austria Thomas Wegscheider a,b Clinical Skills Center, Medical University of Graz, Austria b Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Austria a
∗ Corresponding author at: Clinical Skills Center, Medical University of Graz, Auenbruggerplatz 33, 8036 Graz, Austria. E-mail address: [email protected] (L.P. Mileder)
20 October 2013
