Dr. Allan L and Mary L Graham Clinical Performance Center Annual Report 2012 Rachel Yudkowsky, MD, MHPE, Director Martin Hurm, MFA, Associate Director Mission The mission of the Dr. Allan L. and Mary L. Graham Clinical Performance Center (GCPC) is to help educators in the health professions improve clinical performance and patient safety by using simulated clinical encounters for Instruction Assessment Quality Improvement Research Who We Are and What We Do The GCPC, a unit of the Department of Medical Education (DME) in the UIC College of Medicine, is a comprehensive simulation center providing education programs that feature standardized patients, task trainers, mannequins and other simulations. GCPC facilities include two eight-room “clinics” for standardized patient encounters, two mannequin simulation suites, two procedural skills labs, a clinical findings simulation lab, and two classrooms, all equipped with AV recording and playback capability, as well as office and administrative spaces. The GCPC is affiliated with the College of Medicine’s Surgical Skills Lab and the Perinatal Simulation Lab, together comprising the UIC Health Sciences Simulation Consortium. We serve medical students and residents, nursing and nurse practitioner students, pharmacy students and residents, hospital staff including nurses and respiratory therapists, physicians in practice, and mid-career professionals who are students in the DME Masters of Health Professions Education and the College of Medicine Masters in Patient Safety Leadership programs. Health Professions faculty from around the world attend short-term fellowship programs at the GCPC to learn how to implement simulation activities effectively in their own schools. GCPC staff members serve as workshop instructors, plenary speakers and Special Project faculty for health professions students and residents at UIC. We disseminate knowledge gained through our activities through peer reviewed publications, workshops, paper presentations and posters at national and international conferences, including the American Association of Medical Colleges (AAMC), the International Meeting on Simulation in Healthcare (IMSH), and the Association of Standardized Patient Educators (ASPE). GCPC Highlights - 2012 ACS Accreditation As a member of the UIC Health Sciences Simulation Consortium, in December 2011 the GCPC was accredited by the American College of Surgeons as a Level I (Comprehensive) Accredited Educational Institute. The UIC Consortium is one of a select group of 62 ACS accredited simulation centers worldwide, facilitating opportunities for research and collaboration in the development of innovative simulation-based educational programs. Program Growth About 2,000 individual learners came to the GCPC in 2012 for over 30,000 learner-hours of education activities in 77 different simulation-based educational programs. A total of 2,766 program half-days were conducted in 2012 – an average of 6 programs/day, with standardized patient, procedural skills and mannequin programs running concurrently. Programs were conducted on 240 of 247 days FY11 Client FY11 FY12 FY12 that the Center was open; five Programs Learner Programs Learners additional days were occupied Hours Hours with instructor training 34 College of Medicine 18,535 35 22,064 programs, for a 99% program 8 College of Nursing 1,582 9 1,671 occupancy rate. 3 College of Pharmacy 956 2 819 Volume increased substantially since 2011, with a 13% growth in programs and a 26% increase in learner-hours. Graduate Medical Education UIC Medical Center Other UIC Internal External Total 14 2,692 14 3,292 5 1 3 68 362 232 NA 24,359 6 7 4 77 601 263 1946 30,656 Staff Transitions The Graham CPC added or promoted several key staff members to support the increased demand for educational programs: Cindy LeDonne: Cindy has served as the GCPC’s simulation specialist in charge of the mannequin and procedural skills (mechanical) simulation programs since their inception in 2007. In 2012 Cindy was named Assistant Director for Mechanical Simulation in recognition of her pivotal role in developing and administering the mannequin and procedural skills simulation programs. Jennifer Livingston: Jennifer has been a paramedic for 13 years, serving as a senior paramedic and dispatcher at two Chicago-area private ambulance companies. Jennifer joined the GCPC in 2008 as a Clinical Skills Instructor, and joined the staff as Simulation Technology Coordinator in 2012. She is currently working on her Bachelor’s Degree in Business from DePaul University. Lynda Shadrake: Lynda is a graduate of The Ohio State University and a former high school English and drama teacher; she has been a professional actress in Chicago for over 25 years. GrahamCPC 2012 Annual Report Page 2 of 15 Lynda started her career at UIC as a standardized patient in 2006, and joined the staff as SP Coordinator in 2012. Emergency Medicine Simulation Fellow In July of 2012 the Department of Emergency Medicine initiated an Emergency Medicine Education Fellowship. The EM Fellow spends one day a week in the Graham CPC learning to create and implement a full range of simulation-based educational programs. The Fellow also participates in the DME Scholars for Teaching Excellence Faculty Fellowship (STEFF) program. New Equipment & Facilities New Mannequin Simulation Suite: With demand for mannequin simulation growing rapidly, we have repurposed one of our classrooms to serve as a second mannequin simulation suite complete with a mannequin, crash cart, critical care equipment, control room and AV debriefing capability. New Simulation Equipment includes: SimBaby High Fidelity Mannequin ResusciAnne CPR trainer Pediatric procedure models Chest Tube Trainer Injection/aspiration knee and shoulder models Research and Development Impact of Clinically Discriminating Clinical Findings on the Validity of Performance Test Scores: Drs. Rachel Yudkowsky, Georges Bordage and Janet Riddle are investigating the impact of an innovative checklist design approach on the validity of standardized patient-based performance exams. The checklists focus on hypothesisdriven clinically discriminating findings, thus encouraging and assessing clinical reasoning. Funded by the National Board of Medical Examiners Stemmler Fund, this study is based on the results of a previous Stemmler grant to Drs Yudkowsky and Bordage, also conducted at the GCPC. Intervening to Prevent Contextual Errors in Medical Decision Making: Drs Saul Weiner, Alan Schwarz, Rachel Yudkowsky, Keith Muccino, and Ilene Harris with Sonal Patel, Frances Weaver, Gunjan Sharma, and Amy Binns-Calvey are assessing the efficacy of a curriculum teaching residents to probe for contextual issues (such as patients' access to care) that affect patients' plans of care, using standardized patients in simulated encounters at the GCPC and at the Loyola Clinical Skills Center. This study is funded by a VA Education Grant. Assessing Resident Physician Melanoma Detection Across Ethnic Groups. Dr. Claudia Hernandez and colleagues are exploring whether an educational program on how to detect melanomas has an impact on melanoma detection by residents. This study was a pilot program for Dr. Hernandez’ NIH Grant Application. GrahamCPC 2012 Annual Report Page 3 of 15 Do Standardized Patients Alter Their Portrayals to Assist Learners During Clinical Performance Center Encounters? Amy Binns-Calvey and Dr. Rachel Yudkowsky are surveying SPs to explore factors that may lead to inconsistent portrayals during SP encounters. Immersive Touch Module Development: Drs. Alexandra Vanmeter (Internal Medicine) and Rachel Yudkowsky are working with Drs. Pat Banerjee and Cristian Luciano of the UIC College of Engineering and Immersive Touch Inc to develop new simulator modules and curricula for the Immersive Touch augmented reality/haptic simulator, focusing on Lumbar Puncture and Central Venous Catheter Insertion. Recent Publications Based on Work Done in or with the GCPC 1. Yudkowsky R, Luciano C, Banerjee P, Schwartz A, Alaraj A, Lemole M, Charbel F, Smith K, Rizzi S, Byrne R, Bendok B, Frim D. Practice on an Augmented Reality/Haptic Simulator and Library of Virtual Brains Improves Residents’ Ability to Perform a Ventriculostomy. Simulation in Healthcare, in Press. 2. Weiner SJ, Schwartz A, Cyrus K, Binns-Calvey A, Weaver F, Sharma G, Yudkowsky R. Unannounced Standardize Patient Assessment of the Roter Interaction Analysis System: The Challenge of Measuring Patient-Centered Communication. Journal of General Internal Medicine. DOI: 10.1007/s11606-012-2221-3 Published online 19 Sept 2012. 3. Binns-Calvey AE, Rush N, Hansen A, Soto K, Yudkowsky R: Improving Ambulatory Services Using Unannounced Standardized Patients. Simulation in Healthcare 2012; 7(3):203. 4. Schwartz A, Weiner SJ, Weaver F, Yudkowsky R, Sharma G, Benns-Calvey A, Preyss B, Jordan N: Uncharted Territory: Measuring Costs of Diagnostic Errors Outside the Medical Record. BMJ Quality & Safety 7 July 2012; doi:10.1136/bmjqs-2012-000832. 5. Yudkowsky R, Riddle J, Feinzimer B, Kondos G, Bordage G: Learning to Listen: A Guide to Simulator-Assisted Practice in Recognizing and Interpreting Abnormal Physical Exam Findings. Simulation in Healthcare 2011; 6(6):455. 6. Yudkowsky R, Luciano C, Banerjee P, Alaraj A, Lemole M, Schwartz A, Charbel F, Smith K, Rizzi S: Ventriculostomy Practice on a Library of Virtual Brains Using a VR/Haptic Simulator Improves Simulator and Surgical Outcomes. Simulation in Healthcare, 2011; 6(6):395. Recent Presentations Based on Work Done in or with the GCPC 1. Yudkowsky R. Ventriculostomy Practice on a Library of Virtual Brains Using a VR/Haptic Simulator Improves Simulator and Surgical Outcomes. Poster presentation at the Agency for HealthCare Research and Quality Annual Meeting, Bethesda MD, September 2012. GrahamCPC 2012 Annual Report Page 4 of 15 2. Gangopadhyaya A, Kiser R, Valdes W, Raja S, Smith K, Yudkowsky R: Using Standardized Patients for Assessing Resident Comfort and Skills in Telehealth Communication. Oral abstract presented at the annual meeting of the Association of Standardized Patient Educators, San Diego CA, June 2012. 3. Binns-Calvey AE, Rush N, Hansen A, Soto K, Yudkowsky R: Improving Ambulatory Services Using Unannounced Standardized Patients. Poster presented at the annual meeting of the Association of Standardized Patient Educators, San Diego CA, June 2012. 4. Binns-Calvey A, Milos S: Portraying the Patient…With a Minimum of Drama: Using Basic Acting Techniques to Train SP’s with Non-Performance-Based Backgrounds. Workshop presented at the 10th annual conference of the Association of Standardized Patient Educators (ASPE), San Diego CA, June 2012. 5. Binns-Calvey A, Hurm M, Kiser R, McKenzie L, Milos S, Yudkowsky R: Advanced Learner-Center Feedback Coaching Skills. Workshop presented at the 10th annual conference of the Association of Standardized Patient Educators, San Diego CA, June 2012. 6. Yudkowsky R, Blatt B, Nicholas C: Beyond the Head-to-Toe: Strategies to Improve Clinical Reasoning During the Physical Exam. Presentation/discussion at the annual meeting of the Association of Standardized Patient Educators, San Diego CA, June 2012. 7. Idler A, Srivastava P, Robin B, Yudkowsky R: "See one, do one, teach one" A Thing of the Past: Using Simulation Technology to Teach Pediatric Procedural Skills. Poster presented at the annual meeting of the Association of Pediatric Program Directors, San Antonio TX, March 2012. 8. Ledonne C, Fisher K: Growing Our Own: Teaming up with Paramedics to Successfully Operate a Simulation Center. Podium presentation at the 12th annual international meeting for Simulation in Healthcare, San Diego CA, January 2012. 9. Yudkowsky R, Riddle J, Feinzimer B, Kondos G, Bordage G: Learning to Listen: A Guide to Simulator-Assisted Practice in Recognizing and Interpreting Abnormal Physical Exam Findings. Technical/Innovations poster presented at the 12th annual international meeting on Simulation in Healthcare, San Diego CA, January 2012. 10. Yudkowsky R, Luciano C, Banerjee P, Alaraj A, Lemole M, Schwartz A, Charbel F, Smith K, Rizzi S: Ventriculostomy Practice on a Library of Virtual Brains Using a VR/Haptic Simulator Improves Simulator and Surgical Outcomes. Research poster presented at the 12th annual international meeting on Simulation in Healthcare, San Diego CA, January 2012. Awarded first place research abstract. 11. Yudkowsky R, Tumuluru S, Casey P, Herlich N: Setting Standards For Procedural Skills Checklists With Patient Safety Considerations. Research in Medical Education poster at the Meeting of the Assoc. of American Medical Colleges, Denver CO, November 2011. GrahamCPC 2012 Annual Report Page 5 of 15 New Programs developed in 2011-2012 Gross Anatomy Pilot Program: The GCPC collaborated with Dr Norman Lieska and Dale Lorens to provide basic physical exam technique instruction in conjunction with Gross Anatomy studies. Practical Instructors from the GCPC taught students how to locate and auscultate heart sounds and peripheral pulses in the fall, and to perform a basic abdominal exam in the spring. The program will be expanded in 2013 to include other physical exam maneuvers, helping students link their basic science anatomy studies to their future clinical practice. Telehealth Communication Project: Telehealth is a rapidly expanding modality for interacting with patients and colleagues. In 2011-12 the GCPC developed SP-based telehealth training and assessment scenarios for Internal Medicine, General Surgery, Pediatrics and Obstetrics/Gynecology; we plan to develop an instructional program in telehealth for residents in 2012-13. Interprofessional Conflict Resolution Scenarios: Miscommunication and conflict between residents, nurses and other health professionals can be a major source of error in patient care. The GCPC has begun to develop interprofessional conflict scenarios to be used in our resident communication assessments for Internal Medicine, General Surgery, Pediatrics and Obstetrics/Gynecology. Certificate Program for SP Educators: The GCPC inaugurated a one-week intensive certificate program in Standardized-Patient-Based Education, allowing an international group of faculty and simulation educators to acquire the knowledge and skills needed to create compelling education programs using standardized patients (SPs). Basic Life Support (BLS) Recertification: The GCPC now offers BLS Recertification to College of Medicine, College of Nursing, College of Pharmacy, and College of Dentistry faculty, staff, residents, and students. This is an American Heart Association course in which learners complete the didactic portion of the course online and come to the GCPC for hands-on practice and assessment of skills. This has been a very busy and exciting year for the GCPC; we look forward to continuing to provide high quality simulation programs in support of instruction, assessment, patient safety and research. GrahamCPC 2012 Annual Report Page 6 of 15 Learner Hour Growth 35,000 30,000 External 25,000 Other Internal UIH 20,000 CON 15,000 GME COM 10,000 5,000 0 FY11 FY12 Program Growth 80 70 60 External 50 Other Internal UIH 40 CON GME 30 COM 20 10 0 FY11 FY12 GrahamCPC 2012 Annual Report Page 7 of 15 COM Space Usage by Year M4 M3 M2 M1 8.9% Center Usage 1.0% 5.3% 5.1% COM GME CON 18.6% UIH 61.1% Other Internal External Usage is measured in half-days. COM, for example had programs running for 1,522 half-days at the Center in FY12 GrahamCPC 2012 Annual Report Page 8 of 15 Dr Allan L and Mary L Graham Clinical Performance Center Programs AY2011-2012 Number of Learners Simulation Modality M1 Gross Anatomy Physical Exam (PE) Workshop M1 History Interview Assessment M1 Practice History Workshop M1 Vital Signs Workshop 195 SP Learning physical examination skills 4 hours 195 SP 4 hours 195 SP Assessing history taking skills Practice history taking 195 SPs are used as instructors Learning to take vital signs 4.5 hours M2 Abdominal Workshop 192 SP used as model 2.5 hours M2 Breast Exam Workshop 192 M2 Cardiac Workshop 192 Gynecologic Teaching Associates SP used as model M2 Communication Assessment M2 Complete History I Workshop M2 Domestic Violence Workshop 192 SP 192 SP 192 SP Learning proper abdominal examination Learning proper technique of breast examination Learning proper cardiac examination techniques Communication skills with patients Learning proper history taking skills Learning how to communicate with women who are victims of domestic violence Program Skills learned or assessed Experiential Hours per Learner UIC College of Medicine 4 hours 1.5 hours 2 hours 2 hours 2 hours 3 hours GrahamCPC 2012 Annual Report Page 9 of 15 M2 Emergency Medicine 30 Interest Group Procedural Task Trainers Students practice basic procedural skills necessary for emergency physicians. 2 hours M2 Focused History/PE Workshop 192 SPs 3 hours M2 Giving Bad News Workshop M2 Lung and Thoracic Workshop 192 SP 192 SP is used as model M2 Male G/R Workshop 192 Male G/U instructors M2 Mental Status Workshop 192 SP M2 Musculoskeletal Workshop 192 SPs with real findings M2 Ophthalmic Workshop 192 SP M2 Pelvic Exam Workshop 192 M2 Head to Toe Assessment 192 Gynecologic Teaching Associates SP Learn how to perform a focused history and PE Practice delivering bad news Learn proper techniques of the lung exam Learn proper techniques for the male genital/rectal examination Learn to conduct a mental status examination Learn PE techniques for a musculoskeletal examination Learn proper techniques of the ophthalmic examination Learn proper techniques of the pelvic examination Assessment of the full Head to Toe Physical Exam M3 Essentials of Clinical Practice and Professionalism (ECP&P) 188 SPs, Procedural Task Trainers and Mannequins 4.5 hours Each student attends 4 times a year M3 Graduation Competency Exam Procedure Skills 188 Task trainer Learn 12 basic procedural skills, practice EKG interpretation, and gain experience in teamwork and decision-making. Students are assessed on 12 procedural skills and EKG interpretation. 3 hours 1.5 hours 1.5 hours 3 hours 3 hours 3 hours 1.5 hours 1.5 hours 2 hours GrahamCPC 2012 Annual Report Page 10 of 15 M3 Graduation Competency Exam - SP Encounters M3 Internal Medicine Clerkship - workshop 188 SP Assess clinical and communication skills 4 hours 188 SP 1.5 hours M3 Pediatric Clerkship Simulation Workshop 87 (started mid year) Mannequin and SPs M3 Psychiatry Clerkship Assessment 188 SP Focus on data gathering and patientcentered communication Students work in pairs to elicit a focused pediatric history and physical and initiate appropriate patient interventions. Assess ability to obtain history evaluate mental status exam of psychiatry patients (SPs) M4 Anesthesia Clerkship Procedure Skills Workshop 168 Task trainers + Mid-fidelity mannequin 4 hours M4 Anesthesia Clerkship Mannequin Workshop 168 Mannequin Learn anesthesia procedures and practice conducting a pre-operative assessment. Practice with presurgical patients and patients requiring ACLS interventions. Practice invasive procedures commonly seen in an ER setting and work in teams to care for 2-3 critically ill mannequin patients. Orientation to UIC hospital protocol and working with patients 2 hours 2 hours 4 hours M4 Emergency Medicine 168 Clerkship Workshop SPs, Procedural Task Trainers and Mannequins 3 hours M4 International Student Workshop Chiba and Jazan students MHPE 505, 502 SP Demonstration 8 SP 20 SP Demonstration of what an SP does/ question-answer 1.5 hours 72 Mannequin Assess “hospitalized patients” and provide initial stabilizing 2 hours 3 hours UIC College of Nursing Graduate Entry Program Mannequin Workshop GrahamCPC 2012 Annual Report Page 11 of 15 Interprofessional Education Workshop 24 SP Male Genitourinary Exam 97 Nurse Practitioner History and PE Workshop Nurse Practitioner Mannequin Workshop 59 Male Urinary Teaching Associate (MUTA) SPs 31 Mannequin Nurse Practitioner Skills Workshop Pelvic Exam Workshop 44 Student Nurse Pediatric Mannequin Workshop 96 Task Trainer + Mannequin Gynecologic Teaching Associates Mannequin + SPs 97 interventions Learn roles of 4 hours different healthcare professionals while caring for a patient Learning proper 1.5 hours techniques of the practice male Genitourinary exams Practice obtaining a 1 hour focused History and PE Conduct a thorough H+P and present the patient to senior staff Practice advanced invasive skills Learn proper techniques of the pelvic examination Assess and treat two infant patients while communicating with the parent 1 hour Learn to take a history from an SP Learn to communicate effectively with an SP 4 hours Practice advanced airway maneuvers, central lines, and managing the surgical patient Residents practice oral board cases and participate in 2 complex mannequin simulations with a 3-4 hours 7 hours 1.5 hours 3 hours UIC College of Pharmacy History/Counseling Workshop Patient Centered Communication Workshop 182 SP 182 SP Anesthesia Simulation Workshop 68 Mannequin + Task Trainers Emergency Medicine Boards Practice 52 Mannequin 4 hours Graduate Medical Education 6 hours, three times a year GrahamCPC 2012 Annual Report Page 12 of 15 Emergency Medicine Conference Workshop 120 SP, task trainers, mannequins Internal Medicine Procedure Skills Internal Medicine Communication Skills Assessment Internal Medicine PreCritical Care Rotation Workshop 48 Task Trainers 57 SP 105 Mannequin Neuro Lumbar Puncture Workshop OB/GYN Communication Skills Assessment 22 12 Task trainers + SPs SP Pediatric Procedure Skills Workshop 105 Task Trainers Pediatric Mannequin Workshop 51 Mannequin + SPs Pediatrics Communication Skills Assessment New Resident Procedural Skills Assessment 27 SP 248 Task Trainers Surgery Communication Skills Assessment 27 SP COM Rockford - Breast & Pelvic Workshop 27 CON Rockford - Male GU Workshop 34 Gynecologic Teaching Associates Male Urogenital team approach Residents participate in organ-system themed days that include procedures, assessments, and mannequin treatment Practice invasive procedures Assessment of patientcentered communication skills Practice working as a team to resuscitate patients per ACLS protocols Practice performing LPs on difficult spines Assessment of patientcentered communication skills Practice and assessment of seven pediatric procedures Assess and treat pediatric mannequin scenarios while practicing team communication Assessment of patientcentered communication skills Assessment of four basic procedural skills, with remedial instruction if needed Assessment of patientcentered communication skills 2-5 hours, nine times a year 1-2 hours 3.5 hours 2 hours 3 hours 3.5 hours 4 hours 2 hours 3.5 hours 2 hours 3.5 hours Other UIC Projects Learn proper techniques of the pelvic examination Learning proper techniques of the 2 hours 1.5 hours GrahamCPC 2012 Annual Report Page 13 of 15 CON Rockford - Pelvic Workshop 34 Distance Education – Second Life Project 8 Teaching Associates Gynecologic Teaching Associates SP School of Continuing Studies – Masters in Patient Safety Leadership (MPSL) UIUC Graduation Competency Exam – SP encounters 12 SP 22 Lewis University Male/Female Exam Male GU exams Learning proper techniques of the pelvic examination Practice motivational interviewing in a virtual immersive environment (Second Life) Practice disclosing medical error 1.5 hours SP Assess students on clinical and communication skills 3.5 hours 21 GTA/MUTA 3 hours Malcolm X College – Physician Assistants 36 Universidad de Chile – Visiting Faculty Professional Development Program Veterans Administration - Brief Intervention 5 Task trainer + mid-fidelity mannequins SP Learn proper techniques of male and female intimate examinations Practice recognizing clinical findings and EKG interpretation. Learn how to create and implement SP program 252 SP Practice Motivational Interviewing Techniques 4 hours AHRQ Disclosure Grant NA SP 4 hours Melanoma Detection by Medicine Residents Resident Contextual Medical Decision Making 6 Unannounced SPs SPs Offsite workshops on patient safety and disclosing adverse events Proof of concept for NIH grant application Assess efficacy of educational intervention on contextualizing care 4 hours 4 hours External Clients 3 hours 3 weeks intensive program Research 20 1 hour 2 hours GrahamCPC 2012 Annual Report Page 14 of 15 UIC Hospital and Health Sciences System Emergency Department In-Situ Mock Codes 42 Mannequin + SP Central Venous Catheter Workshops 80 Task trainer + SP Moderate Sedation Simulation Workshops 20 Mannequin + Task Trainer UIC Outpatient Care Clinic Quality Assurance NA Unannounced SPs Respiratory Therapy Arterial Blood Gas (ABG) Workshop 18 Task trainers Outpatient In Vitro Clinic In Situ Simulations 20 Mannequin Interprofessional teams practice critical care scenarios on-site in the ED Residents practice and are assessed on central line placement and removal Interprofessional teams practice response to adverse events during moderate sedation Mystery shoppers provide feedback on outpatient processes Respiratory therapists practice ABGs before ABGs added to scope of practice Clinic staff practice responding to adverse events 2 hours 4 hours 3 hours NA 1 hour 2 hours GrahamCPC 2012 Annual Report Page 15 of 15