Implementation of
Full Patient Simulation Training
in Surgical Residency
Gladys L. Fernandez, MD
Baystate Medical Center
Tufts University School of Medicine
Baystate Simulation Center, ACS-accredited Level I Education Institute
2010 APDS Annual Meeting, San Antonio, Texas
Disclosure
Consultant for Medical Education Technologies, Inc.
Objectives
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Review course of Patient Simulation
implementation in our surgical residency
Discuss aims and methods of Patient
Simulation integration into curriculum
Describe our program experiences
Explore future implementation plans
Surgical Patient
Simulation
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Clinical management performed in a high
fidelity simulation environment using a
manikin simulator
Specifically modeled experiential
learning
Knowledge
 Skills
 Behaviors

Evolution of Surgical Patient Simulation
at BMC
Phase III
Trauma Orientation
Team Training
QA/HCQ initiatives
Curriculum integration
Center expansion
1st Boot Camp
ACS EI accreditation
Curriculum development
1st PS use
2005
2006
2007
2008
2009
Curriculum Design
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Needs assessment based
Critical management problems
–
–
–
–
–
Objectives-based
Patient management skills
Clinical decision-making
Learner-specific needs
Assessment around core competencies
Curriculum Content
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Introduction / orientation
Modeling Best Practice
Global initiatives
Institutional M & M
Institutional QA / HCQ
Remediation
Preparation
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Teaching Team Preparation
– Facilitator
– Embedded educator
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Scene preparation
Rehearsal
– “Flow”
– Educational cues
Simulated Clinical
Experiences
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One hour sessions
– Shock states
– Trauma
– Critical Care
– Preoperative processes
– Postoperative complications
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Multi-item assessment
Debriefing
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Structured
Objectives-based
Assessment
Learner-driven
Self-reflective
Positives
Challenges
Video playback
Take-home messages
Teaching Team Debrief
Results
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July 2006—June 2009
4.5 ± 1.4 sessions per academic year
39 PGY 1, 2, 3 residents
– 10 followed PGY 1  2
– 4 followed PGY 1  2  3
Results
100
PS Compliance over Successive Years
99
95
90
% Attendance
90
88
85
80
75
70
AY '06-'07
AY '07-'08
AY '08-'09
Results
PS Performance Over 3 Years
[n=4]
100
100
95
95
90
90
85
85
PGY-1
80
PGY-2
75
Score (%)
Score (%)
PS Performance Over 2 Years
[n = 10]
80
PGY-2
75
PGY-3
70
70
65
65
60
60
A
B
C
D
E
F
G
Resident
H
I
J
PGY-1
A
B
C
D
Resident
81 ± 5 vs 86 ± 4
82 ± 4 vs 86 ± 2 vs 91 ± 1
(p<0.01)
(p<0.005)
Results
39
residents
8
> 2 SD
below mean
5
= clinical
Conclusions
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Patient simulation training was successfully
implemented in our surgical residency.
Assessment instrument can detect
predictable improvements across years
Challenges:
– Competition with other educational activities
– Fidelity and realism

Further work required to determine effects
on resident clinical competency
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