Friday, May 29, 2015

Forming Interest Groups… Introducing the first ever UC Irvine Simulation Interest Group

As a new fellow at the only simulation fellowship in southern California, I felt it was important to spread the word about the power of medical simulation education.  After months of planning, I sent out an email to our medical students to gauge their interest in forming a simulation interest group.  I received about 15 responses, and then got the ball rolling!  Introducing the first ever UC Irvine School of Medicine Medical Student Simulation Interest Group! 


UC Irvine School of Medicine Medical Student Simulation Interest Group
Featured in this photo: Front row, left: Dr Cameron Ricks, Simulation Center Director, Assistant Professor Department of Anesthesia; Front row right: Dr Eric McCoy, director of Emergency Medicine Simulation Fellowship, Assistant Professor Department of Emergency Medicine 
A few weeks ago, we had our first simulation interest group meeting, and it was a total success!  I wanted to share with you some of the highlights of the meeting, in case you are looking to do the same at your own facility.  In order to make the group successful, I urge you to consider the 7 following steps:
1.  Obtain and Introduce the supporting faculty and staff.  
a.     Ensure that prior to starting your group, you have faculty and staff support who will sponsor, mentor and dedicate time to ensuring the growth, development, and persistence of your group.  For me as a fellow, I have 2 supporting faculty members, Dr Eric McCoy (right, behind me in the photo) the emergency medicine fellowship director, and Dr Cameron Ricks (left), the director of anesthesia simulation and the simulation center at UCI.  
b.   Give the students some background information about you and other staff members, and your motivation behind the group.  I wanted the students to know about my background in education, and why academic medicine was so important to me.  I also wanted them to understand why I chose to complete a fellowship in simulation education, as by providing both emotional and hands-on components to learning, I feel it is one of the most effective ways to teach.
c.     This introduces a feeling of mentorship to the students.  Let them know you are there for their benefit and education, and that all ideas for the group regarding education, research and community service are open to discussion.
2.    Get to know your students, and their motivation behind joining the group.
a.     The most important reason for this is to ensure that the students are going to be dedicated to keeping the group running successfully, both now and in the years to come.
b.     It is also important to initiate a feeling of camaraderie among the group, understanding their backgrounds and interests, and learning who they are as a person will help to make a better collaborative whole.
3.    Set your goals and objectives for the group
a.     Make sure you let the students know what is expected for the group, and what will make the group thrive. One of the best ways of doing this is by creating a group statement of purpose.  For us, it was fulfilling a presence of education and learning, community service, and research for our group.  The students were very happy with this as our defining theme.  Initially you may need to guide this step, as I did, because after all, you are the developer of the group.    Ask the students how they would like to redefine or state these goals and objectives, as it allows them to take ownership of the group.
4.     Create specific rolls that should be fulfilled
a.     For our group, I knew from preplanning, that there were specific roles I wanted the students to fill.  Take a look at the following list and description of these roles as an idea for your own group.
                                               i.     President: to initiate and run group meetings, discuss agenda items, etc
                                             ii.     Vice President: to aid the president in the above and serve in his/her absence
                                            iii.     Faculty Liaison:  I knew that having a large group of student would be tough for me to manage, so I wanted to assign a role to one student who would serve as the voice for the collective group.  This person would be the “go-to” for the students, as well as for me if there was a particular message I needed to get out to the group.
                                            iv.     Web Master: As a student of a multi-media masters program, for me having our own group webpage was key.  There will always be one student in the group interested in IT, and will help with web page development, announcements, calendar, and web site maintenance.  There are several free programs available for this, such as word press.  Speak with your facilities IT department to inquire about web space domains for getting your site up on the web.
                                             v.     President/VP of Community Service:  With a strong community service background, I knew that this was something that I wanted to pursue.  As health care providers who have been granted the opportunity to get into and through medical school, I wanted the students to know the importance of giving back to and educating the community.
                                            vi.     President/VP of Education: Although running cases in the simulation lab is very fun and exciting, not educating the students to the power of simulation would be doing them a disservice.  I wanted the students to understand the educational value of simulation in education. By assigning the role of President or VP of education, you can work with a few students to develop a small group of lectures that could be taught each meeting to enhance the knowledge base of the students to what simulation is. 
                                          vii.     President/VP of Research: As with all institutions of higher learning, research is a big component to medical education.  As a new field in medicine, the opportunities to conduct simulation-based research are endless.  Student input is also useful for developing new projects.
5.    Allow the students to take the reins
a.     Allow the students to self-assign roles.  They know their own strengths and weaknesses, and this will allow for a more collaborative environment without resentment toward the group leader.  Surprisingly the students were very quick to decide the role they wanted to fulfill.
b.     Allow the students to choose what they want the group to achieve.  For our group, it was conducting simulation-based workshops for the school of medicine.  They also wanted to work with other interest groups, such as the emergency medicine interest group, surgery and ultrasound interest groups, to form collaborative workshops, conferences, and lectures. 
6.      Set up monthly meetings to discuss new ideas and actions for the group
a.     The group needs to know that they have your support, and that there is vested interest in making the group thrive.  Consider monthly faculty/student meetings, and monthly student group leader meetings to keep your interest group on a track to success.
7.      Choose a day specific to your group and make it yours

a.     As a new group, we wanted to gain credibility on campus at UC Irvine.  Our group came up with the idea of putting on a conference called “SIMtober Fest.”  It would be a half day event where students immerse themselves in medical simulation high-fidelity cases, task trainers, and education. 

These are only my suggestions, but there is a wealth of information available on the web about how to start an interest group.   Hopefully you found this resource and its links helpful. 




References: 
1. Goals and Objectives image. Retrieved May 29, 2015 from https://micajeho.files.wordpress.com/2012/08/meta_sprint_time_scrum.jpg



Already started an interest group?  Share your experiences below! 




Monday, May 25, 2015

Simulation and why it's important to me.


I remember the first time I was exposed to simulation.  I was an intern in my emergency medicine residency.  I was so intimidated by sitting in a room of peers that were my senior and residency directors.  I was called on with a few others to walk into the simulation lab and care for a 1 year old simulated baby who was having difficulty breathing.  Everyone's nightmare... a sick kid.


Although the situation was not real, my fear of not exactly knowing what to do was…. It was VERY real.  I felt my heart pounding in my chest, beads of sweat on my forehead. “I can’t let this kid die” I said to myself.   After talking to the "mother," a tech playing the role, I found out that the child had eaten a cookie that contained peanuts.  At first I thought he was choking, but when his oxygen saturation started to fall, and I saw the mannequin's lips becoming cyanotic, I knew I had to intubate the child to protect his airway. 

With my heart pounding, I stepped to the head of the bed.  Laryngoscope in one hand, and endotracheal tube in the other, I stood at the head of the bed.  “I got this!”  I thought.  But when I opened the child’s mouth, I could only see a diffusely swollen tongue, and was unable to intubate the child. I panicked… The kid was going down the tubes.  “Call anesthesia!” I yelled out, hoping that a consulting service could help me.  "Anesthesia is not available" I heard over the overhead.  My heart stopped.  I watched as my senior resident asked for a large bore needle and quickly shoved it in the child's neck.  After being prompted by the nurse, we ordered jet ventilation for the child, and admitted him to the pediatric ICU.  I learned later during the debriefing session, that this procedure was called a needle cricothyrotomy.  And I never forgot it...


4 years later as a senior resident, I stepped into the simulation lab during one of our monthly meetings.  Again, I was faced with a scenario of a child in what I later learned was anaphylactic shock.  This time, after peeking into the child's mouth and noting the swelling, I quickly grabbed a needle angiocath and placed it into the child's neck.  Then I asked for the nurse to set up jet ventilation and call the PICU.


I had never seen an actual case of pediatric anaphylaxis during my residency training, but it really dawned on me how, despite this, I remembered exactly what to do.  Was it my skills?  My knowledge?  Or was there something else that happened that day as an intern that helped me to recall exactly what to do to save this kid?


At that moment I realized the power in learning through simulation.  Not only does it provide a hands-on approach to learning, but the associated emotional component that leads to learning retention and accuracy of performing procedures.1  I fell in love with using simulation as a learning tool, and decided to do a fellowship in simulation after I graduated from residency.


Now I get to create, design and run simulated sessions for medical students and residents.  As stated in the photo above, I work at the UC Irvine School of Medicine Simulation Lab, the only simulation fellowship for emergency medicine in all of Southern California! 


If you're not convinced by my story, take a look for yourself at the graph below depicting the rates of retention from different learning techniques:  




1. Okuda Y, Bryson EO, DeMaria S, Jacobson L, Quinones J, Shen B, Levine A. (2009). The utility of simulation in medical education: what is the evidence?  Mt Sinai Journal of Medicine. 76(4):330-43.
2. Image retrieved on May 25, 2015 from http://www.simulationpoweredlearning.com/retention-graph.html


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