A Graduate Level Immersive-Simulation Program for Teaching and Assessing Fundamental Skills in Entry Level Clinical Perfusionists
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| Title: | A Graduate Level Immersive-Simulation Program for Teaching and Assessing Fundamental Skills in Entry Level Clinical Perfusionists |
|---|---|
| Language: | English |
| Authors: | Bruce Searles |
| Source: | ProQuest LLC. 2021Ph.D. Dissertation, Syracuse University. |
| Availability: | ProQuest LLC. 789 East Eisenhower Parkway, P.O. Box 1346, Ann Arbor, MI 48106. Tel: 800-521-0600; Web site: http://www.proquest.com/en-US/products/dissertations/individuals.shtml |
| Peer Reviewed: | N |
| Page Count: | 445 |
| Publication Date: | 2021 |
| Document Type: | Dissertations/Theses - Doctoral Dissertations |
| Education Level: | Higher Education Postsecondary Education |
| Descriptors: | Computer Simulation, Clinical Experience, Surgery, Allied Health Occupations Education, Graduate Medical Education, Equipment, Medical Services, Allied Health Personnel, Performance Based Assessment, Job Skills, Technology Uses in Education, Skill Development, Educational Technology |
| ISBN: | 979-87-621-9648-2 |
| Abstract: | Background: The clinical perfusionist is a member of the open-heart-surgery team and responsible for operating the life support equipment that replaces the function of the patient's heart and lungs and arrests and restarts the patient's heart in the course of a Cardiopulmonary Bypass (CPB) procedure. In the perfusionists scope of practice, the consequence of unskilled actions, inaccurate understanding or delayed decision making may result in significant patient morbidity or even death. Historically, perfusion students have learned and practiced their skills within a clinical preceptorship program in which an experienced clinician allows the novice student to operate the life support equipment under their direct supervision and consultation. While there is clinical evidence from numerous surgical specialties which establishes that learning curve associated errors have a negative effect on patient outcomes, this has not been researched for clinical perfusionists. Despite this evidence gap, the professions leaders have been instrumental in driving educational innovation and the development of medical simulation models that may reduce the patient's exposure to learning curve associated morbidity by developing competence with high-risk clinical skills prior to patient contact. The purpose of this research is to develop, validate and apply novel medical simulation techniques and technologies to the preparation of entry level clinical perfusionists and demonstrate pre-clinical competence with the fundamental perfusion skills. Methods and Results: To inform the development of a skills curriculum we conducted two national surveys using online survey tools. Through these surveys we validated a list of fundamental skills, and the deconstructed sub-elements involved in the conduct of these skills. Additionally, we identified the typical ranges of physiologic and technical parameters that clinicians maintain during clinical procedures. With this foundational benchmark data we validated the performance of a simulated patient to establish that the patient surrogate generates data that is substantially similar to the physiologic and technical data that a perfusionist would manage during a live clinical procedure. This validated simulation technology was then incorporated into a high-fidelity simulation suite and applied to an innovative immersive curriculum which included hands on repetitive practice, live and video supported self, peer and expert observation and feedback as well as a battery of high-stakes assessments. The validity and fidelity of the simulated experience was established through analysis of over 800 opinions generated over 10 years by novice and expert perfusionists after performing simulated cases. Finally, the efficacy of the simulation curriculum was assessed by comparing our simulation trained students to a national pool of their peers from other schools and expert clinicians. Through this process we generated the first measurements of the typical learning curve for the fundamental skills of CPB, the first estimates of error rates for students navigating the learning curve and the first benchmark measures of competent performance in a simulated environment. This data establishes that students learning in traditional clinical training programs conduct three-fold more errors than experts and will have approximately 99 high-risk patient encounters prior to developing competence with fundamental skills. By comparison, simulation trained students demonstrated competence with fundamental skills that was similar to the experts with almost no high-risk patient encounters. Discussion: The implications to patient safety are clearly implied. These studies establish that there is a high level of agreement among clinicians regarding the skills that are necessary to operate perfusion equipment and that realistic simulation environments can be designed and applied to the development of student's fundamental perfusion skills without exposing patients to the threat of students learning curve associated errors. This data may catalyze a larger national dialog regarding Entrustable Professional Activities for perfusionists and influence national accreditation standards for educational programs. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.] |
| Abstractor: | As Provided |
| Entry Date: | 2024 |
| Access URL: | https://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqm&rft_dat=xri:pqdiss:28869510 |
| Accession Number: | ED641949 |
| Database: | ERIC |
| FullText | Text: Availability: 0 |
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| Header | DbId: eric DbLabel: ERIC An: ED641949 AccessLevel: 3 PubType: Dissertation/ Thesis PubTypeId: dissertation PreciseRelevancyScore: 0 |
| IllustrationInfo | |
| Items | – Name: Title Label: Title Group: Ti Data: A Graduate Level Immersive-Simulation Program for Teaching and Assessing Fundamental Skills in Entry Level Clinical Perfusionists – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Bruce+Searles%22">Bruce Searles</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22ProQuest+LLC%22"><i>ProQuest LLC</i></searchLink>. 2021Ph.D. Dissertation, Syracuse University. – Name: Avail Label: Availability Group: Avail Data: ProQuest LLC. 789 East Eisenhower Parkway, P.O. Box 1346, Ann Arbor, MI 48106. Tel: 800-521-0600; Web site: http://www.proquest.com/en-US/products/dissertations/individuals.shtml – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: N – Name: Pages Label: Page Count Group: Src Data: 445 – Name: DatePubCY Label: Publication Date Group: Date Data: 2021 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Dissertations/Theses - Doctoral Dissertations – Name: Audience Label: Education Level Group: Audnce Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink> – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Computer+Simulation%22">Computer Simulation</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+Experience%22">Clinical Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Surgery%22">Surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Allied+Health+Occupations+Education%22">Allied Health Occupations Education</searchLink><br /><searchLink fieldCode="DE" term="%22Graduate+Medical+Education%22">Graduate Medical Education</searchLink><br /><searchLink fieldCode="DE" term="%22Equipment%22">Equipment</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Services%22">Medical Services</searchLink><br /><searchLink fieldCode="DE" term="%22Allied+Health+Personnel%22">Allied Health Personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Performance+Based+Assessment%22">Performance Based Assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Job+Skills%22">Job Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Technology+Uses+in+Education%22">Technology Uses in Education</searchLink><br /><searchLink fieldCode="DE" term="%22Skill+Development%22">Skill Development</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Technology%22">Educational Technology</searchLink> – Name: ISBN Label: ISBN Group: ISBN Data: 979-87-621-9648-2 – Name: Abstract Label: Abstract Group: Ab Data: Background: The clinical perfusionist is a member of the open-heart-surgery team and responsible for operating the life support equipment that replaces the function of the patient's heart and lungs and arrests and restarts the patient's heart in the course of a Cardiopulmonary Bypass (CPB) procedure. In the perfusionists scope of practice, the consequence of unskilled actions, inaccurate understanding or delayed decision making may result in significant patient morbidity or even death. Historically, perfusion students have learned and practiced their skills within a clinical preceptorship program in which an experienced clinician allows the novice student to operate the life support equipment under their direct supervision and consultation. While there is clinical evidence from numerous surgical specialties which establishes that learning curve associated errors have a negative effect on patient outcomes, this has not been researched for clinical perfusionists. Despite this evidence gap, the professions leaders have been instrumental in driving educational innovation and the development of medical simulation models that may reduce the patient's exposure to learning curve associated morbidity by developing competence with high-risk clinical skills prior to patient contact. The purpose of this research is to develop, validate and apply novel medical simulation techniques and technologies to the preparation of entry level clinical perfusionists and demonstrate pre-clinical competence with the fundamental perfusion skills. Methods and Results: To inform the development of a skills curriculum we conducted two national surveys using online survey tools. Through these surveys we validated a list of fundamental skills, and the deconstructed sub-elements involved in the conduct of these skills. Additionally, we identified the typical ranges of physiologic and technical parameters that clinicians maintain during clinical procedures. With this foundational benchmark data we validated the performance of a simulated patient to establish that the patient surrogate generates data that is substantially similar to the physiologic and technical data that a perfusionist would manage during a live clinical procedure. This validated simulation technology was then incorporated into a high-fidelity simulation suite and applied to an innovative immersive curriculum which included hands on repetitive practice, live and video supported self, peer and expert observation and feedback as well as a battery of high-stakes assessments. The validity and fidelity of the simulated experience was established through analysis of over 800 opinions generated over 10 years by novice and expert perfusionists after performing simulated cases. Finally, the efficacy of the simulation curriculum was assessed by comparing our simulation trained students to a national pool of their peers from other schools and expert clinicians. Through this process we generated the first measurements of the typical learning curve for the fundamental skills of CPB, the first estimates of error rates for students navigating the learning curve and the first benchmark measures of competent performance in a simulated environment. This data establishes that students learning in traditional clinical training programs conduct three-fold more errors than experts and will have approximately 99 high-risk patient encounters prior to developing competence with fundamental skills. By comparison, simulation trained students demonstrated competence with fundamental skills that was similar to the experts with almost no high-risk patient encounters. Discussion: The implications to patient safety are clearly implied. These studies establish that there is a high level of agreement among clinicians regarding the skills that are necessary to operate perfusion equipment and that realistic simulation environments can be designed and applied to the development of student's fundamental perfusion skills without exposing patients to the threat of students learning curve associated errors. This data may catalyze a larger national dialog regarding Entrustable Professional Activities for perfusionists and influence national accreditation standards for educational programs. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.] – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2024 – Name: URL Label: Access URL Group: URL Data: <link linkTarget="URL" linkTerm="https://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqm&rft_dat=xri:pqdiss:28869510" linkWindow="_blank">http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqm&rft_dat=xri:pqdiss:28869510</link> – Name: AN Label: Accession Number Group: ID Data: ED641949 |
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| RecordInfo | BibRecord: BibEntity: Languages: – Text: English PhysicalDescription: Pagination: PageCount: 445 Subjects: – SubjectFull: Computer Simulation Type: general – SubjectFull: Clinical Experience Type: general – SubjectFull: Surgery Type: general – SubjectFull: Allied Health Occupations Education Type: general – SubjectFull: Graduate Medical Education Type: general – SubjectFull: Equipment Type: general – SubjectFull: Medical Services Type: general – SubjectFull: Allied Health Personnel Type: general – SubjectFull: Performance Based Assessment Type: general – SubjectFull: Job Skills Type: general – SubjectFull: Technology Uses in Education Type: general – SubjectFull: Skill Development Type: general – SubjectFull: Educational Technology Type: general Titles: – TitleFull: A Graduate Level Immersive-Simulation Program for Teaching and Assessing Fundamental Skills in Entry Level Clinical Perfusionists Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Bruce Searles IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2021 Identifiers: – Type: isbn-print Value: 979-87-621-9648-2 Titles: – TitleFull: ProQuest LLC Type: main |
| ResultId | 1 |
