Experience Curves as an Organizing Framework for Deliberate Practice in Emergency Medicine Learning

2012 ◽  
Vol 19 (12) ◽  
pp. 1476-1480 ◽  
Author(s):  
Martin V. Pusic ◽  
David Kessler ◽  
Demian Szyld ◽  
Adina Kalet ◽  
Martin Pecaric ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Deliberate Practice ◽  
Experience Curves

scholarly journals MP20: ImageSim - performance-based medical image interpretation learning system

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S47-S47
Author(s):  
K. Boutis ◽  
M. Pecarcic ◽  
M. Pusic
Keyword(s):  
Emergency Medicine ◽  
Clinical Practice ◽  
Medical Image ◽  
Medical Images ◽  
Image Interpretation ◽  
Deliberate Practice ◽  
Learning System ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Emergency Medicine Physician

Introduction: Medical images (e.g. radiographs) are the most commonly ordered tests in emergency medicine. As such, emergency medicine physicians are faced with the task of learning the skill of interpreting these images to an expert performance level by the time they provide opinions that guide patient management decisions. However, discordant interpretations of these images between emergency physicians and expert counterparts (e.g. radiologists) is a common cause of medical error. In pediatrics, this problem is even greater due to the changing physiology with age. Methods: ImageSim (https://imagesim.com/) is an evidence-based on-line learning platform derived and validated over an 11 year period (https://imagesim.com/research-and-efficacy/). This learning system incorporates the concepts of cognitive simulation, gamification, deliberate practice, and performance-based competency in the presentation and interpretation of medical images. Specifically, ImageSim presents images as they are experienced in clinical practice and incorporates a normal to abnormal ratio is representative of that seen in emergency medicine. Further, it forces the participant to commit to the case being normal or abnormal and if abnormal, the participant has to visually locate the specific area of pathology on the image. The participant submits a response and gets text and visual feedback with every case. After each case, the participant gets to play again until they reach a desired competency threshold (80% is bronze resident; 90% silver staff emergency medicine physician; 97% gold radiologist). Importantly, the learning experience also emphasizes deliberate practice such that the learning system provides hundreds of case examples and therefore each participants performance has the opportunity to improve along their individual learning curve. Results: Course selection was made based on known medical image interpretation knowledge gaps for practicing emergency physicians. Currently, ImageSim live courses include pediatric musculoskeletal radiographs (2,100 cases, 7 modules) and pediatric chest radiographs (434 cases). In 2018, we will also release a pediatric point-of-care ultrasound course (400 cases, 4 modules) and the pre-pubertal female genital examination (150 cases). For a demo, go to https://imagesim.com/demo/. Using ImageSim, the deliberate practice of about 120 cases (1 hour time commitment) increases accuracy on average by 15%. Currently integrated into 10 emergency medicine training programs and there are about 300 continuing medical education world-wide participants. Conclusion: While acquiring mastery for these images may take years to acquire via clinical practice alone, this learning system can potentially help achieve this in just a few hours.

scholarly journals Dedicated time for deliberate practice: one emergency medicine program’s approach to point-of-care ultrasound (PoCUS) training

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 558-561 ◽  
Author(s):  
Melissa Hayward ◽  
Teresa Chan ◽  
Andrew Healey
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Skill Acquisition ◽  
Point Of Care ◽  
Deliberate Practice ◽  
Lessons Learned ◽  
Point Of Care Ultrasound ◽  
Residency Programs ◽  
Education Literature ◽  
Scholarly Discussion

AbstractPoint-of-care ultrasound (PoCUS) has become an essential skill in the practice of emergency medicine (EM). Various EM residency programs now require competency in basic PoCUS applications. The education literature suggests that deliberate practice is necessary for skill acquisition and mastery. We used an educational theory, Ericsson’s model of deliberate practice, to create a PoCUS curriculum for our Royal College of Physicians and Surgeons of Canada EM residency.Although international recommendations around curriculum requirements exist, this will be one of the first papers to describe the implementation of a specific PoCUS training program. This paper details the features of the program and lessons learned during its initial 3 years. Sharing this experience may serve as a nidus for scholarly discussion around how to best approach medical education in this area.

scholarly journals LO096: Comfortable with your thoracotomy skills? An innovative simulation-based curriculum to teach rare procedures in emergency medicine

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S63-S63
Author(s):  
S.H. Gray ◽  
J. Owen ◽  
A. Petrosoniak
Keyword(s):  
Emergency Medicine ◽  
Experiential Education ◽  
Deliberate Practice ◽  
Technical Skills ◽  
Skills Training ◽  
Residency Programs ◽  
Ongoing Work ◽  
Life Saving ◽  
Simulation Based ◽  
Technical Skills Training

Introduction / Innovation Concept: Emergency medicine (EM) residents must demonstrate proficiency in several rare, life-saving procedures but few clinical opportunities exist to practice and master these skills. Currently no standardized curricula exist for the instruction of these skills during EM residency. Accordingly, many residents graduate without the experience to perform these critical procedures confidently. We developed a novel, simulation-based curriculum for six rare, life-saving, EM skills that integrates deliberate practice and Kolb’s theory of experiential education. Methods: We used existing EM training objectives and a recent national resident needs assessment to develop a simulation-based technical skills curriculum. The six station curriculum was underpinned by the pedagogical framework of experiential education and deliberate practice. Instructor and participant feedback directed subsequent curriculum modifications. Curriculum, Tool, or Material: This one-day intensive curriculum was successfully implemented at two Canadian EM residency programs for 54 EM residents, from both CCFP-EM and FRCP-EM streams. Participant feedback was highly favorable. An iterative approach to curriculum implementation at two separate residency programs effectively allowed educators to respond to participant needs. Conclusion: A novel simulation-based curriculum for rare procedures in EM is feasible, practical, and highly valued by participants. Ongoing work is underway to refine the curriculum and assess its efficacy in creating competence. Deliberate practice and Kolb’s theory of experiential education provide useful frameworks for technical skills training.

scholarly journals MP17: Education innovation: A tool to teach consultation skills using rapid cycle deliberate practice

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S48
Author(s):  
A. Johnston
Keyword(s):  
Emergency Medicine ◽  
Direct Observation ◽  
Clinical Teaching ◽  
Deliberate Practice ◽  
Frames Of Reference ◽  
Emergency Physicians ◽  
Phase 3 ◽  
Actual Consultation ◽  
Consultation Skills ◽  
Three Phases

Innovation Concept: Consultation skills (the collaborator role) are key for safe and effective Emergency Medicine practice. The tool described uses educational techniques familiar to Emergency Physicians and residents (rapid cycle deliberate practice and focused debriefing) to incorporate teaching of this skill into on-shift clinical teaching of Emergency Medicine residents. Methods: We searched the literature for consultation teaching methods. We developed a tool to teach consultation as part of on-shift clinical teaching using pedagogical concepts familiar to Emergency Medicine residents, rapid cycle deliberate practice and focused debriefing. The developed tool has three phases; 1) Introduction to a framework for good consultation skills, 2) Managing push-back and understanding competing frames of reference and 3) Direct observation and feedback on the actual consultation. The tool is designed to be used during a clinical shift. Over a series of consecutive cycles the resident refines a consultation and is eventually directly observed during the actual interaction with a consultant. Curriculum, Tool or Material: For each of the three phases the tool provides a framework for the preceptor to use to guide the presentation and discussion. During phases 1 and 2 the resident will present the consultation a number of times and the preceptor will provide focused debriefing allowing the presentation to be refined and optimized. During phase 3 the preceptor provides direct observation of the actual consultation followed by focused debriefing. Phase 1: Focuses on understanding the learners current skill level and presents a framework for a high quality consultation. Phase 2: Introduces the concept of competing frames of reference and push-back and patient centred strategies for managing this situation. Phase 3: The actual consultation interaction between resident and consultant is observed and debriefed. Conclusion: Consultation skills are important in the day to day practice of Emergency Medicine but rarely the subject of specific teaching. The tool presented can be used during clinical shifts to teach consultation skills using pedagogy familiar to both Emergency Physicians adEM residents.

scholarly journals Rapid Cycle Deliberate Practice in Virtual Reality: Teaching Transvenous Pacemaker Insertion to Emergency Medicine Residents

Cureus ◽  
2021 ◽  
Author(s):  
Cynthia Peng ◽  
Kristen M Ng ◽  
Kelly N Roszczynialski ◽  
Steven J Warrington ◽  
Kimberly Schertzer
Keyword(s):  
Emergency Medicine ◽  
Virtual Reality ◽  
Deliberate Practice ◽  
Pacemaker Insertion

scholarly journals MP09: Critical care skills training day for emergency medicine residents: A curriculum in evolution

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S45
Author(s):  
J. Riggs ◽  
S. Gray ◽  
M. McGowan ◽  
A. Petrosoniak
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Deliberate Practice ◽  
Skills Training ◽  
Central Line ◽  
Free Text ◽  
Fibre Optic ◽  
Training Models ◽  
Central Line Insertion ◽  
Line Insertion

Introduction: Emergency medicine (EM) residents are expected become proficient in a number of rarely performed, high risk procedures. We developed Critical Care Skills Training Day for senior FRCP and CCFP EM residents at a single university program to fill a gap in resident confidence with these procedures. The day applies principles of deliberate practice with focused feedback using simulation-based training for several rarely performed procedures including thoracotomy, fibre-optic intubation, pericardiocentesis, resuscitative hysterotomy and central line insertion. The objectives of this work was to improve the residents’ scores of self-perceived comfort independently performing these procedures by completion of the training day. Methods: Clinician educators, residency program directors and simulation specialists designed and taught the curriculum. We used pre- and post-training day surveys blending Likert, multiple choice and free text comments to measure comfort performing each procedure, overall satisfaction and usefulness of this training. Descriptive statistics were used to analyze results. Pre-post differences were assessed using paired sample T-tests. Comments and themes from course evaluations were used to make yearly iterative changes. Results: A total of 95 residents completed the curriculum between 2016-2018. 89 completed evaluations (93%). Residents reported significant (p < 0.05) improvement in comfort independently performing fibre optic intubation, thoracotomy and central line insertion. The day was rated very highly, 9.4/10 (SD, 0.72), over 3 years. Feedback was positive with participants identifying opportunities for repeated practice, feedback from instructors and practical tips to improve performance as valuable aspects. Iterative changes were made yearly in response to resident feedback including introduction of new procedures, incorporating skills into sim-based cases, and different training models for skill training. Conclusion: Critical Care Skills Training Day for EM residents was created using the principle of deliberate practice to fill a perceived gap in resident training. Residents who completed the annual curriculum showed a marked increase in comfort independently performing several of the procedures. Ongoing challenges include the length of the day, economies of scale, and training models available for the rare procedures. Future directions include the integration of longitudinal objective performance evaluations to align with the competency by design curriculum.

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