Simulation and Procedural Training:
Carl J. Shapiro Simulation and Skills Center
The SASC is a multidisciplinary facility equipped with state of the art medical and educational technology to provide unparalleled clinical skills training.
The mission of the center encompasses:
- training healthcare providers at BIDMC, the entire Harvard community and beyond;
- incorporating the best training methods with the most sophisticated tools available to ensure the highest degree of patient safety;
- promoting interdisciplinary teaching, team training and communication skills among healthcare providers; and
- advancing educational simulation through innovative methods of education and research.
BIDMC uses a “trigger” system in place of a rapid response to care for acutely decompensating patients on the inpatient units. The triggers training curriculum encompasses the evaluation and management of emergent cases that are commonly encountered on the medical floors, such as massive pulmonary embolism, acute respiratory failure, and shock. The use of simulation for trigger and cardiac arrest situations enables the learner to manage critical illnesses in a safe, non-evaluative learning environment.
Code Team Leadership
Multi-disciplinary, resident led simulated codes are facilitated in the SASC intensive care unit, outfitted with all of the same monitoring equipment, and medical devices used throughout our medical center and on high-fidelity SimMan simulators. Each simulated code is led by a rising junior resident inclusive of learners from nursing, and pharmacy. These trainings provide opportunities for the rising junior resident to solidify ACLS algorithms, practice skills of running a code, and include elements of team dynamic and resource management. All medical residents participate in the curriculum during the spring of their intern year.
Resident as Leader
The Resident-as-Leader curriculum aims to facilitate the transition from intern to resident role by familiarizing residents with fundamental characteristics of effective inpatient team managers, to incorporate these skills on the general medicine wards, and to focus training the role of residents as leaders of healthcare teams.
Resident as Teacher
Peer and near peer-teaching are incorporated into the simulation training
curriculum in order to enhance teaching skill development. Opportunities to
teach in simulation include facilitating and debriefing during medical
student and intern clinical simulation encounters, and communication skills
training. Dedicated faculty oversee resident run simulation and debriefing
encounters to provide direct observation and feedback of teaching skills.
All residents are expected to perform a broad range of procedures during
training which include thoracentesis, paracentesis, central venous
catheterization, arterial catheterization, and lumbar puncture. In order to
preserve patient safety and ensure all trainees are skilled performing
invasive maneuvers, housestaff participate in simulation based procedural
training. Trainings include a combination of online videos, small group
didactics and hands on experience with task trainers.
Additionally, residents may select a dedicated week as the "Procedure Resident." During this week the resident’s sole responsibility is to be available to perform a broad range of diagnostic and therapeutic procedures for inpatients on medical floors and intensive care units. Simulation training and 1:1 faculty education are incorporated into every “procedure week.”
Given the expanding role of bedside ultrasound for both diagnostic and procedural guidance, BIDMC has integrated a formal ultrasound curriculum into the training program. Annual academic half-days are dedicated to procedural and ultrasound training which include physics, knobology, vascular ultrasound, and thoracic ultrasound under the direction of trained faculty from the Division of Pulmonary and Critical Care Medicine. In addition, residents will learn the basics of transthoracic echocardiography during their rotations in the CCU and on the cardiology service. Ultrasound machines are available in each of the medical ICUs as well as in the simulation center, and we rely on ultrasound guidance for many invasive procedures.
Communication skills training exist in a variety of settings. Standardized family members are used to emphasize skills in facilitating family meetings, recognizing and responding to emotion and discussing death with dignity. Standardized family members include former patient or family member volunteers who are formally trained in simulation and feedback. Additional elements of communication skills training include reframing code status discussions, “talking about death” and consent practices.