Background: Clinical training for healthcare professionals traditionally relies on learning through experiences with patients, even for high-risk invasive procedures and life-threatening situations. To bridge the gap between classroom teaching and real-world clinical experiences, our program launched a new patient safety simulation program combining “Mishap” room and high-value clinical case scenarios in a risk-free environment for the incoming physician trainees.
Purpose: The goal of simulation-based training is to enable the accelerated development of expertise in both individual and team skills by applying classroom knowledge on the simulated scenarios. This training also addresses the ACGME Milestones specifically in the recognition of system error and advocation for system improvement.
Description: All of our Internal Medicine interns are required to attend the simulation. It was a two-and-a-half-hour simulation with thirty minutes of introduction followed by two practical sessions each lasting one hour. The two sessions were conducted simultaneously with separate groups. Session one was the “Mishap” room with a high-fidelity mannequin set up for participants to identify the errors and patient safety hazards. A group of three to four participants entered the room each time for five to seven minutes. This session ended with a thirty-minute post simulation debriefing session moderated by a faculty attending. In session two, there were four clinical case scenarios (two outpatient and two inpatient) reflecting major and common medical errors or near miss events. Participants were divided into four groups and each group was assigned one case to lead the discussion moderated by a faculty attending and co-facilitator/senior resident. A post-simulation survey was conducted on the twenty-seven participants. Fifty-nine percent of the participants did not have prior training in patient safety curriculum and ninety-three percent of them had no prior patient safety simulation activities, indicating the need for safety simulation in this particular group is significant. All interns strongly agree/agree the simulation activities raised their awareness on common inpatient patient safety issues, while eighty-five percent strongly agree/agree the activities raised their awareness on common outpatient patient safety issues. All of the participants strongly agree/agree the simulation activities enhanced their learning about the practical aspects of patient safety. When asked how the simulation activities would impact their clinical practice, the majority of them expressed that they are more mindful of safety issues and more eager to address them. Other comments included: feel empowered to speak up regarding safety concerns, increased confidence when encountering and handling a potential error, will be more careful checking the lists and charts, and will ensure good communication with other staff and the patient etc. Some commented they enjoyed both case-based discussions and simulated scenarios very much.
Conclusions: Teaching and learning patient safety requires demonstration of competencies such as teamwork, communication skills, and recognition of system errors. Our survey result demonstrated that this pilot simulated program can function as an effective and valuable training tool for physicians prior to encountering said scenarios in the real clinical settings.