Biomedical Engineering Reference
In-Depth Information
an acute, life-threatening crisis, will only on occa-
sion train or practice acute care skills despite the
fact that life and limb are involved. This disparity
may be addressed with an aggressive approach to
improving and better maintaining one's acute care
skills. This may be accomplished by incorporating
high-fidelity simulation training into our educa-
tional practices.
Imagine stepping onto a plane with an inex-
perienced crew who has never worked together
as a team. One would be foolish to accept this
level of experience and training, but this very
scenario plagues our system of medical care
delivery. The aviation industry, as many others
have, adapted simulation training as a means of
training their crew for optimal human performance
under normal and adverse, crisis conditions. They
gel the team members by teaching them “crew
resource management” principles (Figure 20.4).
Consider the issue of patient safety, and imagine
a practitioner who makes a clinical mistake; imme-
diately after realizing the error, he or she will
experience an emotional reaction that is powerfully
instructive—but this may only be instructive for
the next patient. What if educators could replicate
such an experience with a much greater impact
than simply discussing it at a case conference. Re-
presenting the case in a simulated environment
allows students to “live through” a compendium
of important, rare and difficult cases in a fraction
of real-time? The benefits from simulation-based
education may, in part, be due to the focus that
complex information may be better understood and
Convergent search process
Several specific cues
leading to a similarity-matching process that leads to a
likely response, i.e. tachycardia, shortness of breath,
hypoxemia, wheezing, immobile-bedridden patient
→
pulmonary embolus
Divergent search process
Broad category-cue leads
to a multi-answer query based on frequency-gambling,
i.e., a differential diagnosis of Wheezing
asthma,
URI, pneumonia, ETT occlusion, main stem bronchus
intubation, pulmonary edema, pulmonary embolus
Slips of the Tongue
untoward, unsolicited comments
about behavior, actions or responses
Slips of Action
due to preoccupation or distraction
Maladaptive behaviors
amongst poor performers
1. Thematic vagabonding (flitting from issue to issue
in a superficial manner as an escape behavior to
avoid facing their helplessness)
2. Encysting: opposite of vagabonding; topics are
lingered over and small details attended to in
excess. Both reveal a poor self-assessment and
intellectual inadequacy
Skill based performance
Inattention
Over-attention
→
Rule-based performance
Misapplication of good rules
Application of bad rules
Knowledge based performance
Overconfidence
Out-of-sight, out-of-mind mentality
Problems with causality, complexity
Biased reviewing of subject
Figure 20.3
Elements for the educator to understand [23].
1. Leadership skills
2. Critical thinking
3. Communication
4. Prioritization of care (triage)
5. Effective use of monitoring
6. Effective and efficient use of resources/equipment
7. Organization of care
8. Distribution of workload amongst team members
9. Stress management
commence the season with practice and a preseason
game schedule to prepare for the real games.
The season is essentially 10-12 months in dura-
tion with the motivation of stardom, endorsements
and monetary gain. Conversely, the fire, police,
counter-terrorist, anti-riot professionals, military
personnel, and SWAT team members drill and
fine tune their skills on a frequent and regular
basis. Despite the intensive training, some may
only rarely or never employ these special skills in
an act to preserve life and limb. Surprisingly, those
in the medical field who are very likely to face
Figure 20.4
Key Elements of Crew Resource Management
(CRM) [3].
