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Simulation for Maintenance of Certification Planning Guide


What  are  we  looking  for  from  our  certification? What  do  we  get? What  do  we  give  to  our  profession? When  the  American  Board  of  Medical  Specialties  set  out   the  guidelines  for  Maintenance  of  Certification  (MOC),   that  board  described  a  need  to  maintain  the  care  of   patients  at  the  highest  quality.      That  is  what  we  all  seek.     Over  time  we  have  read  reams  of  written  materials,   taken  a  score  of  exams,  maintained  our  licensure,  and   done  a  good  job  taking  care  of  our  patients.    New   devices,  new  techniques,  and  new  technologies  have   come  along  which  have  made  our  work  safer  and  more   complex.    We  have  maintained.    

Clinical Simulation for Patient Safety and Performance Improvement

Here  is  an  opportunity  to  learn  by  doing,  to  advance  our   skills  at  our  own  pace,  and  to  refresh  our  thinking.    We   can  learn  together  through  simulations  that  engage  and   challenge,  guided  by  colleagues  who  are  knowledgeable   and  supportive.       Clinical  simulation  has  come  a  long  way  since  the  CPR   dummy.      These  devices  keep  pace  with  the  most  current   technologies  used  in  our  clinical  work.      It  is  time  to  get   something  substantial  back  from  our  MOC  process.    The   experience  will  be  challenging,  and  effortful,  no  doubt,   but  the  rewards  will  be  relevant  and  substantial.  

Establishing a US-wide MOC network will take time and substantial effort to coordinate. With any process of this magnitude, careful planning is key, followed by proof-of-concept testing in the field. Initial steps include: vetting of curricula site visits at prospective centers creation of data-sharing agreements establishing a shared IS infrastructure Already in progress, several potential initial sites are being evaluated, using a rubric adapted from several simulation accreditation bodies. At this time, Northwestern University has been designated the coordinating center for this effort. This is, in part, due to the proximity of SAEM headquarters, and through the leadership of that center’s director in the field of MOC using simulation.

2

The goal is to have approximately six centers up and running a series of shared CME-MOC courses within the first year. In future steps, approximately thirty centers will be identified to serve the over 25,000 diplomates in Emergency Medicine. Each center will commit to providing an outstanding learning experience to ABEM’s diplomates, to share data on course and learner performance, and to contribute to future course offerings. Each center will provide, at minimum one SMOCEM course per month.

3


What  are  we  looking  for  from  our  certification? What  do  we  get? What  do  we  give  to  our  profession? When  the  American  Board  of  Medical  Specialties  set  out   the  guidelines  for  Maintenance  of  Certification  (MOC),   that  board  described  a  need  to  maintain  the  care  of   patients  at  the  highest  quality.      That  is  what  we  all  seek.     Over  time  we  have  read  reams  of  written  materials,   taken  a  score  of  exams,  maintained  our  licensure,  and   done  a  good  job  taking  care  of  our  patients.    New   devices,  new  techniques,  and  new  technologies  have   come  along  which  have  made  our  work  safer  and  more   complex.    We  have  maintained.    

Clinical Simulation for Patient Safety and Performance Improvement

Here  is  an  opportunity  to  learn  by  doing,  to  advance  our   skills  at  our  own  pace,  and  to  refresh  our  thinking.    We   can  learn  together  through  simulations  that  engage  and   challenge,  guided  by  colleagues  who  are  knowledgeable   and  supportive.       Clinical  simulation  has  come  a  long  way  since  the  CPR   dummy.      These  devices  keep  pace  with  the  most  current   technologies  used  in  our  clinical  work.      It  is  time  to  get   something  substantial  back  from  our  MOC  process.    The   experience  will  be  challenging,  and  effortful,  no  doubt,   but  the  rewards  will  be  relevant  and  substantial.  

Establishing a US-wide MOC network will take time and substantial effort to coordinate. With any process of this magnitude, careful planning is key, followed by proof-of-concept testing in the field. Initial steps include: vetting of curricula site visits at prospective centers creation of data-sharing agreements establishing a shared IS infrastructure Already in progress, several potential initial sites are being evaluated, using a rubric adapted from several simulation accreditation bodies. At this time, Northwestern University has been designated the coordinating center for this effort. This is, in part, due to the proximity of SAEM headquarters, and through the leadership of that center’s director in the field of MOC using simulation.

2

The goal is to have approximately six centers up and running a series of shared CME-MOC courses within the first year. In future steps, approximately thirty centers will be identified to serve the over 25,000 diplomates in Emergency Medicine. Each center will commit to providing an outstanding learning experience to ABEM’s diplomates, to share data on course and learner performance, and to contribute to future course offerings. Each center will provide, at minimum one SMOCEM course per month.

3


What are these ‘initial courses’ all about? In general, these courses are intensely hands-on and practical. There is a roughly 50:50 ratio of new content and didactic material and hands-on and deliberate practice. They use best-practices in the field of simulation for clinical education to ensure a learning experience of the highest quality. Learners will find that instructors are experienced simulation practitioners who bring generous respect for professional learners’ life experiences. The best simulation experiences are bolstered by adult learning theory, recognizing that when an adult learner has control over the nature, timing, and direction of the learning process, the entire experience is facilitated.

What will centers need to have to participate? ^ŝŵƵůĂƟŽŶĐĂĚĞŵLJĞŶƚĞƌǀĂůƵĂƟŽŶ A  vetting  process  will  identify  features  of  your  simulation  program  which  may  be   important  to  future  Simulation-­based  Maintenance  of  Certification  in  Emergency  Medicine   activities.    SMOCEM  activities  are  designed  to: - Provide  a  relevant  and  meaningful  experience  to  the  ABEM  Diplomate - Accomplish  the  MOC  Part  IV  requirements  set  by  ABEM.     Centers  which  will  engage  in  SMOCEM  activities  will  demonstrate: - A  history  of  high  quality  educational  offerings. - Faculty  resources  necessary  to  provide  quality  education     - Procedures  for  faculty  training  and  evaluation. - An  infrastructure  appropriate  for  regular  and  frequent  SMOCEM  activities  including: o    equipment,   o   space  allocation,   o   assessment  infrastructure o   technology  support o   administrative  and  financial  support   o   SMOCEM  course  director  responsible  for  event  quality - Policies  and  procedures  that  assure  a  confidential  and  secure  environment  for   participants.   - A  faculty  which  includes  current  ABEM  diplomates  who  participate  in  the  educational   offerings

ĚƵĐĂƟŽŶĂůKīĞƌŝŶŐƐ Selected  centers  and  programs  will  have  current  curricular  offerings,  including  examples  of   curricula  and  objectives  for:

Who is paying for all of this? A common question. It is a question that requires a deeper analysis of the current practices in continuing professional education, and how these efforts have been supported in the past. One might ask first: Is the current process working? What do professionals get from their current continuous learning options? Who is paying for this now? Are these sources getting anything of value in return? If a practicing physician takes a SMOCEM course, then they come away with a high-value, hands-on, practical, and relevant experience that is germane to their work environment. These courses generate CME credits, and will be paid for by the same mechanisms that physicians currently use to obtain CME. This time, the courses will be more personal, and will enhance the practice of emergency medicine through new essential skills and refreshment of skills last used in residency.

4

1.   Post  Graduate  Education  training  (CME  or  Practicing  Physicians 2.   Interprofessional  Education  (teams  of  physicians  and  nurses,  etc)     3.   Graduate  Medical  Education  (GME)  training.        Selected  centers  and  programs  will  have  a  curriculum  and  scenario  development  process:   a.   Needs  assessments b.   Development  of  Objectives c.   Selection  of  Methods d.   Creation  of  Materials e.   Delivery f.   Assessment  of  Learner  Performance g.   Assessment  of  Materials h.   Measures  of  overall  effectiveness

/ŶƐƚƌƵĐƚŽƌƐĂŶĚWĞƌƐŽŶŶĞů Selected  centers  and  programs  will  have  a  process  which  ensures  instructor  quality. The  Simulation  Academy  will  offer  faculty  development  programs  for  those  interested  in   becoming  facilitators.  

5


What are these ‘initial courses’ all about? In general, these courses are intensely hands-on and practical. There is a roughly 50:50 ratio of new content and didactic material and hands-on and deliberate practice. They use best-practices in the field of simulation for clinical education to ensure a learning experience of the highest quality. Learners will find that instructors are experienced simulation practitioners who bring generous respect for professional learners’ life experiences. The best simulation experiences are bolstered by adult learning theory, recognizing that when an adult learner has control over the nature, timing, and direction of the learning process, the entire experience is facilitated.

What will centers need to have to participate? ^ŝŵƵůĂƟŽŶĐĂĚĞŵLJĞŶƚĞƌǀĂůƵĂƟŽŶ A  vetting  process  will  identify  features  of  your  simulation  program  which  may  be   important  to  future  Simulation-­based  Maintenance  of  Certification  in  Emergency  Medicine   activities.    SMOCEM  activities  are  designed  to: - Provide  a  relevant  and  meaningful  experience  to  the  ABEM  Diplomate - Accomplish  the  MOC  Part  IV  requirements  set  by  ABEM.     Centers  which  will  engage  in  SMOCEM  activities  will  demonstrate: - A  history  of  high  quality  educational  offerings. - Faculty  resources  necessary  to  provide  quality  education     - Procedures  for  faculty  training  and  evaluation. - An  infrastructure  appropriate  for  regular  and  frequent  SMOCEM  activities  including: o    equipment,   o   space  allocation,   o   assessment  infrastructure o   technology  support o   administrative  and  financial  support   o   SMOCEM  course  director  responsible  for  event  quality - Policies  and  procedures  that  assure  a  confidential  and  secure  environment  for   participants.   - A  faculty  which  includes  current  ABEM  diplomates  who  participate  in  the  educational   offerings

ĚƵĐĂƟŽŶĂůKīĞƌŝŶŐƐ Selected  centers  and  programs  will  have  current  curricular  offerings,  including  examples  of   curricula  and  objectives  for:

Who is paying for all of this? A common question. It is a question that requires a deeper analysis of the current practices in continuing professional education, and how these efforts have been supported in the past. One might ask first: Is the current process working? What do professionals get from their current continuous learning options? Who is paying for this now? Are these sources getting anything of value in return? If a practicing physician takes a SMOCEM course, then they come away with a high-value, hands-on, practical, and relevant experience that is germane to their work environment. These courses generate CME credits, and will be paid for by the same mechanisms that physicians currently use to obtain CME. This time, the courses will be more personal, and will enhance the practice of emergency medicine through new essential skills and refreshment of skills last used in residency.

4

1.   Post  Graduate  Education  training  (CME  or  Practicing  Physicians 2.   Interprofessional  Education  (teams  of  physicians  and  nurses,  etc)     3.   Graduate  Medical  Education  (GME)  training.        Selected  centers  and  programs  will  have  a  curriculum  and  scenario  development  process:   a.   Needs  assessments b.   Development  of  Objectives c.   Selection  of  Methods d.   Creation  of  Materials e.   Delivery f.   Assessment  of  Learner  Performance g.   Assessment  of  Materials h.   Measures  of  overall  effectiveness

/ŶƐƚƌƵĐƚŽƌƐĂŶĚWĞƌƐŽŶŶĞů Selected  centers  and  programs  will  have  a  process  which  ensures  instructor  quality. The  Simulation  Academy  will  offer  faculty  development  programs  for  those  interested  in   becoming  facilitators.  

5


Selected  centers  and  programs  will   have  robust  support  from   (non-­instructor)  personnel    and  a   support  infrastructure,  including   administrative  and  IT  functions,   and  the  security  measures  in   place  to  assure  participant   confidentiality.  

What are the ‘initial courses’ ? Advances  in  Emergency  Management  of  Critically  Ill  patients   (adult  and  peds—non-­trauma) Advances  in  Trauma  care

^ƉĂĐĞĂŶĚƋƵŝƉŵĞŶƚ              Our  goal  is  to  initially  enlist   centers  which  can  handle  20-­30   learners,  and  has  the   appropriate  educational,   storage  and  support  facilities  to   make  events  comfortable  for   learners   Certainly,  participating  centers   will  have  available  a  sufficient  number  and  type  of  relevant  simulation  technologies  (manikins,   virtual  reality,  computer-­based  simulation,  etc.)  to  deploy  the  curriculum.    These  centers  will   require  access  to  a  number  of  other  clinical  devices  including;;              Ultrasound  equipment                  Fluid  infusers,  ventilators              Airway  trainers  and  adjuncts              Pediatric  and  neonatal  resuscitation  equipment              Adult  and  pediatric  trauma  equipment AV  and  related  software  systems  will  be   needed  to  facilitate  debriefing  and   assessment  as  well  as    information   technology  (IT)  used  to  schedule  and   organize  courses  and  curriculum.  

           KƚŚĞƌŬĞLJŝƐƐƵĞƐŝŶĐůƵĚĞ͗



ƵƐƚŽŵĞƌͲƌĞůĂƚĞĚƐĞƌǀŝĐĞ͕  ĂŶŽŶŐŽŝŶŐǀĂůƵĂƟŽŶŽĨWƌŽŐƌĂŵ  īĞĐƟǀĞŶĞƐƐ͕ĂŶĚ Ă,ŝƐƚŽƌLJŽĨŽůůĂďŽƌĂƟŽŶ

6

Advances  in  Emergency  Medicine  Procedures Advances  in  Ultrasound Advances  in  Airway  Management

                             [not  all  centers  will  offer  all  courses] Events  are  based  in  adult  learning  theory  and  use  “real-­  time  peer   review  and  reflection,  arguably  the  most  effective  approach  to  adult   learning” The  goal  “is  to  refresh  and  revitalize  skills  and  to  reveal  new   techniques  and  protocols” Events  will  provide  practicing  emergency  physicians  with:            -­  opportunities  to  receive  supportive  feedback  on  simulation-­          based  performance,  based  on  objective  standards;;          -­  opportunities  to  practice  with  newer  techniques  or  devices            sufficient  to  demonstrate  competence;;            -­  a  personalized  review  of  the  skills  required  to  maintain            competence;;  and            -­  tools  to  continue  practice  at  or  near  their  home  environment. 7


Selected  centers  and  programs  will   have  robust  support  from   (non-­instructor)  personnel    and  a   support  infrastructure,  including   administrative  and  IT  functions,   and  the  security  measures  in   place  to  assure  participant   confidentiality.  

What are the ‘initial courses’ ? Advances  in  Emergency  Management  of  Critically  Ill  patients   (adult  and  peds—non-­trauma) Advances  in  Trauma  care

^ƉĂĐĞĂŶĚƋƵŝƉŵĞŶƚ              Our  goal  is  to  initially  enlist   centers  which  can  handle  20-­30   learners,  and  has  the   appropriate  educational,   storage  and  support  facilities  to   make  events  comfortable  for   learners   Certainly,  participating  centers   will  have  available  a  sufficient  number  and  type  of  relevant  simulation  technologies  (manikins,   virtual  reality,  computer-­based  simulation,  etc.)  to  deploy  the  curriculum.    These  centers  will   require  access  to  a  number  of  other  clinical  devices  including;;              Ultrasound  equipment                  Fluid  infusers,  ventilators              Airway  trainers  and  adjuncts              Pediatric  and  neonatal  resuscitation  equipment              Adult  and  pediatric  trauma  equipment AV  and  related  software  systems  will  be   needed  to  facilitate  debriefing  and   assessment  as  well  as    information   technology  (IT)  used  to  schedule  and   organize  courses  and  curriculum.  

           KƚŚĞƌŬĞLJŝƐƐƵĞƐŝŶĐůƵĚĞ͗



ƵƐƚŽŵĞƌͲƌĞůĂƚĞĚƐĞƌǀŝĐĞ͕  ĂŶŽŶŐŽŝŶŐǀĂůƵĂƟŽŶŽĨWƌŽŐƌĂŵ  īĞĐƟǀĞŶĞƐƐ͕ĂŶĚ Ă,ŝƐƚŽƌLJŽĨŽůůĂďŽƌĂƟŽŶ

6

Advances  in  Emergency  Medicine  Procedures Advances  in  Ultrasound Advances  in  Airway  Management

                             [not  all  centers  will  offer  all  courses] Events  are  based  in  adult  learning  theory  and  use  “real-­  time  peer   review  and  reflection,  arguably  the  most  effective  approach  to  adult   learning” The  goal  “is  to  refresh  and  revitalize  skills  and  to  reveal  new   techniques  and  protocols” Events  will  provide  practicing  emergency  physicians  with:            -­  opportunities  to  receive  supportive  feedback  on  simulation-­          based  performance,  based  on  objective  standards;;          -­  opportunities  to  practice  with  newer  techniques  or  devices            sufficient  to  demonstrate  competence;;            -­  a  personalized  review  of  the  skills  required  to  maintain            competence;;  and            -­  tools  to  continue  practice  at  or  near  their  home  environment. 7


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