RAMS Simulation Roadmap

Simulation Medical Simulation increases the confidence and technical expertise of Emergency Medicine physicians through the use of virtual reality, computer-based simulators, task trainers, and standardized patients. This method of education is instrumental in the evaluation of leadership skills, interdisciplinary teamwork, procedural training and formative feedback in a safe and collaborative environment.

MED STUDENT (MS3/4)

JUNIOR RESIDENT

background

Senior RESIDENT

Resources

AUTHOR: Anisha Lashkari Contributors: Jennifer Yee, DO and Suzanne Bentley, MD, MPH Welcome to the Emergency Medicine Education Roadmap, your definitive step-by-step guide on how to succeed in Simulation at every training level. Don’t know where to start? Click on “Background” or select your training level above. A full list of fellowships, conferences, publications can be found in “Resources”.

For pearls of wisdom from faculty and residents in the trenches, click on “Insider Advice.”

FELLOW

insider Advice

1 - SENIOR MEDICAL STUDENT How should I plan my M3/M4 year for an Emergency Medicine-Simulation Track?

M3: If your school offers a core Emergency Medicine (EM) rotation, inquire what simulation opportunities exist by asking faculty at your institution. Inquire if any research opportunities in simulation are available. Alternatively consider getting involved in national committees such as the SAEM Simulation Academy and EMRA’s Simulation Committee.

M4: This is the time where your freedom to pursue any and all aspects of EM are at your finger-tips. Most medical institutions have a simulation center in place for the training of medical students and residents on technical skills.

• Look into spending time in the lab and supporting the education of others who come into the lab for training.

• Gather information on the training modules that the technicians undergo to assess credentialing opportunities through Society for Simulation in Healthcare (SSIH) during your lightened academic load of 4th year.

• Consider setting up an away rotation in EM simulation as a fourth year. Several institutions may offer a 2 or 4-week elective in simulation.

2 - JUNIOR RESIDENT PGY1-PGY2: • Introduce yourself to different simulation cases/scenarios created by educators by utilizing resources such as: – h ttp://thesimtech.com/ – h ttps://emsimcases.com/ • Make an effort to reach out to programs/fellowships during conferences sponsored by SAEM, ACEP or the Society for Simulation in Healthcare.

• If possible, get involved in simulation research opportunities.

• Inquire if your institution has a QI/QA committee to learn more on patient safety and quality management as these committees are often tied to simulation workshops.

• By early PGY2 you should have a mentor set up. Your mentor will also be very valuable as your future Letter of Recommendation (LOR) writer!

3 - SENIOR RESIDENT Early PGY3/PGY4: • If you are seriously considering simulation, then every effort should be made to set up an elective at an institution that you’re interested at to see if simulation is for you. Many institutions offer 2 week or 4 week rotations for residents.

• Plan for who you would like to ask for letters of recommendation for your application and inform them.

Summer of PGY3/PGY4: • Start applying in the summer of your PGY3 year and prepare for your interview; be prepared to talk about your contributions as a resident in simulation. While there is no magic number in the amount of interviews you should be going on, attending anywhere from three to five, increases your likelihood in matching into a Simulation Fellowship!

• Lastly, continue working on your personal statement and give the program you’re interested in a reason why simulation is the right fit for you. Consistent contributions in committees and research are examples of continued focus towards the field of simulation that can be chronologically noted throughout your time in residency. This as well as consistent work ethic are just a few traits and items that programs are usually looking for.

4 - FELLOWSHIP By pursuing a simulation fellowship, you learn to become a true leader in the emergency room. Fellows get involved with writing and evaluating cases, but also participate in inter-department level team training sessions. You not only get to stay up to date with the medical technologies out there but also serve as a leading educator while experiencing the fun side of simulation by leading SimWars at national competitions.

Like EM, simulation is very broad. Currently, two simulation tracks are available for the EM trained resident. These include going through a 1 year fellowship after EM residency and a 2-year fellowship that combines the simulation training with a Master in Education (MEd) or a Master in Business and Administration (MBA). Alternatively, while most simulation fellowships that are available are catered towards someone who has completed his/her EM residency, some simulation fellowships are available to medical doctors of other fields such as Surgery, Medicine and OB/GYN as well as nurses, PAs, and other healthcare professionals.

Currently, at least 30 simulation programs are offered, however there are more out there that may not be listed on SAEM’s Fellowship Directory. While specific requirements may differ with each institution, most include: • Applicant must have graduated from or have successfully completed their third year of an approved ACGME residency program in Emergency Medicine.

• Successful completion of USMLE parts 1, 2, and 3 are required.

• A record of achievement in medical education, as provided by letters of recommendation, publications, teaching evaluations, or prior specialized training or experience in medical education is desired, but not required.

• CV & Personal statement • A pre-admission health review and current immunization record are required before the start of the fellowship. Perspective fellows must pass a criminal background check and drug test. Board certification may or may not be mandated (depending on institution). ***Each Simulation Fellowship may differ from another. Some may require a minimum of three letters of recommendation so make sure to do your research first!*** • W hile simulation is a fellowship of growing interest, it still may not offer as many positions nationally as other EM fellowships so it’s important to reach out to institutions you may be potentially interested in applying to.

• This Fellowship does not go through the ERAS Match Process. Refer to the specific institution for guidance on the application cycle and what is required.

• Additionally, as a Simulation fellow you will be working with different fields ranging from Surgery to Anesthesiology to Pediatrics.

It’s important to be ready to serve as a leader for not just Emergency Medicine but also other fields you will be working with.

5 - BACKGROUND The History of Medical Simulation The British Medical Ultrasound Society states that medical simulation originally stemmed from the aviation industry. Shortly after the first World War, pilots utilized simulation based practices as part of their training, allowing them to engage in aerial maneuvers that would otherwise be too risky to practice in. While practicing drills midair proved to be both expensive and perilous, the advent of the hydraulic simulator let pilots learn this drill safely on the ground. Likewise, in the field of Emergency Medicine (EM), new physicians and expert physicians can train and perfect techniques in performing life-saving procedures without any harm to the patient.

In the field of EM a manikin representing an adult, child or newborn may serve as the patient simulator. Any type of patient presentation is portrayed, complete with vital signs, and physical exam findings. The learners are challenged with specific objectives to assess and treat a patient just as they would in the real world. A debrief follows the case where a facilitator guides the learners through their thought process and performance to engrain key teaching points. The debrief may include videotaped playback from the scenario�

Why We Use It Today Medical simulation is used throughout medicine predominantly to enhance student and physician education by reducing medical errors and ultimately improving patient care. In the field of EM, simulators can mimic airway and breathing complications and can even respond to medical interventions such as chest compressions, needle decompression, etc. Examples of simulators commonly encountered are ACLS simulators, Perinatal and birthing simulators. However, simulation does not need to be just limited in the context of an emergency department. Surgeons, internal medicine, OB-GYN are just some of many other fields that incorporate simulation. Nearly every physician at some point in their training has encountered simulation!

Why Emergency Physicians Choose Simulation Simulation training provides an opportunity to use equipment such as mannequins and practices such as verbal and video debriefing to discuss effective teamwork strategies that support collaboration while working in an ED. Simulation also offers hands on training for many high risk procedures. This is not just a great learning tool for residents but also helps us improve patient care. A career in simulation incorporates many facets of emergency medicine-it prepares one not only the years beyond residency but also prepares one to be a leader, educator, as well as an administrator. This involvement can vary from wide committee strategic planning to small-scale operational management in order to ensure proper functionality of the simulation center.

6 - RESOURCES Conferences/Organizations • • • •

S ociety for Academic Emergency Medicine (SAEM) Simulation Academy E mergency Medicine Residents Association (EMRA) Simulation Committee S ociety for Simulation in Healthcare (SSIH) A merican College of Emergency Physicians (ACEP) Simulation Training

Grants

• S AEMF Simulation Academy Novice Research Grant • E MRA Simulation Research Grant

Fellowships

• S AEM Fellowship

Additional Advice & Resources: • • • • •

h ttps://www.aliem.com/2015/10/em-fellowship-match-advice-simulation-toxicology-ultrasound/ h ttp://thesimtech.com/ h ttps://emsimcases.com/ R iley R. A Manual of Simulation in Healthcare. New York, NY: Oxford University Press; 2008.

P alaganas J, Maxworthy J, Epps C, Mancini M. Defining Excellence in Simulation Programs. St. Louis, MO: Wolters Kluwer; 2015

Journals and Publications: • • • •

A cademic Emergency Medicine A dvances in Simulation J ournal of Surgical Simulation S imulation in Healthcare

7 - INSIDER ADVICE Dr. Jennifer Yee, EM Simulation Director, Ohio State University “It’s an exciting time to be involved in medical simulation! The field is embracing and integrating technological advances, such as virtual reality to telemedicine. People are also incorporating human factor and psychology principles to evaluate how learners think, and simulation is an ideal platform to investigate this further.”

“Reach out! … there are numerous organizations to assist you such as SAEM. The Society for Simulation in Healthcare (SSIH) also has a national conference, it is a great place to network, check out new products and technology, and learn about current trends in the field.”

“Simulation is a very heterogeneous field with copious opportunities, including medical education, research, product development, and administration. As simulation in emergency medicine continues to grow, interested residents should contact fellowship directors to discuss learning opportunities and potential avenues for career development.”

Dr. Rochelle Zarzar, Education and Simulation Fellow, Hennepin County Medical Center “During residency, I became interested in residency program leadership through my involvement in PEIC and other program committees. I decided that someday I wanted to be a program director, and with this career path in mind I landed on a medical education fellowship. Nowadays, it helps to have a background in medical education (especially a masters degree) to help with career progression in program leadership.

I decided to complete the 2 year rather than 1 year fellowship so that I could complete the masters as well.

I didn’t look into any other programs since I wanted to remain at HCMC.”