LearningSpace – Mizzou – Neurology Clerkship Workflow 2012

LearningSpace – Mizzou – Neurology Clerkship Workflow 2012

The ability to provide a quality simulation learning experience depends highly on the curriculum design and the preparations completed to meet the training goals. In this article I highlight how the LearningSpace system can be used to manage lessons for 3rd year Medical Students. With the use of LearningSpace we were able to provide a workflow that engages the learners in a thoughtful and time sensitive manner, provides timely and expert feedback from faculty during the process while relying on the strengths of the LearningSpace simulation management system.

In 2012 in collaboration with the Department of Neurology Clerkship, we designed an education workflow that utilizes the LearningSpace solution. The solution provided structure and was used to keep the learners on track through a series of semi-automatic communications and content delivery in the form of pre surveys, online education material, virtual patients, simulated patients and feedback/review.

Core learner interactions during a two week intensive session:
1. Pre-Survey and Training Preparation Materials
— Status Epilepticus – online preparation materials
— Acute Stroke – online preparation materials
— Online Virtual Patient
2. Neuro Simulations Part 1 – Status Epilepticus/Acute Stroke
— Itinerary and introduction to simulation environment and simulators
— Live simulation experiences
— Acute Stroke and Status Epilepticus post debrief survey and questionnaire
— Online educational prescription and review
3. Neuro Clinical Skills Experience Simulations Part 2
— Simulation introduction / scheduling
— Simulation itinerary
— Live simulation experiences
— Online feedback and review

Calendar of communication and interaction:
LSneuroexampleLrn

Detailed schedule communication and interaction:

Friday prior to start of the clerkship:
Pre-Survey and Training Preparation Materials
Neurology learners receive a neurology clerkship introductory email with a pre-survey, two online articles and interactive materials as well as an online virtual patient to build the learners knowledge base prior to the first simulation encounter. The learners are given time to complete the preparation materials on LearningSpace from any location with an internet connection. The materials are due prior to the first Thursday simulation encounters.

Wednesday Week 1:
Itinerary and introduction to simulation environment and simulators
An email communication from LearningSpace is sent to the learners for Neuro Simulations Part 1 – Status Epilepticus/Acute Stroke. The email includes simulation itinerary and an introduction to the simulation environment and simulators included in the training. Learners can review the materials online prior to Thursday’s simulation training.

Thursday Week 1:
Live simulation experiences
The learners arrive at the simulation center for a status epilepticus and acute stroke simulation with faculty led debriefing following the simulation. During the simulation learners are assessed by faculty and standardized patients. The learners complete a questionnaire and survey in LearningSpace after the simulation while faculty grade the online virtual patient that was completed by the learners earlier in the week.

Friday Week 1:
Online educational prescription and review & simulation introduction / scheduling
A post simulation email with key review information and an auto generated education prescription report gives each learner details on how to improve their performance. Along with the written feedback the learners can review video of the status epilepticus and acute stroke simulations which will include annotations of all the essential simulation tasks.
The learners are also allowed to schedule a convenient time for the next simulation experience on the coming Thursday through the online LearningSpace scheduling tool. The schedule request should be completed by learners prior to Sunday evening.

Monday Week 2:
Simulation itinerary
A schedule confirmation email is sent to the learners and the details of the upcoming clinical skills experience (CSE) goals and expectations are outlined to prepare the students of the coming week of simulation experiences.

Thursday Week 2:
Live simulation experiences
Learners complete two simulation experiences including a patient write up. The standardize patients complete a written feedback for each learner. After the simulated encounter the standardized patients review the encounter video and complete preset annotations to allow the faculty to easily review and grade the encounter.

Monday following clerkship:
Online feedback and review
After the simulation experience video is reviewed and write up is graded by the faculty, an email from LearningSpace provides additional feedback. A pass or fail grade is given and a detailed education prescription identifies essential items not completed during the CSE encounter.


How to:

The entire course and lesson plan is deployed in LearningSpace with a number of events and cases used in concert to create an education delivery system that flows with the course design.

The course deployment starts with an email that introduces the students to the clerkship and provides the steps for completing a successful clerkship. A LearningSpace event was created with four LearningSpace cases. The four cases provide a pre-survey, training for common neuro cases and an online virtual patient. A LearningSpace event email is created and set to automatically sent to all the learners in the training session.

Part 1. – Introduction, training materials and pre-survey:
(LearningSpace email communication / online training access)

An event was created for part 1 Introduction, training materials and pre-survey.
The event included the following email to be sent to learners.

______________
Hello John/Jane Doe,

Welcome to the M3 Neurology Clerkship.

This email will give you the information needed to get started on your neurology clerkship simulation training. As part of the neurology clerkship we have integrated simulation training as a key tool to introduce you to experiences that we consider necessary for neurology services. We have provided preparation materials and online cases to study and review. It is very important that you complete the following pre-simulation modules.

Log into LearningSpace (learnngspace.umh.edu) anytime to complete the modules. Click the “Introduction and pre-survey” event and select the module from the drop down list.
Modules:
1. Pre-survey
2. Status Epilepticus – online preparation materials – includes Continuum Status Epilepticus article
3. Acute Stroke – online preparation materials – includes NIH Stroke Scale Certification
4. Online virtual patient – includes written summary, plan and diagnosis

Please complete the above preparation materials before the simulation activity schedule for Thursday at 1:00pm at the Clinical Simulation Center CE629 Debrief room.

During week two you will also have a OSCE simulation experience scheduled. You will receive updated information and itinerary prior to your simulation experiences.

Thank you,
Signature
______________

Part 2a. Neuro Simulations Part 1 – Status Epilepticus/Acute Stroke – Itinerary and introduction to simulation environment and simulators
(LearningSpace email communication)

The event included the following email to be sent to learners.

______________

Hello John/Jane Doe,

The Status Epilepticus and Acute Stroke simulation event will be held at the Clinical Simulation Center room 629 tomorrow from 1 to 3:30 pm.

Simulation Training Itinerary:
– 10 min – Demonstration of the simulation environment.
– 10 min – Team discussion
– 60 min – Simulation encounters (1:20 total)
– 30 min – Debrief and discussion
Completing all training activity within 2.5 hours.

Please verify you have completed the below pre-simulation event materials before the simulation:
1. Complete materials and the NIH Stroke Scale Certification available at National Stroke Association website:
http://www.nihstrokescale.org/
2. Completed Continuum Status Epilepticus materials and article. You may bring a printed copy of the Status Epilepticus Treatment Protocol to the simulation as a reference if needed.
3. Completed the online virtual patent module (M3 Neuro Sim Online Virtual Patient).

Watch the following videos to familiarize yourself with the simulation center.
—-Link to simulation training environment video
—-Link to simulator video

Bring your laptop or tablet device for online components of the training.

Thank you,
Signature
______________

 

Part 2c. Neuro Simulations Part 1 – Acute Stroke and Status Epilepticus post debrief survey and questionnaire
(LearningSpace video recording, live annotations, patient orders, standardized patient feedback )

The live simulation case utilizes action item scoring that uses the annotations to produce an overall score and produce an education prescription report.

Part 2d. Neuro Simulations Part 1 – Online educational prescription and review
(LearningSpace email communication reports from standardized patient, faculty annotations)

An email from learningspace event is scheduled to be sent after the encounter.

After completion of your M3 Neurology Clerkship Sim Center simulations we are providing automatically generated feedback based on some of the action performed in your simulation.
M3 Acute Care – Interpersonal and Communication Skills actions
The information below provides feedback based actions performed in your simulation.

Status Epilepticus – Neuro 2013 (Prolonged Convulsion)
M3 Acute Care – Interpersonal and Communication Skills actions (M3-ICS)
Interpersonal and Communication Skills where considered SATISFACTORY for this simulation.
You performed some of the following key communications elements we evaluated.
– Requested additional patient history from the nurse.
– Exchanged closed loop communication to eliminate any errors in communications between team members.
– Vocalize future actions to give team foresight in to the future.
– Provided good overall team communication speaking loudly and clear enough that entire team and reducing any confusion and patient care.
– Spoke to patient with caring and concern.

Step 3a. Neuro Clinical Skills Experience Simulations Part 2 – Simulation introduction / scheduling
(LearningSpace email communication and scheduling)

An event was created for “Neuro Clinical Skills Experience Simulation Part2 – Simulation introduction / scheduling”
The event included the following email to be sent to learners.

______________

Dear John/Jane Doe,
In an effort to utilize your time effectively, we are providing you a few optional times to meet your next simulated patients.  During the upcoming simulation you will be asked to perform a thorough neurological history interview and physical examination for two patients and complete a writeup of each individual patient. Your neurology faculty will not be present of the live simulation but they will review the video soon after completing the experience.

Login to LearningSpace and select “Your dates” to select a date and time for the Neuro OSCE simulation event, running between 9:00am and 11:30am next Thursday. If you don’t select a preferred time you will be assigned a time automatically.Your deadline for setting your preferred date is Sunday.

***************************************************

Thank you,
Signature
______________

Part 3b. Neuro Clinical Skills Experience Simulations Part 2 – Simulation itinerary
(LearningSpace email communication and training)

The event included the following email to be sent to learners.

______________

Dear John/Jane Doe,
Your patient encounter event is confirmed for OSCE simulation at the Simulation Center room CE617.
Your encounter is set to start at 8:40.
PREPARATION:
A simulation facilitator will review the simulation goals and address any questions and give room assignments.
Case 1: (50 minutes total)
–  25 minutes encounter, 25 minutes write up
Case 2: (50 minutes total)
–  25 minutes encounter, 25 minutes write upBring your Laptop
– Have your laptop fully charged.
– Use Mozilla Firefox, Internet Explorer 9+ or Safari or Chrome.POST ENCOUNTER FACULTY ASSESSMENT & FEEDBACK:The OSCE will be part of your Faculty Evaluation Grade and will completed this weekend with feedback sent next Monday.

SIMULATION OBJECTIVES:
Perform a thorough neurological history interview and physical examination for two patients and complete a write up of each patient.

You will be assessed on the completion of the following items and the write up of the patient.

History Taking
– History of Present Illness
– Past Medical History
– Surgical History
– Personal and Social History
– Family History
– Allergies
– Review of Systems
– Medications

Mental Status Examination
– Language Testing
– Registration and Attention
– Immediate and Delayed Recall
– Orientation
– Visual field extinction
– Sensory Extinction

Cranial Nerves:
– CN I: Smell
– CN II: Fundoscopy
– CN II: Visual acuity
– CN II: Confrontation Testing
– CN II-III Pupil size
– CN II-III Light response
– CN III, IV, VI: Extra-ocular eye movements
– CN III Accommodation /Convergence
– CN V: Jaw movements and Face Sensation
– CN VII Facial movement
– CN VII Taste
– CN V-VII Corneal Reflex
– CN VIII: Hearing
– CN IX Palatal movement
– CN IX-X Gag reflex
– CN XI: Head/Shoulder movements
– CN XII Tongue

Motor Examination
– Pronator Drift
– Upper Limb Motor Power, Tone Testing
– Lower Limb Motor Power, Tone Testing
– Upper Limb Motor Coordination
– Lower Limb Motor Coordination

Deep Tendon and Superficial Reflexes
– Upper Limb DTR
– Lower Limb DTR
– Plantar Response

Station and Gait
– Station and Walking
– Heel to Toe or Tandem Walking
– Romberg’s Test

Sensory Testing
– Pinprick, Light Touch or Temperature (at least 1)
– Joint Position Sense
– Vibration Sense

***************************************************

Thank you,
Signature

______________

 

Part 3c. Live simulation experiences
(LearningSpace email communication and training)

Part 3d. Online feedback and review
(LearningSpace email communication and training)


Pro:

Helps organize and provide structure for material to students.
The method insures consistent delivery of information and materials to learners throughout the year and different learner blocks.
Help faculty provide feedback to students on progress interaction, anytime and anywhere.


Cons:

With no method within LearningSpace to group events it is required to copy events and schedules forward to setup the next round of identical experiences.


Review:

This method of training takes some in-depth thought and consideration of the medical training goal but once the ground work has been laid for the training the lessons can be consistently duplicated for students throughout the year.  The method has flipped the classroom and allows the student to spend valuable time asking the faculty questions about the learning materials and experiences. LearningSpace is not meant to be a LMS replacement for large universities but instead has strengths in connecting users to the simulated clinical experiences in a effective manor.

0 Comments

Leave a reply

Your email address will not be published. Required fields are marked *

*