Before attending physician Jennifer Mink, M.D., started working shifts at Christiana Care’s new Middletown Emergency Department, she wanted to assess and possibly improve her skills at performing cricothyrotomy — a rare but vital procedure. Cricothyrotomy is an emergency procedure for treating patients experiencing a potentially lethal blocked or swollen airway. It involves creating a temporary opening below the blocked area and inserting a breathing tube into the airway.
Dr. Mink consulted colleague Brian Levine, M.D., Emergency Medicine Residency Program director, for coaching. They went to Christiana Care’s Virtual Education and Simulation Training center in the John H. Ammon Medical Education Center to practice on one of the center’s advanced simulation mannequins, which would signal the doctor if she did not perform the procedure perfectly.
“It turns out that Dr. Mink had good foresight to practice her cricothyrotomy skills,” said Susan Coffey Zern, M.D., director of simulation education. “A short time later a patient having a severe allergic reaction arrived unable to breathe and needed the procedure.”
Not all skills that professionals can practice or coach at the Virtual Education and Simulation Traning Center are likely to save a life in such a dramatic style. “But deliberate practice definitely helps improve the quality and safety of care, and saves lives in ways we might not imagine,” Dr. Coffey Zern said. “We need to be using our simulation center to grow as professionals and as lifelong learners. There’s a lot of value in practicing. You may be using certain clinical skills or procedural techniques every day, but you might be doing some part of it incorrectly. In the simulation center, we can teach you how to do it better.”
“The Virtual Education and Simulation Training Center is the appropriate place to practice procedures that we don’t perform often,” said Dr. Levine. “The community expects emergency physicians to be competent to handle anything that enters our doors. It is common practice for our emergency residents and faculty to keep up their skills on an annual basis, and the best process is through well-designed simulation like we have at Christiana Care. We continue to prove that the process works and saves lives.”
Many other opportunities for deliberate practice await learners at the center, which is accredited as a Level I Comprehensive Education Institute through the American College of Surgeons. These range from basic skills, such as sterile technique, knot tying, or placing a peripheral IV, to more complicated skills, such as placing a central venous catheter or performing surgery with a robotic simulator.
“The possibilities for learning are endless, Dr. Coffey Zern said. “If you can think it, we can probably help you simulate it.”
Trained as a pediatrician, Dr. Coffey Zern served as associate dean of medical education at Drexel University College of Medicine for 10 years. As an educator, the director of simulation training often talks about deliberate practice, citing studies by American educational psychologist Benjamin Bloom. “Bloom looked at elite performers, studied their childhoods, to learn how they became great — whether they were born that way or achieved it,” she said. “He found the things they had in common were devoted teachers, family support — and the quality of practice is what made them experts. Here at Christiana Care we offer all of the above”
“We have credentials that say we’ve done a certain number of cases and we’re proficient,” she said. “Now we’re finding that the number of cases we’ve done is not a surrogate for proficiency. It has to be embedded in your skill set.”