%% #project/done Lia and Lon 1) — prior publications on how these objectives have been met %% There are mildly descriptive series of websites, none of these has any form of real description of the process, the case, the educational outcome, or the logistical setup 2022-04-19: # Three themes: 1. Growth mindset 1. awareness 2. Name-Claim-Aim 1. practice and video feedback 2. debriefers look for N-C-A uterances 3. Conflict Management/Feedback 1. case based ? split case ## Cases: - End of case turnover with hypotension/ pressure to extubate, unclear cause - laparoscopic case - CRNA/Attending conflict - Need for in the moment intervention - need for feedback/resolution conversation - Prone/Trach - Offsite Endocsopy/IR ## Essential Questions Draft Mindset - What can push me to focus on performance and what conditions enable me to focus on learning? Name-Claim-Aim - Why do some teams succeed and others do not? Case 1 (DNR): - How do I manage a situation where I am one of multiple physicians who have roles in deciding what happens and it appears that we see things differently? - When do I speak up vs when do I allow a dominant personality to keep their perceived hierarchy? Case 2 (hypotensive at end of case) - How does the perception of the urgency of the situation impact my performance, language, willingness to explore multiple solutions? - When is diagnostic closure indicated, and how do I keep the door open to other ideas? Case 3: (offsite) - How do I best integrate into a team that needs my help? I am offering these as a way to make sure I’m understanding the purposes behind your (our) design! And, I think it’s a clarifying step that can also help other co-faculty and potentially with debriefing. ## Sources Reviewed ### Vague description of hemoptysis as a case used in simulation and take-aways (EM focused) [https://www.downeastem.org/downeastem/2017/2/26/simulation-cases-cliffs-notes-massive-hemoptysis](https://www.downeastem.org/downeastem/2017/2/26/simulation-cases-cliffs-notes-massive-hemoptysis) ### Has a case and debriefing guide with xrays pre-post intubation, does not have the educational outcomes or the moulage/setup [https://www.mededportal.org/doi/10.15766/mep_2374-8265.533](https://www.mededportal.org/doi/10.15766/mep_2374-8265.533) ### Diffuse Alveolar Hemorrhage case description [https://escholarship.org/content/qt3ss7x2s4/qt3ss7x2s4_noSplash_de7812dd99fed82aa348403dfa3cd53f.pdf?t=qdolw0](https://escholarship.org/content/qt3ss7x2s4/qt3ss7x2s4_noSplash_de7812dd99fed82aa348403dfa3cd53f.pdf?t=qdolw0) ### "research outcomes" surveymonkey.com to all the participants. The survey collected responses to the following questions: (1) the case was believable, (2) the case had right amount of complexity, (3) the case helped in improving medical knowledge and patient care, (4) the simulation environment gave me a real-life experience and, (5) the debriefing session after simulation helped improve my knowledge. A Likert scale was used to collect the responses. Results: Seven learners responded to the survey. One hundred percent of them either agreed or strongly agreed that the case was beneficial in learning and improving patient care. They also agreed that it helped in improving medical knowledge. The post-session debrief was found to be very helpful by all the learners. Discussion: High-fidelity simulation was a cost-effective yet realistic way to manage severe hemoptysis, PEA (pulseless electrical activity), and persistent hypoxia in patients with diffuse alveolar hemorrhage. Starting the case with severe hypoxia that quickly progresses to PEA helps the learner to manage the patient quickly and effectively. Overall, learners enjoyed managing the patient, followed by discussing the various management strategies. ### Description of "educational outcomes" [https://www.thoracic.org/professionals/career-development/fellows/innovations-in-fellowship-education/2016/university-of-maryland-3.php](https://www.thoracic.org/professionals/career-development/fellows/innovations-in-fellowship-education/2016/university-of-maryland-3.php) **RESULTS** There was a significant increase in comfort level in managing massive hemoptysis after the HFS despite intentionally high cognitive load. There was also a significant increase in scores surrounding knowledge on management of massive hemoptysis, from an average score of 77.5 percent to 96.2 percent on the post-simulation questionnaire (p = 0.001). ### Describes development of a hemoptysis trainer, but appears to be a plan to develop and does not include any description that I can find [https://simulation.health.ufl.edu/technology-development/systems-devices/hemoptysis-trainer/](https://simulation.health.ufl.edu/technology-development/systems-devices/hemoptysis-trainer/) ### Description of a proposed theraputic approach but no sim setup [https://emcrit.org/wp-content/uploads/2017/05/mass-hemoptysis.pdf](https://emcrit.org/wp-content/uploads/2017/05/mass-hemoptysis.pdf) ### Reference to a case but no other information Northwestern: [https://northwestern.cloud-cme.com/course/courseoverview?P=0&EID=84442](https://northwestern.cloud-cme.com/course/courseoverview?P=0&EID=84442) ### Description of a trial being done, uses cadavers [https://clinicaltrials.gov/ct2/show/NCT04087135](https://clinicaltrials.gov/ct2/show/NCT04087135) - trial comparing intubation approaches, simulating using cadavers ### Anesthesia Patient Safety Foundation article describing a case of hemoptysis in IR during CT guided biopsy - this is a "why" for our program APSF: [https://www.apsf.org/article/massive-hemoptysis-a-rare-but-catastrophic-complication/](https://www.apsf.org/article/massive-hemoptysis-a-rare-but-catastrophic-complication/) This is a protocol described by a multidisciplinary team created for massive hemoptysis during interventional radiology procedures ## Trach emergencies: EMSIMCASES.COM does have a case around trach emergencies we could consider using parts of [https://emsimcases.com/2021/10/26/trach-emergency/](https://emsimcases.com/2021/10/26/trach-emergency/)