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Collaboration through Telehealth

Longtime partners, VCU School of Nursing Clinical Learning Center and School of Medicine Center for Human Simulation and Patient Safety Standardized Patient Program, collaborated this fall on two telehealth simulated events - a first for the VCU Health System community. These events challenged students, faculty and staff to engage through an ever-more technologically connected patient care system.

Telehealth

In recent years, the medical community has consistently sought additional opportunities to reach more patients.  Telehealth, the practice of meeting with patients via video or telecommunication technology, has provided an opportunity for medical providers to reach patients who previously may not have had access to care.  This opportunity has also paved the way for patients to see specialists for care, even if those specialists would have been otherwise unaccessible.  Telehealth, understandably, has become an increasingly utilized tool, challenging the medical education community to prepare our health system students to use this technology once they get into practice.

This increased need was one of the motivating factors of researcher and School of Nursing Psychiatric Mental Health Nurse Practitioner faculty member Dr. Dawn Goldstein and her 2017 Telehealth project. Goldstein and the School of Nursing Clinical Learning Center partnered with the School of Medicine Center for Human Simulation and Patient Safety Standardized Patient program to develop, train and implement 2 brand new Telehealth simulations for master’s level Nurse Practitioner students to undertake in the Fall 2017 semester.

Grant + Development Process

The process began in Spring 2017 with Psychiatric Mental Health Nurse Practitioner faculty member, Dr. Dawn Goldstein, PhD, RN, PMHNP-BC, CCM, identifying a gap in the graduate psychiatric mental health nursing education curriculum: Telehealth.

In the past 10 years, there has been a significant uptick in the utilization of Telehealth, particularly in the field of psychiatric nurse practitioners. Telehealth technology enables providers to reach remote populations, continue care with existing patients if the provider or patient moves away, as well as provide patients access to specialist care.

Dawn Goldstein sought to utilize the final didactic semester for the Psychiatric Mental Health Nurse Practitioner students in the VCU School of Nursing to bridge the knowledge gap about Telehealth.  She obtained a Clinical Scholars Fund grant from the VCU School of Nursing, and set about building her research project, bringing on board Dr. Carla Nye, DNP, RN, CPNP-PC, CNE, Ms. Lyons Hardy, M.S., RN, P-MHNP, Ms. Allison Gregory, M.S., RN, FNP-BC, all from the School of Nursing and Mrs. Christine Arena, BA, MA, from the School of Medicine Center for Human Simulation and Patient Safety, to develop the project.

Goldstein’s research focused on curriculum improvement, thus her research tools captured student data about both Telehealth utility and Interprofessional Collaboration.

CLC + CHSPS partnership

Beginning in 2009, the VCU School of Nursing Clinical Learning Center and the burgeoning Center for Human Simulation and Patient Safety in the VCU School of Medicine partnered to bring specified communication training to nursing students.  This training was conducted by Dr Aaron Anderson, PhD, who brought his expertise as a theatre professional into the medical education field.  These trainings kickstarted what would later be known as the Center for Human Simulation and Patient Safety (CHSPS) Standardized Patient Program, which officially began in 2011. 

The CHSPS Standardized Patient Program works with members of the VCU Health community to develop scenarios and give students simulated encounters in order to better prepare them for situations that the students can encounter in their professional practice.  Students engage in the scenarios in an environment that closely resembles professional practice -- putting credence to the concept of developing good habits in practice.

The niche that the CHSPS Standardized Patient Program occupied was in the employee pool -- the majority of the Standardized Patients (SPs) employed by the program were local theatre practitioners, just like Dr Anderson. This shared knowledge base allowed the program to train the SPs with thin-sliced training -- the SPs would learn the cases in a similar mode to how they prepared for a play. This meant that the SPs could be highly knowledgeable about the patient from the patient’s perspective, creating space for specialized, pinpointed feedback for the students. The feedback is rooted in the Delta Plus, Inquiry/Advocacy model and Macy’s Scale.

The School of Nursing Clinical Learning Center (CLC) has enveloped Standardized Patient simulations in their curriculum for more than 10 years. With the advent of the CHSPS SP program in 2011, the CLC integrated the CHSPS SPs with their inhouse SPs for different simulations.  Over time, the CHSPS SPs were contracted more for the higher intensity, feedback-focused events -- including a 2015-16 research project lead by Dr. Carla Nye and Ms. Genevieve Beaird that was featured in multiple conferences, particularly the International Nursing Research Congress in Capetown, South Africa.

The curricular integration of the CHSPS SPs within the School of Nursing enhanced the long standing relationship between CHSPS and CLC, leading to shared work.

Feedback Circle in Action

Beginning in 2016, the CLC and the CHSPS SP program honed a process lovingly known as the Feedback Circle. This process, developed from a meshing of both Centers’ simulation design procedures, relies on group work, expertise and consistent feedback. The feedback circle process begins with a team meeting, with experts focused on different parts of the event: Patient expert, Simulation expert, Content expert, Standardized Patient Expert. The faculty, typically the content expert, starts with the learning objectives for the simulation and opens it up to the group to collaboratively build a detailed, focused simulation that is both realistic and educationally focused.

The team piloted the process within the Psychiatric Mental Health Nurse Practitioner (PMHNP) program, developing 6 new simulations for the students to encounter during the summer of 2016.  These simulations challenged the students effectively, but also highlighted the value of the collaborative Feedback Circle model.  The team, Drs. Carla Nye, Sean Convoy of the School of Nursing and Mrs. Christine Arena of the School of Medicine CHSPS, went on to present this model within the VCU Health Community at an IPEC event as well as at both INACSL and VASSA conferences.

When Spring 2017 rolled around, the team, now grown to include Dr. Dawn Goldstein and Ms. Lyons Hardy, decided to take on Goldstein’s challenge to close the gap in knowledge about Telehealth technology within PMHNP education. The team also partnered with Family Nurse Practitioner (FNP) Concentration Coordinator, Ms. Allison Gregory, to envelope the FNP students into the second simulation. The Feedback Circle commenced in late May 2017.

The Fall semester focused on special populations that the students may not have yet encountered in their practice or education.  Thus, the team chose to focus the two simulations on the Transgender community and the Veteran community.  The first major meeting about the individual simulations included patient experts -- in this case, members of the Transgender and Veteran communities, respectively. These team members were invaluable, providing much needed insight about their respective communities, which resulted in a more realistic development of the patient profiles.

Training

As this Telehealth project is a first for the VCU Health Community, CHSPS SP program was also tasked in developing appropriate and effective training materials, both for SPs and for technological access.  Led by Mrs. Christine Arena, the team decided on 3 training packets: Sensitivity, Technology and Case content. Sensitivity training was taken on at the urging of the Transgender community members who served as patient experts in the Feedback Circle case development, specifically for the SPs. The team brought in simulation veteran Dr. Aaron Anderson to assist with this training.

The other two training packets developed were focused on the technology and then the more typical case training requisite with all SP scenarios.

Events

Prepped and ready, the first event kicked off on September 26, 2017 with a singular cohort of 9 PMHNP students.  Using the cloud-based video application, Zoom, the students interviewed the SPs, obtaining a history, presenting a differential diagnosis, plan of care and scheduling a follow-up. After the interview, the SPs provided focused feedback on student performance, with special attention to their interaction with telehealth technology and sensitivity regarding the transgender patient.  Following all student interviews, the SPs provided the Outside SP Client Coordinator, Mrs. Christine Arena, with global observations about student practices across the board. Ms. Arena then brought these observations to the large group debrief, co-facilitating the debrief with Dr. Goldstein.

The simulation development team took observations and practices from the first simulation and integrated them into the second, larger simulation on October 30, 2017. This second simulation focused on a patient in the veteran community, with a total of 42 students from the PMHNP and FNP programs as well as 4th year Pharmacy students.  The objective for this simulation included interprofessional collaboration -- 7 students, a mix of FNP, PMHNP and 4th year Pharmacy students, saw the same patient via telehealth appointment, portrayed by 6 Standardized Patients.  During the interviews they elicited a history, presented a differential diagnosis, tentative plan of care and scheduled a follow-up.  After the interview portion of the encounter was complete the SPs provided focused feedback on student performance, with special attention to their interaction with the telehealth technology and nonverbal communication. Immediately following the SP feedback, all 7 students gathered to collaboratively develop an interprofessional plan of care, with both pharmaceutical and non-pharmacological interventions.

Due to the large numbers of students, the students were split into morning and afternoon groups, with a large group debrief session for each major group.  As in September, the SPs provided the Outside SP Client Coordinator, Mrs. Christine Arena, with global observations about student practices across the board. Mrs. Arena facilitated the large group debrief with these observations to the large group debrief.

Moving Forward

Dawn Goldstein identified a gap in nurse practitioner education -- learning about and using Telehealth technology prior to professional practice. This is especially important as rates of Telehealth usage in professional healthcare practice continues to rise. The solution of developing two Telehealth simulations provided exposure and practice in this technology in both uniprofessional and interprofessional environments.  The subsequent success was made possible by the positive, collaborative relationship between the VCU Schools of Nursing and Medicine, and their respective simulation programs.

This large endeavor is a first for the VCU Health Community, and has already garnered interest from other schools and departments seeking to increase the exposure of their students to these technological practices. The team hopes to share this project and the research findings at various conferences throughout the upcoming academic year.

The long-term relationship between the VCU School of Nursing Clinical Learning Center and the VCU School of Medicine Center for Human Simulation and Patient Safety Standardized Patient Program has borne much fruit in student competencies.  The team seeks to continue to grow, collaborate and innovate, finding new ways to challenge students to become excellent healthcare professionals.

 

TeleHealth Nurse Group Huddle Nurse Conference Call Standardized Patient telecomm 1

Standardized Patient telecomm 2 Telecomm Monitor TeleHealth Nurse Group Huddle pictures

 
 

s of November 1, 2017, we now have 2 brand new sign-in computers along with a much more efficient and user-friendly sign-in software.

Remember, everyone must sign-in including learners and instructors!

Come check out our new computers and sign-in software on the 9th floor of MMEC!

Also, coming in 2018, we are installing 2 more sign-in computers on the 10th floor of MMEC for all of our standardized patient sessions!

New Sign-in Computers! Learners Signing In New Sign-in Software Homepage

 
 

The Center for Human Simulation and Patient Safety just got a brand new airway trainer!

Dr. Cathy Grossman takes the first run at trying out the new 7-Sigma airway trainer!

The 7-Sigma Simulation Systems 7S3 modular airway trainer is an unparralleled tool that details the realistic intubation of an adult patient.

For more information on the 7S3, visit the 7-Sigma website!

If you're interested in using the 7-Sigma airway trainer, please request a simulation reservation here.

Airway Trainer 7-Sigma Poster Airway Trainer 7-Sigma Head Airway Trainer 7-Sigma BVM

Airway Trainer 7-Sigma Intubate Airway Trainer 7-Sigma Glidescope1 Airway Trainer 7-Sigma Glidescope2

 
 

The VCU Department of Surgery's Division of Acute Care Surgical Services in cooperation with the Center for Trauma and Critical Care Education hosted two ASSET (Advanced Surgical Skills Exposure for Trauma) courses on Monday and Tuesday October 9th and 10th on the medical campus.  Dr. Mark Bowyer, the Ben Eiseman Professor of Surgery, and surgical director of Simulation in the Division of Trauma and Combat Surgery of the Uniformed Services University of the Health Sciences (USU)-Walter Reed National Military Medical Center (WRNMMC) Department of Surgery, served as the Course Director on October 9th.  The course enabled Dr. Paula Ferrada to become a Course Director, Dr. Levi Procter, an Instructor and Dr. Alan Rossi, an Instructor Candidate.  ASSET courses train residents, fellows and attending surgeons to better care for severely injured patients. VCU will now be able to provide this specialized training to the Richmond and regional communities.

 
 

2017 Good Grief Conference imageYesterday (October 24th, 2017) two of our Standardized Patients (actors trained to portray a patient in a medical situation, sometimes called an SP) took part in a live action simulation at the 27th Annual Good Grief Conference. The conference theme this year was “A Place at the Table – Hospitality: Cultivating Diversity and Inclusion.” Each medical situation that the Standardized Patients portrayed included scenes with one person playing the role of a nurse/doctor and the other a patient. The patient played 3 different roles – a person of the LGBTQ community, a person with HIV, and an inmate – with all three either dying or grieving. These scenes supported the theme of cultivating diversity and inclusion for those that work or deal with mental health, spiritual and emotional counseling around loss, grief, and bereavement issues.

2017 Good Grief Conference brochure

 
 

VCU School of Medicine Pediatric Interest Group Presented the 9th Annual Pediatric Conference on October 14, 2017 at 8:30AM in the McGlothlin Medical Education Center.  The event consisted of a keynote speaker, pediatric professionals panel, series of interactive clinical workshops, and networking opportunities.

The keynote speaker was Dr. Romesh Wijesooriya, Assistant Professor and Chief of General Pediatrics at the Children’s Hospital of Richmond and one of Style Weekly’s Top 40 under 40 in 2016. Hands-on workshops covered a variety of clinical skills, including lumbar punctures, suturing, pediatric counseling, birthing simulations, and more. The conference also provided a great opportunity to network with pediatric clinicians, residents, and peers from other health professional schools. Follow this link below to see the event flyer: VCU School of Medicine Pediatric Interest Group Presents 9th Annual Pediatric Conference October 14th, 2017 at MMEC

Photos taken at the event are below:

VCU School of Medicine Pediatric Interest Group Presents 9th Annual Pediatric Conference October 14th, 2017 at MMECVCU School of Medicine Pediatric Interest Group Presents 9th Annual Pediatric Conference October 14th, 2017 at MMECVCU School of Medicine Pediatric Interest Group Presents 9th Annual Pediatric Conference October 14th, 2017 at MMEC

VCU School of Medicine Pediatric Interest Group Presents 9th Annual Pediatric Conference October 14th, 2017 at MMECVCU School of Medicine Pediatric Interest Group Presents 9th Annual Pediatric Conference October 14th, 2017 at MMECVCU School of Medicine Pediatric Interest Group Presents 9th Annual Pediatric Conference October 14th, 2017 at MMEC

 

 
 

An article about Dr. Pedram and Dr. Joyce both of whom teach ultrasound to our M1 and M2 medical students at the Center for Human Simulation and Patient Safety. The students are taught about ultrasound not only on task trainers that mimic the human body, but on actual human models through our Standardized Patient Program!

Read more: http://news.vcu.edu/article/VCU_physicians_for_ultrasounds_at_every_bedside

 
 

Throughout the year, the Center for Human Simulation and Patient Safety hosts fourth-year medical students along with nursing students for a 6-hour simulation on critical care skills called ICCS (Integrated Critical Care Selective). Critical are the scenarios that occur in an interprofessional context where patient indicators change dynamically and shared decision making must occur quickly. The ICCS course includes four modules in critical care medicine that operate in a capstone interprofessional simulation where students practice teamwork and critical care skills.
 
Follow the link to an article about ICCS by Dr. Alan Dow and Dr. George Thibault in the New England Journal of Medicine.
 
http://www.nejm.org/doi/full/10.1056/NEJMp1705665
 

 
 

Harinder Dhindsa, M.D., associate professor and chief of emergency medicine in VCU’s School of Medicine, medical director for the university’s Critical Care Transport team, was the recipient of the Outstanding Term Faculty award.
 
Dr. Dhindsa leads the clinical operations of the Emergency Department and has worked tirelessly with all his colleagues to improve efficiencies that raise the level of care patients receive. HD has an exceptional record of teaching and service. He is equally passionate about ensuring that not only future physicians are trained well, but other hospital personnel, including EMTs and paramedics, are also trained well to create an environment of first-class support for patients at all levels of interaction with health care staff.
 
You can read more about Dr. Dhindsa's accomplishments at:
 
http://wp.vcu.edu/somprofiles/2017/08/24/harinder-s-dhindsa-m-d/

 
 
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