Over the past seven years, the American College of Chest Physicians (ACCP) has invested significant time and resources in developing a wide range of simulation-based educational activities for its members to complement and advance their daily practice of pulmonary, critical care and sleep medicine, according to Alexander S. Niven, MD, chair of the ACCP's Simulation Work Group. An important part of the ACCP's simulation education program focuses on a team-based approach to care in the ICU.

The value of this approach to care is self-evident, Niven stressed. "Critically ill patients are complex, high acuity, and possess little functional reserve," he said. "The delivery of high quality critical care is dependent on the effective use of rapidly evolving technology and treatments and thoughtfully designed clinical pathways, utilized and continuously monitored by highly skilled nurses, respiratory therapists, pharmacists, and physicians." The literature would argue that managing this complex environment effectively improves ICU outcomes-which saves lives, he added.

Simulation attendees frequently begin their experience focused on the technology-the tools and the simulators-that programs offer, Niven noted. They leave more proficient with the use of these tools but also increase their abilities to leverage the talents of the team at the bedside to maximize their procedural success. "As faculty, the most gratifying experiences we have are interacting one-on-one with our learners, sharing our professional experiences with them and learning from theirs, and watching them grow and work together as a team," he said. "It is amazing to watch the difference that a few essential crew resource management principles make to improve communication and teamwork and the dramatic difference that it makes in our medial teams' ability to successfully manage medical problems of increasing complexity in the simulated clinical environment."

Safety and Proficiency
Niven believes the simulation-based-education experience is invaluable to everyday practice, while offering something unique and special. Having the opportunity to learn and practice procedure-based skills in a simulated clinical environment offers a tremendous advantage for patient safety and, some data would argue, reduces the time that it takes a physician to learn and become proficient in a new skill, he explained. Simulation-based medical education also provides the opportunity to offer learners "on demand" training in the diagnosis and management of common and rare clinical conditions and situations and provides them with the opportunity to reflect and learn from their experiences so that they may more effectively apply these lessons in the future.

"Being a leader in clinical education is in the ACCP's mission statement, and active learning strategies increasingly have been reported in the medical literature to be superior methods of advancing both procedure-based skills and the practical application of medical knowledge," Niven noted.  The ACCP has trained hundreds of pulmonary/critical care and critical care physicians, hospitalists, nurse practitioners, physician assistants and respiratory therapists with an ambitious range of hands-on simulation offerings.

Popular simulation offerings at CHEST include self-study opportunities and small group discussions, some of which include simulation, as well as half-day simulation offerings in airway management, bronchoscopy, mechanical ventilation and ultrasound that provide attendees with a focused learning experience in subject areas of consistently high demand. The ACCP also offers a series of simulation courses both at its headquarters in Northbrook, Ill., and throughout the United States that last between 1 and 2.5 days. These courses focus on skills acquisition and hands-on experience using task trainers and high fidelity human simulators, keeping lectures to a minimum and providing attendees with opportunities to develop and practice new clinical skills in a high fidelity simulated clinical environment.

Upcoming topics include "Essentials of Airway Management," "Essentials of Bronchoscopy," "Endobronchial Ultrasound," "Mechanical Ventilation: Advanced Critical Care Management," and "Ultrasonography: Essentials in Critical Care."

The organization currently is seeking to expand these activities, including a train-the-trainer program both within the United States and abroad, a certificate of completion program to provide more longitudinal, coordinated training in specific areas for its membership, and standardized modules to help facilitate simulation training within the discipline at centers outside of the ACCP. In preparation for the Accreditation Council for Graduate Medical Education's (ACGME) next accreditation system, ACCP is developing procedure training and evaluation tools to help pulmonary/critical care fellowship programs meet ACGME requirements. "We also hope to broaden our educational opportunities to a wider target audience, recognizing the essential role of the interdisciplinary team in the delivery of cost effective and safe patient care," Niven told ADVANCE.

Kerri Hatt is on staff at ADVANCE. Contact: khatt@advanceweb.com