University of Colorado at Denver
Aurora, CO 

Program Description
We developed a progressive multi-modality curriculum to teach first year pulmonary and critical care fellows the skills to independently manage shock syndromes. We began with pathophysiologic case-based workshops and progressed to high-fidelity simulation. Fellows were subsequently evaluated on their ability to lead case-based teaching workshops for internal medicine house staff. Each modality re-enforced base physiologic concepts and introduced new skills and also served to evaluate the effectiveness of the previous modality in teaching core concepts.

Type of Program
Pulmonary and Critical Care

Number of Fellows in Program
6 per year (18-24 overall)

Submitter(s) of Abstract
Alexander Benson; Mark Kearns; Janet Corral

NEEDS
Appropriate early recognition and management of shock improves patient outcomes. Effective analysis, diagnosis and Management of shock syndromes require that pulmonary and critical care fellows have a strong pathophysiologic understanding of shock. Fellows must be able to communicate their thought processes and rationale clearly and concisely to the house staff treatment team and attending physician, so that shared hypothesis generation and physiologically-based diagnostic and treatment trials can be rapidly implemented.

OBJECTIVES
1. Create a serial multimodality educational curriculum that facilitates the development of complex pathophysiologic reasoning skills, physiologic hypothesis testing and the ability of our fellows to execute and communicate these processes to a team of internal medicine residents.
2. Utilize performance measures obtained during high fidelity simulation and the observed teaching of resident case conferences to evaluate and improve the effectiveness of these fellow educational sessions.

DESCRIPTION AND EVALUATION
Physiologic case-based learning: We developed and delivered five one hour problem-based learning workshops focusing on pathophysiology and management of shock.

High-fidelity simulation: After completion of the shock workshops all six fellows participated in three high-fidelity simulation scenarios that were developed by integrating the key pathophysiologic and management strategies discussed in the workshops. During these simulation scenarios, all diagnostic and treatment technology used in a real ICU setting was available including a multidisciplinary team of professionals.

Teaching physiologic based learning: Each of the simulation scenarios (septic shock, obstructive shock due to massive venous thromboembolism and hemmorhagic shock due to massive varicealbleeding) were simplified and altered to create case based 1 hour teaching workshops for the internal medicine house staff. Each first year fellow will be observed running two of these sessions.

EVALUATION MEASURES
Program Evaluation measures include:
Qualitative written and verbal feedback regarding content, teacher, teaching technique and suggestions for improvement immediately after each workshop given to the fellows.

Qualitative feedback ~6 months after the workshops given to the fellows prompting them to remember the most important take home points from each individual workshop. These will be used to revise objectives and feedback to faculty for next year’s workshops.

Video review of all three scenarios with the fellows 6 months after completion with an open discussion of how to re-format the scenarios to best integrate and evaluate core concepts.

Learner assessment will include:
Checklist of expected diagnostic and management decisions reviewed during a 30 minute debrief at end of each high fidelity simulation scenario.

Checklist assessing whether the fellow covered the expected content, educational and communication objectives along with qualitative feedback will be completed by observing faculty member for each fellow following their teaching conference.

Medicine residents will be surveyed regarding content, teaching effectiveness, format after the second case conference utilizing a qualitative survey.

DISCUSSION
The curriculum described above uses multimodal learning strategies with a goal of transitioning competent learners (fellows) to content experts who are able to integrate knowledge and make appropriate rational decisions in a high-stress environment and communicate this complex information to the novice learner (IM resident) in a clear concise manner. Each step of this curriculum evaluates the effectiveness of the previous learning strategy while introducing, teaching and evaluating important new skill sets required for success as an academic clinical expert. We use this same curriculum to teach respiratory failure and it can likely be used to teach the diagnosis and management of many other complex physiologically based syndromes.