Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
4Activity
0 of .
Results for:
No results containing your search query
P. 1
Annals of Delirium October 2012

Annals of Delirium October 2012

Ratings: (0)|Views: 859 |Likes:
Published by tony_jameson-allen
The newsletter of the www.europeandeliriumassociation.com
The newsletter of the www.europeandeliriumassociation.com

More info:

Published by: tony_jameson-allen on Oct 16, 2012
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

10/17/2012

pdf

text

original

 
©
EuropeanDeliriumAssociation2012www.europeandeliriumassociation.com
 AnnalsofDeliriumOctober2012
Editorial
LastmonthIwasonintensivecareandcametoanelderlypatientwhowasrecoveringfromsepsis..IassessedhermentalstatusbyaskinghertotellmethemonthsoftheyearbackwardsfromDecember.ShemanagedtotellmethatNovembercamebeforeDecemberbutnomore.Inthematterofafewminutes,inbetweentellingmehowshewas,shewassmilingandrepeated5timesthatshewastherebusytryingtodie.Thenursewhohadrecentlytakenoverhercaretoldmeshedidnotbelievethispatientwasdeliriousbutthatitwasherpersonality.Thepatient’sdeliriumwasquitecleartome.Whyisitthatwewillalwaysgivenormalmentalstatusthebenefitofdoubt?Deliriumissoplausible,apowerfulcloakofdeceptioncreatedbyamalfunctioningbrainsoeffectiveitmaystayhiddenevenwhenwearelookingdirectlyatit.Eventhoseofuswhohaveabetterunderstandingofdeliriumwillstruggletodifferentiateitfromdepression,agitationoreveneccentricity.Inthecriticalcarearenaourvalidatedscreeningtoolsmaybecriticizedfornotbeingsensitiveenoughwhileatthesametimethereareseniorintensivistswhodismissthesymptomsofdeliriumastheinevitableeffectsofsedation.Afterallsedationcausesinattentionanddecreasedlevelofconsciousnesswhichiswhatwebaseourdiagnosison.Itisalmostasifwehaveavestedinterestinbelievingapatientisnotdeliriousevenwhenthereisevidencetothecontrary.Thediagnosisofdeliriumisfundamentalandwestilllackanidealdiagnostictoolbutitappearstomethatwealsoneedtoaskourselvesisitthatclinicianscan’tseedeliriumorthattheywon’tseeit?Andwhatcanwedoaboutthat?!Onthatthemethiseditioncontainsanarticletouchingonphilosophyandthedeliriouspatientaswellasacontributionregardingtheadultlearning.Thiseditionistimedtocoincidewiththe7
th
ScientificCongressoftheEuropeanDeliriumAssociationbeingheldthisyearinBielefeld,Germany.Wehopeyouallhaveanenjoyable,stimulatingandproductivetime.PleaseshareyourviewsandopinionsinthenextAnnalsofDelirium.ValeriePageCo-Editor
 
©
EuropeanDeliriumAssociation2012www.europeandeliriumassociation.com
“SimulationinDeliriumEducation”
MichaelAlcornisaClinicalTeachingFellowandtraineeinGeriatricMedicineinNHSLanarkshire,justoutsideGlasgow,Scotland.
Adultlearningtheoryaimsthatthelearnerbecomeautonomousandself-directed-theidealroleofateacherthenisthatofafacilitatorofthestudent’sownlearning.Theprocessoflearningitselfrequiresparticipationandemotionalengagement.Constructivistandcognitivistschoolsofthinkingsupporttheviewofateacherasonewhosupports,encouragesanddirectsthestudent’sautonomouslearning
i
ii
.Mistakes,whenrecognisedandanalysedcanbeveryinformativetoolsforlearning–butashealthcareprofessionals,howcanweminimisetherisktorealpeoplewhenwearetalkingabouttheirwellbeing?Feedbackononeindividual’sperformancefrommoreexperiencedindividuals,whohaveseenitanddoneitbefore,isoftenhugelyinstructive.Simulation–“animitationofsomerealthing,stateofaffairsorprocess”
iii
–isafrequentlyemployedtoolacrossmanyareasofmedicaleducation.Itwasimportedfromhigh-riskfieldssuchtheaviationindustry,fire-fightingandnuclearpower.
iv
Inmedicalsimulation,theuseofrole-playandunfoldingscenarios,patientactorsandhigh-fidelitymannequinshelprecreatetheenvironmentofarealpatientencounterandpromotethepracticeofdifficultskillsinacontrolledenvironment.Opportunitiesforenhancingofperformanceormistakescanbeexploredinadebriefingsessionwiththechancetorepeattheexerciseandimprove.Evidenceisaccumulatingthattheclinicalknowledge,skillsandattitudes
v
vi
ofstudents/traineesarebenefitedbyexposuretosimulation-basedteaching.Whileevidenceforimprovementindirectmeasuresofpatientsafetyandoutcomesislacking,DrDavidGaba-oneofthepioneersofmedicalsimulationteaching–pointedout20yearsago,“noindustryinwhichhumanlivesdependonskilledperformancehaswaitedforunequivocalproofofthebenefitsofsimulationbeforeembracingit”
2
.Basicallysomethingssimplydonotneedproving.Whenseeninthelightofthe“coal-face”environment,whereoutcomesandpatientsafetyaredependentonpractisedskillsandintelligentsynthesisofdiverseinformation,itisclearwhymedicaleducatorstheworldoverhavemovedtousingsimulation-basedteachingtools.Mostoftheevidenceandexperienceovertheyearshasbeengatheredinthearenasofmedicalandnursingpracticewhereprotocols,checklistsandalgorithmsdominate–anaesthetics,surgery,obstetriccareandemergencyresuscitationandtheseareallwellrepresentedintheliterature.Iaminterestedinaskingifaconditionascomplexashyperactiveandhypoactivedeliriumbesimulatedtotrainhealthcareprofessionalstorecognisethecondition,thecausesandmanagetheindividualpatientoreventheirrelatives?Allsortsofaspectsofsuchinteractionscanbeexploredbysimulation,whether
 
©
EuropeanDeliriumAssociation2012www.europeandeliriumassociation.com
thediagnosticskillsofthestudent,thehands-onmedicalcareoffered,communicationwithrelatives,carersandcolleaguesoralmostanyotherfacetofourcomplicatedhumaninteractions,otherwiseknownasanormaldayonthewards!Ibelievethatsimulationisaversatiletoolthatneednotbelimitedtotheapplicationofadidacticsetofinstructionsintheeventofaclinicalemergency.Theuseofsimulationasateachingtoolhasobviousbenefitsofferingtheopportunityofpracticedexperienceinacontrolledfashion;spaceismadetoprovideimmediate,directedfeedbacktoenhancethelearningexperiencewhichcanthenbereflectedon.RecentpublishedmateriallookingattheteachingofGeriatricMedicineinUKmedicalschoolsgeriatricmedicinetopicsareoftenintegratedwithotherareasofmedicine
vii
viii
,whereasevidencesuggeststhatadiscrete,focussedplaceinthecurriculumleadstoanimprovementinattitudesandknowledge.,Actualteachingmethodsemployedacrossthecountryvaryalongwiththecurriculumtheyaredesignedtoteach,butitcanbeseenthatascurriculaadapttothetimes(theGMC’stemplate“Tomorrow’sDoctors”wasmostrecentlyupdatedin2011)andthepopulationbecomesolderandmorecomplex.,thereisanimperativetofindreliable,effectivemethodsforteachingundergraduatestheprinciplesofreallycaringforelderlypatients.ThereisalackofpublishedworkthatspecificallylooksatusingsimulationteachinginGeriatricmedicine–however,thedatapublishedsupportstheroleofsimulationinimprovingbothattitudesandknowledge
.
OurgroupinLanarkshirearecurrentlyintheprocessofdesigningandimplementinganovelsimulation-basedtrainingdayforfinalyearmedicalundergraduates,aimedatexposingthemtochallengingscenariosofcaringforelderly,complexpatientsthattheyarelikelytoencounteronthewards.Scenariossimulatingencounterswithdeliriouspatientswillbeapriority,usinghigh-fidelitymannequinsandunfoldingscenarios,pre-recordedvideoencounterswithactorsplayingthepatientrole,video-assisteddebriefingandworkshops.Iwouldwarmlywelcomeanyenquiriesandconstructivecontributionsfromthisjournal’sreadershipasourgroupseektorefineoureducationalintervention,withtheaimofimprovingthecareourjuniordoctorsareequippedtogivetosomeofourmostvulnerableinpatients.
References
1
SinghI,HubbardR;TeachingandLearningGeriatricMedicine.
ReviewsinClinicalGerontology 
(2011)21;180–92
2
FanningRM,GabaDM;TheRoleofDebriefinginSimulation-basedLearning.
SimulationinHealthcare
(2007)2(2):115-25
3
RosenK;TheHistoryofMedicalSimulation.
 JournalofCriticalCare
(2008)23(2):157-66
4
GabaDM;ImprovingAnesthesiologist’sPerformancebySimulatingReality.
 Anesthesiology 
(1992)76(4):491-94

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->