the use of dramatic simulation in patient safety education or doc u drama
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The Use of Dramatic Simulation in Patient Safety Education or “Doc-U-Drama”. Margaret Kirkegaard, MD, MPH. Outline of Workshop. History of Doc-U-Drama Description of Doc-U-Drama Educational Rationale for Doc-U-Drama Evaluation data How to try Doc-U-Drama yourself

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the use of dramatic simulation in patient safety education or doc u drama

The Use of Dramatic Simulation in Patient Safety Educationor “Doc-U-Drama”

Margaret Kirkegaard, MD, MPH

outline of workshop
Outline of Workshop
  • History of Doc-U-Drama
  • Description of Doc-U-Drama
  • Educational Rationale for Doc-U-Drama
  • Evaluation data
  • How to try Doc-U-Drama yourself
  • Doc-U-Drama with participants
history of doc u drama
History of Doc-U-Drama
  • Result of previous failure
  • Built on realization that our medical education system produces highly autonomous, perfectionistic residents who are inherently refractory to talking about medical errors: “no trust”
  • Goal is to open brains to the concept of systems theory and medical errors
description of doc u drama
Description of Doc-U-Drama
  • Scripts dramatizing real adverse events
  • Performed by learners
  • Followed by discussion
    • Usually starts with trying to assign blame then moves to recognition of complexity
educational rationale for doc u drama
Educational Rationale for Doc-U-Drama
  • Focuses on communication
  • Drama-based education techniques
  • Standardized patients
  • Simulation training, clinical (ACLS) and other high-tech industries
safety and communication
Safety and Communication
  • Overfocus on Content in healthcare
    • CPOE
    • Abbreviations
    • Computerized sign-outs
safety and communication1
Safety and Communication
  • Underfocus on Context and Process
    • Hierarchy
    • Interpersonal conflict
    • Role ambiguity
    • Lack of training
    • Fragmented communication
drama based education
Drama-based education
  • Used to teach about complex doctor and patient relationship issues
  • Engages the “players”
  • “Real” but anonymous
  • Evidence that it promotes empathy and attitude change
standardized patients
Standardized patients

AAMC Report, May 1998

  • 97% of all schools report using in some capacity
  • 80% of all schools use to teach doctor-patient communication skills
  • Focuses on individual doctor-pt communication rather than complex communication networks
doc u drama evaluation
Doc-U-Drama Evaluation
  • 69 total evaluations
  • Completed in four different settings
feedback
Feedback
  • “Fun!” 
  • “Great! Now how do we fix it?” 
  • “I worked on the pt safety committee at a major medical center. This was a really good lecture. The examples were very realistic. A couple were similar to incidents we had. Thank you.”
slide12

SA

%

A

%

N

%

D%

SD%

Doc-U-Drama is an effective way to learn about medical errors.

39

56

4

0

0

Doc-U-Drama is an effective way to see medical errors from the viewpoint of all the people involved.

45

51

3

1

0

Doc-U-Drama creates an emotionally comfortable environment in which to explore medical errors.

48

49

3

0

0

Doc-U-Drama is more effective than didactic presentations for learning about patient safety.

49

35

14

1

0

Doc-U-Drama effectively illustrates the complexities of our health care system.

46

45

9

0

0

benefits of doc u drama
Benefits of Doc-U-Drama
  • Emotionally safe
  • Explores complexity and communication patterns
  • Explores multiple perspectives
  • Fun, relaxed
  • Requires no prep time from participants
doc u drama format
Doc-U-Drama Format
  • 60 minutes to 3 hours
  • Classroom or conference room
  • Can use simple props or signs
  • 10-40 participants
  • Medical students, PA students, attendings, residents (JF has worked with interdisciplinary groups)
doc u drama format1
Doc-U-Drama Format
  • Brief introduction: IOM report
  • Discussion about why this is a “hard topic”
  • Bad apples vs swiss cheese demo
  • Doc-U-Drama
  • Discussions shifting from “bad apples” to “swiss cheese”
  • Include remediation techniques
  • One page handout or PDA memo
doc u drama focuses
Doc-U-Drama Focuses
  • Engaging or joining with learner: “This is hard stuff” (Marine technique)
  • Use group facilitation to promote learning
    • Eg: That’s an interesting idea, does anyone else have a different opinion?”
  • Promote “swiss cheese thinking”
conclusion
Conclusion
  • No real outcomes data
  • Fun, high energy
  • Use and adapt scripts
  • Create own scripts (JF found script writing to be an interdisciplinary pt safety learning exercise)
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