- Email: [email protected]
American College of Surgeons Comprehensive Education Institute: Hartford Hospital
EDUCATION INSTITUTES
American College of Surgeons Comprehensive Education Institute: Hartford Hospital Lenworth M. Jacobs, MD, and Karyl J. Burns, PhD Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine and Hartford Hospital, Hartford, Connecticut OVERVIEW OF THE INSTITUTE Hartford Hospital, the flagship of Hartford Healthcare Corporation, is a nonprofit 867-bed hospital.1 It is the oldest largest hospital in Hartford, Connecticut. As a Level I Trauma Center, Hartford Hospital is a major regional resource. Providing all clinical specialties, it cares for approximately 39,000 admitted patients and 176,000 ambulatory patients each year.1 Hartford Hospital has always maintained a strong commitment to research and education. Through its affiliation with the University of Connecticut Health Center, Hartford Hospital is a major teaching facility.1 History of Education at Hartford Hospital Beginning in the 1800s education has been an integral and valued component of the mission of Hartford Hospital.2 Early educational programs in nursing, medicine, and auxiliary training distinguished Hartford Hospital from other area hospitals as not only a provider of excellent clinical care but also of as a champion of first-rate education. In 1942, a director of medical education was appointed at Hartford Hospital. This position was the first of its kind in a nonuniversity teaching hospital in the United States.2 After World War II the residency programs started in the 1930s at Hartford Hospital were expanded as the GI Bill offered additional opportunities for medical education.2 Over the years, education continued at Hartford Hospital with exemplary programs and state-of-the art facilities. Building upon this strong commitment, the Simulation Center at Hartford Hospital was opened on July 29, 2004.3 Its mission is to promote “excellence in clinical care, advance patient safety and improve multidisciplinary team performance though highfidelity medical simulation.”3
In 2006, the Simulation Center at Hartford Hospital was designated as a Center of Excellence by the Laerdal Corporation. This designation was renewed in 2009. The Simulation Center at Hartford Hospital is one of 15 Laerdal Centers of Excellence in the world. In 2007, Hartford Hospital became accredited as a Comprehensive Education Institute by the American College of Surgeons (ACS). It is the only ACS-designated Comprehensive Education Institute in Connecticut.
LEARNERS TARGETED Hartford Hospital offers a broad range of education programs for medical students and practicing physicians. There is an extensive Department of Education that maintains affiliation agreements with 23 organizations.4 Sixteen residency and fellowship programs are offered through Hartford Hospital. An additional 23 are offered at Hartford Hospital through the University of Connecticut. For the education of practicing physicians, the Division of the Continuing Medical Education is responsible for assuring that all of Hartford Hospital’s sponsored programs comply with the Connecticut State Medical Society’s Essentials for Continuing Medical Education (CME) accreditation.5 The Department of Nursing Education at Hartford Hospital offers education and continuing education for members of the nursing profession.6 Several area schools of nursing use Hartford Hospital as a clinical teaching site. The Department of Nursing Education is an approved provider of nursing continuing education by the Connecticut Nurses Association. In addition, Hartford Hospital maintains a School of Allied Health as well as an extensive program of Emergency Medical Services (EMS) education.7,8 The EMS Education Department is 1 of the largest American Heart Association Community Training Center in the state and is also a Community Training Center for the National Safety Council.8 Resources and Facilities
Correspondence: Inquiries to Lenworth M. Jacobs, MD, Hartford Hospital, Trauma Program, 80 Seymour Street, Hartford, CT 06102; fax: (860) 545-5132; e-mail: [email protected]
The resources of the Simulation Center, located on the fifth floor of the South Building at Hartford Hospital, include 3
Journal of Surgical Education • © 2010 Association of Program Directors in Surgery Published by Elsevier Inc. All rights reserved.
1931-7204/$30.00 doi:10.1016/j.jsurg.2010.05.022
341
high-fidelity simulators each housed in its own room to replicate the trauma/resuscitation emergency medicine bay, the intensive care unit, and the operating room. Each room is configured and fully equipped as the actual rooms that they simulate. In addition, there are 3 control stations where the operator and instructor present the scenarios from behind a 1-way glass. The control rooms are equipped with digital video disc (DVD) recorders, computers to operate the manikins, and controls to maneuver the cameras so that every angle of the session can be captured and recorded. The classroom is equipped with a digital video disc and video home system (VHS) player, and a projection screen on which an ongoing simulation or PowerPoint presentation can be projected.9 New training devices that have recently been acquired include the Blue Phantom™ ultrasound Training Model, Laerdal’s NewSimB which is a neonatal simulator, and a training model of the daVinci® Surgical System. The ultrasound Training Model will be used in a new course to teach ultrasoundguided central line placement to surgeons, critical care physicians, and emergency medicine physicians. NewSimB will be used in a collaborative agreement between Connecticut Children’s Medical Center and the Simulation Center at Hartford Hospital. The training model of the daVinci® Surgical System will allow surgeons to gain experience in the simulated environment under the direct guidance of an experienced surgeon. The model allows both an operator and a student to sit at the controls. Hartford Hospital is the first hospital in the country to have this training model of the daVinci® Surgical system. In addition to the Simulation Center several other learning environments are available on the Hartford Hospital campus. These include the Pyrtek Learning Resource Center, the Animal Facility, the Health Science Library, the Education and Resource Center and several lecture/meeting rooms in the Bliss Wing, the Jefferson Building, and the Conklin Building that also includes Gilman Auditorium. All of these facilities combine to offer all educational modalities that include, besides high-fidelity simulation, various low-fidelity simulation, teleconferencing, computers with internet access, webcasts, study areas, and state-of-the art lecture halls. Table 1 lists examples of education programs offered Hartford Hospital.
SPECIAL FEATURES A special feature of Hartford Hospital as an Education Institute is its designation by the State of Connecticut Department of Public Health as a Center of Excellence for Emergency Medical Preparedness. Staff at the Center is responsible for assessment, planning, and training in the 15 acute care hospitals and the 76 communities that make up the northern tier of Connecticut. A Hartford Hospital surgeon is a member of the State of Connecticut Department of Public Health Mobile Field Hospital Project and is the Lead Medical Team Manager for the State of Connecticut Department of Emergency Management and Homeland Security, Urban Search, and Resource Task Force. One of our emergency medicine physicians has been active with 342
TABLE 1. Examples of Simulation Education Offered at Hartford Hospital3 Basic and Advanced Airway Management ED/Trauma Airway Management Review of Advanced Cardiac Life Support Algorithms Operating Room Crisis Management ICU Crisis Management Anesthesia Crisis Management Trauma Crisis Management The Advanced Trauma Operative Management Course Advanced Trauma Life Support® Advanced Laparoscopic Training Emergency Procedures for Flight Personnel Mega Code Training Emergency Preparedness Training Obstetrical Emergencies Orientation to Critical Care Nursing Orientation to Cardiology Nursing Fire Safety ED, ; ICU, intensive care unit.
the United States Department of Homeland Security since 2001 and is currently the Senior Medical Advisor for the Office of Health Affairs for that department. Toxicologists, emergency physicians and nurses, trauma surgeons, and anesthesiologists at Hartford Hospital routinely use the Simulation Center to train for biohazardous events and the use of Level C protective gear. Supplementary Fig. 1 shows a simulation exercise for emergency preparedness. Besides the training that Hartford Hospital does for emergency preparedness, another special feature of our Education Institute is that it is a site for the training of the United States Navy. Medical corpsmen from the submarine base in Groton, Connecticut train for crisis management in our Simulation Center. The faculty for this course represents a collaborative effort across specialties and includes emergency physicians, a trauma surgeon, an anesthesiologist, and our simulation coordinator.
STRENGTHS The strength of our educational programs is the solid foundation upon which they are based. This includes the high quality of the faculty and the use of sound educational theory and teaching methods. Two exemplars are the Advanced Trauma Operative Management (ATOM) course10-12 and the Simulation Education Course for the Initial Management of Blunt Trauma.13 Both courses were developed at Hartford Hospital. ATOM was designed to teach surgeons the management of penetrating trauma using a porcine model. It is grounded in social cognitive theory and its standardized content, teaching and evaluation methods, and validity have been documented.10 Students’ cognitive, affective, and psychomotor skills are assessed in the ATOM course. Surgeons must meet certain standards to become a certified ATOM instructor.12 The ATOM Course has been adopted as an
Journal of Surgical Education • Volume 67/Number 5 • September/October 2010
official ACS educational offering. Supplementary Fig. 2 shows the simulated ATOM operating room and patient. The Simulation Education Course for the Initial Management of Blunt Trauma uses a mannequin as the simulated patient. It is also grounded in social cognitive theory and has specific course objectives, standardized scenarios, consistent teaching strategies, and pre- and postevaluation.13 Future Plans for the Education Institute The ultimate goal is that the Education Institute at Hartford Hospital will become fully integrated into serving the education needs of the region. Hartford Hospital will continue to partner with the University of Connecticut School of Medicine as well as with other educational venues that serve the citizens of the state and the region. We will offer community hospitals a comprehensive curriculum for patient safety.
KEY PERSONNEL AND CONTACT INFORMATION For more information about the Simulation Center at Hartford Hospital, please visit our web site at http://www.harthosp.org/ SimCenter/default.aspx.
REFERENCES 1. Hartford Hospital. About our residency programs, graduate
medical education. Available at: http://www.Harthosp.org/ ResidenciesFellowships/About. 2. Clouette B, Lever B. The Healing Triangle: Hartford
Hospital’s First 150 Years. Hartford, CT: Hartford Hospital; 2004. 3. Hartford Hospital. SimCenter-Training Programs. Avail-
able at: http://www.harthosp.org/SimCenter/Training.
4. Hartford Hospital, Dept of Education. Administration.
Available at: http://www.harthosp.org/Education/ DeptOfEducation/Administration. 5. Hartford Hospital, Dept of Education. Continuing Med-
ical Education. Available at: http://www.harthosp.org/ Education/DeptOfEducation/CME. 6. Hartford Hospital. Nursing Education. Available at:
http://www.harthosp.org/nursing/Education. 7. Hartford Hospital. School of Allied Health. Available at:
http://www.harthosp.org/AlliedHealth. 8. Hartford Hospital. EMS Education - Courses. Available
at: http://www.harthosp.org/EMSEducation/Courses. 9. Hartford Hospital. SimCenter - Facilities. Available at:
http://www.harthosp.org/SimCenter/Facilities. 10. Jacobs LM, Burns KJ, Kaban JM, et al. Development and
evaluation of the advanced trauma operative management course. J Trauma. 2003;55:471-479. 11. Jacobs LM, Burns KJ, Luk S, Gross RI. Implementation
of the Advanced Trauma Operative Management Course. PanAm J Trauma. 2004;11:21-27. 12. Jacobs LM, Luk SS, Burns KJ. Advanced Trauma Oper-
ative Management Course. Site and instructor selection and evaluation. J Am Coll Surg. 2006;203:772-779. 13. Brautigam RT, Schott E, Burns KJ. A simulation educa-
tion course for the initial management of blunt trauma. Conn Med. 2009;73:267-271.
Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.jsurg.2010.05.022.
Journal of Surgical Education • Volume 67/Number 5 • September/October 2010
343
American College of Surgeons Comprehensive Education Institute: Hartford Hospital Lenworth M. Jacobs, MD, and Karyl J. Burns, PhD Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine and Hartford Hospital, Hartford, Connecticut OVERVIEW OF THE INSTITUTE Hartford Hospital, the flagship of Hartford Healthcare Corporation, is a nonprofit 867-bed hospital.1 It is the oldest largest hospital in Hartford, Connecticut. As a Level I Trauma Center, Hartford Hospital is a major regional resource. Providing all clinical specialties, it cares for approximately 39,000 admitted patients and 176,000 ambulatory patients each year.1 Hartford Hospital has always maintained a strong commitment to research and education. Through its affiliation with the University of Connecticut Health Center, Hartford Hospital is a major teaching facility.1 History of Education at Hartford Hospital Beginning in the 1800s education has been an integral and valued component of the mission of Hartford Hospital.2 Early educational programs in nursing, medicine, and auxiliary training distinguished Hartford Hospital from other area hospitals as not only a provider of excellent clinical care but also of as a champion of first-rate education. In 1942, a director of medical education was appointed at Hartford Hospital. This position was the first of its kind in a nonuniversity teaching hospital in the United States.2 After World War II the residency programs started in the 1930s at Hartford Hospital were expanded as the GI Bill offered additional opportunities for medical education.2 Over the years, education continued at Hartford Hospital with exemplary programs and state-of-the art facilities. Building upon this strong commitment, the Simulation Center at Hartford Hospital was opened on July 29, 2004.3 Its mission is to promote “excellence in clinical care, advance patient safety and improve multidisciplinary team performance though highfidelity medical simulation.”3
In 2006, the Simulation Center at Hartford Hospital was designated as a Center of Excellence by the Laerdal Corporation. This designation was renewed in 2009. The Simulation Center at Hartford Hospital is one of 15 Laerdal Centers of Excellence in the world. In 2007, Hartford Hospital became accredited as a Comprehensive Education Institute by the American College of Surgeons (ACS). It is the only ACS-designated Comprehensive Education Institute in Connecticut.
LEARNERS TARGETED Hartford Hospital offers a broad range of education programs for medical students and practicing physicians. There is an extensive Department of Education that maintains affiliation agreements with 23 organizations.4 Sixteen residency and fellowship programs are offered through Hartford Hospital. An additional 23 are offered at Hartford Hospital through the University of Connecticut. For the education of practicing physicians, the Division of the Continuing Medical Education is responsible for assuring that all of Hartford Hospital’s sponsored programs comply with the Connecticut State Medical Society’s Essentials for Continuing Medical Education (CME) accreditation.5 The Department of Nursing Education at Hartford Hospital offers education and continuing education for members of the nursing profession.6 Several area schools of nursing use Hartford Hospital as a clinical teaching site. The Department of Nursing Education is an approved provider of nursing continuing education by the Connecticut Nurses Association. In addition, Hartford Hospital maintains a School of Allied Health as well as an extensive program of Emergency Medical Services (EMS) education.7,8 The EMS Education Department is 1 of the largest American Heart Association Community Training Center in the state and is also a Community Training Center for the National Safety Council.8 Resources and Facilities
Correspondence: Inquiries to Lenworth M. Jacobs, MD, Hartford Hospital, Trauma Program, 80 Seymour Street, Hartford, CT 06102; fax: (860) 545-5132; e-mail: [email protected]
The resources of the Simulation Center, located on the fifth floor of the South Building at Hartford Hospital, include 3
Journal of Surgical Education • © 2010 Association of Program Directors in Surgery Published by Elsevier Inc. All rights reserved.
1931-7204/$30.00 doi:10.1016/j.jsurg.2010.05.022
341
high-fidelity simulators each housed in its own room to replicate the trauma/resuscitation emergency medicine bay, the intensive care unit, and the operating room. Each room is configured and fully equipped as the actual rooms that they simulate. In addition, there are 3 control stations where the operator and instructor present the scenarios from behind a 1-way glass. The control rooms are equipped with digital video disc (DVD) recorders, computers to operate the manikins, and controls to maneuver the cameras so that every angle of the session can be captured and recorded. The classroom is equipped with a digital video disc and video home system (VHS) player, and a projection screen on which an ongoing simulation or PowerPoint presentation can be projected.9 New training devices that have recently been acquired include the Blue Phantom™ ultrasound Training Model, Laerdal’s NewSimB which is a neonatal simulator, and a training model of the daVinci® Surgical System. The ultrasound Training Model will be used in a new course to teach ultrasoundguided central line placement to surgeons, critical care physicians, and emergency medicine physicians. NewSimB will be used in a collaborative agreement between Connecticut Children’s Medical Center and the Simulation Center at Hartford Hospital. The training model of the daVinci® Surgical System will allow surgeons to gain experience in the simulated environment under the direct guidance of an experienced surgeon. The model allows both an operator and a student to sit at the controls. Hartford Hospital is the first hospital in the country to have this training model of the daVinci® Surgical system. In addition to the Simulation Center several other learning environments are available on the Hartford Hospital campus. These include the Pyrtek Learning Resource Center, the Animal Facility, the Health Science Library, the Education and Resource Center and several lecture/meeting rooms in the Bliss Wing, the Jefferson Building, and the Conklin Building that also includes Gilman Auditorium. All of these facilities combine to offer all educational modalities that include, besides high-fidelity simulation, various low-fidelity simulation, teleconferencing, computers with internet access, webcasts, study areas, and state-of-the art lecture halls. Table 1 lists examples of education programs offered Hartford Hospital.
SPECIAL FEATURES A special feature of Hartford Hospital as an Education Institute is its designation by the State of Connecticut Department of Public Health as a Center of Excellence for Emergency Medical Preparedness. Staff at the Center is responsible for assessment, planning, and training in the 15 acute care hospitals and the 76 communities that make up the northern tier of Connecticut. A Hartford Hospital surgeon is a member of the State of Connecticut Department of Public Health Mobile Field Hospital Project and is the Lead Medical Team Manager for the State of Connecticut Department of Emergency Management and Homeland Security, Urban Search, and Resource Task Force. One of our emergency medicine physicians has been active with 342
TABLE 1. Examples of Simulation Education Offered at Hartford Hospital3 Basic and Advanced Airway Management ED/Trauma Airway Management Review of Advanced Cardiac Life Support Algorithms Operating Room Crisis Management ICU Crisis Management Anesthesia Crisis Management Trauma Crisis Management The Advanced Trauma Operative Management Course Advanced Trauma Life Support® Advanced Laparoscopic Training Emergency Procedures for Flight Personnel Mega Code Training Emergency Preparedness Training Obstetrical Emergencies Orientation to Critical Care Nursing Orientation to Cardiology Nursing Fire Safety ED, ; ICU, intensive care unit.
the United States Department of Homeland Security since 2001 and is currently the Senior Medical Advisor for the Office of Health Affairs for that department. Toxicologists, emergency physicians and nurses, trauma surgeons, and anesthesiologists at Hartford Hospital routinely use the Simulation Center to train for biohazardous events and the use of Level C protective gear. Supplementary Fig. 1 shows a simulation exercise for emergency preparedness. Besides the training that Hartford Hospital does for emergency preparedness, another special feature of our Education Institute is that it is a site for the training of the United States Navy. Medical corpsmen from the submarine base in Groton, Connecticut train for crisis management in our Simulation Center. The faculty for this course represents a collaborative effort across specialties and includes emergency physicians, a trauma surgeon, an anesthesiologist, and our simulation coordinator.
STRENGTHS The strength of our educational programs is the solid foundation upon which they are based. This includes the high quality of the faculty and the use of sound educational theory and teaching methods. Two exemplars are the Advanced Trauma Operative Management (ATOM) course10-12 and the Simulation Education Course for the Initial Management of Blunt Trauma.13 Both courses were developed at Hartford Hospital. ATOM was designed to teach surgeons the management of penetrating trauma using a porcine model. It is grounded in social cognitive theory and its standardized content, teaching and evaluation methods, and validity have been documented.10 Students’ cognitive, affective, and psychomotor skills are assessed in the ATOM course. Surgeons must meet certain standards to become a certified ATOM instructor.12 The ATOM Course has been adopted as an
Journal of Surgical Education • Volume 67/Number 5 • September/October 2010
official ACS educational offering. Supplementary Fig. 2 shows the simulated ATOM operating room and patient. The Simulation Education Course for the Initial Management of Blunt Trauma uses a mannequin as the simulated patient. It is also grounded in social cognitive theory and has specific course objectives, standardized scenarios, consistent teaching strategies, and pre- and postevaluation.13 Future Plans for the Education Institute The ultimate goal is that the Education Institute at Hartford Hospital will become fully integrated into serving the education needs of the region. Hartford Hospital will continue to partner with the University of Connecticut School of Medicine as well as with other educational venues that serve the citizens of the state and the region. We will offer community hospitals a comprehensive curriculum for patient safety.
KEY PERSONNEL AND CONTACT INFORMATION For more information about the Simulation Center at Hartford Hospital, please visit our web site at http://www.harthosp.org/ SimCenter/default.aspx.
REFERENCES 1. Hartford Hospital. About our residency programs, graduate
medical education. Available at: http://www.Harthosp.org/ ResidenciesFellowships/About. 2. Clouette B, Lever B. The Healing Triangle: Hartford
Hospital’s First 150 Years. Hartford, CT: Hartford Hospital; 2004. 3. Hartford Hospital. SimCenter-Training Programs. Avail-
able at: http://www.harthosp.org/SimCenter/Training.
4. Hartford Hospital, Dept of Education. Administration.
Available at: http://www.harthosp.org/Education/ DeptOfEducation/Administration. 5. Hartford Hospital, Dept of Education. Continuing Med-
ical Education. Available at: http://www.harthosp.org/ Education/DeptOfEducation/CME. 6. Hartford Hospital. Nursing Education. Available at:
http://www.harthosp.org/nursing/Education. 7. Hartford Hospital. School of Allied Health. Available at:
http://www.harthosp.org/AlliedHealth. 8. Hartford Hospital. EMS Education - Courses. Available
at: http://www.harthosp.org/EMSEducation/Courses. 9. Hartford Hospital. SimCenter - Facilities. Available at:
http://www.harthosp.org/SimCenter/Facilities. 10. Jacobs LM, Burns KJ, Kaban JM, et al. Development and
evaluation of the advanced trauma operative management course. J Trauma. 2003;55:471-479. 11. Jacobs LM, Burns KJ, Luk S, Gross RI. Implementation
of the Advanced Trauma Operative Management Course. PanAm J Trauma. 2004;11:21-27. 12. Jacobs LM, Luk SS, Burns KJ. Advanced Trauma Oper-
ative Management Course. Site and instructor selection and evaluation. J Am Coll Surg. 2006;203:772-779. 13. Brautigam RT, Schott E, Burns KJ. A simulation educa-
tion course for the initial management of blunt trauma. Conn Med. 2009;73:267-271.
Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.jsurg.2010.05.022.
Journal of Surgical Education • Volume 67/Number 5 • September/October 2010
343