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Scenario-based Skill Teaching ® ATLS th 10 Edition

7 skills stations • Airway (x 2) • Breathing • Circulation • Disability • Secondary Survey • Adjuncts • Trauma Team

Skills stations • Airway • Breathing • Circulation • Disability • Secondary Survey • Adjuncts • Trauma Team Appear in the course in a logical order – for all candidates A B/C D…………

Skills stations • Airway • Breathing • Circulation • Disability • Secondary Survey • Adjuncts • Trauma Team Multiple stations need to run in parallel eg. 4 airway stations for 16 candidates

Skills stations • Airway • Breathing • Circulation • Disability • Secondary Survey • Adjuncts • Trauma Team Skills taught or demonstrated in the context of unfolding scenario(s) Stimulus questions

Skills stations • Airway • Breathing • Circulation • Disability • Secondary Survey • Adjuncts • Trauma Team Need to know (cognitive) skills (demo/discuss) Need to do (psychomotor) skills (DO)

1. airway Basic Advanced Paediatric/Surgical Airway assessment Laryngeal mask (or tube) insertion – DO Basic airway (paed v adult) demo/discuss Jaw thrust demo/discuss LEMON demo/discuss Nasal airway, suction, oral Oral endotracheal Surgical cricothyroidotomy airway - DO intubation – demo/discuss - DO Bag Valve Mask (1 and 2 person) - DO Needle cricothyroidotomy Do

2. breathing (1) • Breathing assessment – DO or demo/discuss • Needle decompression – DO • Chest drain (thoracostomy tube) insertion – DO • Elderly chest injury – demo/discuss • Sucking chest wound – demo/discuss • Severe chest injury scenario – demo/discuss

2. breathing (2) • Introduction and skill level ascertainment • scenario 1 (m-cycle) • Assessment to detect life-threatening injuries – DO or interactive discussion • case 1 progression • Needle decompression of tension pneumothorax – DO • case 1 what next? • Insertion of intercostal drain – DO • close scenario

2. breathing (3) • scenario 2 (elderly fall) • Assessment to detect life-threatening injuries – re-cap • case 2 progression • Management of haemo-pneumothorax in elderly – interactive discussion

2. breathing (4) • scenario 3 (propellor) • Assessment to detect life-threatening injuries – re-cap • case 3 progression • Management of open (sucking) pneumothorax - demo/discuss occlusive dressing • case 3 what next? • Insertion of intercostal drain – re-cap • Surgical referral - discuss

2. breathing (5) • scenario 4 (car) • Assessment to detect life-threatening injuries – re-cap • case 4 progression • Management of life-threatening injuries – discussion • Aortic injury • case 4 what next? • Interventions and investigations • Definitive (surgical) care • ? ? ? Summary and closure

3. circulation • Assessment of Shock – demo/discuss • Wound packing – demo/discuss • Application of tourniquet – demo/discuss • Insertion of intra-osseous needle – DO • Application of pelvic binder – demo/discuss • Femoral access – DO or demo/discuss • Non-haemorrhagic shock – demo/discuss

4. disability • Assessment of neurological status – demo/discuss • Evaluation of C spine injury – demo/discuss • Reassessment of changing neurological status – demo/discuss • Referral process – demo/discuss • Detailed neurological exam – demo/discuss • Log roll – demo/discuss (rotate all roles) • Elderly patient assessment of neurological status – demo/discuss • Central cord syndrome assessment – demo/discuss

5. secondary survey • Application of hard collar - DO • Perform secondary survey patient 1 – demo/discuss • Perform secondary survey patient 2 – demo/discuss • Open fracture management – demo/discuss • Perform secondary survey patient 3 – demo/discuss • Perform secondary survey patient 4 – demo/discuss

6. adjuncts • e. FAST probe positioning/scanning – demo/discuss • Chest X ray interpretation – DO • Pelvic X ray interpretation – DO • Spine X ray interpretation - DO

10 th edition Scenario Based Teaching • Scenarios unfold throughout the skills stations • At relevant point in scenario, students identify a skill to be performed • Skill is taught using 4 stage model • Scenario continues • Skills are identified as: • Demonstration only (need to know of) • Performance (need to do)

Miller’s Pyramid Metacognitive knowledge Procedural knowledge Conceptual knowledge Factual knowledge Miller, GE, 1990; 65

Krathwohl’s modified Bloom’s Cognitive Taxonomy Metacognitive Knowledge Real Life Practice Procedural Knowledge Initial Assessment Conceptual Knowledge Factual Knowledge Krathwohl, 2002, p 216 Skills scenarios Manual & m learning

• Skills station 1 video

Principles of teaching a psychomotor skill (ATLS) 1. 2. 3. 4. 5. 6. 7. Conceptualisation – scenario drawing on knowledge from manual Visualisation – seeing the skill Verbalisation – hearing the skill, then describing the skill Practice – performing the skill Reinforcement & correction – whilst performing the skill Skill mastery Skill autonomy

ATLS model of skill acquisition 1. Conceptualisation – facilitator does, all watch 2. Visualisation – facilitator does and describes, (all watch and listen) 3. Verbal – facilitator does and learner A describes 4. Practical – learner A describes and then does (instructor auto corrects)

• Skills station 2 video

• Skills station 3 video

• Skills station 4 video

Why scenarios? • Greater participant engagement - asking and answering questions • Improved integration of knowledge and skill • Improved transfer of knowledge and understanding through application • More opportunity to identify gaps – immediate feedback • Alpha testing showed more engagement from learners • Mimics learning in clinical practice

Facilitators will: • • • Present scenarios to contextualise ATLS principles Ask range of questions to elicit application of knowledge Build on questioning to help students identify interventions Use four stage approach to facilitate skill acquisition Scaffold different levels of learning Immediate situational feedback

Learners will: • Demonstrate understanding of context by responding to scenario questions • Apply knowledge from manual by suggesting interventions • Develop relevant skills by 4 stage approach • Be engaged throughout • Identify knowledge gaps with immediate feedback • Relate scenario to real life practice

Pitfalls or risks • Not using scenario, just teaching skills • Lecturing, using no questions • Discussion, no skills • Lack familiarity with scenario and skill • Side tracking – requiring facilitator focus • Multiple conversations – requiring group dynamics management • Errors made in 4 th stage – requiring immediate facilitator correction • Time!