Healthcare simulation is an effective methodology to teach clinical thinking, which lies at the heart of effective medical practice, requiring professionals to analyze complex situations and make informed decisions swiftly. One of the most potent tools for honing these skills is through immersive learning experiences such as branching case scenarios. These scenarios, built on mathematical models, facilitate critical thinking and offer a structured approach to understanding and mitigating medical errors. This HealthySimulation.com article written by Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN, will review a published research study: A Mathematical Model Based on Stratifying the Severity of Medical Errors for Building Scenarios for Clinical Cases with Branching.
Global State of Patient Safety and Healthcare Simulation
According to the World Health Organization (WHO), Patient Safety “is the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.” Common healthcare errors include patients receiving the wrong medications, contracting hospital-acquired infections, having the wrong body part removed during surgery, receiving an incorrect diagnosis, or having a missed diagnosis or treatment.
Patient safety is paramount in healthcare, defined by the World Health Organization as the absence of preventable harm during treatment. Common errors include medication mix-ups, infections, surgical mistakes, misdiagnoses, and missed treatments. Healthcare simulation, while increasingly vital and significantly beneficial for patient safety, needs help in securing funding.
Simulation assists with the creation of High-Reliability Organizations (HROs) capable of near-error-free performance despite potential catastrophic failures. Healthcare, unlike industries like aviation, faces unique challenges due to diverse settings, patient-centric focus, and individualized failures. Unlike major air disasters, individual patient incidents often lack widespread attention.
Clinical Simulations foster a blame-free, proactive safety culture. Healthcare experiential learning offers training at individual, team, and unit levels that replicates real clinical scenarios to identify potential hazards before they occur. Simulation instills crucial insights in learners, transforming future practices positively.
In essence, healthcare simulation serves as a cornerstone for advancing patient safety. Despite challenges in funding and implementation, its proactive approach, ability to instill critical insights, and refinement of processes make it indispensable in cultivating a safer healthcare environment.
Medical Errors and Branching Case Scenarios
Medical errors, though unintended, can have grave consequences for patients. They encompass a broad spectrum, ranging from diagnostic inaccuracies to communication breakdowns, procedural mishaps, and systemic failures within healthcare organizations. Educators and practitioners turn to innovative approaches like branching case scenarios to combat this multifaceted challenge.
Branching case scenarios immerse learners in realistic clinical situations where they must navigate decision points, each leading to different outcomes. This dynamic learning format allows individuals to explore various evaluation and management pathways, fostering critical thinking and clinical reasoning skills.
Consider, for example, a branching case scenario focusing on the evaluation of chest pain—a common yet diagnostically challenging presentation in clinical practice. Learners are presented with a patient case and prompted to make decisions at critical junctures, such as ordering diagnostic tests, considering differential diagnoses, and determining treatment strategies. As they progress through the scenario, the consequences of their choices unfold, offering valuable insights into the complexities of clinical decision-making.
The effectiveness of branching case scenarios is further augmented when integrated with narrative medicine principles. Narrative medicine, which emphasizes the importance of storytelling and empathetic understanding in healthcare, enriches the learning experience by imbuing scenarios with humanistic elements. Through engagement with patient narratives, learners enhance their clinical skills and cultivate empathy, communication prowess, and self-reflective thinking.
Mathematical Model Addition to Clinical Case Scenarios
The National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) Classification of Medication Error Seriousness serves as a foundational framework to build the mathematical model for clinical cases with branching scenarios. This widely recognized classification system categorizes medication errors based on severity, providing a structured approach for stratifying errors in clinical scenarios.
A mathematical model for building scenarios of clinical cases with branching was developed, leveraging the NCCMERP classification to predict and model the development of clinical situations based on learner choices. This model is an educational tool and doubles as an assessment strategy, enabling educators to evaluate learners’ clinical reasoning and decision-making abilities.
Seriousness is categorized using nine different categories, from A to I. The classification includes the occurrence of an error, whether the error reached the patient or not, the harm associated with the error, and the necessary measures. The classification was based on the National Coordinating Council for Medication.
When building a mathematical model or score system for clinical cases with branching, an integrated assessment and a mathematical scale are required to build a predictive model of the development of events in each specific clinical case.
For providing clinical prediction and modeling in branching scenarios, two additional columns could be added (points for clinical decision-making and clinical case situation development)
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Methodology of the Research
This study was undertaken from August 2020 to August 2023. A mathematical model was built to predict and model the development of a clinical situation and as an assessment strategy using the NCC MERP. The study was conducted at the Simulation Training Platform for continuous medical education, “ClinCaseQuest”. The study recruited a total of 34 participants, with 16 participants assigned to the branching scenarios without the mathematical model group and 18 participants assigned to the branching scenarios with the mathematical model group.
Results Show Promise for Use of Mathematical Model
The study findings underscore the efficacy of the mathematical model-based approach in enhancing learning outcomes and learner satisfaction. The results of internal implementation and validation studies indicate significant improvements in various aspects:
- scenario realism
- decision-making clarity
- integration of clinical knowledge
- scenario adaptability
- learner engagement
- learning depth from mistakes
- platform user-friendliness
- overall satisfaction
Next Steps and Future Implications
Further evaluation and validation of the proposed mathematical model are warranted to comprehensively establish its reliability and validity. Future studies should focus on refining the model parameters, expanding the scope of clinical scenarios, and assessing its applicability across diverse learner populations and educational settings.
The integration of mathematical model-based stratification of medical error severity with branching case scenarios offers a robust framework for enhancing clinical thinking in medical education. By engaging learners in immersive, narrative-driven experiences, educators can instill clinical competence, empathy, communication skills, and a commitment to patient safety. As the healthcare landscape continues to evolve, innovative pedagogical approaches such as this will play a vital role in shaping the next generation of healthcare professionals.
