Skill Set layering
Patient scenarios are created based on the skills (competencies - tasks) faculty want students to learn or demonstrate. Typically there are several competencies or basic steps that make up the "skill" or "task." The total number of individual steps for a single "skill" or "task" can be called a Skill Set.
The Skill Set that the student is expected to learn or demonstrate, drives what type of simulated patient, related equipment, supplies, and personnel are needed for the scenario. A task trainer may work for a single Skill Set, but add a second Skill Set (layer) and you may need to change patient, supplies, and equipment. Here is an example:
Skill Set Layer 1.
The student will use a blood pressure cuff and stethoscope to obtain blood
pressure within 2 points of actual blood pressure.
Easy stuff. The student has to know how to:
- place the cuff properly (right place...not too tight or loose, etc.)
- inflate the cuff to the proper pressure
- place the stethoscope properly
- release cuff pressure at appropriate rate
- from listening and watching the dial accurately determine systolic and diastolic pressures
You might even have them document the numbers somewhere.
All of this can be done on a human (fellow classmate) or a task trainer. A task trainer may allow you to alter the BP for each student and several times for the same student so you have a better idea they can really perform the task. Unless you have the student repeat the skill at different BP's, it may have been just plain ole luck.
Here is where things change by adding what many call a set of core competencies. Core competencies are important key skills that the student is expected to always perform. They know them so well that you could call them "habits."
Skill Set - Layer 2.
You decide that you want the student to obtain BP and WIPES at the same time.
(Wash hands, Introduce yourself to patient and ID patient, Provide privacy,
Explain the procedure, and adhere to Safe practices for self and
patient.)
A task trainer typically provides opportunity to learn or demonstrate ONE task (skill set.) How aptly named. You, however, want a second Skill Set (layer number 2) demonstrated. Lets take the individual steps and see how they drive the whole scenario.
Wash hands:
Not all of our rooms have a sink...so we bought a "touch less" wall
mounted unit that automatically sprays your hand with an antiseptic
liquid.
Introduce self to patient and ID patient:
Hard to perform this step unless the patient can talk back. We now make
sure the patient simulator used for this step can talk in real time to the
student. We are now out of the task trainer category all together.
Provide Privacy:
There was NO patient privacy until we installed full length patient privacy
curtains. The task trainer did not need curtains.
Explain the Procedure;
Back to having the patient respond in real time voice. Having the patient
ask questions gives you (faculty) opportunity to more accurately test the
student's ability to communicate effectively.
Safety:
This is safety for the patient and the student. One example is body
mechanics for the student. Does the student raise the bed to a position so
that he/she is not straining themselves? Did the student make sure they
used the appropriate arm?
For something like WIPES, a set of core skills, only part of the skill sets could be evaluated with a task trainer. All of the core skills could be evaluated with low fidelity or high fidelity patient simulation. WIPES requires a method for cleaning hands, a bed, perhaps privacy curtains and a patient who can talk. As you add additional skill layers, you will need more/different supplies, equipment and perhaps even a different patient simulator.
MCF