**Technology**

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**Chapter 10**

**Provisional chapter**

**Education Curriculum on Extracorporeal Membrane**

**Education Curriculum on Extracorporeal Membrane** 

Simon Sin Wai Ching, Pauline Yeung Ng, Wallace Ngai Chun Wai, Peter Lai Chi Keung, Ricky Chan Wai Kit and Andy Mok Yuen Tin

Simon Sin Wai Ching, Pauline Yeung Ng, Wallace Ngai Chun Wai, Peter Lai Chi Keung, Ricky Chan Wai Kit and Andy Mok Yuen Tin

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76656

simulation, debriefing, credentialing

**Abstract**

**1. Introduction**

**Oxygenation: The Evolving Role of Simulation Training**

Continuing education is essential for the success and safety of an extracorporeal membrane oxygenation (ECMO) programme. However, it is challenging due to the intrinsic characteristic of ECMO—a complex, high-risk, low-volume clinical activity which require teamwork, inter-professional communication, critical decision and rapid response especially in emergency. Thus, simulation is a rapidly evolving teaching methodology in ECMO education to address those training needs that cannot be entirely addressed by traditional teaching modalities. The development of a simulation programme requires commitment on resources for equipment, environment setup and training of personnel. Knowledge on ECMO management, education science and debriefing technique forms the cornerstone of successful ECMO simulation facilitators and hence the simulation programme. Currently, researches have already shown that ECMO simulation can improve individual and team performance despite that its impact on patient outcome is still unknown. In the future, the role of simulation will increase importantly in multicentre research, certifying specialists

and credentialing if standardization of training curriculum can be achieved.

**Keywords:** extracorporeal membrane oxygenation, human learning, high-fidelity

Extracorporeal membrane oxygenation (ECMO) is well known to be a highly complex but low-volume clinical activity. Complications may arise at many stages of ECMO care—from cannulation to during the ECMO run, to weaning and decannulation. Most complications are

**Oxygenation: The Evolving Role of Simulation Training**

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.76656

#### **Education Curriculum on Extracorporeal Membrane Oxygenation: The Evolving Role of Simulation Training Education Curriculum on Extracorporeal Membrane Oxygenation: The Evolving Role of Simulation Training**

DOI: 10.5772/intechopen.76656

Simon Sin Wai Ching, Pauline Yeung Ng, Wallace Ngai Chun Wai, Peter Lai Chi Keung, Ricky Chan Wai Kit and Andy Mok Yuen Tin Simon Sin Wai Ching, Pauline Yeung Ng, Wallace Ngai Chun Wai, Peter Lai Chi Keung, Ricky Chan Wai Kit and Andy Mok Yuen Tin

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76656

#### **Abstract**

Continuing education is essential for the success and safety of an extracorporeal membrane oxygenation (ECMO) programme. However, it is challenging due to the intrinsic characteristic of ECMO—a complex, high-risk, low-volume clinical activity which require teamwork, inter-professional communication, critical decision and rapid response especially in emergency. Thus, simulation is a rapidly evolving teaching methodology in ECMO education to address those training needs that cannot be entirely addressed by traditional teaching modalities. The development of a simulation programme requires commitment on resources for equipment, environment setup and training of personnel. Knowledge on ECMO management, education science and debriefing technique forms the cornerstone of successful ECMO simulation facilitators and hence the simulation programme. Currently, researches have already shown that ECMO simulation can improve individual and team performance despite that its impact on patient outcome is still unknown. In the future, the role of simulation will increase importantly in multicentre research, certifying specialists and credentialing if standardization of training curriculum can be achieved.

**Keywords:** extracorporeal membrane oxygenation, human learning, high-fidelity simulation, debriefing, credentialing

#### **1. Introduction**

Extracorporeal membrane oxygenation (ECMO) is well known to be a highly complex but low-volume clinical activity. Complications may arise at many stages of ECMO care—from cannulation to during the ECMO run, to weaning and decannulation. Most complications are

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

low occurrence but potentially life-threatening events. As a result, continuing education is essential to ensure the success and safety of an ECMO programme. Due to the inherent characteristics of ECMO service provision, the implementation of such educational activities is not straightforward. Firstly, professionals who undergo training for ECMO are usually experienced health-care providers. The learning processes of experienced adults are more complex, requiring assimilation of newly acquired knowledge with past experiences and roles. In these instances, learning will be more effective when the teaching is learner-centred and the learner is actively engaged. Secondly, the low-volume nature of severe ECMO complications renders training by apprenticeship difficult. Thirdly, while most ECMO runs are uneventful, in situation when crises occur, ECMO care providers have to respond emergently and proficiently under a stressful environment and often in a team-based approach. Fourthly, the provision of ECMO care often requires critical decision-making across specialties and professions.

effectively when they receive specific types of stimulation. Simulation, through active engage-

Education Curriculum on Extracorporeal Membrane Oxygenation: The Evolving Role of Simulation Training

http://dx.doi.org/10.5772/intechopen.76656

137

Simulation experiences can trigger learner emotions and it is known that a highly activated core affect can positively influence the uptake and retention of knowledge and skills. The Change Theory proposed by Lewin/Schein highlights the relationship between affect and learning. It theorized a three-stage model of change, namely unfreezing, transition and refreezing. 'Unfreezing' refers to the motivation to change by adding new force or removing existing concepts that are influencing behaviour. It unavoidably leads to emotional stress, largely a sense of dissatisfaction with oneself as a result of disconfirmation of the present condition. Moreover, it creates a survival anxiety as the pre-existing belief is rejected and a learning anxiety in which the previously learnt knowledge has to be unlearnt. 'Unfreezing' is followed by 'transition', a process of moving onto a new state, which requires reconstruction of one's thoughts, feelings and behaviours. 'Refreezing' is the final stage in which the newly

The principles underlying simulation scenario design, together with the debriefing process, are largely developed based on one of these educational theories. Simulation training aims to facilitate acquisition of knowledge and skills and to change one's perceptions and behaviour. The following sections further elaborate on scenario design and debriefing in ECMO simulation.

Scenario design is one of the key elements in simulation education. On designing a scenario, thorough understanding of the background, training needs and experience of learners is essential. In particular, meticulous attention must be paid to tailor the learning goals and objectives to the target learner. The goal of a scenario refers to the overall educational mission the learners are expected to achieve. Detailed objectives may be made up of cognitive, psychomotor, behavioural or affective component [4]. As an example, the goals and objectives for novice ECMO learners would be different from experienced ECMO learners in a scenario of ECMO blood pump failure. For the novice, the goal would be 'to switch to a standby machine in emergency setting', with objectives including 'recognize blood pump failure and its related physiological changes' (cognitive) and 'acquire the technical skill of using hand crank' (psychomotor). For the experienced learner, the goal may be more advanced, such as 'demonstration of teamwork in managing blood pump failure crisis', achieved through the objective of 'demonstrating effective communication and leadership skills' (behavioural), in addition to the cognitive and psychomotor skills. **Table 1** lists examples of common scenarios used in an Asia-Pacific ELSO Adult ECMO Training Course and **Table 2** illustrates the goals and objectives of some of these scenarios.

Some deviation of simulation scenarios from the real-world practice is acceptable. Especially for novice ECMO learners, they are expected to adopt the role of the ECMO specialist during simulation learning, regardless of their current position as senior consultants, junior doctors, nurses or perfusionists. This is to ensure competency in the various aspects of troubleshooting and response to ECMO emergencies after they undergo training. This training concept reflects the reality that

ment with hands-on action, produces better training effect in kinesthetic learners.

acquired knowledge, concepts and behaviours are adopted and assimilated [3].

**3. Scenario design in ECMO simulation**

Traditional ECMO teaching modalities like reading, didactic lectures, water drills (referring to deliberate practice in a closed-loop ECMO circuit model, e.g. changing the oxygenator or using the hand crank) and practices in the animal laboratory (where a living animal is cannulated to simulate human responses) primarily focus on cognitive and technical skills, with little emphasis on behavioural skills like communication and leadership that are fundamental during training for ECMO. ECMO simulation has rapidly evolved as an effective learning methodology that supplements traditional teaching modalities. It creates a standardized, controlled, safe and repeatable environment that aims to mimic the realistic clinical environments, so that new skills can be learnt and practised without doing harm to patients and learners.

In this chapter, we discuss simulation training in ECMO from the perspectives of human learning theory, simulation programme setup (including scenario design, equipment and resources), debriefing, current evidence and future challenges.
