Taylor Sawyer - Academia.edu (original) (raw)

Papers by Taylor Sawyer

Research paper thumbnail of Simulation to Assist in the Selection Process of New Airway Equipment in a Children's Hospital

Cureus, 2015

To provide an informed choice of equipment purchase, we sought to use simulation to allow medical... more To provide an informed choice of equipment purchase, we sought to use simulation to allow medical providers an opportunity to evaluate two potential laryngoscopes. The study followed a prospective, blinded comparison design. Participants were blinded to the laryngoscope brands by using alphabetic labels on the handles ("A" and "B"). Participants included a convenience sample of healthcare providers who perform intubation. Participants were allowed to perform intubation with the two laryngoscope brands on neonatal, child, and adolescent/adult airway simulators. After practicing with each of the two different laryngoscopes, participants completed an evaluation indicating their preference for one laryngoscope versus the other for each patient age group. Thirty-four healthcare providers participated in the study, including attendings, fellows, nurse practitioners, and transport team members from Neonatology, Pediatric Intensive Care, Anesthesiology, Emergency Medicine, Cardiac Intensive Care, and Otolaryngology. Participants overwhelmingly preferred brand 'A' (89%) over brand 'B' (11%). Providers overwhelmingly chose one laryngoscope over the other. Data from this evaluation were used to determine which of the two laryngoscope brands was purchased. Based on our experience, we feel other hospitals should consider the use of simulation to allow providers to examine, compare, and rate medical equipment prior to making purchasing decisions.

Research paper thumbnail of Adaptation of the US Army’s After-Action Review for Simulation Debriefing in Healthcare

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013

Postsimulation debriefing is a critical component of effective learning in simulation-based healt... more Postsimulation debriefing is a critical component of effective learning in simulation-based health care education. Numerous formats in which to conduct the debriefing have been proposed. In this report, we describe the adaptation the US Army's After-Action Review (AAR) debriefing format for postsimulation debriefing in health care. The Army's AAR format is based on sound educational theory and has been used with great success in the US Army and civilian organizations for decades. Debriefing using the health care simulation AAR process requires planning, preparation, and follow-up. Conducting a postsimulation debriefing using the health care simulation AAR debriefing format includes 7 sequential steps as follows: (1) define the rules of the debriefing, (2) explain the learning objectives of the simulation, (3) benchmark performance, (4) review what was supposed to happen during the simulation, (5) identify what actually happened, (6) examine why events occurred the way they did, and (7) formalize learning by reviewing with the group what went well, what did not go well and what they would do differently if faced with a similar situation in real life. We feel that the use of the health care simulation AAR debriefing format provides a structured and supported method to conduct an effective postsimulation debriefing, with a focus on the learning objectives and reliance on preidentified performance standards.

Research paper thumbnail of Simulation-Based Medical Education in Pediatrics

Academic Pediatrics, 2015

The use of simulation-based medical education (SBME) in pediatrics has grown rapidly over the pas... more The use of simulation-based medical education (SBME) in pediatrics has grown rapidly over the past 2 decades and is expected to continue to grow. Similar to other instructional formats used in medical education, SBME is an instructional methodology that facilitates learning. Successful use of SBME in pediatrics requires attention to basic educational principles, including the incorporation of clear learning objectives. To facilitate learning during simulation the psychological safety of the participants must be ensured, and when done correctly, SBME is a powerful tool to enhance patient safety in pediatrics. Here we provide an overview of SBME in pediatrics and review key topics in the field. We first review the tools of the trade and examine various types of simulators used in pediatric SBME, including human patient simulators, task trainers, standardized patients, and virtual reality simulation. Then we explore several uses of simulation that have been shown to lead to effective learning, including curriculum integration, feedback and debriefing, deliberate practice, mastery learning, and range of difficulty and clinical variation. Examples of how these practices have been successfully used in pediatrics are provided. Finally, we discuss the future of pediatric SBME. As a community, pediatric simulation educators and researchers have been a leading force in the advancement of simulation in medicine. As the use of SBME in pediatrics expands, we hope this perspective will serve as a guide for those interested in improving the state of pediatric SBME.

Research paper thumbnail of Pediatric Procedural Skills Training Curriculum

MedEdPORTAL Publications, 2010

Research paper thumbnail of Deliberate Practice Using Simulation Improves Neonatal Resuscitation Performance

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2011

Simulation will soon become the standard method of training in the Neonatal Resuscitation Program... more Simulation will soon become the standard method of training in the Neonatal Resuscitation Program (NRP). Deliberate practice (DP) using simulation has been shown to improve performance in other areas of medicine. The objective of this study was to evaluate the effectiveness of DP using simulation on improving NRP performance. Using a pretest-posttest design, 15 teams of 2 residents participated in a series of 3 NRP simulations followed by a facilitated debriefing. Objective measures of NRP performance and time to complete critical tasks were evaluated on the first (pretest) and the third (posttest) simulations by blinded video review using a validated scoring instrument. Improvements were seen in scores for overall NRP performance (pretest 82.5% vs. posttest 92.5%, mean difference 10% [95% CI, 1.5-18.5]; P = 0.024) and positive-pressure ventilation (pretest 73.3% vs. posttest 95.0%, mean difference 21.7% [95% CI, 0.8-42.5]; P = 0.043). Time to the vascular access decreased by over 1 minute from baseline (pretest 404 second vs. posttest 343 second, mean difference -60.3 second [95% CI, -119.6 to -0.9]; P = 0.047) as did the time to first IV medication (pretest 452 second vs. posttest 387 second, mean difference -64.9 second [95% CI, -112.4 to -17.5]; P = 0.011). Our results suggest that DP using simulation is associated with improvements in NRP performance and support the use of DP using simulation in NRP training.

Research paper thumbnail of The Effectiveness of Video-Assisted Debriefing Versus Oral Debriefing Alone at Improving Neonatal Resuscitation Performance

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2012

Debriefing is a critical component of effective simulation-based medical education. The optimal f... more Debriefing is a critical component of effective simulation-based medical education. The optimal format in which to conduct debriefing is unknown. The use of video review has been promoted as a means of enhancing debriefing, and video-assisted debriefing is widely used in simulation training. Few empirical studies have evaluated the impact of video-assisted debriefing, and the results of those studies have been mixed. The objective of this study was to compare the effectiveness of video-assisted debriefing to oral debriefing alone at improving performance in neonatal resuscitation. Thirty residents, divided into 15 teams of 2 members each, participated in the study. Each team completed a series of 3 neonatal resuscitation simulations. Each simulation was followed by a facilitated debriefing. Teams were randomly assigned to receive either oral debriefing alone or video-assisted debriefing after each simulation. Objective measures of performance and times to complete critical tasks in resuscitation were evaluated by blinded video review on the first (pretest) and the third (posttest) simulations using a previously validated tool. Overall neonatal resuscitation performance scores improved in both groups [mean (SD), 83% (14%) for oral pretest vs. 91% (7%) for oral posttest (P = 0.005); 81% (16%) for video pretest vs. 93% (10%) for video posttest (P < 0.001)]. There was no difference in performance scores between the 2 groups on either the pretest or posttest [overall posttest scores, 91.3% for oral vs. 93.4% for video (P = 0.59)]. Times to complete the critical tasks of resuscitation also did not differ significantly between the 2 study groups. The educational effect of the video-assisted debriefing versus oral debriefing alone was small (d = 0.08). Using this study design, we failed to show a significant educational benefit of video-assisted debriefing. Although our results suggest that the use of video-assisted debriefing may not offer significant advantage over oral debriefing alone, exactly why this is the case remains obscure. Further research is needed to define the optimal role of video review during simulation debriefing in neonatal resuscitation.

Research paper thumbnail of Neonatal Pulmonary Artery Thrombosis Presenting as Persistent Pulmonary Hypertension of the Newborn

Pediatric Cardiology, 2009

Pulmonary artery thrombosis in neonates occurs rarely. This report describes the case of a term i... more Pulmonary artery thrombosis in neonates occurs rarely. This report describes the case of a term infant with a pulmonary artery thrombosis presenting as persistent pulmonary hypertension of the newborn. The risk factors identified in the case included maternal diabetes and heterozygous factor V Leiden deficiency. The pulmonary thrombus was successfully treated with percutaneous catheter-based embolectomy.

Research paper thumbnail of The Central Simulation Committee (CSC): A Model for Centralization and Standardization of Simulation-Based Medical Education in the U.S. Army Healthcare System

Military Medicine, 2012

In this report, we describe the organizational framework, operations and current status of the Ce... more In this report, we describe the organizational framework, operations and current status of the Central Simulation Committee (CSC). The CSC was established in 2007 with the goals of standardizing simulation-based training in Army graduate medical education programs, assisting in redeployment training of physicians returning from war, and improving patient safety within the Army Medical Department. Presently, the CSC oversees 10 Simulation Centers, controls over 21,000 sq ft of simulation center space, and provides specialty-specific training in 14 medical specialties. In the past 2 years, CSC Simulation Centers have trained over 50,000 Army medical students, residents, physician assistants, nurses, Soldiers and DoD civilian medical personnel. We hope this report provides simulation educators within the military, and our civilian simulation colleagues, with insight into the workings of our organization and provides an example of centralized support and oversight of simulation-based medical education.

Research paper thumbnail of Ophthalmological Aspects of Pierson Syndrome

American Journal of Ophthalmology, 2008

To study the ocular phenotype of Pierson syndrome and to increase awareness among ophthalmologist... more To study the ocular phenotype of Pierson syndrome and to increase awareness among ophthalmologists of the diagnostic features of this condition. Retrospective, observational case series. A multicenter study of 17 patients with molecularly confirmed Pierson syndrome. The eye findings were reviewed and compared to pertinent findings from the literature. The most characteristic ocular anomaly was microcoria. A wide range of additional abnormalities were found, including posterior embryotoxon, megalocornea, iris hypoplasia, cataract, abnormal lens shape, posterior lenticonus, persistent fetal vasculature, retinal detachment, variable axial lengths, and glaucoma. There was high interocular and intrafamilial variability. Loss-of-function mutations in laminin beta2 (LAMB2) cause a broad range of ocular pathology, emphasizing the importance of laminin beta2 in eye development. Patients with Pierson syndrome can initially present with ocular signs alone. In newborns with marked bilateral microcoria, Pierson syndrome should be considered and renal function investigated.

Research paper thumbnail of Generalized Arterial Calcification of Infancy and Pseudoxanthoma Elasticum Can Be Caused by Mutations in Either ENPP1 or ABCC6

The American Journal of Human Genetics, 2012

Generalized arterial calcification of infancy (GACI) is associated with biallelic mutations in EN... more Generalized arterial calcification of infancy (GACI) is associated with biallelic mutations in ENPP1 in the majority of cases, whereas mutations in ABCC6 (ATP-binding cassette subfamily C number 6) are known to cause pseudoxanthoma elasticum (PXE). However, ABCC6 mutations account for a significant subset of GACI cases, and ENPP1 mutations can also be associated with PXE lesions. Based on the considerable overlap of GACI and PXE, both entities appear to reflect two ends of a clinical spectrum of ectopic calcification rather than two distinct disorders. ABCC6 and ENPP1 mutations might lead to alterations of the same physiological pathways.

Research paper thumbnail of Learn, See, Practice, Prove, Do, Maintain: An Evidence-Based Pedagogical Framework for Procedural Skill Training in Medicine

Academic medicine : journal of the Association of American Medical Colleges, Jan 15, 2015

Acquisition of competency in procedural skills is a fundamental goal of medical training. In this... more Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to pr...

Research paper thumbnail of Simulation to Assist in the Selection Process of New Airway Equipment in a Children's Hospital

Cureus, 2015

To provide an informed choice of equipment purchase, we sought to use simulation to allow medical... more To provide an informed choice of equipment purchase, we sought to use simulation to allow medical providers an opportunity to evaluate two potential laryngoscopes. The study followed a prospective, blinded comparison design. Participants were blinded to the laryngoscope brands by using alphabetic labels on the handles ("A" and "B"). Participants included a convenience sample of healthcare providers who perform intubation. Participants were allowed to perform intubation with the two laryngoscope brands on neonatal, child, and adolescent/adult airway simulators. After practicing with each of the two different laryngoscopes, participants completed an evaluation indicating their preference for one laryngoscope versus the other for each patient age group. Thirty-four healthcare providers participated in the study, including attendings, fellows, nurse practitioners, and transport team members from Neonatology, Pediatric Intensive Care, Anesthesiology, Emergency Medicine, Cardiac Intensive Care, and Otolaryngology. Participants overwhelmingly preferred brand 'A' (89%) over brand 'B' (11%). Providers overwhelmingly chose one laryngoscope over the other. Data from this evaluation were used to determine which of the two laryngoscope brands was purchased. Based on our experience, we feel other hospitals should consider the use of simulation to allow providers to examine, compare, and rate medical equipment prior to making purchasing decisions.

Research paper thumbnail of Adaptation of the US Army’s After-Action Review for Simulation Debriefing in Healthcare

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013

Postsimulation debriefing is a critical component of effective learning in simulation-based healt... more Postsimulation debriefing is a critical component of effective learning in simulation-based health care education. Numerous formats in which to conduct the debriefing have been proposed. In this report, we describe the adaptation the US Army's After-Action Review (AAR) debriefing format for postsimulation debriefing in health care. The Army's AAR format is based on sound educational theory and has been used with great success in the US Army and civilian organizations for decades. Debriefing using the health care simulation AAR process requires planning, preparation, and follow-up. Conducting a postsimulation debriefing using the health care simulation AAR debriefing format includes 7 sequential steps as follows: (1) define the rules of the debriefing, (2) explain the learning objectives of the simulation, (3) benchmark performance, (4) review what was supposed to happen during the simulation, (5) identify what actually happened, (6) examine why events occurred the way they did, and (7) formalize learning by reviewing with the group what went well, what did not go well and what they would do differently if faced with a similar situation in real life. We feel that the use of the health care simulation AAR debriefing format provides a structured and supported method to conduct an effective postsimulation debriefing, with a focus on the learning objectives and reliance on preidentified performance standards.

Research paper thumbnail of Simulation-Based Medical Education in Pediatrics

Academic Pediatrics, 2015

The use of simulation-based medical education (SBME) in pediatrics has grown rapidly over the pas... more The use of simulation-based medical education (SBME) in pediatrics has grown rapidly over the past 2 decades and is expected to continue to grow. Similar to other instructional formats used in medical education, SBME is an instructional methodology that facilitates learning. Successful use of SBME in pediatrics requires attention to basic educational principles, including the incorporation of clear learning objectives. To facilitate learning during simulation the psychological safety of the participants must be ensured, and when done correctly, SBME is a powerful tool to enhance patient safety in pediatrics. Here we provide an overview of SBME in pediatrics and review key topics in the field. We first review the tools of the trade and examine various types of simulators used in pediatric SBME, including human patient simulators, task trainers, standardized patients, and virtual reality simulation. Then we explore several uses of simulation that have been shown to lead to effective learning, including curriculum integration, feedback and debriefing, deliberate practice, mastery learning, and range of difficulty and clinical variation. Examples of how these practices have been successfully used in pediatrics are provided. Finally, we discuss the future of pediatric SBME. As a community, pediatric simulation educators and researchers have been a leading force in the advancement of simulation in medicine. As the use of SBME in pediatrics expands, we hope this perspective will serve as a guide for those interested in improving the state of pediatric SBME.

Research paper thumbnail of Pediatric Procedural Skills Training Curriculum

MedEdPORTAL Publications, 2010

Research paper thumbnail of Deliberate Practice Using Simulation Improves Neonatal Resuscitation Performance

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2011

Simulation will soon become the standard method of training in the Neonatal Resuscitation Program... more Simulation will soon become the standard method of training in the Neonatal Resuscitation Program (NRP). Deliberate practice (DP) using simulation has been shown to improve performance in other areas of medicine. The objective of this study was to evaluate the effectiveness of DP using simulation on improving NRP performance. Using a pretest-posttest design, 15 teams of 2 residents participated in a series of 3 NRP simulations followed by a facilitated debriefing. Objective measures of NRP performance and time to complete critical tasks were evaluated on the first (pretest) and the third (posttest) simulations by blinded video review using a validated scoring instrument. Improvements were seen in scores for overall NRP performance (pretest 82.5% vs. posttest 92.5%, mean difference 10% [95% CI, 1.5-18.5]; P = 0.024) and positive-pressure ventilation (pretest 73.3% vs. posttest 95.0%, mean difference 21.7% [95% CI, 0.8-42.5]; P = 0.043). Time to the vascular access decreased by over 1 minute from baseline (pretest 404 second vs. posttest 343 second, mean difference -60.3 second [95% CI, -119.6 to -0.9]; P = 0.047) as did the time to first IV medication (pretest 452 second vs. posttest 387 second, mean difference -64.9 second [95% CI, -112.4 to -17.5]; P = 0.011). Our results suggest that DP using simulation is associated with improvements in NRP performance and support the use of DP using simulation in NRP training.

Research paper thumbnail of The Effectiveness of Video-Assisted Debriefing Versus Oral Debriefing Alone at Improving Neonatal Resuscitation Performance

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2012

Debriefing is a critical component of effective simulation-based medical education. The optimal f... more Debriefing is a critical component of effective simulation-based medical education. The optimal format in which to conduct debriefing is unknown. The use of video review has been promoted as a means of enhancing debriefing, and video-assisted debriefing is widely used in simulation training. Few empirical studies have evaluated the impact of video-assisted debriefing, and the results of those studies have been mixed. The objective of this study was to compare the effectiveness of video-assisted debriefing to oral debriefing alone at improving performance in neonatal resuscitation. Thirty residents, divided into 15 teams of 2 members each, participated in the study. Each team completed a series of 3 neonatal resuscitation simulations. Each simulation was followed by a facilitated debriefing. Teams were randomly assigned to receive either oral debriefing alone or video-assisted debriefing after each simulation. Objective measures of performance and times to complete critical tasks in resuscitation were evaluated by blinded video review on the first (pretest) and the third (posttest) simulations using a previously validated tool. Overall neonatal resuscitation performance scores improved in both groups [mean (SD), 83% (14%) for oral pretest vs. 91% (7%) for oral posttest (P = 0.005); 81% (16%) for video pretest vs. 93% (10%) for video posttest (P < 0.001)]. There was no difference in performance scores between the 2 groups on either the pretest or posttest [overall posttest scores, 91.3% for oral vs. 93.4% for video (P = 0.59)]. Times to complete the critical tasks of resuscitation also did not differ significantly between the 2 study groups. The educational effect of the video-assisted debriefing versus oral debriefing alone was small (d = 0.08). Using this study design, we failed to show a significant educational benefit of video-assisted debriefing. Although our results suggest that the use of video-assisted debriefing may not offer significant advantage over oral debriefing alone, exactly why this is the case remains obscure. Further research is needed to define the optimal role of video review during simulation debriefing in neonatal resuscitation.

Research paper thumbnail of Neonatal Pulmonary Artery Thrombosis Presenting as Persistent Pulmonary Hypertension of the Newborn

Pediatric Cardiology, 2009

Pulmonary artery thrombosis in neonates occurs rarely. This report describes the case of a term i... more Pulmonary artery thrombosis in neonates occurs rarely. This report describes the case of a term infant with a pulmonary artery thrombosis presenting as persistent pulmonary hypertension of the newborn. The risk factors identified in the case included maternal diabetes and heterozygous factor V Leiden deficiency. The pulmonary thrombus was successfully treated with percutaneous catheter-based embolectomy.

Research paper thumbnail of The Central Simulation Committee (CSC): A Model for Centralization and Standardization of Simulation-Based Medical Education in the U.S. Army Healthcare System

Military Medicine, 2012

In this report, we describe the organizational framework, operations and current status of the Ce... more In this report, we describe the organizational framework, operations and current status of the Central Simulation Committee (CSC). The CSC was established in 2007 with the goals of standardizing simulation-based training in Army graduate medical education programs, assisting in redeployment training of physicians returning from war, and improving patient safety within the Army Medical Department. Presently, the CSC oversees 10 Simulation Centers, controls over 21,000 sq ft of simulation center space, and provides specialty-specific training in 14 medical specialties. In the past 2 years, CSC Simulation Centers have trained over 50,000 Army medical students, residents, physician assistants, nurses, Soldiers and DoD civilian medical personnel. We hope this report provides simulation educators within the military, and our civilian simulation colleagues, with insight into the workings of our organization and provides an example of centralized support and oversight of simulation-based medical education.

Research paper thumbnail of Ophthalmological Aspects of Pierson Syndrome

American Journal of Ophthalmology, 2008

To study the ocular phenotype of Pierson syndrome and to increase awareness among ophthalmologist... more To study the ocular phenotype of Pierson syndrome and to increase awareness among ophthalmologists of the diagnostic features of this condition. Retrospective, observational case series. A multicenter study of 17 patients with molecularly confirmed Pierson syndrome. The eye findings were reviewed and compared to pertinent findings from the literature. The most characteristic ocular anomaly was microcoria. A wide range of additional abnormalities were found, including posterior embryotoxon, megalocornea, iris hypoplasia, cataract, abnormal lens shape, posterior lenticonus, persistent fetal vasculature, retinal detachment, variable axial lengths, and glaucoma. There was high interocular and intrafamilial variability. Loss-of-function mutations in laminin beta2 (LAMB2) cause a broad range of ocular pathology, emphasizing the importance of laminin beta2 in eye development. Patients with Pierson syndrome can initially present with ocular signs alone. In newborns with marked bilateral microcoria, Pierson syndrome should be considered and renal function investigated.

Research paper thumbnail of Generalized Arterial Calcification of Infancy and Pseudoxanthoma Elasticum Can Be Caused by Mutations in Either ENPP1 or ABCC6

The American Journal of Human Genetics, 2012

Generalized arterial calcification of infancy (GACI) is associated with biallelic mutations in EN... more Generalized arterial calcification of infancy (GACI) is associated with biallelic mutations in ENPP1 in the majority of cases, whereas mutations in ABCC6 (ATP-binding cassette subfamily C number 6) are known to cause pseudoxanthoma elasticum (PXE). However, ABCC6 mutations account for a significant subset of GACI cases, and ENPP1 mutations can also be associated with PXE lesions. Based on the considerable overlap of GACI and PXE, both entities appear to reflect two ends of a clinical spectrum of ectopic calcification rather than two distinct disorders. ABCC6 and ENPP1 mutations might lead to alterations of the same physiological pathways.

Research paper thumbnail of Learn, See, Practice, Prove, Do, Maintain: An Evidence-Based Pedagogical Framework for Procedural Skill Training in Medicine

Academic medicine : journal of the Association of American Medical Colleges, Jan 15, 2015

Acquisition of competency in procedural skills is a fundamental goal of medical training. In this... more Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to pr...