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Scenario-based Skill Teaching
ATLS ® 10th Edition
7 skills stations
• Airway (x2)
• 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
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
• eFAST probe positioning/scanning – demo/discuss
• Chest X ray interpretation – DO
• Pelvic X ray interpretation – DO
• Spine X ray interpretation - DO
10th 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, p216
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 4th stage – requiring immediate facilitator correction
• Time!