Johns Hopkins Medical Education Goes Digital

As Ashley Law (left) and Megan Thorne (right), film, Julie Perretta (right of bed) and Richard Collins (in green scrubs) demonstrate a simulation education technique with the help of high school summer interns.

Published in Dome - September/October 2018 Dome

Julie Perretta leans over the hospital bed. “Ralph! Ralph!” she says. “Are you OK? Can you breathe?”

Ralph doesn’t answer — he’s a manikin in the Johns Hopkins Medicine Simulation Center. Perretta, lead educator for the center, has programmed him with a soundtrack of labored gasping to mimic a patient in anaphylactic shock. She’s demonstrating rapid cycle deliberate practice (RCDP), a novel way of teaching clinicians what to do in situations that rarely happen, but require quick action when they do.

As Perretta stands over the manikin, two cameras gather footage for videos that will become part of an online course for simulation educators at Johns Hopkins and other hospitals.

The RCDP teaching method was introduced in 2013 by Elizabeth Hunt, director of the Johns Hopkins Simulation Center and associate professor of anesthesiology and critical care medicine.

In standard simulation training, students act out their responses to medical situations, and instructors provide feedback only after they have finished.

RCDP is different. The educational technique requires that instructors pause learners frequently as they run through scenarios, in order to figure out ways to improve. Learners keep problem-solving and repeating the actions until they have mastered the steps they need to take.

Studies show clinicians who learn by the RCDP method have a better foundation to act quickly and correctly during potentially fatal time-critical events such as a patient going into cardiac arrest or anaphylactic shock. In other words, RCDP saves lives.

Perretta, who helped Hunt fine-tune the technique, wants more simulation centers to use the RCDP instruction method. She is working closely with online education director Robert Kearns, instructional designer Megan Thorne and instruction technologist Ashley Law to develop an engaging five-module course for simulation educators. Each section will be about 25 minutes long, with engaging videos.  

“Right now people are learning how to teach RCDP by reading a paper or going to a conference,” Perretta says. “We have not been able to scale up because we can’t do enough face-to-face training.”

The online education office, established in 2016, has so far developed a handful of courses, says Kearns, including one on curriculum development for medical educators and another on patient safety.

The RCDP course, like others, will be hosted on the Johns Hopkins University School of Medicine’s external course portal, where learners from all around the world can enroll in the RCDP course as well as other courses created by the Office for Online Education. Other online courses created by the Office for Online Education are currently available for anyone to enroll in and receive continuing medical education credit.

Kearns and others in the office work closely with faculty to figure out how to add a little dazzle to important but sometimes dry material. They tell faculty members — gently — that lectures and small-group discussions rarely hold attention on computer screens, even if they’re riveting in person.

“There’s a bit of edutainment,” says Kearns. “You can pick it up, learn a little bit, come back to it later.” 

Most courses include quizzes and exams that users take to earn certifications or continuing medical education credits. The RCDP course will give a certificate of completion to simulation instructors, says Perretta, plus the opportunity to earn a “master trainer” designation by following up with instruction in the Johns Hopkins Medicine Simulation Center. 

For now, though, the center is being used to create the RCDP course. As Thorne and Law film, Perretta, still standing over Ralph, calls for help. Simulation specialist Richard Collins rushes into the mock hospital room, followed by high school summer interns Amilee Huang, Sonalika Challa and Reshma Jasmin.

Collins examines the manikin, commenting that he has hives and concluding that he is in anaphylactic shock. He says Ralph needs an intramuscular dose of epinephrine.

Jasmin dashes to the supply closet to get the medication. When she returns, she fumbles while filling a syringe. Perretta pauses them there. 

“The medication needs to go in within five minutes, but it took you three and a half minutes to get it into the room,” she says. How can they improve? She tells Collins to ask for the epinephrine sooner and instructs Jasmin to assertively ask for help if she doesn’t know how to load the syringe with medication.

As she talks, the cameras keep rolling. Collins and the high school students leave the room, and Perretta once again leans over Ralph, once again asks if he can breathe. Her students will run through the scenario several more times, gaining speed and confidence with each iteration. And Perretta will bring RCDP simulation education to the largest audience yet.

Sample video: