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I CURSO ECO OB CON SIMULACION

ENTRENAMIENTO EN ECOGRAFIA OBSTÉTRICA.BASADO EN SIMULACION

ENTRENAMIENTO EN ECOGRAFIA OBSTÉTRICA.BASADO EN SIMULACION - SIMULACIÓN OBS&GIN

El entrenamiento en ecografía obstétrica básica y avanzada es un campo prometedor en el entrenamiento basado en simulación en esta  especialidad. Los modelos de entrenamiento basados en realidad aumentada que tanto éxito han tenido en el entrenamiento de ecografía abdominal y ecocardiografía  se han adoptado al entorno obstétrico y  supondrán un cambio en la manera que nos nuevos médicos se entrenan en ecografía de diagnóstico prenatal .

 

Existen fantomas ecolúcidos que simulan bien una pelvis en la que podemos hacer ecografía vaginal y aprender a localizar embarazos intrauterinos y extrauterinos en el primer trimestre  .También existen fantomas que simulan úteros gestantes de 20 semanas en  los que podemos realizar ecografías básicas para localizar la posición  y situaciones fetales ,  hacer biometrías  y localizar la placenta.

Podemos con los nuevos entrenadores ( CAE Vimedix Obs Gin) introducir en un ordenador diferentes malformaciones para que el alumno aprenda a localizarlas en el feto simulado mientras que  en un parte de su monitor visualiza a la vez  los cortes anatómicos con  una infografía muy  bien diseñada con sistemas de ayuda a la exploración( ver foto)

 

 

 

PROGRAMA

ECO SIM1 ECO SIM1 [802 Kb]

I CURSO DE DIAGNOSTICO PRENATAL Y TECNICAS ECOGUIADAS BASASO EN SIMULACION

I CURSO DE ENTRENAMIENTO  EN DIAGNOSTICO PRENATAL BASADO EN LA SIMULACION: ECOGRAFIA 20 Y PRUEBAS INVASIVAS

 

 

 

Dra  Cristina Martínez Payo Servicio de Obstetricia y Ginecología

Dr Oscar Martínez Pérez. Servicio de Obstetricia y Ginecología

 

Destinado a:

Residentes  R2 -R4 y Adjuntos de Obstetricia  y Ginecología

Obligatorio programa residencia Obstetricia Puerta de Hierro

TEORIA

Los alumnos recibirán previamente al curso material docente para su estudio. Se pasará un cuestionario antes del incio de las prácticas.Es preciso superar el 80% de las preguntas del cuestionario para acceder a las prácticas

PRÁCTICAS

Fecha 24 de Noviembre 2015.Curso Residentes Hospital Puerta de Hierro -Majadahonda

Fecha: 26 Noviembre 2015:
Residentes R4 R3 de la Comunidad de Madrid.Incripcion abierta

Fecha 27 de Noviembre 2015 :  Adjuntos. Aula Toshiba.Previa invitación 

 

 Incripciones del curso a traves del enlace:

Precio : 70€Becadas a los Residentes

Plazas dia 24 : 12

 

Lugar :Unidad de Simulacion del Hospital Puerta de Hierro Majadahonda

 

 

Entrenamiento en ecografía obstétrica

El entrenamiento en ecografía obstétrica básica y avanzada es un campo prometedor en el entrenamiento basado en simulación en esta  especialidad. Los modelos de entrenamiento basados en realidad aumentada que tanto éxito han tenido en el entrenamiento de ecografía abdominal y ecocardiografía  se han adoptado al entorno obstétrico y  supondrán un cambio en la manera que nos nuevos médicos se entrenan en ecografía de diagnóstico prenatal .

 

Existen fantomas ecolúcidos que simulan bien una pelvis en la que podemos hacer ecografía vaginal y aprender a localizar embarazos intrauterinos y extrauterinos en el primer trimestre  .También existen fantomas que simulan úteros gestantes de 20 semanas en  los que podemos realizar ecografías básicas para localizar la posición  y situaciones fetales ,  hacer biometrías  y localizar la placenta.

Podemos con los nuevos entrenadores ( CAE Vimedix Obs Gin) introducir en un ordenador diferentes malformaciones para que el alumno aprenda a localizarlas en el feto simulado mientras que  en un parte de su monitor visualiza a la vez  los cortes anatómicos con  una infografía muy  bien diseñada con sistemas de ayuda a la exploración( ver foto)

 

 

SIMULACIÓN DE TECNICAS INVASIVAS ECOGUIADAS

COMUNICACION DE MALAS NOTICIAS EN DIAGNÓSTICO PRENATAL

 

BREAKING BAD NEWS

The aim for any health-professional is to use their

skills to deliver bad news clearly,h onestly and sensitively in order that patients can

both understand and feel supported.

One framework that healthprofessionals find helpful is that developed by Baile and

Buckman (2000). The components convey the major points to be considered when giving bad news to patients and/or their relatives. These

may vary according to context, the severity of the news, the people involved, time giv

en for planning, etc.

 

“In general, however, the more attention that can b

e given to each of these points the better the eventual performance is likely to be. A bove all it is necessary to plan as carefully as possible and to respect the people to whom the information is being given by listening and watching them at all stages and being responsive to their wishes and reactions, which will be diverse. It is important to realise that the environment and healthcare professionals’ behaviour will have a pro

found influence upon the patient and family in all respects.”

 

Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000) SPIKES – A Six- Step Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist

5:302-311

 

SPIKES -

The Six-Step Protocol for Delivering Bad News

This unfortunate acronym nevertheless helps memoris

e the steps and consider their

elements

STEP 1: SETTING UP the Interview

STEP 2: Assessing the Patient’s PERCEPTION

STEP 3: Obtaining the Patient’s INVITATION

STEP 4:Giving KNOWLEDGE and Information to the Patient

STEP 5:Addressing the Patient’s EMOTIONS with empathic responses

STEP 6:Strategy and Summary

 

Step 1 SETTING UP the Interview

The aim of this is to get the physical context right, maximise privacy, avoid interruption, tohelp patients listen and understand, respect confidentiality and provide support. Liaise with staff as necessary. The more reassured you feel about the setting the more at ease,and hence more available and helpful you will be to the patient.

* What? Make sure you have checked all the available information and have test results (including getting the right patient!)

 

 

 

 

 

 

 

Decide general terminology to be used

* Where? Arrange for some privacy,

* Who? Should break the news, should other staff be there orsignificant others?

* Starting off? Introductions and appropriate opening

CETL 2010, Feedback Opportunities, A Training Resource for Healthcare Professionals 2Handout: Breaking bad news

 

STEP 2:

Assessing the Patient’s PERCEPTION

Finding out how much the patient knows. In particular how serious he or she thinks the

illness is, and/or how much it will affect the future.

* What have you made of the illness so far?

* What did doctor X tell you when he sent you here?

This helps you gauge how close to the medical reality the patient’s understanding is and

will tell you about pacing. Also whether the patient is in denial.

The style and emotional content of the patient’s statements provide you with information.

Terms that are used or avoided and tone of voice will give information about the patient’s level of understanding and whether the implications

of the information have been taken in.

It is important to learn the patient’s level of understanding and articulation so that the

professional can later begin the information-giving at the same level.

Verbal (words the patient uses to convey emotion) and non-verbal (body posture, handmovements) will indicate anxiety possibly under a brave front. You are not required to judge these responses, change them or try to make them better. They are however,important data to help you understand what is going on for the patient.

 

STEP 3: Obtaining the Patient’s INVITATION

Finding out how much the patient wants to know.

In any conversation about bad news the real issue is not “do you want to know?” but “at

what level do you want to know?”This is a potentially controversial issue. Guidelines for informed consent indicate information which patients need to make informed decisions. Equally respecting patients’ autonomy also means that patients have a right not to know or want to hear information.

The challenge in communication is how to know what a patient wants and also how to

ensure that there are other opportunities if a patient decides at present that he or she does not wish to know all the details. Rob Buckman illustrates how skilful communicators deal sensitively with such situations where patients explicitly say the do not wish to know, whilst leaving the door open and giving information about treatment and management which patients need for making decisions.

Unless the patient is asked it is not possible to k now how much they wish to know and the doctor may be projecting his or her own reticence to fully disclose the information.

 

 

 

 

 

 

 

 

 

There are however ways and ways of asking questions

. “You don’t want to be bothered

with the details do you?” is obviously a leading question. The doctor

must be committed to honesty and fully informing the patient. In that frame of reference, pacing and phrasing of questions are geared to this goal. Some examples of questions are: “Would you like me to tell you the details of the diagnosis?”

“If this turns out to be something serious are you the kind of person who likes to know

exactly what’s going on”

 

CETL 2010, Feedback Opportunities, A Training Resource for Healthcare Professionals 3Handout: Breaking bad news

 

STEP 4: Giving KNOWLEDGE and Information to the Patient First decide on your objectives for the consultation. This does not mean that you forge blindly ahead with your own agenda ignoring the patient’s responses. But it does mean that you keep in mind what you are wanting to coverand how you are progressing to fulfil your agenda.

 

The four crucial headings are:

Diagnosis

Treatment Plan, Prognosis and Support Check whether your objectives are legitimate.

Sometimes doctors might want the patient to accept their advice on treatment, not get upset and to feel optimistic and reassured about the future. It is not possible to predict how patients will respond to news.

 

One of the difficulties for doctors is accepting that mentally competent and informed

patients have a right to (a) accept or reject treatment offered and (b) to react to news and

express their own feelings in any (legal) way she or he chooses.

 

Aligning

(Start from the patient’s starting point) - Having

found out what the patient already understands, reinforce those parts which are correct using their words if possible – this builds patient’s confidence that they have been heard and are being taken seriously.

This process of aligning helps the next stage of modifying, correcting or educating a

patient with new information.

 

Educating

Changing the patient’s understanding in small steps and observing the

patient’s responses, reinforcing those that are bringing the patient closer to the medical

facts and emphasising the relevant medical information if the patient is straying from anaccurate understanding.

 

 

 

 

 

 

 

 

The Warning Shot e.g. “

 

Well, the situation does appear to be more serious

than that

Give information in small chunks

English not Medspeak

Check Reception Often and Clarify e.g.

“Am I making sense?”

“This might be a bit bewildering, do you follow ro

ughly what I’m saying?”

Reinforce Information Often & Clarify e.g.

Could you just tell me the general drift of what I have been saying, to check I’ve explained it clearly?”

Repeat Important Points – patients who are upset or shocked don’t hear or remember well.

Use diagrams, written messages as an aide memoir, audiotapes or leaflets. Check your level – try to simplify without being patronising

Listen to Patient’s Agenda: what are their concerns e.g. Patients may be more worried about hair loss fromchemotherapy than potential risk of the disease.

- listen to the buried questions & invite questions

SPIKES SPIKES [277 Kb]