Training with Practicum Script supports certainty in decision making and could reduce medical error

DR. MIGUEL RAÚL ASAD BLANCO

Cardiologist and medical director of the Pura Vida center in Santiago del Estero, Argentina

Outside the orbit of the capital of Buenos Aires, Dr. Miguel Raúl Asad Blanco works as a cardiologist in Santiago del Estero. The specialist, also an occupational physician and auditor, evaluates the simulator of real clinical cases Practicum Script as an effective asset in the crusade against medical error. With a 12.1% rate of adverse events recorded in hospital admissions, “the permanent evaluation of professionals’ management is fundamental in the Argentine health system’s efficiency.”

Madrid, June 8, 2018. “A training system in clinical reasoning that generates trust and diagnostic certainty like Practicum Script would alleviate the stress inherent in the doctor/patient relationship.” The statement is from Dr. Miguel Raúl Asad Blanco, cardiologist and medical director of the Pura Vida health center, in the city of Loreto, in Santiago del Estero (northern Argentina), and reflects on the occupational burnout in the health care area and the need of placing the patient at the center of the health system. He then points out: “Periodic training with Practicum Script would be very helpful in enhancing certainty in decision making and statistically reducing medical error.”

For 11 years as a specialist in cardiology and four years in areas such as occupational medicine and medical auditing, Dr. Asad considers the Practicum Script simulation tool a valuable asset in the continuing training required by the medical profession. The specialist concluded the course of Cardiology in the summer of 2017 in record time, with an average of two cases per day, out of a total of 40 online vignettes. “I was able to solve more than two cases a day consecutively because Practicum Script was truly attractive and entertaining,” he says as a sign of his interest in the program. Currently, the simulator does not allow solving of more than three cases per week, precisely so as not to overload the users.

In Dr. Asad's opinion, “The key to Practicum Script is that it recreates scenarios similar to clinical reality and leaves room for doubt and debate.” By establishing itself in contexts of uncertainty, the simulator stimulates the development of analytical thinking before complex dilemmas. “Quality management programs audited by competent medical staff, trained for this purpose, would be very useful to increase the level of the medical services provided,” emphasizes the doctor. “The immediate barrier that hinders continued professional development in my country — he says next — is lack of resources.” In his view, “scholarships are scarce, and postgraduate training alternatives aren’t affordable.”

In this sense, educational interventions aimed at providing more resources to the worker result in the benefit of the respective organizations. Having published a paper in 2014 on the prevention of the burnout syndrome, Dr. Asad does not hesitate to point out that “the dynamics that operate for the worker in a given environment will promote the means at his disposal, provide him with a challenging job, and generate a satisfying and supportive climate.” Regarding this point, he says: “On a global scale, these last 20 years have been characterized by a fast and life-changing pace, and among the most vulnerable occupations are those related to health care and face-to-face interactions.” The reason argued is that these interactions are characterized by a high personal and professional commitment, so there is a fear of not meeting expectations.

According to the literature, in addition to those related to health, the professions that are most vulnerable to the burnout syndrome are those providing psychological, psychiatry, and social assistance, as well as education. “The common characteristics are the development of people in extremely demanding domains where they are in close contact, and the organization provides inadequate or limited support for their work.” So, is it then necessary to adopt systematic interventions? “In order to prevent occupational burnout, it is necessary to focus on explicit policies of recognition for a job well done, as well as opportunities for career development and a culture of valuing the worker as an individual, as well as an administration whose actions are consistent with the declaration of organizational values.”

One in ten suffers an adverse event
Dr. Asad is clear: “To provide the reasoning skills and available resources to the professional results in a benefit to the patient.” In a context in which 1,2 in ten patients suffers an adverse event, skills assessment and continuous training seem imperative. In 2010, the Ibero-American Study of Adverse Events (IBEAS) on hospital safety revealed that, in Argentina, 12.1% of the individuals admitted suffering one or more adverse events during care, and that the risk doubles as hospitalization is prolonged. In 3.4% of cases, the patients die and, in 33.8%, they remain with a moderate to severe disability. The tragedy is that 46% of these errors are considered avoidable.

For the expert, “often these errors are not due to lack of knowledge, but to errors of reasoning.” That is why health institutions, like other complex organizations, need to measure their performance and share it with the population. “They should become safer and more reliable for patients,” says Dr. Asad. In another important work, this time on the importance of the incorporation of medical auditors in public hospitals, the doctor pointed out the importance of audits to critically evaluate a state or situation with objective evidence. Let us remember that in Argentina, the evaluation’s recognition of institutional quality through compliance with certain norms and regulations is not mandatory.

Radiography of Santiago del Estero
The perception of public health in Santiago del Estero is that of a generalized oversizing. This region is among the provinces with the highest national poverty index, with 38.3%, surpassed only by the Chaco province. The province of Santiago has two public and free hospitals of medium complexity. “Personally, over 10 years ago, I decided to work in a small rural hospital in the city of Loreto,” says Dr. Asad. He continues: “The Cardiology service consists of two cardiologists, a technician, the electrocardiograph and our stethoscopes, which leads us to face important clinical challenges in the treatment of emergencies.”

In the clinical context, the cultural, environmental, and socioeconomic conditions of the census are taken into account. An example of this is the prevalence of chagasic cardiomyopathy, which is endemic in the region. “A detail of my specialty here is that there are no coronary units, in notorious contrast to its counterpart in the province of Tucumán, less than two hundred miles away, where there are seven designated centers for this function, six of which are trainers for experts in cardiology,” says the specialist. In Santiago del Estero, multipurpose intensive-care units are responsible for intervening in cases of acute coronary events and a single public hemodynamic service serves the entire province. “In view of all this, for small fish, Practicum Script is a great ally as a tool to address the everyday cardiological practice.”