The document discusses whether a medical school needs an extracorporeal circulation (EC) science program or a perfusion technoschool. It describes a study that evaluated a perfusion skills course for perfusionists on handling difficult perfusion situations. The study found that perfusionists who took the course had significant improvements in self-efficacy and performance compared to the control group, as measured by questionnaires and an objective structured clinical exam. The document concludes that a short perfusion skills course can help perfusionists improve their ability to handle difficult clinical situations.

1. Does The Medschool Need An Extracorporeal Science
Program or A Perfusion Technoschool
Ezzeldin A. Mostafa, MD, PhD, MBA
Professor & HOD of Cardiovascular & Thoracic Surgery
Ain Shams Univ. Hosp., Cairo, Egypt
Company
LOGO

2. Does The Medschool Need An EC Science Program or A
Perfusion Technoschool
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 2

3. Does The Medschool Need An EC Science Program or A
Perfusion Technoschool
Knowledge is power,
so Learn and Live!
5 S’s
Systemise
Sort
Straighten
Shine
Sustain
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 3

4. Does The Medschool Need An EC Science Program or A
Perfusion Technoschool
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 4

5. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
The Actual & Expected Perfusionists Workforce in the 21st Century
The 33:67 Distribution
Positive The 50% Solution
Positive
Actual Expected
0%
0% 0% 0%
NPP
33%
PP
NPP 50%
50%
PP
67%
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 5

6. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
The sales @ revenue = expenses & net income = zero
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 6

7. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
The sales @ revenue = expenses & net income = zero
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 7

8. Does The Medschool Need An EC Science
Program or A Perfusion Technoschool
Background
PM or PI is the systematic
process of: PMDRR
Planning work and setting
expectations continually
Monitoring performance,
Developing the capacity to
perform,
Rating (periodically )
performance in a summary
fashion
Rewarding good
performance.
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 8

9. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Objective
1
The aim of the study is 2
to evaluate the 3
impact of a perfusion 4
skills course for
perfusionists on how
to handle difficult
perfusion situations
in their daily work
(the self-efficacy &
performance).
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 9

10. 3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 10

11. Does The Medschool Need An EC Science
Program or A Perfusion Techschool 41)
Subjects & Methods (#
In a prospective comparative
randomized study
Group I (intervention, 21 completed all
assigned parts of the study) had the
critical perfusion skills course (as a
part of The Quality Education On
The Standards (QUEST) program).
Group II: (control, 20 volunteered) had
no training.
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 11

12. Ain Shams University Hosp
• ASUH
• CTS
Cardiac Surgery Academy
• CSA
Ain Shams Univ. Specialized Hosp
• ASUSH
National Health Insurance
• NHI
• All Egypt Children Hosp
National Health Insurance
Company
. NHI
LOGO • Nasr City Health Insurance Hosp

13. Does The Medschool Need An EC Science
Program or A Perfusion (Cont’d)
Methods Techschool
A 6-module 7-h course was developed
using a construct of
‘‘Awareness, Feelings, Listen, Solve’’
(AFLS).
A pedagogy of experiential, learner-
centered learning was adopted.
The course was given as two 3 ½ hr
sessions separated by 1 or 2 weeks.
The course evaluation used a
randomized controlled design with
pre- and post-measures of self-
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 13

14. Does The Medschool Need An EC Science
B. Human error 1. background
Catastrophe Program or A Perfusion Techschool
III. Systems analysis 2. communication
Management A. Complex interaction 3. ability to perform multiple
UNIT OBJECTIVE: 1. intrinsic complexity tasks
This unit details the a. highly technical - close B. Scope of practice
components of catastrophe & coordination among various 1. complexity
catastrophe management. components 2. uncertainty
2. proliferation complexity C. Interfacing
LEARNER OBJECTIVES: a. multiple simple components 1. more tasks - more errors
Upon completion of this unit the 3. uncertainty complexity
2. reaction time
student will be able to:
a. relatively straight forward - 3. preventative measures
(1) Discuss the potential for a not well understood
catastrophe; and V. Errors
B. Tightness A. Inadequate experience
(2) Describe the proper
1. tight B. Unfamiliarity with
responses and actions to a
catastrophe. a. leaves no room for error equipment
OUTLINE: 2. loose coupling C. Inadequate
I. Incidence of perfusion a. margin of error between communication
accidents coupling D. Haste
II. Causes of accidents IV. Cardiopulmonary bypass E. Distraction
A. Device A. Personnel F. Lack of vigilance
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 14

15. Methods (Cont’d)
Laboratory ER
ICU
Radiology
S.Hub Hub
Maintenance OR
BACKUP SERVER FILE SERVER
Kitchen ADT – Reservation
Inventory
Pharmacy
Purchasing Accounting In Patient
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, Clinics
O P MBA 15

16. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Inclusion & Exclusion Criteria
Inclusion
Positive Exclusion
Negative
Physician perfusionists (PP) Perfusion supervisors
Nonphysician perfusionist Perfusion nursing assistants.
(NPP).
Methods (Cont’d)
Participants and Randomization
Out of 53 eligible perfusionists, 21 volunteered, were consented,
and were randomly assigned to the intervention (Group I) or
control (Group II) .
N.B.: Randomization was performed by work team, not individually
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 16

17. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
PATIENT POPULATION (Flow diagram # 41 )
53 42 41
w/ w
20 21
6 -20 mon µ Age: 36±20.63 yr. µ Age: 35.96±8.53 yr
(Ø 14)
/ ratio (16/4) / ratio (14/7)
Schulz, K. F, Altman, D.G.& Moher, D. BMJ 2010;340:c332
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 17

18. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Methods (Cont’d)
Course Content and Administration
Objective Structured Clinical Examination (OSCEs) is a form of
performance-based testing used to measure candidates’ clinical
competence.
During an OSCE, candidates are observed and
evaluated as they go through a series of stations
in which they treat critical perfusion situations
with some type of medical problem.
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 18

19. Does The Medschool Need An EC Science
Program or A Perfusion Technoschool
Subjective & Objective Evaluation (Measures & Endpoints)
Subjective
Positive Objective
Positive
Questionnaire: 5-station (OSCE)
Background (education, age,
work environment),
Emotional awareness
Satisfaction with the course
To assess participant
characteristics and self-efficacy
( confidence scale* & extent of
difficulty scale**)
Davis Interpersonal Reactivity Index***
(perspective-taking and empathic concern) To assess perfusion performance
*Parle M, MacGuire P, and Heaven C. Soc Sci Med 1997;44:231–40.
**Arranz P, Ulla S, et al., Patient Educ Couns 2005;56:233–9.
***Davis MH, Empathy: A social psychological approach. Boulder, Co: Press; 1996
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20. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Objective Evaluation (Measures & Endpoints)
Objective
Positive Objective
Positive
The OSCE exam is an assessment of 5-station (OSCE)
clinical knowledge, skills, and attitude.
The critical perfusion skills you
demonstrate and the process you go
through in obtaining a diagnosis or
preventing are more important than To
determining a management. assess
What are the communication performance
Critical Perfusion
Skills that will be
assessed in OSCEs?
*
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21. 3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 21

22. Does The Medschool Need An EC Science Program
or A Perfusion Techschool
Baseline Characteristics of Perfusionists
Participants (#41)
25
20
15
10
5
0
Group I Intervention (# 20) Group II Control (# 21)
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23. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Self-Efficacy Results
100
80
60
40
20
0
Composite scale Confidence scale Difficulty scale
Group I (Intervention (S/P µ, 95% CI) Group II (Control) (S/P µ, 95% CI)
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 23

24. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Friedl R. et al.; Ann Thorac Surg 2006;81:1760-1766
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25. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
The psychometric evaluation with HILVE
Friedl R. et al.; Ann Thorac Surg 2006;82:1790-1795
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 25

26. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Results for performance on OSCE post-test
3.5
3
2.5
2
1.5
1
0.5
0
Overall score Solving Awareness and Listening
feelings
Group I Intervention (# 20) Group II Control (# 21)
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28. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Pros and cons of the study
Pro Cons
1. The choice between developing a 1. The study numbers were SMALL.
local training versus the tailoring of 2. The rating scale, used for coding
an existing national course should videotaped performance, was NEW.
3. The congruence between the
be weighed carefully.
conceptual model, the actual course,
2. While self-efficacy is an important and the rating scale was consciously
predictor of positive behavior sought but MODESTLY ACHIEVED.
change, it does not operate in 4. The amount of training time was
isolation from other environmental SHORT for the breadth of skills.
and reinforcing factors. 5. The study did NOT include F/U
measurements beyond the post-test
evaluations
Conclusion
In this randomized controlled evaluation of a course to improve perfuionists’ handling of difficult
perfusion situations, intervention perfusionists improved significantly both self-efficacy &
performance compared to control perfusionists.
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 28

29. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 29

30. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Conclusion Advantages
Headline
A short perfusion skills course
for perfusionists on handling
difficult perfusion situations
achieved significant
improvements in self-efficacy &
Critical Perfusion performance.
Skills Course .
Drawbacks
Non.
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31. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
EC Science Program Perfusion Technoschool
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32. Does The Medschool Need An EC Science Program
or A Perfusion Technoschool
Ezzeldin A. Mostafa, MD, PhD, MBA
3/18/2012 Ezzeldin A. Mostafa, MD, PhD, MBA 32