• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
SIMULATION IN MEDICAL EDUCATION Professor Harry Owen
 

SIMULATION IN MEDICAL EDUCATION Professor Harry Owen

on

  • 2,404 views

 

Statistics

Views

Total Views
2,404
Views on SlideShare
2,399
Embed Views
5

Actions

Likes
1
Downloads
86
Comments
0

1 Embed 5

http://careerportfolio.mb.ca 5

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    SIMULATION IN MEDICAL EDUCATION Professor Harry Owen SIMULATION IN MEDICAL EDUCATION Professor Harry Owen Presentation Transcript

    • SIMULATION IN MEDICAL EDUCATION Professor Harry Owen and Val Follows Flinders University School of Medicine [email_address]
    • Simulation in Medical Education
      • Simulation technologies used in Medical Education in Australia, the US and Europe
      • Setting up the Flinders University Medical School Clinical Skills and Simulation Unit
      • Fundamentals of high-fidelity simulation
      • Where do we go from here? Some observations on the future of simulation
    • Who’s who in medical education
      • Basic medical education
        • Medical students
      • Pre-vocational medical education
        • Interns, RMOs, PGY 1&2
      • Specialist training (discipline-based)
        • Registrars/Senior registrars/Fellows
      • Specialists and GPs (life-long learning)
        • CME, MOPS, IRM, etc
      • Teachers and trainers
    • Adelaide South Australia 1 1 2 1 (1) (1)
    • Source: Jones A (BMSC)
    • Simulation centres 2 20 9 5 25 10 195 6 11 2 10 2
    • Publications on ‘patient simulation’ in clinical care Year
    • Simulation technologies used in medical education
      • Computer-based simulations (micro-worlds, micro-simulation)
      • Virtual environments +/- haptics
      • Part-task trainers
      • Low-fidelity simulators/manikins
      • Simulated or standardised patients
      • Hybrid simulations
      • High-fidelity (full mission) simulation
    • Knowledge/Skills/Attitudes
      • Individual psychomotor skills
      • Appropriate application of skills
      • Communication / Team performance / Leadership skills (CRM)
      • Supervision/teaching
      • Assessment
    • Knowledge/Skills/Attitudes
      • Teaching best practice
        • learner centred
        • appropriate use of technology
      • Assessment best practice
        • Valid and reliable
        • Reproducible
    • The Flinders Clinical Skills and Simulation Unit
      • Grew from a project to improve airway management teaching to medical students
      • Value to teaching other health professionals and other skills recognised
      • Funding generated from teaching outside the medical school
    • Endotracheal intubation
      • Learnt on patients under anaesthesia
      • No special consent
      • Duty of care to protect patient from harm
      • Increased risk when performed by a student or trainee
    • Endotracheal intubation
      • ETI needed by many health professionals, including anesthesiologists, paramedics/EMTs, rural GPs, emergency physicians, ICU staff, respiratory therapists, etc.
      • Competence requires practise
      • Animals
        • Small, e.g. cats
        • Large, e.g. dogs or monkeys
      • Unconscious patients
        • In the OR
        • In ICU
      • Newly dead/recently deceased
      • Cadavers
      • Simulators
      When and how should ETI be taught?
    • The learning environment
      • Quiet, few distractors
      • Clinical equipment
      • Expert tutors
      • Realistic models
      • Many different models
        • Easy  difficult  very difficult
    • CPR Prompt ® (Compliant) Little Anne™ (Laerdal) CPR Pal ® (Ambu) Basic Buddy™ (Lifeform) Economy Saniman ® (Nasco) Adult A-A Female ® (Nasco) Fat Old Fred ® (Lifeform) David/Adam ® (Nasco) Actar D-Fib ® (Armstrong)
    • The Flinders Clinical Skills and Simulation Unit
      • Computer-based Teaching
        • ResusSim
        • CathSim
        • PA simulator
        • ECG
        • Local anaesthesia
      • Part-task trainers
        • BLS & ALS
        • IVI & CVC
        • Trauma
        • Adult
        • Gynae & Obstetric
        • Neonatal
        • Premature (28wks)
        • Paediatric (age range)
    • The Flinders Clinical Skills and Simulation Unit
      • Several whole body manikins including:
        • ResusciBaby
        • ALS baby
        • ResusciAnne with SkillReporter
        • Mr Hurt
        • Nursing Anne
        • Megacode Kid
        • etc
      • SimMan UPS
        • Postoperative care modules
        • Trauma modules
        • Severe Trauma modules
        • Local produced dental trauma modules
    • Anatomy of a simulation (1)
      • Components
      • Student/trainee/ health professional
      • Procedure/task/skill/test/ treatment or equipment
      • Patient and/or disease process
      • Trainer/supervisor
    • Anatomy of a simulation (2)
      • Function of components
      • Passive
        • Enhance setting for realism
      • Active
        • Change in a programmed way
      • Interactive
        • Responds to action or event
      • Trainees learning cricothyrotomy on a part-task trainer
      • (Note educational aids in background)
      • Trainee performing an emergency cricothyrotomy in a full-mission simulation.
      • (Note more realistic setting)
    • High fidelity simulation (1)
      • Determine educational needs and choose most efficient and effective
      • Need to balance resource availability and student demand
      • May need to ‘promote’ low-tech solutions
    • High fidelity simulation (2)
      • Confirm teaching goals can be achieved using simulation
      • Develop scenario, acquire equipment needed and prepare associated materials
      • Test and validate the simulation
    • Options for running simulations
      • Free-form
        • Easy but poor learning
      • ‘On the fly’
        • Scripted but intensive for the ‘controller’ and some variables may appear discontinuous
      • Programmed trends
        • More sophisticated simulations possible
      • Trends and event handlers
        • Facilitates high-fidelity simulation with most realistic response to interventions
    • Resources needed
      • Equipment:
        • Simulators, monitors, defibrillator, trolleys, etc
      • Disposables:
        • Appropriate for scenario, setting and participants, re-use w/o compromising fidelity
      • Faculty:
        • Trained, available, practised
      • Support staff:
        • Technician/bio-medical engineer essential!
    • Before and after simulations...
      • Set-up scenario
        • eg. make blood, set up area, X-rays, notes, etc
      • Load simulation program
      • Check everything works
        • Cameras, VCR, communicators
      • Afterwards...
      • Check simulator (replace or repair parts)
      • Clean everything used and put away
      • Replace/reorder all used items
    • High fidelity simulation (3)
      • Allow time for briefing and familiarisation with the patient simulator and equipment
      • Brief participants on:
        • Broad objectives
        • The scenario
        • How to get help
    • High fidelity simulation (4)
      • Always follow the script but...
      … have alternative outcomes planned and rehearsed Simulation control room
    • High fidelity simulation (5)
      • Using simulation situations can be re-run to explore outcome with different treatments
      Mission critical tasks can be performed by learners without putting patients at risk
    • High fidelity simulation (6)
      • Facilitated debriefing with an expert practitioner. Participants reflect on their own performance and discuss this with the group
    • How we use the SimMan UPS
      • Anaesthesia
      • Emergency medicine
      • Family Medicine/GP
      • CCU/ICU
      • Trauma/retrievals
      • Paramedics/EMT
      • Specialist nurses
      • Medical Imaging
      • Paediatrics
      • Rural health workers
      • Sim Centre settings
        • OR, PACU, ER, Imaging suite, post-op ward, clinic, aircraft, ambulance, home, roadside, terrorist incident, etc
      • Outreach settings
        • Regional hospitals, rural settings, etc
    • Medicine: A High-Risk Industry
      • Harvard Medical Practice Study (1991) identified a ‘serious error’ rate of 3.7%
        • (serious error leads to prolonged hospital stay or disability)
      • Vincent (2001) NHS ~11% error rate with 50% preventable
        • ~50,000 patients pa die from medical error or accident. Litigation cost £44billion
      • Australian data - adverse event rate of ~17%
    • Successful strategies for crisis management:
      • Use of written checklists to help prevent crises
      • Use of established procedures in responding to crises
      • Training in decision making and resource co-ordination
      • Systematic practise in handling crises including part-task trainers and full-mission realistic simulation
    • The future of simulation...
      • Skills training tool for all disciplines
        • Acute care
        • Try new techniques and/or equipment
        • Patient safety initiatives
        • Retraining
      • Multi-disciplinary training
        • inter-professional communication
        • team performance
      • Training in decision-making/resource co-ordination
    • Simulation technologies used in medical education
      • Computer-based simulations (micro-worlds, micro-simulation)
      • Virtual environments +/- haptics
      • Part-task trainers
      • Low-fidelity simulators/manikins
      • Simulated or standardised patients
      • Hybrid simulations
      • High-fidelity (full mission) simulation
    • Simulation research must address healthcare training needs
      • Improved outcomes
        • Fewer adverse events, fewer preventable incidents, fewer ‘near miss’ events
      • Increased efficiency of training
        • Improved outcomes in same or (preferably) less training time
      • Improved use of resources
        • Fewer failures, more efficient training, quicker performance