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  • Settled 1670
  • This is key to what you will see
  • There are hundreds of possible controls selections and just adjusting vital signs for a modern monitor is tough to do in real time
  • NOTE:With a scenario, the menu either serves to advance the scenario or document an action that is coupled to an evaluation point. The simulator has multiple sensors that in a scenario do the same thing. THEREFORE the number of actions a facilitator has to perform at any one time is manageable with practice (2-6 practice runs). Also the intuitiveness of running a scenario is enhanced when the menus are well organized and use terminology matched to the teachers that will be running it (i.e. Nursing--- NLN , Anesthesia –LMA.
  • Note:1) In this scenario when the anesthetic is started, 1 action by the facilitator cues complicated physiology that in the manual mode would be very tough to emulate on the fly AND a specific pattern of airway obstruction is triggered
  • Note:1) Embedding this standard info. Into the scenario makes for less “stuff” needed to support it (paper, electronic files etc) And2) Less things you have to train a facilitator to do.
  • Note:Embedding diagnostic info. Into the scenario can increase the critical fidelity of the training encounter (stuff critical to training/testing clinical judgment).Embedding also has the benefit of decreasing the work load of setting up/running/training people to use the scenario.
  • Note:Using embedded/automated multimedia this way is a critical step to addressing the fidelity short comings of existing simulators to flexibly add important clinical signs and symptoms.Embedding also has the benefit of decreasing the work load of setting up/running/training people to reliably otherwise cue/create clinical signs and symptoms simulators can’t do.This helps to standardize potentially critical elements of “high stakes” evaluation or research.This may be a reasonable compromise between the trade-offs of expensive hardware additions to simulators and fidelity.Currently this allows tremendous flexibility in creating ranges of scenarios to meet a wide array of stake holders training variability.
  • Note : these cues can be used in different ways:---cue timing ---provide real time feedback of correct & incorrect performance issuesTHIS helps to support standardization which a) improves the quality and reproducibility of a learning objective and b) lowers the training threshold of the facilitator (there are less things to remember or script).
  • -Embedding has the benefit of decreasing the work load of setting up/running/training people to use the scenario.-Doing it this way decreases Admin. Support and Sim specialists workload.-All the above impacts scenario quality assurance.-Simplifies the process of collaboration.-Can print this out from the Monitor for a hard copy.
  • Ford assembly line was the standardization key to practical automobile production,Educational objective based scenario design with semi-automated driven reflection process has been our key to “mass”, “practical” healthcare simulationWith this approach we have taken groups that had little experience and now do thousands of simulations/yearThe future focus is further automation of the data to more easily create/communicate value statements
  • Video: PedsResc Demo2.wmv
  • Video: Nursing Med Admin Demo.wmv
  • Video: SIRE Demo 2.wmv
  • Video: ACLS IPhone App Demo.wmv
  • Video: PedsResc Demo2.wmv
  • Video: Golden Hr Demo.wmv
  • Video: Sawbones Demo.wmv
  • This is key to what you will see
  • Transcript

    • 1. Practical Simulation: Key Principles & Methodologies:
      “—making the rubber meet the road”
      by John J. Schaefer, III, MD,
      Professor Anesthesia and Perioperative Medicine Assistant Dean MUSC College of Medicine,
      Lewis Blackman Endowed Chair
      South Director: HealthCare Simulation of South Carolina email: schaefer@musc.edu
    • 2. Charleston, SC and the Medical University of South Carolina
    • 3. Established 1824
      Colleges Medicine, Nursing, Dentistry, Pharmacy, Health Professions
      MUSC Medical Center is comprised of four separate hospitals (the University Hospital, the Institute of Psychiatry, the Children's Hospital, and the Ashley River Tower).
      The Medical Center includes centers for specialized care (Heart Center, Transplantation Center, Hollings Cancer Center, Digestive Diseases Center).
    • 4.
    • 5. Objectives:“Practical Simulation Methods in HealthCare Education”
      Practical Simulation Defined
      Why “Practical Simulation” is critical to your success
      The operational concept to achieve it
      Practical Simulation Demonstrations across range of “Simulation types”
      Task training: NG tube objective assessment (interactive demo)
      Task Training: Orthopedic Surgery (video demo)
      Student run multi-simulator, single instructor interactive demo
      Individual assessment----Nursing student med administration (video demo)
      Individual assessment----Pediatric Resident NRP Individual assessment (video demo)
      Team Training:
      Team Leader Focus: Pediatric ER emergencies (video demo)
      Interdisciplinary Focus: SIRE (video demo)
      Specialty Team Focus: Neonatal LBW Team (video demo)
      Research using Simulation
      Summary
    • 6. Objectives:“Practical Simulation Methods in HealthCare Education”
      Practical Simulation Defined
      Why “Practical Simulation” is critical to your success
      The operational concept to achieve it
      Practical Simulation Demonstrations across range of “Simulation types”
      Task training: NG tube objective assessment (interactive demo)
      Task Training: Orthopedic Surgery (video demo)
      Student run multi-simulator, single instructor interactive demo
      Individual assessment----Nursing student med administration (video demo)
      Individual assessment----Pediatric Resident NRP Individual assessment (video demo)
      Team Training:
      Team Leader Focus: Pediatric ER emergencies (video demo)
      Interdisciplinary Focus: SIRE (video demo)
      Specialty Team Focus: Neonatal LBW Team (video demo)
      Summary
    • 7. Practical Simulation Pyramid of Success
      Communicate Value
      Establish Value
      Create/Deliver Quality Courses
      Create a Functional Center/Lab
      Focus will be on simulation methodology critical to achieving success!
      Develop a Realistic Plan
    • 8. What is meant by “practical” simulation in Healthcare?
      Simulation as a teaching methodology that takes advantage of simulator tools where diverse and large numbers of Healthcare students and practitioners have individual and group access to training.
      Healthcare teachers with reasonable training can adopt simulation training methodologies rapidly.
      The “value” of using simulation justifies the capital, operating and indirect costs associated with it.
    • 9. Objectives:“Practical Simulation Methods in HealthCare Education”
      Practical Simulation Defined
      Why “Practical Simulation” is critical to your success
      The operational concept to achieve it
      Practical Simulation Demonstrations across range of “Simulation types”
      Task training: NG tube objective assessment (interactive demo)
      Task Training: Orthopedic Surgery (video demo)
      Student run multi-simulator, single instructor interactive demo
      Individual assessment----Nursing student med administration (video demo)
      Individual assessment----Pediatric Resident NRP Individual assessment (video demo)
      Team Training:
      Team Leader Focus: Pediatric ER emergencies (video demo)
      Interdisciplinary Focus: SIRE (video demo)
      Specialty Team Focus: Neonatal LBW Team (video demo)
      Research using Simulation
      Summary
    • 10. MUSC Healthcare Simulation Center
      11,000 sq ft training space, 15 available training rms.
      Stake holders: All Colleges & Medical Center
      Opened June 2008
      Activities 2008-09:
      70 course
      9,000 student encounters
      6,000 full scale simulations
      2,000 task trainer simulations
      70 faculty involved in simulation
      Focus will be on simulation methodology critical to achieving success!
    • 11. Simulation Center Capital Costs Example:
      Large Center:
      Size: 11,000 sq ft facility
      Capital Costs:
      Renovation ~ $1,566,353
      Simulation equip. ~ $810,000
      AV equipment ~ $300,638
      Computers ~ $206,500
      Other ~ $25,000
      Total: ~ $2,908,491
      Average capital cost / sq. ft ~ $250
    • 12. Simulation Center Costs/yr. Examples:
      Large Center:
      Staff: 30% Med. Director, 2 Admin., 2 Sim., Spec., 1 IT
      Operational Costs:
      Salaries ~ $303,027
      Rent ~ $208,847
      Other ~ $61,250
      subtotal: ~ $573,124
      Recapitalization Costs: ~$117,250
      Total Costs per year: ~$690,374
    • 13. Typical busy week’s schedule
      Focus will be on simulation methodology critical to achieving success!
    • 14. Advocacy vs. Value based funding:
      Advocacy based funding:
      “The concept seems valuable-- so I’ll pay”
      Generates “enthusiasm” but is harder to translate into $
      Difficult to sustain
      “Fickle/Vulnerable” to change
      Value based funding:
      “The results of training—are valuable--- so I’ll pay”
      “The training cost $ you save us is worth what we pay you--- so I’ll pay”
      “The malpractice cost $ you save us is worth what we pay you--- so I’ll pay”
      Focus will be on simulation methodology critical to achieving value!
    • 15. Value Model (which is the basis of what a stakeholder is paying for):
      Value from the viewpoint of those funding medical simulation commonly falls into at least four forms:
      Utilization:
      • # students trained
      • 16. # courses delivered
      • 17. # faculty involved
      Measured Educational Value:
      • Subjective evaluations
      • 18. Objective evaluations
      • 19. Peer reviewed publications
      • 20. Non-peer reviewed publications
      • 21. Grant dollars generated
      Financial Educational Value:
      • Indirect dollar savings (Malpractice Costs)
      • 22. Direct dollar generation or savings (Save direct training dollars)
      Public Relations Value:
    • Communicate Value (to Stakeholders)
    • 26. Objectives:“Practical Simulation Methods in HealthCare Education”
      Practical Simulation Defined
      Why “Practical Simulation” is critical to your success
      The operational concept to achieve it
      Practical Simulation Demonstrations across range of “Simulation types”
      Task training: NG tube objective assessment (interactive demo)
      Task Training: Orthopedic Surgery (video demo)
      Student run multi-simulator, single instructor interactive demo
      Individual assessment----Nursing student med administration (video demo)
      Individual assessment----Pediatric Resident NRP Individual assessment (video demo)
      Team Training:
      Team Leader Focus: Pediatric ER emergencies (video demo)
      Interdisciplinary Focus: SIRE (video demo)
      Specialty Team Focus: Neonatal LBW Team (video demo)
      Research using Simulation
      Summary
    • 27. Competent Facilitator
      (runs own simulator)
      Lower cost per student
      Student self training
      or 1 facilitator with
      multiple sim. activities
      Low cost
      Range of HealthCare Simulation Operational Use:
      This is what we have been doing since 2002---
      Most Users are here---
      We do some of this now too--
      Expert Instructor,
      Expert Simulator Operator
      High Costs per student
      Complexity of operating simulator & Teaching
      Utilization of Simulation-based Education Methods
    • 28. Current “Expert” Instructor/Sim Operator approach
      Expert Curriculum/Scenario, Competent Facilitator Model
      Expert Instructor
      Expert Sim. Operator
      Competent Facilitator
      Competent Facilitator
      Competent Facilitator
      Practical Simulation
      • Simulator predominantly in manual mode or scenario (3G) is modified on the fly
      • 29. Limited “Objective” educational outcomes
      • 30. Utilization is severely limited by limited # of “Expert” Instructors and “Expert” simulator operators
      • 31. Simulator only running a scenario with a specific set of objectives with grading and feedback
      • 32. Extensive “Objective” educational outcomes
      • 33. Utilization is significantly increased because competent Facilitator training threshold is lowered
      Small grp. exercises
    • 34. And in some cases
      Competent Supervisor
      • Simulator only running a scenario with a specific set of objectives with grading and feedback and operated by trainees
      • 35. Extensive “Objective” educational outcomes
      • 36. Utilization is maximized because complexity of operation threshold is lowered to the point that trainees can learn to run a scenario in minutes.
      Student independent learning
      Student independent learning
      Student independent learning
      Student independent learning
      Note: until this level is achieved, using simulation requires more “Instructors” than traditional educational methods though many believe simulation decreases the need.
    • 37. What does not work well--
      Manually adjusting the simulator “on the fly” to create a case that tracks with training objectives can only be done by a highly trained operator (even with a script).
      Simultaneous paper and pencil or electronic evaluation with some type of evaluation form while you are also running a simulator (this requires concentration) is generally impractical.
      “Non-structured Debriefing”. While some people have been formally trained as educators, most Healthcare providers that teach are not.
    • 38. With “manual” operation of the simulator, you have to teach a teacher to competently run this GUI with enough expertise to create “Human Reactions” in real time while watching the trainees:
    • 39. What does work pretty well--
      Pre-course participant preparation through studying online curricula based on “adult learning” principles.
      With just about any simulation training exercise, the facilitator has immediately available well designed curricula to support standardization (usually web-based) with less time in training of the trainer.
      The simulation exercise uses a well designed, pre-programmed simulation scenario run by the facilitator (teacher). This scenario incorporates semi-automated evaluation of key educational objectives embedded in the scenario that are automatically flagged for focused feedback specific to the individual or group’s performance and additionally supports standardization of the whole evaluation/feedback process.
      The facilitator then uses this debriefing file as a preliminary educational diagnosis that when coupled with a standardized “reflection” process leads to a focused, standardized (yet individually specific) learning encounter with the student.
    • 40. With a well programmed scenario, a teacher (or student) only has to accurately run this-
      Bag-Mask competency skill scenario
      BP assessment practice skill scenario
      Nursing Critical Care Assessment Training scenario
      Anesthesia Difficult Airway Management Competency scenario
      LMA skill competency scenario
      Nursing Med Surg Training scenario
      Trauma Assessment Demo scenario
    • 41. With a well programmed scenario, physiology, pathophysiology, pharmacodynamics, seizures, airway obstruction, etc. are pre-programmed
      With selection of “Standard induction of general anesthesia”, apnea, airway obstruction, hypoxic physiology automatically occur
    • 42. Multimedia can be embedded in a programmed scenario to:
      Present simulation “case stem”
    • 43. Multimedia can be embedded in a programmed scenario to:
      Diagnostic information: labs, EKGs, X-rays, videos—ECHO, ultrasounds
      Choosing a menu item here returns a set of Physician orders on the monitor
    • 44. Multimedia can be embedded in a programmed scenario to:
      Clinical signs & symptoms (as a picture, sound, movie or document that is presented on the monitor) that the actual simulator can’t otherwise emulate.
    • 45. Multimedia can be embedded in a programmed scenario to:
      Standardized debriefing cues during the simulation that automatically appear on the monitor.
    • 46. Multimedia can be embedded in a programmed scenario to:
      Scenario support info.: i.e. equipment list, equipment layout & QA, instructions, etc.
    • 47. Nursing Aspiration Prevention & Rx”Semi-Automated, Standardized Guide for“Diagnostic Educational Objectives based Reflection”
    • 48. Well designed/programmed scenarios that are simple to run coupled with“Semi-Automated Objective Driven Reflection Process”


    • 49. Objectives:“Practical Simulation Methods in HealthCare Education”
      Practical Simulation Defined
      Why “Practical Simulation” is critical to your success
      The operational concept to achieve it
      Practical Simulation Demonstrations across range of “Simulation types”
      Task training: NG tube objective assessment (interactive demo)
      Task Training: Orthopedic Surgery (video demo)
      Student run multi-simulator, single instructor interactive demo
      Individual assessment----Nursing student med administration (video demo)
      Individual assessment----Pediatric Resident NRP Individual assessment (video demo)
      Team Training:
      Team Leader Focus: Pediatric ER emergencies (video demo)
      Interdisciplinary Focus: SIRE (video demo)
      Specialty Team Focus: Neonatal LBW Team (video demo)
      Research using Simulation
      Summary
    • 50. Task training: NG tube objective assessment (interactive demo)
    • 51. Good “Theater” does not equal “Learning”!
      =
    • 52. Task training: NG tube objective assessment (interactive demo)
    • 53. Task training: NG tube objective assessment (interactive demo)
      Key Points to observe:
      Using SimMan or SimBaby or VitalSim Advanced software with a “dumb” task trainer to enhance simulation
      Specific educational objectives driven
      Simplified menus
      Use of multimedia to support standardization
      Debriefing log documents performance of specific educational objectives
      Performance is automatically scored!
    • 54. Lets do it---
      Need a volunteer to run scenario (familiar with a nasogastric tube)
      Minimal experience with SimMan
      NOTE: I will be the
    • 55. Vital Signs Training
      Competent Supervisor
      Student independent learning
      Student independent learning
      Student independent learning
      Student independent learning
    • 56. Vital Signs Training
      ALS (Vital Sim Advanced) & SimMan Simulators
      1 student runs simulator, 1 student measures RR, 1 student measures HR, 1 student measures BP then switch & practice again, & again---etc.
      Call facilitator for help as needed, when confident take summative version.
    • 57. Student run multi-simulator, single instructor interactive demo
      Competent Supervisor
      • Simulator only running a scenario with a specific set of objectives with grading and feedback and operated by trainees
      • 58. Extensive “Objective” educational outcomes
      • 59. Utilization is maximized because complexity of operation threshold is lowered to the point that trainees can learn to run a scenario in minutes.
      Student independent learning
      Student independent learning
      Student independent learning
      Student independent learning
      Note: until this level is achieved, using simulation requires more “Instructors” than traditional educational methods though many believe simulation decreases the need.
    • 60. Student run multi-simulator, single instructor interactive demo
      Key Points
      Specific educational objectives driven
      Simplified menus
      Use of multimedia to support standardization
      Performance is automatically scored and shows on monitor!
      Debriefing log documents performance of specific educational objectives
    • 61. Lets do it---
      Need 8 volunteers to run scenario (familiar with measuring HR, BP, RR)
      Minimal experience with SimMan
    • 62. Practical Model used in following examples:
      Expert Curriculum/Scenario, Competent Facilitator Model
      Competent Facilitator
      • Simulator only running a scenario with a specific set of objectives with grading and feedback
      • 63. Extensive “Objective” educational outcomes
      • 64. Utilization is significantly increased because competent Facilitator training threshold is lowered
    • Team Leader Focus: Pediatric ER emergencies (video demo)
    • 65. Individual assessment----Nursing student med administration (video demo)
    • 66. Interdisciplinary Focus: SIRE (video demo)
    • 67. Research using Simulation
    • 68. Individual assessment----Pediatric Resident NRP Individual assessment (video demo)
    • 69. Specialty Team Focus: Neonatal LBW Team (video demo)
    • 70. Task Training: Orthopedic Surgery (video demo)
    • 71. Objectives:“Practical Simulation Methods in HealthCare Education”
      Practical Simulation Defined
      Why “Practical Simulation” is critical to your success
      The operational concept to achieve it
      Practical Simulation Demonstrations across range of “Simulation types”
      Task training: NG tube objective assessment (interactive demo)
      Task Training: Orthopedic Surgery (video demo)
      Student run multi-simulator, single instructor interactive demo
      Individual assessment----Nursing student med administration (video demo)
      Individual assessment----Pediatric Resident NRP Individual assessment (video demo)
      Team Training:
      Team Leader Focus: Pediatric ER emergencies (video demo)
      Interdisciplinary Focus: SIRE (video demo)
      Specialty Team Focus: Neonatal LBW Team (video demo)
      Research using Simulation
      Summary
    • 72. Competent Facilitator
      (runs own simulator)
      Lower cost per student
      Student self training
      or 1 facilitator with
      multiple sim. activities
      Low cost
      Range of HealthCare Simulation Operational Use:
      Focus on the methods to work in towards this quadrant
      Expert Instructor,
      Expert Simulator Operator
      High Costs per student
      Complexity of operating simulator & Teaching
      Utilization of Simulation-based Education Methods
    • 73. Specific Focus Areas:
      Focus on complex scenarios that run simply
      Take advantage of multimedia fx. to support simplification & standardization
      Whatever grading paradigm you prefer, maximize the opportunity for simplification & value through automation
      Focus on designing intuitive menus
      It’s all about removing barriers & creating value statements at the individual & stakeholder level
    • 74. Hope this was inspiring---

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