High fidelity simulation for healthcare education iii

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High fidelity simulation for healthcare education iii

  1. 1. High Fidelity Simulation for Healthcare Education.Time to move forward?<br />Helen Wood<br />Nursing Education Specialist<br />Mayo Clinic Health Systems<br />Rochester <br />Minnesota<br />
  2. 2. Current Situation<br />A movement toward making simulations a part of the clinical practicum, either as a clinical substitute or as an adjunct.<br />Movement arises out of need for:<br /><ul><li>More clinical sites
  3. 3. More nurse educators
  4. 4. New clinical practice models to prepare 21st century graduates in high-tech, complex environments</li></li></ul><li>Simulation Training Effectiveness<br />40 years of empirical research<br />Thousands of research reports<br />Education and health services research<br />Five comprehensive reviews<br />Simulation based medical education is a powerful educational intervention and innovation to increase medical learner competence measured in the learning laboratory, during patient care delivery, and improves patient health outcomes measured quantitatively (Farfel, Hardoff, Afek, & Ziv, 2010)<br />
  5. 5. Towards Hypothesis Driven Medical Education Research: Task Force Report From the Millennium Conference 2007 on Educational Research<br />Could simulated emergency procedures practiced in a static<br />environment improve the clinical performance of a Critical Care<br />Air Support Team (CCAST)?:<br />CONCLUSION: <br /> For CCASTs to have a standardized training curriculum, they should undertake real-time missions in a flight simulator, supported by a human patient simulator programmed to respond to the physiological changes associated with altitude. Real scenarios could then be practiced, on demand, in a safe environment as an augmentation to the current training program. Consequently, those acquired skills could then be carried out with improved proficiency during real missions with a concomitant potential for improvement in the standard of patient care<br />
  6. 6. Challenges to consider when diffusing SBME (simulation based medical education) into medical education.<br />The right conditions:<br />Mastery Learning and deliberate practice<br />Skillful Faculty<br />Curriculum Integration<br />Institutional Endorsement<br />Healthcare System Acceptance<br />
  7. 7. Summit on Simulation Research<br />Institute of Medicine studies/reports (1999 - 2003)<br />strongly suggest that the traditional apprentice <br />model” has not sufficiently prepared today’s health<br />care providers.<br />For example medical errors:<br />Result in 44,000-98,000 deaths annually<br />8th leading cause of death (at 44,000)<br />$37-50 billion for adverse events<br />$17-29 billion for preventable adverse events<br />
  8. 8. How does healthcare simulation work and what is it?<br />http://youtu.be/I_NEsLXtuwI<br />
  9. 9. Issenberg SB, McGaghie WC, Petrusa ER, et al. Eeatures and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10-28.<br />McGaghie WC, Issenberg SB, Petrusa ER, et al. Effect of practice on standardised learning outcomes in simulation-based medical education. Med Educ 2006;<br />40: 792-797.<br />
  10. 10. Elements of Diffusion<br />There are four elements of diffusion <br />(Rogers, 2003)<br />AN INNOVATION<br />COMMUNICATION <br />TIME<br /> A SOCIAL SYSTEM.<br />
  11. 11.
  12. 12.
  13. 13. INNOVATIVENESS AND ADOPTER CATEGORIES<br /><ul><li>INNOVATIVENESS IS THE DEGREE TO WHICH AN INDIVIDUAL OR</li></ul>OTHER UNIT OF ADOPTION IS RELA-TIVELY EARLIER IN<br />ADOPTING NEW IDEAS THAN THE OTHER MEMBERS OF A<br />SYSTEM.<br /><ul><li>ADOPTER CATEGORIES ARE THE CLASSIFICATIONS OF</li></ul>MEMBERS OF A SOCIAL SYSTEM ON THE BASIS OF<br />INNOVATIVENESS.<br /><ul><li>THE FIVE ADOPTER CATEGORIES ARE:
  14. 14. 1. INNOVATORS
  15. 15. 2. EARLY ADOPTERS
  16. 16. 3. EARLY MAJORITY
  17. 17. 4. LATE MAJORITY
  18. 18. 5. LAGGARDS</li></li></ul><li>
  19. 19. The Origins of Simulation in Nursing Education<br />During the past decade, the use of simulations as a teaching-learning intervention in nursing curricula has increased greatly. <br />Nursing students, clinicians, and educators alike appear to be strongly in agreement about the importance of incorporating simulations as a teaching practice because of several factors<br />
  20. 20. CHARACTERISTICS OF INNOVATIONS<br /><ul><li>Relative advantage (in economic terms, social prestige factors, convenience, satisfaction).
  21. 21. Compatibility ( the degree to which an innovation is perceived as being consistent with the existing values, past experiences, and needs of potential adopters)
  22. 22. Complexity ( the degree to which an innovation is perceived as difficult to understand and use).
  23. 23. Trialability (the degree to which an innovation may be experimented with on a limited basis)
  24. 24. Observabiltity ( the degree to which the results of an innovation are visible to others).</li></li></ul><li>High Fidelity Simulation Implementation/Adoption Events Timeline<br />Shortridge, A., McPherson, M., Ellison, G. & Kientz, E. (2008). A Case Study Implementing High Fidelity Clinical Skills Education Using Innovation Diffusion Theory. In J. Luca & E. Weippl (Eds.), Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications 2008 (pp. 3054-3062). Chesapeake, VA: AACE.Retrieved from http://www.editlib.org/p/28804<br />
  25. 25. Faculty Observations: High Fidelity Simulation vs. Live Clinical Scenarios<br />Shortridge, A., McPherson, M., Ellison, G. & Kientz, E. (2008). A Case Study<br /> Implementing High Fidelity Clinical Skills Education Using Innovation Diffusion Theory<br />. In J. Luca & E. Weippl (Eds.), Proceedings of World Conference on Educational Multimedia,<br /> Hypermedia and Telecommunications 2008 (pp. 3054-3062). Chesapeake, VA: AACE.Retrieved from http://www.editlib.org/p/28804<br />
  26. 26. Simulation-based education improves proceduralcompetence in central venous catheter (CVC) insertion. The effectof simulation-based education in CVC insertion on the incidenceof catheter-related bloodstream infection (CRBSI) is unknown.The aim of this study was to determine if simulation-based trainingin CVC insertion reduces CRBSI.<br />Simulation-based education improves proceduralcompetence in central venous catheter (CVC) insertion. The effectof simulation-based education in CVC insertion on the incidenceof catheter-related bloodstream infection (CRBSI) is unknown.The aim of this study was to determine if simulation-based trainingin CVC insertion reduces CRBSI.<br />There were fewer CRBSIs after the simulator-trainedresidents entered the intervention ICU (0.50 infections per1000 catheter-days) compared with both the same unit prior tothe intervention (3.20 per 1000 catheter-days) (P = .001)and with another ICU in the same hospital throughout the studyperiod (5.03 per 1000 catheter-days) (P = .001).<br />An educational intervention in CVC insertionsignificantly improved patient outcomes. Simulation-based educationis a valuable adjunct in residency education.<br />Barsuk, J., Cohen, E., Feinglass, J., McGaghie, W., & Wayne, D. (2009). Use of simulation-based education to reduce catheter-related bloodstream infections. Archives of Internal Medicine, 169(15), 1420-1423. doi:10.1001/archinternmed.2009.215<br />
  27. 27. Conclusion<br />“In Situ” Simulation as a Strategy<br />Simulation training conducted on a <br />hospital unit where real patient <br />care is delivered and errors occur<br />Allows clinicians to practice & <br />problem solve patient issues with <br />their team in their “real” work <br />Environment<br />Allows opportunity to uncover and <br />identify latent safety threats and <br />Micro-system deficiencies<br />
  28. 28. The effects of a simulation-driven, patient safety program aimed at improving early detection & treatment of hospital-acquired complications will:<br />PRIMARY OUTCOMES: Decrease<br />Rate of hospital-acquired:<br />Rate of unplanned transfers to higher level of care <br />Risk-adjusted hospital mortality<br />Severe sepsis/septic shock<br />Acute respiratory failure <br />SECONDARY OUTCOMES: Improve: <br />Teamwork performance and communication skills<br />Knowledge, critical thinking and decision-making <br />Safety culture on involved units<br />Nurses’ comfort & confidence in calling for help early<br />Patterns of social interaction among nurses and residents<br />
  29. 29. Summary facts found from Beacon Benchmarking:<br />Success with simulation program largely due to :Buy-in from the CMO & CNO<br />Strong partnerships with Unit Leadership<br />Conducting frequent, in situ simulation exercises: Feasible<br />Not dependent on “fidelity”<br />Participants enjoy in situ simulation training<br />Simulation training reveals deficiencies with teamwork; debriefing offers unique coaching opportunity<br />A simulation-driven patient safety program holds serious opportunity in improving clinical outcomes<br />_ ... <br />
  30. 30. References<br />Barsuk, J., Cohen, E., Feinglass, J., McGaghie, W., & Wayne, D. (2009). Use of simulation-based education to reduce catheter-related bloodstream infections. Archives of Internal Medicine, 169(15), 1420-1423. doi:10.1001/archinternmed.2009.215<br />Cannon-Diehl, M. (2009). Simulation in healthcare and nursing: state of the science. Critical Care Nursing Quarterly, 32(2), 128-136. doi:10.1097/CNQ.0b013e3181a27e0f<br />Eleven Research Priorities developed by the Millennium Conference 2007 Retrieved http://journals.lww.com/academicmedicine/_layouts/oaks.journals/imageview.aspx?k=academicmedicine:2010:05000:00027&i=ttu3a<br />Farfel, A., Hardoff, D., Afek, A., & Ziv, A. (2010). Effect of a simulated patient-based educational program on the quality of medical encounters at military recruitment centers. The Israel Medical Association Journal: IMAJ, 12(8), 455-459. Retrieved from EBSCOhost.<br />Fincher, R., White, C., Huang, G., & Schwartzstein, R. (2010). Toward hypothesis-driven medical education research: task force report from the Millennium Conference 2007 on educational research. Academic Medicine: Journal Of The Association Of American Medical Colleges, 85(5), 821-828. Retrieved from EBSCOhost<br />Gaba, D. (2004). The future vision of simulation in health care. Quality & Safety in Health Care, 13 Suppl 1i2-i10. Retrieved from EBSCOhost<br />Issenberg SB, McGaghie WC, Petrusa ER, et al. Eeatures and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10-28.<br />McGaghie WC, Issenberg SB, Petrusa ER, et al. Effect of practice on standardized learning outcomes in simulation-based medical education. Med Educ 2006; 40: 792-797<br />McGaghie, W., Issenberg, S., Petrusa, E., & Scalese, R. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education, 44(1), 50-63. Retrieved from EBSCOhost .<br />McGaghie, W., Issenberg, S., Petrusa, E., & Scalese, R. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education, 44(1), 50-63. Retrieved from EBSCOhost<br />Towards Hypothesis Driven Medical Education Research: Task Force Report from the Millennium Conference 2007 on Educational Research http://journals.lww.com/academicmedicine/_layouts/oaks.journals/ImageView.aspx?k=academicmedicine:2010:05000:00027&i=TTU3A <br />Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press<br />Shortridge, A., McPherson, M., Ellison, G. & Kientz, E. (2008). A Case Study Implementing High Fidelity Clinical Skills Education Using Innovation Diffusion Theory. In J. Luca & E. Weippl (Eds.), Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications 2008 (pp. 3054-3062). Chesapeake, VA: AACE.Retrieved from http://www.editlib.org/p/28804<br />_ ... <br />

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