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High fidelity simulation for healthcare education iii

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  • 1. High Fidelity Simulation for Healthcare Education.Time to move forward?
    Helen Wood
    Nursing Education Specialist
    Mayo Clinic Health Systems
    Rochester
    Minnesota
  • 2. Current Situation
    A movement toward making simulations a part of the clinical practicum, either as a clinical substitute or as an adjunct.
    Movement arises out of need for:
    • More clinical sites
    • 3. More nurse educators
    • 4. New clinical practice models to prepare 21st century graduates in high-tech, complex environments
  • Simulation Training Effectiveness
    40 years of empirical research
    Thousands of research reports
    Education and health services research
    Five comprehensive reviews
    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)
  • 5. Towards Hypothesis Driven Medical Education Research: Task Force Report From the Millennium Conference 2007 on Educational Research
    Could simulated emergency procedures practiced in a static
    environment improve the clinical performance of a Critical Care
    Air Support Team (CCAST)?:
    CONCLUSION:
    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
  • 6. Challenges to consider when diffusing SBME (simulation based medical education) into medical education.
    The right conditions:
    Mastery Learning and deliberate practice
    Skillful Faculty
    Curriculum Integration
    Institutional Endorsement
    Healthcare System Acceptance
  • 7. Summit on Simulation Research
    Institute of Medicine studies/reports (1999 - 2003)
    strongly suggest that the traditional apprentice
    model” has not sufficiently prepared today’s health
    care providers.
    For example medical errors:
    Result in 44,000-98,000 deaths annually
    8th leading cause of death (at 44,000)
    $37-50 billion for adverse events
    $17-29 billion for preventable adverse events
  • 8. How does healthcare simulation work and what is it?
    http://youtu.be/I_NEsLXtuwI
  • 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.
    McGaghie WC, Issenberg SB, Petrusa ER, et al. Effect of practice on standardised learning outcomes in simulation-based medical education. Med Educ 2006;
    40: 792-797.
  • 10. Elements of Diffusion
    There are four elements of diffusion
    (Rogers, 2003)
    AN INNOVATION
    COMMUNICATION
    TIME
    A SOCIAL SYSTEM.
  • 11.
  • 12.
  • 13. INNOVATIVENESS AND ADOPTER CATEGORIES
    • INNOVATIVENESS IS THE DEGREE TO WHICH AN INDIVIDUAL OR
    OTHER UNIT OF ADOPTION IS RELA-TIVELY EARLIER IN
    ADOPTING NEW IDEAS THAN THE OTHER MEMBERS OF A
    SYSTEM.
    • ADOPTER CATEGORIES ARE THE CLASSIFICATIONS OF
    MEMBERS OF A SOCIAL SYSTEM ON THE BASIS OF
    INNOVATIVENESS.
    • THE FIVE ADOPTER CATEGORIES ARE:
    • 14. 1. INNOVATORS
    • 15. 2. EARLY ADOPTERS
    • 16. 3. EARLY MAJORITY
    • 17. 4. LATE MAJORITY
    • 18. 5. LAGGARDS
  • 19. The Origins of Simulation in Nursing Education
    During the past decade, the use of simulations as a teaching-learning intervention in nursing curricula has increased greatly.
    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
  • 20. CHARACTERISTICS OF INNOVATIONS
    • Relative advantage (in economic terms, social prestige factors, convenience, satisfaction).
    • 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. Complexity ( the degree to which an innovation is perceived as difficult to understand and use).
    • 23. Trialability (the degree to which an innovation may be experimented with on a limited basis)
    • 24. Observabiltity ( the degree to which the results of an innovation are visible to others).
  • High Fidelity Simulation Implementation/Adoption Events Timeline
    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
  • 25. Faculty Observations: High Fidelity Simulation vs. Live Clinical Scenarios
    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
  • 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.
    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.
    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).
    An educational intervention in CVC insertionsignificantly improved patient outcomes. Simulation-based educationis a valuable adjunct in residency education.
    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
  • 27. Conclusion
    “In Situ” Simulation as a Strategy
    Simulation training conducted on a
    hospital unit where real patient
    care is delivered and errors occur
    Allows clinicians to practice &
    problem solve patient issues with
    their team in their “real” work
    Environment
    Allows opportunity to uncover and
    identify latent safety threats and
    Micro-system deficiencies
  • 28. The effects of a simulation-driven, patient safety program aimed at improving early detection & treatment of hospital-acquired complications will:
    PRIMARY OUTCOMES: Decrease
    Rate of hospital-acquired:
    Rate of unplanned transfers to higher level of care
    Risk-adjusted hospital mortality
    Severe sepsis/septic shock
    Acute respiratory failure
    SECONDARY OUTCOMES: Improve:
    Teamwork performance and communication skills
    Knowledge, critical thinking and decision-making
    Safety culture on involved units
    Nurses’ comfort & confidence in calling for help early
    Patterns of social interaction among nurses and residents
  • 29. Summary facts found from Beacon Benchmarking:
    Success with simulation program largely due to :Buy-in from the CMO & CNO
    Strong partnerships with Unit Leadership
    Conducting frequent, in situ simulation exercises: Feasible
    Not dependent on “fidelity”
    Participants enjoy in situ simulation training
    Simulation training reveals deficiencies with teamwork; debriefing offers unique coaching opportunity
    A simulation-driven patient safety program holds serious opportunity in improving clinical outcomes
    _ ...
  • 30. References
    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
    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
    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
    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.
    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
    Gaba, D. (2004). The future vision of simulation in health care. Quality & Safety in Health Care, 13 Suppl 1i2-i10. Retrieved from EBSCOhost
    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.
    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
    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 .
    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
    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
    Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press
    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
    _ ...