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Simulation training in medicine and technology management
- 1. SIMULATION TRAINING INMEDICINE AND TECHNOLOGY MANAGEMENT I. Shchaviy, A. Bashkov, D. Konkov Ukrainian-Swiss Mother and Child Health Programme, Ukraine
- 2. Why simulation? • Simulationis valuable when „on-the-job‟ training is expensive or risky • Simulation has been adopted for training where consequences of error expose many people to risk or the cost of error is high, for example: – Aerospace – Military – Nuclear power plants Medicine: A High-Risk Industry
- 3. Risk Management Considerations- Hazards in Medicine “Most serious medical errors are committed by competent, caring people doing what other competent, caring people would do.” -Donald M. Berwick, MD, MPP • Not just about the people, it is about the design: • System, medical devices, procedures • Human Factors: safeguard in the design “making it difficult for people to do the wrong thing”
- 4. Advantages of Simulation •Structured learning • Guaranteed and scheduled opportunities for teaching learning – Uncommon situations can be presented – Teacher can model process, give feedback, repeat process, modify process • Repetition as often as needed
- 5. Successful strategies forcrisis 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
- 6. Simulation technologies usedin 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
- 7. Technical infrastructure andtechnology management – key factors • Facility • Manikins • Multimedia equipment • Hardware and software • Human resources • Medical equipment • Good management
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- 9. Debriefing Simulation The Heartof the Matter Frame • Assumptions • Feelings • Mental Model • Knowledge Base • Situation Awareness • Context Actions Results
- 10. Facilitated debriefing withan expert practitioner. Participants reflect on their own performance and discuss this with the group
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- 12. Working place ofoperator
- 13. Resources • 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 – Bio-medical technician essential! Also clerical.
- 14. Before and aftersimulations... • Set-up scenario – eg. make blood, set up OR, X-rays, etc • Load up simulation program • Check everything works – Cameras, VCR, communicators Afterwards... • Check simulator • Clean everything used and put away • Replace/reorder all used items
- 15. Medical equipment Set ofmedical equipment for certain scenario
- 16. Team work isthe key to success
- 17. Why Teamwork? • Reduceclinical errors • Improve patient outcomes • Improve process outcomes • Increase patient satisfaction • Increase staff satisfaction • Reduce malpractice claims
- 18. TeamSTEPPS • Knowledge – SharedMental Model • Attitudes – Mutual Trust – Team Orientation • Performance – Adaptability – Accuracy – Productivity – Efficiency – Safety
- 19. High fidelity simulation •Allow time for familiarisation with the simulator & equipment • Brief participants on: – The scenario – Educational objectives – How to get help
- 20. High fidelity simulation Alwaysfollow the script but... …have alternative outcomes planned and rehearsedSimulation control room
- 21. High fidelity simulation Usingsimulation situations can be re-run to explore outcome with different treatments Mission critical tasks can be performed by learners without putting patients at risk
- 22. The future ofsimulation... • Skills training tool for all disciplines – Acute care – New techniques and/or equipment – Managing complications – Retraining • Multi-disciplinary training – inter-professional communication – team performance • Training in decision-making/resource co- ordination
- 23. Conclusions • A largemajority of medical errors are related to teamwork, communication and technology management, elements that can be improved though use of simulation. • The adequate simulation technology can be used to reduce different types of errors and their contributing factors.
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