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Simulation training in medicine and technology management


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Presentation by the Ukrainian-Swiss Mother and Child Health Programme at 2nd Regional Health Technology Management Worskhop (April 10-11, 2014, Chisinau, Moldova)

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Simulation training in medicine and technology management

  1. 1. SIMULATION TRAINING IN MEDICINE AND TECHNOLOGY MANAGEMENT I. Shchaviy, A. Bashkov, D. Konkov Ukrainian-Swiss Mother and Child Health Programme, Ukraine
  2. 2. Why simulation? • Simulation is 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. 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. 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. 5. 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
  6. 6. 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
  7. 7. Technical infrastructure and technology management – key factors • Facility • Manikins • Multimedia equipment • Hardware and software • Human resources • Medical equipment • Good management
  8. 8. Facility
  9. 9. Debriefing Simulation The Heart of the Matter Frame • Assumptions • Feelings • Mental Model • Knowledge Base • Situation Awareness • Context Actions Results
  10. 10. Facilitated debriefing with an expert practitioner. Participants reflect on their own performance and discuss this with the group
  11. 11. Hardware & Software
  12. 12. Working place of operator
  13. 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. 14. Before and after simulations... • 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. 15. Medical equipment Set of medical equipment for certain scenario
  16. 16. Team work is the key to success
  17. 17. Why Teamwork? • Reduce clinical errors • Improve patient outcomes • Improve process outcomes • Increase patient satisfaction • Increase staff satisfaction • Reduce malpractice claims
  18. 18. TeamSTEPPS • Knowledge – Shared Mental Model • Attitudes – Mutual Trust – Team Orientation • Performance – Adaptability – Accuracy – Productivity – Efficiency – Safety
  19. 19. High fidelity simulation • Allow time for familiarisation with the simulator & equipment • Brief participants on: – The scenario – Educational objectives – How to get help
  20. 20. High fidelity simulation Always follow the script but... …have alternative outcomes planned and rehearsedSimulation control room
  21. 21. High fidelity simulation 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
  22. 22. The future of simulation... • 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. 23. Conclusions • A large majority 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.
  24. 24. Thank you!