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

1. SIMULATION TRAINING IN MEDICINE
AND TECHNOLOGY MANAGEMENT
I. Shchaviy, A. Bashkov, D. Konkov
Ukrainian-Swiss Mother and Child Health Programme,
Ukraine

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. 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 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. 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. Technical infrastructure and technology
management – key factors
• Facility
• Manikins
• Multimedia equipment
• Hardware and software
• Human resources
• Medical equipment
• Good management

8. Facility

9. Debriefing Simulation
The Heart of the Matter
Frame
• Assumptions
• Feelings
• Mental Model
• Knowledge Base
• Situation Awareness
• Context
Actions Results

10. Facilitated debriefing with an expert practitioner.
Participants reflect on their own performance
and discuss this with the group

11. Hardware & Software

12. Working place of operator

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 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. Medical equipment
Set of medical
equipment for
certain scenario

16. Team work is the key to success

17. Why Teamwork?
• Reduce clinical errors
• Improve patient outcomes
• Improve process outcomes
• Increase patient satisfaction
• Increase staff satisfaction
• Reduce malpractice claims

18. TeamSTEPPS
• Knowledge
– Shared Mental
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
Always follow the script
but...
…have alternative
outcomes planned
and rehearsedSimulation control room

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. 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. 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. Thank you!