Implementing Simulation in Rural Healthcare
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The document discusses using simulation training for rural healthcare workers in low-resource settings. It notes that rural physicians have difficulty maintaining skills due to low-frequency, high-stakes procedures and inability to leave their communities. The document proposes a hub-and-spoke model with the university acting as the hub to train local trainers using simulation. This trains rural healthcare workers close to where they practice and addresses the unique challenges of delivering healthcare in remote, underserved areas.
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Implementing Simulation in Rural Healthcare
- 1. constructivism explains how knowledge is constructed when information comes into contact with existing knowledge that has been developed by experiences
- 2. Simulation in Health Professions Education: F r o m T h e o r y t o I m p l e m e n t a t i o n Adam Dubrowski, PhD
- 3. “Country doctors feel uncomfortable with adhering to standards of care felt mandatory by consultants in the city. An occasional rapid sequence intubation is not enough to maintain proficiency in the procedure. Yet rural physicians working in under-staffed settings cannot easily maintain skills because they can’t leave their communities.” The country doctor’s lament Tia Renouf, MD Can J Rural Med 2005; 10 (3)
- 4. Low frequency High stakes Just in-time Just in-place
- 6. Pre-hospital Care Primary Care Community Hospital University/ Tertiary Hospital Development I m p l e m e n t a t i o n
- 7. Silo
- 9. Methods and tools to merge the gap between the development and the implementation of simulation, leading to a hub-and-spoke model
- 15. Modeling of the intervention Exploratory trials Theory RCT KT Implementation MRC D e v e l o p m e n t O f C o m p l e x I n t e r v e n t i o n s Campbell, et al (2000) BMJ.16;321(7262):694-6.
- 16. Modeling of the intervention Exploratory trials Theory RCT KT Implementation MRC D e v e l o p m e n t O f C o m p l e x I n t e r v e n t i o n s CIPP P r o c e s s b a s e d d e v e l o p m e n t Stufflebeam&Shinkfield (2007)Campbell, et al (2000) BMJ.16;321(7262):694-6.
- 17. Modeling of the intervention Exploratory trials Theory RCT KT ImplementationTheory
- 19. Grand Mid-range Micro Why use theories in qualitative research? Scott Reeves et al. BMJ 2008; 337 (3) 631
- 20. Cognitive Load Theory (CLT) Sweller, 1988; van Merrienboer and Sweller, 2010
- 21. Kurahashi et. al. 2011
- 22. Practice: Trained Skills Test Written Test 1 week rest No practice: Novice Kurahashi et. al. 2011
- 23. Skills Test: Expert Opinion 0 5 10 15 20 25 Written Test: Score 0 5 10 15 20 25 Trained Novice Novice Trained Novice Novice Kurahashi et. al. 2011
- 24. Reducing the complexity of the learning environment reduces cognitive load and improves handling and learning novel information. Sweller, van Merrienboer and Paas, 1998
- 25. A number of studies suggest skills learned in simulation improve McGaghie 2011,Gurusamy 2008, Nestle 2011
- 26. A number of studies suggest skills learned in simulation can transfer to the clinical setting Sturm 2008, Grancharov 2009, Seymour 2002, Barusk 2009a, Park 2007,Wahidi 2010
- 27. simulation works How and why
- 28. Need research focuses on instructional design
- 29. […] is the practice of creating "instructional experiences which make the acquisition of knowledge and skill more efficient, effective, and appealing." Merrill et al., 1996 Ins tructional Des ign
- 30. Clinical technical skills are a subset of psychomotor skills
- 31. Psychomotor
- 32. Psychomotor
- 33. P h y s i c a l p r a c t i c e R e p e t i t i v e V a r i a b i l i t y M a s s e d v s D i s t r i b u t e d F e e d b a c k Wolpert,et al.(2001), Rizzolatti et al. (2001), Calvo-Merino et al. (2005) Observational practice Instructions Modeling Social Networking
- 34. Campbell, et al (2000) BMJ.16;321(7262):694-6. Modeling of the intervention Exploratory trials Theory RCT KT Implementation Modeling of the intervention Exploratory trials RCT
- 35. Moulton et al., Ann Surg. 2007 Optimal schedules
- 36. Moulton et al., Ann Surg. 2007 1 2 3 4 1 month 1 2 3 41 week rest 1 month distributed practice massed practice 1 31 31 31 31 2 4 T Transfer
- 37. distributed massed ExpertOpinion 30 20 10 0 Pre-test Microsurgical drill Post-test Rat Transfer Moulton et al., Ann Surg. 2007
- 39. R e p r e s e n t a t i o n s o f A c t i o n s Carroll &Bandura (1990), Bandura et al. (1974), Beek&Lewbel (1995)
- 40. “Psychomotor learning is …. outside the domain of online learning.” Newton, G., Introduction to Developing Online Electrical Course Ware. 1999
- 41. P r e p a r a t i o n
- 42. Instruction
- 44. Traditional Collaborate PDFs + Video Networked Spot-the- difference Observe Spot-the- difference P r e T e s t W o r k s h o p P o s t T e s t
- 46. Future: Preparation 0 5 10 15 20 25 Traditional Observe Collaborate Post-Test GlobalRatings
- 47. Research Social (Ed) netwrokingimproves learning during the workshop Conclusion
- 48. Campbell, et al (2000) BMJ.16;321(7262):694-6. Modeling of the intervention Exploratory trials Theory RCT KT ImplementationImplementation
- 49. MalawiI s s i m u l a t i o n n e e d e d ?
- 51. CIPPP r o c e s s b a s e d d e v e l o p m e n t Stufflebeam&Shinkfield (2007)
- 52. A mother’s journey NiranjanKissoon, MD PediatrCrit Care Med 2010 Vol. 11, No. 4Co n t e x t District Hospital District Health Centre Community Hospital Tertiary Hospital
- 53. W h a t i s d o n e w e l l A healthcare worker journeyCo n t e x t District Hospital District Health Centre Community Hospital Tertiary Hospital
- 54. W h a t i s d o n e w e l l W h a t n e e d s t o b e d o n e A healthcare worker journeyCo n t e x t District Hospital District Health Centre Community Hospital Tertiary Hospital
- 55. W h a t i s d o n e w e l l W h a t n e e d s t o b e d o n e A healthcare worker journeyCo n t e x t S i m u l a t i o n District Hospital District Health Centre Community Hospital Tertiary Hospital
- 57. E T A T Universitylevel Emergency Triage Assessment & TreatmentIn p u t s District Hospital District Health Centre Community Hospital Tertiary Hospital
- 58. Universitylevel ETAT: Instructional DesignPr o c e s s
- 59. E T A T + + E T A T Instructional Design Universitylevel ETAT: Instructional DesignPr o c e s s District Hospital District Health Centre Community Hospital Tertiary Hospital
- 61. HIV HBB ETAT Different programs Similar system “journey” Similar strengths (Inputs) Similar weaknesses (Processes) All connected to the University
- 62. University as the hub (Train the Trainer)
- 63. University as the hub (Train the Trainer) District Hospital District Health Centre Community Hospital Tertiary Hospital
- 64. Is this unique to Malawi?
- 65. “Country doctors feel uncomfortable with adhering to standards of care felt mandatory by consultants in the city. An occasional rapid sequence intubation is not enough to maintain proficiency in the procedure. Yet rural physicians working in under-staffed settings cannot easily maintain skills because they can’t leave their communities.” The country doctor’s lament Tia Renouf, MD Can J Rural Med 2005; 10 (3)
- 66. Modeling of the intervention Exploratory trials Theory RCT KT Implementation MRC D e v e l o p m e n t O f C o m p l e x I n t e r v e n t i o n s CIPP P r o c e s s b a s e d d e v e l o p m e n t Stufflebeam&Shinkfield (2007)Campbell, et al (2000) BMJ.16;321(7262):694-6.
- 69. Home District Centre District Hospital Regional Hospital Tertiary Hospital Home Pre- hospital care Primary Care Community Hospital Tertiary Hospital University Train the Trainer Context Input Process Product
Editor's Notes
- TO frame my talk, I come form constructivists camp…..I assume that you have generated a lot of knowledge, and the new information that I would like to present for you to construct your knowledge is the importance of theory in both research and design of simulation based education
- CLT, played a foundational role in educational and multimedia instructional design, and proposes that human cognition is characterized by …
- The cognitive load theory helps us undertand these results and suggest that simulation not only leads to improvement in the skills, but more importantly it frees some of the cognitive resources which can be then allocated to learning other tasks.
- A number of studies suggest skills learned in simulation imporve….
- And transfer to the clinical setting, resulting in shorter operating times, fewer technical errors, and improved technical performance fora range of medical and surgical procedures
- Given this extensive evidence, presently there is little doubt that simulation ‘works’.
- There is a need for research that focuses on instructional design.
- […] is the practice of creating "instructional experiences which make the acquisition of knowledge and skill more efficient, effective, and appealing.A commonly held belief in SBME instructional design is that
- Psychomotor (Harrow, 1972)“coordination, dexterity, manipulation, grace”
- Psychomotor (Harrow, 1972)“coordination, dexterity, manipulation, grace”
- Psychomotor (Harrow, 1972)“coordination, dexterity, manipulation, grace”
- Wolpert,et al.(2001), Rizzolatti et al. (2001), Calvo-Merino et al. (2005)Schmidt & Lee (2005)
- timing and magnitude of the movements temporal, accuracy, energy and safety Schmidt & Lee (2005)
- It is not known whether this advantage will be present after the workshop