Monthly Archives: May 2013

Data – You Gotta, Get It – Get it ALL, and then USE it!

ImageI recently was a faculty member on a panel at an international simulation meeting involving a number of senior leaders from the simulation community. One senior leader was ridiculing the collection of what he deemed to be insignificant data. He was critical of spending time and resource in the collection of such data points as number of trainees served by the program last year, number of room hour’s utilized amount of money spent on catering, did the student like the simulation etc. I think it was a sad display of a misunderstanding of the importance of data in the modern era of simulation program start up, existence, and expansion.

Data surrounding simulation centers classically is thought of as metrics that are often reported in educational research studies that may include examples such as test scores, participant feedback, various scoring metrics associated with performances observed during simulation etc. But as a senior administrator I recognize that it is so much more.

I was fortunate enough to be mentored by the founding director of WISER, Dr John J. Schaeffer to understand the power of data in a generic sense. We look at data in a very inclusive way. A unit of data may be the answer to test question number six, how many minutes it took to perform a cricothyrotomy on a simulated patient, how many times room one was used last year, how many hours Dr Jones facilitated in our center last year, or how the student “liked” her simulation efforts.

While some of the metrics mentioned are certainly important and often worthy of research publications, the operational examples given in the first paragraph above are equally as important to a program’s existence, sustainment and justification to grow. Admittedly, they may not be important for publishing in educational research, however the program has to exist to be able to allow the educational research to move forward. While we certainly don’t need another peer-reviewed, scientific publication that states “students like simulation”, this type of information can be critically important to the Dean, Hospital Executive or funding authority of a burgeoning simulation program. Don’t underestimate the importance of data for your simulation program. Having valid, reliable data that is easy to access is a powerful element in the day-to-day decision-making that it takes to run a successful simulation program.

A fundamental key to making data useful is to develop a systematic, embedded way attempt to standardize and streamline the data collection involved with your center’s day-to-day operations. It requires far more effort to determine “the number of times simulator room number one was used last year” or “how many students hours of simulation you provided last year”, with a manual retrospective review process, then if you have a system that provided that information automatically. Yes of course when you’re running a specialized research project there might be additional data metrics necessary to collect. I would argue that if the core fundamental data set that assists you in the running of your center, including the common research metrics are built-in to the underlying simulation curricular development processes it will seem like significantly less work overall to reports on such activities. Developing this automaticity in data collection will continue to build a robust data set for your center.

As the data amasses, combined with systems that allow easy access, analytics, and cross-referencing, your center could potentially soon be sitting on a mountain of data that is right for any type of data mining research necessary. The possibilities include but are not limited to justification for new employees, in-depth education simulation research, quality assurance mechanisms to evaluate faculty, facilities and program development processes.

Go forth and collect the data. All of it 🙂

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Purpose of Simulation Isn’t to Mirror Reality

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The purpose of clinical simulation healthcare is not to mirror reality. The primary objective of the most commonly used simulation is to improve the performance of humans as it relates to caring for patients within the context of healthcare. Too many times we get lost in toiling over the details of trying to re-create a scenario as realistic as possible. This often leads to what I describe as invisible barriers to simulation insofar as design, perceived resource limitations, or operational realities limit the bandwidth that the simulation program is able to accomplish. It’s important to remember that the primary objective is not to simulate, but to educate. (Certain exceptions may apply to research projects, and human factors design elements, or other factors studying mimicking existing process flow etc.)

When we run a simulation we are not trying to convince the participant that it is real (because if they did think it was real they would likely be a little crazy J). What we need to do is create an environment that helps the participant feel as if there is some realistic comparison to the simulation to what they do when they are actually caring for patients. We need to enter into what is frequently referred to as a fictional contract or psychological contract that allows the participants to drop into their role as a normal care provider knowing that the simulation is artificial, but has value to their learning and their future practice.

Many, many decisions go into the design of simulation. Often times the specifics of the learning objectives and outcomes do not receive as much attention in the design phase as some of the other elements to try to create “perfect fidelity”.  In doing so we often unnecessarily add to the complexity of the scenario that may increase the setup time, the cleanup time, expose the scenario to the potential of technical failure. Further, we can actually confuse the participant as during the scenario they are constantly trying to assess what they are supposed to be interpreting as “real” versus that which is simulated.

So the next time you’re designing a scenario start with learning objectives, outcome objectives, and then answer the question, “what do I really need to provide to allow the potential participant, or participants” a general feeling of realistic sensation that will allow them to participate in a meaningful way.

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WISER Featured on CBS News

WISER Featured on CBS News

WISER is featured on KDKA TV news Thursday night (Link to Story). Award-winning journalist and news anchor Susan Koeppen prepared a story on the potential for simulation to be used in disaster training for the field as well as trauma Center team training. People featured in the story include paramedics from the greater Pittsburgh region, trauma nurses, technicians as well as an emergency medicine resident. Thanks to KDKA and Susan for their support of the mission of WISER, UPMC and the University of Pittsburgh to provide better healthcare for the greater Pittsburgh region as well as around the globe.

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May 10, 2013 · 4:00 pm

Simulation and Committment

Some interesting words from a talk from David Gaba. The essence Of his message is that the nuclear power industry has made a significant investment in simulation as well as standardization and protocol development. Lastly if you consider the embedded schedule by which each six weeks nuclear power plant operators undergo simulation testing, one could argue there is a significant investment net being made. Thus far, I don’t know of anybody in healthcare that is made this level of investment in safety. Further, I’ll bet the nuclear power industry didn’t have to justify simulation with randomized, placebo-controlled, double-blind studies To determine if nuclear reactor meltdown was going to occur with and without simulation!!!!!!! We need to get real with the justification, and significant impact that we can have with regard to making patients safer with simulation.

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Faculty Development is One of the Keys to Success in Simulation

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The number of brand-new shiny, technologically advanced simulation centers popping up around the world is astounding. It is certainly a growing testament to the importance, adoption and recognition of the power the simulation-based education brings to the world of healthcare safety and quality.

What is equally perplexing to me is the amount of meetings, person-hours, drawings, fees paid to architects etc. that it takes to plan a simulation center. People will toil in the detail for thousands of hours to ensure that they buy the biggest, best and most capable simulator, AV equipment and one-way mirrors, color of the floor tiles for the entrance, but don’t put a similar investment of time and money and faculty development. I think there are a number of contributing factors that contribute to this MISTAKE.

Substantial sums of money to put into the bricks, mortar and equipment that goes into simulation centers. Decision-makers are mistakenly led to believe that the equipment environment will do the teaching for them. While there are some intelligent tutoring systems and many technologically advanced simulators that help educators make efficient and effective use of simulation, there still is a dependency upon the educator.

Another common error that I see program make in the design of simulation-based programs is assumptions that people that are already functioning in the role of educators will do just fine transitioning to that in the simulation world. The fact of the matter is simulation-based education/facilitation is a learned and practice skill set that has various components to it that include understanding the psychology of simulation, the technical capabilities of simulation as well the limitations, being artful with facilitation, and forever attentive to the educational objectives that are trying to be achieved through the use of simulation.

I have seen plenty of examples of educators who are great behind a podium doing fabulous lectures and creating great learning experiences that are rendered ineffective when they attempt to facilitate a simulation or conduct a set debriefing session associated with or during a simulation.

Many simulation programs fail at or are slow to achieve their stated aims because they rely on inexperienced facilitation, or educational leaders not familiar with effective and efficient simulation-based education principles. Additionally, the diversity of approaches to simulation leads some to the false assumption that formal training in preparation, practice and demonstration of ongoing skills is unnecessary. This could not be further from the truth, and unfortunately becomes a barrier to many centers.

The road to securing funding for any education based effort in healthcare is a long and arduous path. There is a general ability to generate the funds to buy equipment, renovate and build buildings for simulation based activities. The way of the future is to also introduce during the foundational funding efforts that investment in the people skills is necessary.  A planned pathway of development for simulation-based specific competencies must be planned to help a center achieve and/or surpass its goals.

So if you’re in the planning phases of a simulation-based program or in the position to try to increase the efficiency or effectiveness of your simulation-based program, be sure to seek out professional development activities, formalized instruction, preparation and certification for your simulation-based educators. I think that this will help create synergy within your center and prepare you for success in the execution of the simulation activities that you may already engage in, and will prepare you for the future than increase in the efficacy and efficiency of simulation-based education.

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