Monthly Archives: February 2014

Good to Hear! Simulation growing in the rural areas of the US.

shutterstock_154777169_aI recently had the pleasure of being interviewed by The Rural Monitor which is a publication of the Rural Assistance Center. They were doing a feature on a fabulous new program  called South Dakota Simulation in Motion (SIM-SD) for healthcare simulation training. Talking to the reporter gave me some great enlightenment and reminders of the challenges of providing healthcare in the rural and underserved areas. It was great to hear of support for forward thinking people supporting such a great training effort to close some critical training gaps. The Article was entitled Patient Simulators Sharpen Skills of Rural Practitioners.

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Running Scenarios “On-the-Fly” is Like Typing PowerPoint Slides in Front of a Live Audience

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Could you imagine sitting at a lecture at a meeting and the presenter was typing the information to create the slides while theydelivered the lecture? I believe it would be maddening, particularly if the person didn’t type very well!  Well folks, that is akin to what you are doing when you run your SimMan scenarios “on the fly”. Actually it is likely worse. I am writing this post in the context of SimMan because that is the system of which I have the most hands on expertise, but this story applies to almost all of the commonly available computerized patient simulators available at the present time.

Begin by asking your self, why do I create a PowerPoint to use during my presentation ahead of time, instead of in front of an audience? The answer is because you want to pre-populate, or preprogram frames of information grouped together to help your audience understand what is going on. The information that you are likely pre-populating your slides with is likely to complex, or at least too cumbersome to type out in front of the audience. In addition, you likely save your PowerPoint presentation so you can use it again and deliver the same or similar presentation with some consistency, I would ask you to realize, that this same thought process could be applied to the preprogramming of the simulator presentation during a scenario.

When you use a computerized simulator during a scenario, you are asking the participant to look at the frames of information that you are presenting to them. The individual vital signs, perhaps a sound or some other visual aid may all be part of what you want them to see. They begin to interpret your story usually in the context of a clinical situation requiring their interpretation, analysis and treatment or decisions.

As you allow the story to evolve in response to their actions or inactions, the simulator may changes states. For instance, in response to a proper treatment, you may want the vital signs to improve. Think of this as when you want to tell something different in your presentation you witch to another PowerPoint slide. Why? Because you want to present the next frame of information to the audience.SimMan

No matter where I travel in the world there is a common theme that I hear regarding SimMan scenarios. That is to say that people say “we tried programming and that didn’t work, so now we do run them on the fly.” When I ask for more details the story is usually the same. Participants always do things that we aren’t expecting and we need to “take over” is a common response. There is a feeling that when you are in a preprogrammed scenario as a simulator operator that you are trapped. Guess what? This feeling may be valid depending on the style of programming that is employed.

Also think of it from a different angle, one of my previous blog post points out the complexity of vitals sign changes that need to change during a course of worsening hypoxia. I argue that it is essentially impossible to change everything in the same way every time a scenario is run. So in essence, you lose the ability to generate consistency in running your scenarios. This consistency, or reliability is important to achieve when using scenarios as assessments.

What is the problem? The Trainees? The Operator? The Software? The Programmer? I would submit that the software systems that accompany most patient simulator these days are quite sophisticated with very deep capabilities. Most of us only learn them superficially at best. Further, those who take classes usually learn from a representative of the company who sold the equipment and there style of programming often doesn’t match reality.

Well the first lessen is participants ALWAYS do something unexpected, or at least almost always. So therefore if your scenario programming STYLE boxes you into a corner when the unexpected happens, you should change your ways, not abandon the work!

One of the best ways to get started with a comfort zone of using programmed scenarios is to use the software to create your initial set of vitals. If you think about it, just setting vitals alone causes a significant amount of task loading at the beginning of the scenario. If a patient is in shock, you would likely at a minimum, change the heart rate, pulse rate, resp rate, oxygen sats, End tidal CO2 and on and on. All of this if of course depending on the complexity and depth of clinical information you are trying to control for a given scenario.

I think of the example above every time I get to drive my wife’s car. I sit in the drivers seat and push a button labeled ‘[Driver] 2’. When I do this, the seat moves, backwards, reclines slightly, the steering wheel moves away from me and down a bit, and the mirrors adjust to where I had them previously. Brilliant! Pushing one button set so many things that I may have to adjust manually. This saves time and ensures a consistency in my experience when driving her car.

The properly pre-programmed scenario offers you quick set up (like my wife’s car), flexibility, consistency in presentation, ways to deal with unexpected, and maybe most importantly, helps allow you to observe the scenario more closely and worry about the simulator less.

This can be accomplished through an increased understanding of what the software can do, and a realistic application to your scenario objectives. Start by unlinking your changes in the vital signs or condition changes to the events playing out in front of you. Create menu items that have the simulator presentation get worse or get better, that you can trigger based on what you think should be happening based on the action or inactions of the participant(s).

Think about taking some small steps into embracing the pre-programmed scenario into your armamentarium of simulation tools. Do yourself a favor and take a simulator programming course from someone who is not a hardware company rep. Done properly, I promise you it will expand your capabilities as a simulation educator. It will also allow more flexibility in your scenario designs and increase the consistency when you run a given scenario.

Lastly, changes in the simulator condition is just part of the power of the software that you already own if you have a Laerdal Simulator. There is so much more to talk about in trying to convince you of the power that lurks inside your SimMan! I haven’t even begin to cover other technological assistance that can help with debriefing accuracy, structure and consistency, automating data collection and on and so much more!

With just a small investment in time and perhaps an adjustment to style, you can significantly boost the productivity of your Simulation program.  So fear no more, take the deep dive and learn more………

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Simulation and the Super Bowl

ImageFor those watching the Super Bowl today think of the amount of Simulation and deliberate practice that goes into the preparation of such a game. For those of you who are not fans of American Gridiron Football, embark on a metaphoric link to your favorite professional sport to fully enjoy this brief post.

As individuals, the craft is practiced time and time again from simple throws of the football, to more complex things such as simulated field goal attempts. Do you really think Peyton Manning needs to perform deliberate practice for accuracy with throwing the football? He does, and he is probably right. In fact he probably does it enough to make Ericsson proud.

In practice sessions team training begins when the offense plays against the defense to simulate plays. I suppose you can say they take on the role of SP’s (Standardized People). ImagePlays are tested and debriefed by facilitators (coaches)….. I wonder what the safe learning environment is for NFL players preparing for such a game. J

But seriously, the amount of individual as well as team practice in both psychomotor skills as well as team based skills and communications training is incredible. Rehearsal, practice, debrief, time and time again until fatigued, emotionally and mentally, is a staggering effort. All to win a game.

I wonder why we don’t do the same in healthcare.

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