I was recently energized by sitting in the back of one of our simulation rooms where two of my faculty colleagues were running simulations for some of Emergency Medicine Residents. They had prepared the session well and had clearly established a previously great and trusting relationship with the residents in a safe learning kind of way.
The residents seemed relaxed, smiling, and many were attending the session dressed in the likes of Khacki shorts, Teva’s and a Hawaiian shirt or two. During one of the scenarios the faculty member operating the simulator made a mistake and the “patient” took a turn for the worse when the correct treatment was ordered. He was on the other side of the glass and immediately said something funny about his mistake over the room speakers in a self-deprecating way. Everyone in the room was cracking up including the other faculty members, me, all of the team members and the resident observers. The simulation came to an end a few minutes later as the rest of the learning objectives were met
During the debriefing the faculty member called out his mistake once again to another round of snickers. Superficially it seemed that he was trying to be funny. Deeper I think he was level setting to ensure there wasn’t confusion of the change in status over the patient. Additionally he was ensuring to demonstrate the safe learning environment in so far as declaring that he was capable of making mistakes as well.
A few moments later the residents were engaged in a debriefing using the Structured and Supportive Debriefing Model and the GAS tool. During the debriefing many topics were covered ranging from teamwork, the initial care and stabilization of the patient, to aberrancies in the electrical system of the heart leading to wide complex tachycardia that can mimic ventricular tachycardia.
A few minutes later the debriefing was wrapped up expertly by the faculty member. Another scenario ensued with a new group of residents and again, unplanned, something funny happened. Again laughter, then back to work, then the end. Debriefing commenced. During the second debriefing led to a discussion of how cyanide poisoning interacts with cellular metabolic pathways of the P450 cytochrome system and the therapeutics that should be considered to save the patient’s life. During the conversation a few light hearted comments by residents created more laughing.
I sat back thinking….. this is really fun…….There they are dressed in their tevas and shorts…..Learning of all things…… imagine that. This is truly patient-centric simulation. Innovative education occurring in a comfortable atmosphere helping these future emergency physicians perfect their diagnostic, therapeutic and leadership skills. They don’t need to be in scrubs, shirts and ties or wearing hospital badges to optimize this learning opportunity. They are not going to show up to work in the hospital wearing shorts and tevas. They are professionals. You know what? They are in fact adult learners being treated as adults.
I was a bite envious of my faculty colleagues having creating this amazingly relaxed environment where the residents felt comfortable to speak up, right or wrong in front of each other and faculty members alike. In fact they were encouraged to explore during the cases. And they were learning. Learning new concepts or at least reviewing topics and learning objectives that were appropriate for their training program.
Guys and gals dressed as if they were going to a picnic, learning from each other, laughing and feeling free to explore and demonstrate their knowledge, skills and attitudes for the purpose of improving. Were they not taking it seriously? Cytochrome P450 and conduction aberrancies sure sounded serious to me, as did the discussion of teamwork and leadership.
Sometimes I think we can easily take ourselves too seriously in the simulation world. While I would be the first to argue there are times to do just that, I am reminded that there are times when it is not the case. People seem to be so caught up in defining rules of how things should and shouldn’t be done in simulation encounters that sometimes I observe huge opportunities to find new and interesting ways in which we can engage learners in their prime. I think that these faculty members new their participants well and designed amazing learning opportunities for them that included some of the power of simulation.
After all, we are not trying to simulate reality, we are trying to use simulation to create a milieu that will enhance our ability to carry out learning and assessment objectives that will eventually influence the care that is delivered by the healthcare system.
It was a great day for me, simulation and especially for future patients!
