Tag Archives: simulation

November 5, 2019 · 8:36 am

Simulation, Music, and Dancing

Many of you know of my crazy thoughts and ideas to try to connect things together with contrasts and comparisons to help people understand concepts and ideas. Well…. Here goes another one of them!Dance

I find that people continuously struggle with understanding the true relationship of the scenario (defined as the collective information, tools, and techniques that are presented to participants of simulations) to the outcomes of the simulation. The confusion arises from the fact that people get inappropriate messaging during the formative times of their simulation careers.

People gain the idea that the scenario must be as real as possible, or perfect mimic some aspect of real life in healthcare in order to be effective instead of recognition that the sole purpose is to create a script and stage that allows participants to perform. Some people believe that the overall goal of simulation is to recreate reality. The sad part is, those misguided thoughts often lead to over-production of the scenario and that the scenario is the primary focus of the activity. This can lead to the unintended consequences of increasing the workload of the simulation relative to the value of performance improvement and/or introduce confusion to the participants of the scenario.  Neither of which are desirable.

It occurred to me recently that a terrific analogy can be made by evaluating the relationship of music, to competitive dance. As it turns out the scenario is simply the music.

Thinks about it. When a dancer or group of dancers are going to compete, a number of things must be in place. First, there is an understanding that the dance will be carried out with the playing of music. The activity will last a certain length of time, involve one or more people who are supposed to do certain things at certain times and that various details will be assessed or evaluated along the way. At times the evaluation maybe be structured to focus on improvement (formative) and perhaps feedback is shared along the way (deliberate practice preparing for a competition), while other times may it may be a high-stakes evaluation (summative) resulting in only a score (the actual competition).

Now let’s focus on the music. What is its purpose in a dance competition? If you think about it, the music providers the framework or backdrop against which the dancing activity occurs. It helps to coordinate the tone, the tempo, and the activities associated with the dance. If the objective is to assess a pair of dancers doing a waltz, then a waltz is played. So the learning objective would read, at the conclusion of this five minute activity, the participants will demonstrate the ability to perform a waltz. If we wanted to evaluate a Latin dance, we would play Latin music and have an appropriate assessment criterion by which to guide the improvement of the activity.

While it is technically possible for the assessment to occur in the absence of the music, it would be awkward for the participants and the evaluators as well. Further, a piece of music may be specifically chosen to encourage a certain dance move that would facilitate the evaluation of the activity, let’s say a twirl or a flip. If we needed to evaluate or score how well one performed a flip, a flip would need to occur during the dance.

When using the methods of simulation in the healthcare world, we need to see people dance. The dance we need to see is often a complex one involving the delivery of healthcare, but it is a dance none the less involving specific movements, communications, and other activities toward a specific goal There are times that we need to see individuals dance, other times teams.

If we are to evaluate a certain element of healthcare, then we must have carefully composed the music that propagated the desired activity to have occurred during the dance. As they dance, we perform an assessment with a goal of helping them improve through various feedback mechanisms. Such feedback may occur through active reflection and facilitated discussion (debriefing), self-reflection, peer to peer engagement, or perhaps in the delivery of a more formal score in the case of summative feedback.

The bigger point is, the scenario is constructed and executed (composed) to provide the background milieu to form the basis of the dance, i.e. have participants perform the activity that we wish to assess. We choose different types [of music] to play that is concordant with the activity we wish to evaluate. At times we play a tune that accentuates the evaluation of critical thinking skills, perhaps the performance of a complex skill, or maybe one that allows a whole team to dance together requiring teamwork that will benefit from feedback.

So, the next time you are composing your scenario, give careful consideration to the moves that you desire to evaluate. The music that plays should allow/encourage your dancers to perform the steps and activities that will be evaluated and turned into useful information to facilitate improvement.

Compose, have people dance and help them get better!

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August 19, 2019 · 11:50 am

Five Pearls for Debriefing 

Sharing some practical considerations to help you with your debriefing efforts!

 

Shell with a pearl

1. Before you begin attend to learner readiness 

Before you begin ensuring the emotional readiness of your learners will be a huge benefit. Learning during a debriefing can be enhanced by reducing distractions. Such distractions can occur from many possible origins. If learners are particularly stressed, angry or perhaps sad after a simulation experience it is best to let them process their emotions or otherwise emotionally and mentally prepare themselves to be able to focus on the content of the debriefing. So, taking a few minutes to observe, or perhaps even directly asking, “Are you ready?” may go a long way. Also, another tool that I use after a stressful simulation is to just acknowledge that there may be stress with a statement such as “Wow. That looked stressful. Are you guys ready to talk about it?” 

2. During the debriefing, listen to the learners, analyze their thoughts and understanding 

A structured debriefing should provide the opportunity to listen to learners. This allows the debriefer to analyze if the learners have a command of the facts and understanding of the intended learning associated with the simulation. It is easy to become impatient with the process and start telling the learners what they need to know. Once this occurs, it is difficult to assess what the learners do know and understand. As you listen to learners during the debriefing think about what you need to ask next, or where you need to take the conversation to be able to analyze the next area of content you wish to explore during the debriefing. So another tip is shift your thoughts to how can I discover if my learners know….. as opposed to the normal transmittal of information that comes from thinking I need to tell them X, Y and Z so that they understand. 

3. What went right is as important as what went wrong 

There is a saying that the negative screams and the positive whispers. This could not be truer when it comes to debriefing. It is far easier to remember what people did wrong during a scenario, then what they did right. But if you sit back and think about it, they are equally as important. Learners leaving a debriefing understanding that they did correctly and why it was correct, paired with an understanding what they did wrong and why it was wrong is critically important for improvement to occur. If the right things are not debriefed, it may be that they were done out of habit or luck and that the learners don’t understand it at all! Or worse yet, they could be perceived as unimportant. So a good tip is to jot some noted down of things that went correctly during a scenario. Trust me, you’ll remember all those mistakes which will be screaming! 

4. Keep the debriefing focused 

A challenge for anyone conducting a debriefing is to keep things focused. Learners love to talk about what learners want to talk about. However, it’s important as the facilitators of the conversation that we have the learners talking about what they need to be talking about. What learners need to be talking about should be driven by the learning objectives of the scenario. This direction needs to come from the debriefer. There is a delicate relationship that exists between the learners and the debriefer so carefully thinking about how to maintain this but being able to gently nudge the conversation back to the right pathway is a skill worth concentrating on. A tip is to develop some scripts that you are comfortable using when such nudging need to occur.  

Consider this example, “I agree that the exact dosage of the medication is critically important, but for this scenario and debriefing we are tasked with focusing on the effectiveness of the communications within the team. So, who can give me an example of effective communications that occurred during the scenario?”  

 5. Bring out summary/take home points 

Every simulation has a plethora of opportunities for learning. It is the job of the debriefer to ensure that the primary learning objectives of the simulation are covered. During complicated cases or cases with multiple learning objectives it is possible to cover a lot of ground along with many topics and facts during the time when you are analyzing the learners grasp of the content. It is important to close with summary points that are crucial take home messages. This can be challenging for some, and often turns into a mini lecture. And remember when you start lecturing to the learners, you are sacrificing the ability to ensure understanding where the learner is at that point and time. Concluding or beginning the wrap up of the debriefing by asking leaners to give one or two things that they think went well during the scenario along with what they would  change next time can be an effective probe into understanding that the learners took away the big learning messages. It also serves as the time to allow you to shape the discussion with further questions that drive home the intended take away points. Always think to yourself what are the two or three things that I want them to remember most from this experience a month from now. 

Well that’s is for now. Remember debriefing gets better with practice, feedback and experience. So, get out there, debrief, get some feedback and debrief again! 

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July 23, 2019 · 2:20 pm

5 Elements in My Approach to the Learning Contract in Simulation

In simulation-based education there is a relationship between the faculty of the program and the participants that is important during all aspects of simulation. The relationship has tenets of trust and respect that must be considered when designing as well as conducting simulations. I have heard this relationship referred to by a few titles such as psychological contract, fiction contract, learning contract, all of which are generally referring to the same thing.Smiling asian female vacancy candidate shaking hand with hr manager

Probably more important than the title, is what such a relationship embodies or focuses on. I view it as an agreement between two or more parties that acknowledges several aspects of simulation based programs and works to establish rules of engagement and principles of interactions between those involved.

In my practice of using simulation for clinical education I work a great deal with practicing professionals, who by in large are physicians. I generally adhere to five elements or premises over the course of interactions that I design as well as provide for the participants of my programs.

  1. Meaningful use of Your Time.

Acknowledging up front that participating in learning activities takes time away from their busy schedule. I assure them that the content of the program is carefully crafted to fill the needs of their learning cohort in the mostly timely way possible. I refer to refinements of the course that have occurred in response to feedback from prior participants to help increase the efficiency and effectiveness of the program.

  1. This is NOT real and that’s really ok!

During the orientation I am always careful to point out that not everything they are going to experience will look or feel real. I include the idea that things are “real-enough” to help us create a successful learning environment. I also let them know the things that may feel somewhat real during the simulation. Additionally, I emphasize that the “realness” is not the primary focus and point out that the learning and reinforcement of high-quality clinical practice is the ultimate outcome.

  1. We are not here to trick you.

I find that practicing professionals often come to simulation training endeavors with an idea that we design programs to exploit their mistakes. I assure them this is not the case. I am careful to include an overview of what they can expect during all phases of the learning. For example, when I am conducting difficult airway programs, I carefully orient them to every feature of the simulators airway mechanics before starting any scenarios. I also let them know that the cases associated with our scenarios are modeled after actual cases of clinical care. I explain that while we don’t model every detail of the case, that we work hard to design situations that provide opportunity to promote discussion and learning that would have or should have resulted from the actual case.

  1. Everyone makes mistakes. We are here to learn from each other.

At the most basic part of this element, I point out that WE all make mistakes and that is part of being human. I let them know that everyone is likely to make a mistake throughout the learning program. I carefully weave in the idea that it is far better to make mistakes in the simulated environment as opposed to when providing actual clinical care.

Further, I advance the idea that we can learn from each other. As everyone in clinical practice knows, there are many ways to do most things correctly. While this idea can be challenging because often people feel that “their way” is the correct way, I point out that with an open mind and professional, collaborative discussion we can share learnings with each other.

Contract Signing Concept

  1. We are here to help you be the best you can be.

Leveraging the idea that almost all practicing professional hold themselves to high levels of performance standards as well as the desire to improve can provide a powerful connection between the faculty and participants of a healthcare simulation program. I put forth this idea along with carefully tying in a review of the prior four elements. Further, I point out to them the opportunity to perfect the routine exists in our learning programs. I then pivot to highlight that some aspects of the program exist to practice and learn from situations that they may encounter infrequently that may have high stakes for the patient.

So, in summary, I believe the relationship between faculty members and participants of simulation-based education programs is multi-factorial and demands attention. Depending on the learners and the topics of the program, the elements that serve as the underpinning of the relationship may range from few to many, and moderate to significant in complexity.

In my simulation work providing clinical education that involves practicing physicians as participants, I pay close attention to the five elements described above throughout the design as well as the conducting of the learning encounters.

I invite you to reflect upon your approach to the development and maintenance of the relationship between your faculty and participants of your simulation efforts.

 

 

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July 23, 2018 · 11:08 am

The First Four Steps of Healthcare Simulation Scenario Design

How can you make your scenario design process more consistent and efficient? One way is by following a step-by-step method to create your masterpieces!

In this post I cover the first four steps of a proven scenario design process.
There are four core steps that must be done in order. After the first four are accomplished you can branch out and be a little bit more variable in your approach to scenario design.

4 Success Steps, business concept

Step One: Pick A Topic

Picking a topic may seem like common sense but there is a lot to think about.

In healthcare simulation we have many topics to choose from. But in step one we want to a little bit specific and figure out that the major topic is that will be covered. We may be cover the teaching of physiologic, diagnostic or treatment where people are going to be making critical decisions, ordering medications, and other therapy, or perhaps our primary focus going to be on team training, teamwork, communications, team leadership. You get to pick!

Step Two: Define the Learner(s)

This is really important because in order to go to the next step which is designing the learning objectives we have to understand our learner population. For example, what do you expect of a fourth-year medical student what you expected them in terms of being able to evaluate and treat a simulated patient that is complaining of chest pain? Now contrast that to if your learners are medical students that are in the second year of medical school and haven’t had any clinical experience. In other words, we can take the same topic but as applied to two different populations, our expectations and what we are going to be evaluating from them is very different.

Step Three: Designing  the Learning Objectives

This is where you want to go into detail, great painstaking detail, about what you’re trying to accomplish with the simulation scenario. It is very important to take time on this step. Many people tend to gloss over this step which can create confusion later.

Let’s take a topic example. Let’s say asthma in the emergency department. When you think about asthma in the emergency department there could be many sub topics or areas from which to choose. It could be focused on competence of managing a minor asthma attack, or it could be a first-ever asthma attack, or it could be management of chronic asthma, or it could be major could be a life-threatening situation.

Carefully consider what do we want this learner group that we have defined in step two. Do you want them to diagnose? To treat? To critical compare and contrast it to other cases of shortness of breath in an acute patient? You get to choose!

Perhaps we want to focus on the step-by-step history presentation or the physical exam or maybe we want to see the learners perform treatment. Or maybe we want to see the overall management or the critical thinking that goes on for managing asthma in the emergency department. There are many possibilities, largely driven by your intended learner group demographics.

So, in other words were taking the big topic of asthma and we are going to cone it down to answer the question of what exactly we want our learners to accomplish by the end of the scenario. We can’t just assume that what is supposed to happen in the real clinical environment will or should happen in the simulation environment. That rarely works. We actually want to later engineer the story and situation to allow us to be able to focus on the learning objectives.

Step Four: Define the Assessment Plan

How are you going to assess that each objective defined in step three was accomplished? That is the fundamental thought process for step four.

What are you going to be watching for when you the creator of this simulation scenario are watching the participants do their thing? What are you going to be focusing your attention on that you’re going to bring into the debriefing? What are you picking up on that you might be filling out assessment tools?

Define your assessment plan with specificity of what you’re looking for. This is different than designing the assessment tools that could come later. Or perhaps not at all. It is important that you remember every simulation is an assessment of sorts. See Previous Blog Post on this!

This doesn’t mean that every simulation needs assessment tool like a checklist, rating scale or formal grading scheme. It simply is referring to consideration of how to focus the facilitating faculty member, or teacher, or whatever you call them, who are observing the simulation. Remember, that to help the learner(s) of the simulation get better, the faculty need to be focused on certain things to ensure that the goals of the scenario are accomplished for our selected learner group, associated with the topic we chose in step one.

Lastly, what I want to point out to you is that you should notice something missing. The story!

The story comes later. Everybody wants to focus on the story because the story is fun. It’s often related to what we do clinically. It’s replicating things that are fun that brings in the theatrics of simulation! But what we really want to do is bring the theatrics of simulation to cause the actors on the stage (the participants) to so some activity. This activity gives us the situation to focus our observations on the assessment of the performance. This in turn allows us to accomplish the learning objectives of the scenario and help the participants improve for the future!

Until next time, Happy Simulating!

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June 28, 2018 · 2:07 pm

Five Tips for Effective Debriefing

There is no doubt that debriefing is an important part of simulation-based education efforts. Further, to do a good debriefing is not necessarily easy. Practice, self-reflection and getting training can help dramatically.  Seeking out help form experts and experienced people can be invaluable. Also, there are many resources in which to learn more about debriefing. I encourage you to take advantage of them!

Here are just five random tips in no particular order to help you increase the effectiveness of your debriefing!

5tIPS

  1. Know what the goal(s) are. Be specific.

Too many times simulation scenarios are executed and the faculty member just kind of winging it during the debriefing. It is far more effective a strategy to be keenly aware of what the learning outcomes and goals are prior to the simulation. This will allow you to focus your thoughts and ideas on helping the participants get better during the simulation which can be carried forward to your debriefing efforts. If you are attempting to have the debriefing constrained to the learning objectives for the simulation it is often easier to organize the information and get across the salient points that are needed to achieve the learning outcomes. It is particularly important to remember that you can’t teach everything with every scenario. The participant brain can only take in or process so much information in any one setting. In this case think of a sponge completely saturated with water, that can’t take any more!

  1. Have a framework or structure in mind

Having a structure to your debriefing ahead of time, or perhaps adopting a model of debriefing can help you significantly overcoming the challenging parts of debriefing. Some of the challenges occur in organizing the information. There are a number of debriefing models out there for consideration of adoption. There is no reason to believe that one is better than the other. I highly recommend that you learn several models and become comfortable with them. What you’ll find is some models work better than others in varying situations based on s number of factors such as the experience and expertise of the debriefer, the subject matter that is the focus of the simulation, as well as the level of the learners.

  1. Involve all the learners

If you are debriefing a group of students a challenging task can be involving all the learners. Often times there will be one or two learners who engage in a dialogue with the debriefer and without conscious effort and skill it is easy to continue the dialogue and allow the other members of the participating team to feel potentially marginalized. Often times this dialogue occurs with the person that was in the “hotseat”. Making a conscious effort during the debriefing to include all of the students in a meaningful way can significantly create more learner engagement. Further, if you are running multiple scenarios I believe that engaging all the learners encourages them to pay closer attention if they are in an observation role for subsequent scenarios.

  1. Pull the ideas, don’t push the facts

I like to think of the debriefing as the time when we explore the learners thought processes. If we are transmitting information or pushing facts to them the situation can become more of a lecture. In fact I see many novice debriefers break into song and start delivering a mini lectures during attempts at debriefing. It is important to remember that when you are pushing the facts to the participants it limits the amount of assessment that you can do in terms of their understanding of the material and what you need to do to create deeper learning. So, if you find yourself making many declarative statements, pullback, and start to ask some questions. Encourage critical thinking, self reflection and ensure you are helping to create linkages of what went well during the scenario and why it was good, along with allowing the participants to discover and identify what they should do differently if they were to face a similar situation in real life or another simulation to improve.

  1. Create a summary of the take home points

Novice debriefers tend to struggle with creating an adequate summary. Also, Beware. This is another time that is at risk for the debriefing turning into a mini lecture. It is helpful to have a list of the major take-home points associated with the scenario. You can contextually adapt the summary to the performance that occurred during the simulation scenario even if you have the summary points written out prior to the simulation occurring. It is important to remember that during a debriefing many areas can be covered and touched upon. Learner should be engaged to identify the major learning points that they experience in the simulation, as well as understanding how the simulation was relevant to helping them become better healthcare providers.

So, this was intended to be five random tips on how to improve the effectiveness of your debriefing strategy. I hope that you found them useful!

Now, go forth and do great debriefings extra mission point

 

Until next time,

Happy Simulating!

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March 23, 2018 · 12:00 pm

Three Things True Simulationists Should NEVER Say Again

From Wiktionary: Noun. simulationist (plural simulationists) An artist involved in the simulationism art movement. One who designs or uses a simulation. One who believes in the simulation hypothesis.

Woman taping-up mans mouth

 

After attending, viewing or being involved in hundreds if not thousands of simulation lectures, webinars, workshops, briefings and conversations there are a few things that I hear that make me cringe more than others. In this post I am trying to simmer it down to the top three things that I think we should ban from the conversations and vocabularies of simulationists around the globe!

1. Simulation will never replace learning from real patients!: Of course it wont! That’s not the goal. In fact, in some aspects simulation offers some advantages over learning on real patients. And doubly in fact, real patients have some advantages too! STOP being apologetic for simulation as a methodology. When this is said it is essentially deferring to real patients as some sort of holy grail or gold standard against which to measure. CRAAAAAAAZY……   Learning on real patients is but one methodology by which to attack the complex journey of teaching, learning and assessing the competence of a person or a team of people who are engaged in healthcare.  All the methodologies associated with this goal of education have their own advantages, disadvantages, capabilities and limitations. When we agree with people and say simulation will never replace learning from real patients, or allow that notion to go unchallenged, we are doing a short service to the big picture of creating a holistic education program for learners. See previous blog post on learning on real patients. 

2. In simulation, debriefing is where all of the learning occurs!: You know you have heard this baloney before. Ahhhhhhhhhhhhh such statements are purely misinformed, not backed up by a shred of evidence, kind of contrary to COMMON SENSE, as well as demeaning to the participants as well as the staff and faculty that construct such simulations. The people who still make this statement are still stuck in a world of instructor centricity. In other words, “They are saying go experience all of that…… and then when I run the debriefing the learning will commence.” The other group of people are trying to hard sell you some training on debriefing and then make you think it is some mystical power held by only a certain few people on the planet. Kinda cra’ cra’ (slang for crazy) if you think about it.

When one says something to articulate learning cannot occur during the simulation is confirming that they are quite unthoughtful about how they construct the entire learning encounter. It also hints at the fact that they don’t take the construct of the simulation itself very seriously. The immersive experience that people are exposed to during the simulation and before the debriefing can be and should be constructed in a way that provides built in feedback, observations, as well as experiences that contribute to a feeling of success and/or recognition of the need for improvement. See previous blog post  on learning beyond debriefing

3. Recreation of reality provides the best simulation! [or some variant of this statement]: When I hear this concept even eluded to, I get tachycardic, diaphoretic, and dilated pupils. My fight or flight nervous system gets fully engaged and trust me, I don’t have any planning on running. 😊

[disclaimer on this one: I’m not talking about the type of simulation that is designed for human factors, and/or critical environmental design decisions or packaging/marketing etc. which depend upon a close replication to reality.]

This is one of the signs of a complete novice and/or misinformed person or sometimes groups of people! If you think it through it is a rather ludicrous position. Further, I believe trying to conform to this principle is one of the biggest barriers to success of many simulation endeavors. People spent inordinate amounts of time trying to put their best theatrical foot forward to try to re-create reality. Often what is actually occurring is expanding the time to set up the simulation, expanding the time to reset the simulation and dramatically increasing the time to clean up from the simulation. (All of the after mentioned time intervals increase the overall cost of the individual simulation, thereby reducing the efficiency.) While I am a huge fan of loosely modeling scenarios off of real cases in an attempt to create an environment with some sense of familiarity to the clinical analog, I frequently see people going to extremes trying to re-create details of reality.

We have hundreds and thousands of design decisions to make for even moderately complex scenarios. Every decision we make to include something to try to imitate reality has the potential to potentially cause confusion if not carefully thought out. It is easy to introduce confusion in the attempts to re-create reality since learners engage in simulation with a sense of hyper-vigilance that likely does not occur in the same fashion when they are in the real clinical learning environment. See previous blog post on cognitive third space.

If you really think about it the simulation is designed to have people perform something to allow them to learn, as well as to allow observers to form opinions about the things that the learner(s) did well, and those areas that can be improved upon. Carefully selecting how a scenario unfolds, and/or the equipment that is used to allow this performance to occur is part of the complex decision-making associated with creating simulations. The scenario should be engineered to exploit the areas, actions, situations or time frames that are desired focal points of the learning and assessment objectives.  Attention should be paid to the specifics of the learning and assessment objectives to ensure that the included cache of equipment and/or environmental accoutrements are selected to minimize the potential of confusion, create the most efficient pathway that allows the occurrence of the assessment that contributes improving the learning.

Lastly, lets put stock into the learning contract we are engaging in with our learners. We need to treat them like adult learners. (After all everybody wants to throw in the phrase adult learning principles…. Haha).

Let’s face it: A half amputated leg of a trauma patient with other signs and symptoms of hemorrhagic shock that has a blood-soaked towel under it is probably good enough for our adult learners to get the picture and we don’t actually need blood shooting out of the wound and all over the room. While the former might not be as theatrically sexy, the latter certainly contributes to the overall cost (time and resource) of the simulation. We all need to realistically ask, “what’s the value?”

While my time is up for this post, and I promised to limit my comments to only three, I cannot resist to share with you two other statements or concepts that were in the running for the top three. The first is “If you are not video recording your scenarios you cannot do adequate debriefing”, and the second one is “The simulator should never die.” (Maybe I’ll expand the rant about these and others in the future 😉).

Well… That’s a wrap. I’m off to a week of skiing with family and friends in Colorado!

Until next time,

Happy Simulating!

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January 29, 2018 · 6:18 pm

Don’t Let the Theory Wonks Slow Down the Progress of Healthcare Simulation

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Those of us in the simulation community know well that when used appropriately and effectively simulation allows for amazing learning and contributes to students and providers of healthcare improving the craft. We also know there is very little published literature that conclusively demonstrates the “right way to do it”.

Yet in the scholarly literature there is still a struggle to define best practices and ways to move forward. I believe it is becoming a rate limiting step in helping people get started, grow and flourish in the development of simulation efforts.

I believe that part of the struggle is a diversity of the mission of various simulation programs ranging from entry level students to practicing professionals, varying foci on individualized learning incompetence, versus and/or team working communications training etc. Part of the challenges in these types of scholarly endeavors people try to describe a “one-size-fits-all“ approach to the solution of best practices. To me, this seems ridiculous when you consider the depths and breadth of possibilities for simulation in healthcare.

I believe another barrier (and FINALLY, the real point of this blog post 🙂  is trying to overly theorize everything that goes on with simulation and shooting down scholarly efforts to publish and disseminate successes in simulation based on some missing link to some often-esoteric deep theory in learning. While I believe that attachments to learning theory are important, I think it is ridiculous to think that every decision, best practice and policy in simulation, or experimental design, needs to reach back and betide to some learning theory to be effective.

As I have the good fortune to review a significant number simulation papers it is concerning to me to see many of my fellow reviewers shredding people’s efforts based on ties to learning theories, as well as their own interpretations on how simulation should be conducted. They have decided by reading the literature that is out there (of which there is very little, if any, conclusive arguments on best practices) has become a standard.

My most recent example is that of a paper I reviewed of a manuscript describing an experimental design looking at conducting simulation one way with a certain technology and comparing it to conducting the simulation another way without the technology. The authors then went on to report the resulting differences. As long as the testing circumstances are clearly articulated, along with the intentions and limitations, this is the type of literature the needs to appear for the simulation community to evaluate and digest, and build upon.

Time after time after time more recently I am seeing arguments steeped in theory attachments that seem to indicate this type of experimental testing is irrelevant, or worse yet inappropriate. There is a time and place for theoretical underpinnings and separately there is a time and place for attempting to move things forward with good solid implementation studies.

The theory wonks are holding up the valuable dissemination of information that could assist simulation efforts moving forward. Such information is crucial to assist us collectively to advance the community of practice of healthcare simulation forward to help improve healthcare globally.  There is a time to theorize and a time to get work done.

While I invite the theorist to postulate new and better ways to do things based on their philosophies, let those in the operational world, tell their stories of successes and opportunities as they are discovered.

Or perhaps it is time that we develop a forum or publication of high quality, that provides a better vehicle for dissemination of such information.

So…… in the mean time….. beware of the theory wonks. Try not to let them deter from your efforts to not only move your own simulation investigations forward, but to be able to disseminate and share them with the rest of the world!

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January 9, 2018 · 2:48 am

FIVE TIPS on effectively engaging adult learners in healthcare simulation

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October 17, 2017 · 9:01 pm

True Systems Integration for Hospital Based Simulation Programs

Businessman is using tablet pc and selecting integrationHospital based simulation programs serve a different need than their counterparts housed in schools of medicine and nursing. The stakeholders, the mission, the program assessment and development of curriculum vary significantly. Not to over-generalize but the overall mission of the school focused simulation programs is based around having them integrated into the education processes that contribute to the development of successful students who will be called graduates. Many times, these students end up taking licensing, certifying or other high-stakes examinations that can serve as a convenient data set to assess the impacts of programs.

The mission of hospital, or health-system based programs can be more complex in terms of alignment within the organization. There is a myriad of possibilities within the healthcare delivery environment that can drive the objectives of simulation programs. Examples range from employee training and education; quality, safety or risk based; or perhaps focusing on facilities engineering perspectives. With all of these possibilities the potential strategies for measurement markers to evaluate the success of the program can become blurry, and at times harder to have ready access to the necessary information.

In an era of healthcare cost reductions that we are experiencing now in the United States and many other areas of the world there is significant pressure coming from many different sides to reduce costs and at the same time improve the quality of care. Thus, to prevail in this era of medicine any entity within healthcare delivery system that costs money to operate (like simulation programs) needs to ensure it is providing value to the hospital or system which supports it.

Determining such value can be very challenging. While there are a couple of examples in the literature of isolated value calculations (such as central line training) the utility of such reports is limited in isolation. In total they are only a minute part of the safety problems associated with the delivery of care in the hospital.

Determining the best value of a hospital based program can be achieved through a series of needs assessments that require the simulation leadership to establish relationships in the hospital leadership teams or C-Suites outside of folks involved in education. The true needs assessment comes from participating in a deep understanding of the existing problems, challenges, solutions and successes that the c-suite is incurring to execute the mission of the hospital. This information is often housed in offices of risk management, quality or patient safety.

Integration with the risk management team can better position the simulation program to understand the legal risks from errors and litigation that is currently facing the hospital. Identifying trends and subject matter that could benefit from simulation training can emerge.

Quality offices generally have significant amounts of information regarding the initiatives that the hospital should be, or is focusing on to better provide care to patients. Such initiatives are often based on measurement programs from payers (insurance companies, whether private of government such as Medicare) that result in significant financial risks and/or benefits for the organization. Thus, identifying simulation solutions that could benefit the initiative in some form or fashion can result in value creation for the program.

Patient Safety Offices (sometimes under, or aligned with quality offices) house much of the data on mistakes, small and large, and in some cases near misses, that are occurring in an institution. Such data will also have information on trends, as well as if there was harm transferred to the patient.

Access to this data over time can help to identify the true needs of organization, and help direct a value-based implementation of the simulation efforts. Importantly though, a careful analysis of this data can also help the simulation program recognize what is not likely to bring as much value to the organization.

Two things are important when considering such integration efforts. The first is, even though there is a new era of transparency emerging regarding patient safety, the information is sensitive. To achieve true integration the simulation program leadership needs to establish relationships across the organization. Ideally you desire not only access to the data, but also a presence that positions themselves closer to the core of the analysis and decision making. Many simulation programs remain peripheral to such processes and thus experience a contractor-vendor type of relationship instead of one more akin to an active partner. It takes time, trust and effort to develop such relationships.

Secondly, a dispassionate evaluation of the data that is achieved from the needs analysis is necessary with regard to properly interpreting the value provided by the simulation program. Many simulation programs are born of a passion to simulate, a passion of the first faculty members, and an attachment to legacy programs that have been running for years. For true alignment within an complex organization and surviving future value analysis initiatives (ie. Remaining supported and funded) a program needs to take a hard look at its existing programs and ensure they are pegged to the overall “true” needs of the institution at large.

While this post is not representative of all the possible strategies to integrate a simulation program, it is meant to give insight into a few examples of possibilities, and articulate the depth of the relationships that should be developed.

 

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August 23, 2017 · 8:20 pm

Recreating Reality is NOT the goal of Healthcare Simulation

Discussing the real goals of Healthcare Simulation as it relates to the education of individuals and teams. Avoiding the tendency to put the primary focus into recreating reality, and instead providing the adequate experience that allows deep reflection and learning should be the primary focus. This will help you achieve more from your simulation efforts!

 

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