high fidelity simulation for healthcare education iii

High Fidelity Simulation for Healthcare Education.Time to move forward?

Helen WoodNursing Education SpecialistMayo Clinic Health SystemsRochester Minnesota

Current Situation•A movement toward making simulations a

part of the clinical practicum, either as a clinical substitute or as an adjunct.

•Movement arises out of need for:– More clinical sites– More nurse educators– New clinical practice models to

prepare 21st century graduates in high-tech, complex environments

Simulation Training Effectiveness• 40 years of empirical research• Thousands of research reports• Education and health services research• Five comprehensive reviews• Simulation based medical education is a

powerful educational intervention and innovation to increase medical learner competence measured in the learning laboratory, during patient care delivery, and improves patient health outcomes measured quantitatively (Farfel, Hardoff, Afek, & Ziv, 2010)

Towards Hypothesis Driven Medical Education Research: Task Force Report From the Millennium Conference 2007 on Educational Research

Could simulated emergency procedures practiced in a staticenvironment improve the clinical performance of a Critical

CareAir Support Team (CCAST)?:CONCLUSION:

For CCASTs to have a standardized training curriculum, they should undertake real-time missions in a flight simulator, supported by a human patient simulator programmed to respond to the physiological changes associated with altitude. Real scenarios could then be practiced, on demand, in a safe environment as an augmentation to the current training program. Consequently, those acquired skills could then be carried out with improved proficiency during real missions with a concomitant potential for improvement in the standard of patient care

Challenges to consider when diffusing SBME (simulation based medical education) into medical education.

The right conditions:•Mastery Learning and deliberate practice•Skillful Faculty•Curriculum Integration•Institutional Endorsement•Healthcare System Acceptance

Summit on Simulation Research

Institute of Medicine studies/reports (1999 - 2003)

strongly suggest that the traditional apprentice

model” has not sufficiently prepared today’s health

care providers.

For example medical errors: Result in 44,000-98,000 deaths annually 8th leading cause of death (at 44,000) $37-50 billion for adverse events $17-29 billion for preventable adverse events

How does healthcare simulation work and what is it?

http://youtu.be/I_NEsLXtuwI

Issenberg SB, McGaghie WC, Petrusa ER, et al. Eeatures and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10-28. McGaghie WC, Issenberg SB, Petrusa ER, et al. Effect of practice on standardised learning outcomes in simulation-based medical education. Med Educ 2006;40: 792-797.

Elements of Diffusion

There are four elements of diffusion (Rogers, 2003)• AN INNOVATION• COMMUNICATION • TIME• A SOCIAL SYSTEM.

INNOVATIVENESS AND ADOPTER CATEGORIES

• INNOVATIVENESS IS THE DEGREE TO WHICH AN INDIVIDUAL OROTHER UNIT OF ADOPTION IS RELA-TIVELY EARLIER INADOPTING NEW IDEAS THAN THE OTHER MEMBERS OF ASYSTEM.• ADOPTER CATEGORIES ARE THE CLASSIFICATIONS OFMEMBERS OF A SOCIAL SYSTEM ON THE BASIS OFINNOVATIVENESS.• THE FIVE ADOPTER CATEGORIES ARE:

• 1. INNOVATORS• 2. EARLY ADOPTERS• 3. EARLY MAJORITY• 4. LATE MAJORITY

• 5. LAGGARDS

The Origins of Simulation in Nursing Education•During the past decade, the use of

simulations as a teaching-learning intervention in nursing curricula has increased greatly.

•Nursing students, clinicians, and educators alike appear to be strongly in agreement about the importance of incorporating simulations as a teaching practice because of several factors

CHARACTERISTICS OF INNOVATIONS

•Relative advantage (in economic terms, social prestige factors, convenience, satisfaction).•Compatibility ( the degree to which an innovation is perceived as being consistent with the existing values, past experiences, and needs of potential adopters)•Complexity ( the degree to which an innovation is perceived as difficult to understand and use).•Trialability (the degree to which an innovation may be experimented with on a limited basis)•Observabiltity ( the degree to which the results of an innovation are visible to others).

DATE EVENT FACULTY INVOLVEMENT USER RESPONSE

Leadership Activity: Relative Advantage Spring - Fall 2012 Arranged simulation vendor

demos Disseminated relevant articles circulated to faculty Journal Club organized

Leadership Activity: Relative Advantage, Complexity and Compatability Summer 2012 Basic Simulator Training Course

by METI, Inc PNCI: Program for Nursing Curriculum Integration Consult Training Session #1 by METI, Inc.

Fall 2012 College-wide discussion and planning

Spring 2013 through

Spring 2014

Provided material, tactical and technical support to conduct simulations, included hiring part-time lab assistant

Gather Student Feedback Data on Simulated Clinical Experiences *** PNCI Consult Training Session

#2 by METI, Inc. To be held after information gathered at a future date

*Relative Advantage: quality of: student learning, instructor-learner interactions, learner motivation and faculty preparation time.

High Fidelity Simulation Implementation/Adoption Events Timeline

Shortridge, A., McPherson, M., Ellison, G. & Kientz, E. (2008). A Case Study Implementing High Fidelity Clinical Skills Education Using Innovation Diffusion Theory. In J. Luca & E. Weippl (Eds.), Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications 2008 (pp. 3054-3062). Chesapeake, VA: AACE.Retrieved from http://www.editlib.org/p/28804

Observation 1:Simulation provides faculty the opportunity to focus on student learning needs without having to focus on the needs of a live patient.

Observation 2: Cues provided by faculty during Simulated Clinical Experiences (SCEs) need to be selected carefully as to what and when to cue.

Observation 3: Quicker determination of student leaders and laggards is possible during SCEs (lagging not related to role in scenario).

Observation 4: If faculty members stand away from the bedside during SCEs, students tend to take charge of the scenario and their own decision-making.

Observation 5: The ability to cause rapid changes in the patient’s condition during SCEs exposes student behaviors-positive and negative.

Observation 6: Simulation and debriefing provide better opportunities to examine how teams function as compared to live clinical environments.

Observation 7: Debriefing is as important to the learning process as the SCE.

Faculty Observations: High Fidelity Simulation vs. Live Clinical Scenarios

Shortridge, A., McPherson, M., Ellison, G. & Kientz, E. (2008). A Case Study Implementing High Fidelity Clinical Skills Education Using Innovation Diffusion Theory. In J. Luca & E. Weippl (Eds.), Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications 2008 (pp. 3054-3062). Chesapeake, VA: AACE.Retrieved from http://www.editlib.org/p/28804

Simulation-based education improves procedural competence in central venous catheter (CVC) insertion. The effect of simulation-based education in CVC insertion on the incidence of catheter-related bloodstream infection (CRBSI) is unknown. The aim of this study was to determine if simulation-based training in CVC insertion reduces CRBSI.There were fewer CRBSIs after the simulator-trained residents entered the intervention ICU (0.50 infections per 1000 catheter-days) compared with both the same unit prior to the intervention (3.20 per 1000 catheter-days) (P = .001) and with another ICU in the same hospital throughout the study

period (5.03 per 1000 catheter-days) (P = .001).

An educational intervention in CVC insertion significantly improved patient outcomes. Simulation-based education is a valuable adjunct in residency education.

Barsuk, J., Cohen, E., Feinglass, J., McGaghie, W., & Wayne, D. (2009). Use of simulation-based education to reduce catheter-related bloodstream infections. Archives of Internal Medicine, 169(15), 1420-1423. doi:10.1001/archinternmed.2009.215

Simulation-based education improves procedural competence in central venous catheter (CVC) insertion. The effect of simulation-based education in CVC insertion on the incidence of catheter-related bloodstream infection (CRBSI) is unknown. The aim of this study was to determine if simulation-based training in CVC insertion reduces CRBSI.

Conclusion

“In Situ” Simulation as a StrategySimulation training conducted on a hospital unit where real patient care is delivered and errors occur

Allows clinicians to practice & problem solve patient issues with their team in their “real” work Environment

Allows opportunity to uncover and identify latent safety threats and Micro-system deficiencies

The effects of a simulation-driven, patient safety program aimed at improving early detection & treatment of hospital-acquired complications will:

PRIMARY OUTCOMES: DecreaseRate of hospital-acquired:Rate of unplanned transfers to higher level of care Risk-adjusted hospital mortalitySevere sepsis/septic shockAcute respiratory failure

SECONDARY OUTCOMES: Improve: Teamwork performance and communication skillsKnowledge, critical thinking and decision-making Safety culture on involved unitsNurses’ comfort & confidence in calling for help earlyPatterns of social interaction among nurses and residents

Summary facts found from Beacon Benchmarking:

Success with simulation program largely due to :Buy-in from the CMO & CNOStrong partnerships with Unit Leadership

Conducting frequent, in situ simulation exercises: FeasibleNot dependent on “fidelity”

Participants enjoy in situ simulation trainingSimulation training reveals deficiencies with teamwork; debriefing offers unique coaching opportunityA simulation-driven patient safety program holds serious opportunity in improving clinical outcomes

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References

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Barsuk, J., Cohen, E., Feinglass, J., McGaghie, W., & Wayne, D. (2009). Use of simulation-based education to reduce catheter-related bloodstream infections. Archives of Internal Medicine, 169(15), 1420-1423. doi:10.1001/archinternmed.2009.215Cannon-Diehl, M. (2009). Simulation in healthcare and nursing: state of the science. Critical Care Nursing Quarterly, 32(2), 128-136. doi:10.1097/CNQ.0b013e3181a27e0fEleven Research Priorities developed by the Millennium Conference 2007 Retrieved http://journals.lww.com/academicmedicine/_layouts/oaks.journals/imageview.aspx?k=academicmedicine:2010:05000:00027&i=ttu3a Farfel, A., Hardoff, D., Afek, A., & Ziv, A. (2010). Effect of a simulated patient-based educational program on the quality of medical encounters at military recruitment centers. The Israel Medical Association Journal: IMAJ, 12(8), 455-459. Retrieved from EBSCOhost.Fincher, R., White, C., Huang, G., & Schwartzstein, R. (2010). Toward hypothesis-driven medical education research: task force report from the Millennium Conference 2007 on educational research. Academic Medicine: Journal Of The Association Of American Medical Colleges, 85(5), 821-828. Retrieved from EBSCOhostGaba, D. (2004). The future vision of simulation in health care. Quality & Safety in Health Care, 13 Suppl 1i2-i10. Retrieved from EBSCOhost

Issenberg SB, McGaghie WC, Petrusa ER, et al. Eeatures and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10-28. McGaghie WC, Issenberg SB, Petrusa ER, et al. Effect of practice on standardized learning outcomes in simulation-based medical education. Med Educ 2006; 40: 792-797McGaghie, W., Issenberg, S., Petrusa, E., & Scalese, R. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education, 44(1), 50-63. Retrieved from EBSCOhost .McGaghie, W., Issenberg, S., Petrusa, E., & Scalese, R. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education, 44(1), 50-63. Retrieved from EBSCOhost Towards Hypothesis Driven Medical Education Research: Task Force Report from the Millennium Conference 2007 on Educational Research http://journals.lww.com/academicmedicine/_layouts/oaks.journals/ImageView.aspx?k=academicmedicine:2010:05000:00027&i=TTU3A Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free PressShortridge, A., McPherson, M., Ellison, G. & Kientz, E. (2008). A Case Study Implementing High Fidelity Clinical Skills Education Using Innovation Diffusion Theory. In J. Luca & E. Weippl (Eds.), Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications 2008 (pp. 3054-3062). Chesapeake, VA: AACE.Retrieved from http://www.editlib.org/p/28804