Rotational Design: Simulation Across the

Curriculum Sara Fruechting, RN, MNSc, CCRN,CHSEJeffrey K. Carmack, DNP, MSN, RN, CHSE

INACSL, 2015, Atlanta

ANCC Required Disclosures

Conflict of interest • Jeffrey Carmack reports no conflict of interest• Sara Fruechting reports no conflict of interestSuccessful completion • Attend 90% of session • Complete online evaluation

Objectives

• The participants will – identify appropriate situations for integration of

simulation based learning experiences across the curriculum

– Understand limitation of the champion model– explore the concierge model of simulation based

learning experiences– examine the financial benefits of using a rotational

design for scheduling of students for simulation based learning experiences.

Terminology… A common ground

• High-fidelity simulation: Irrespective of the type of simulator

• Champion program: One or two faculty lead a single content area

• Full-Faculty program: Every faculty member is required to use the simulation space

• Concierge: Dedicated faculty delivering high-fidelity simulation

High-fidelity Simulation

• Faculty has extensive training• Most faculty have immersion training• INACSL Standards of Best Practice:

SimulationSM is the guiding framework• Faculty utilizes a reflective debriefing tool

Models of Staffing

• Champion– Begin with champion's area of expertise– Build up to further courses• Pros

– Limited support needed– Only one facilitator needs training

• Cons– Limited support given–Workload is often underestimated–May not have training– Simulation lacks “program” status

Models of Staffing• Full-Faculty program – Creates a more inclusive curriculum

• Pros– Limited support needed– Simulations occur during regular clinical hours– May meet the definition of “program”

• Cons– Workload is often underestimated– Training costs are substantial– Oversight is intensive if you meet a standard– Equipment training for all faculty

» Manikin» A/V system» Debriefing system

Models of Staffing• Concierge Model– Creates a comprehensive and cohesive curriculum

• Pros– Faculty are dedicated (Workload is known)– Limited faculty training needed

» Manikin (in-house PM program)» A/V system» Debriefing system

– Simulation program » Budget

– Training costs are limited to faculty facilitating simulations • Cons

– Needs at least 1 FTE without a teaching load– University policies– Evaluation method may not exist for tenure track

High-fidelity Simulation

• Faculty has extensive training• Most faculty have immersion training• INACSL Standards of Best Practice:

SimulationSM is the guiding framework• Faculty utilizes a reflective debriefing tool

Silo or Program? AZ ADVISORY OPINION: EDUCATION USE

OF SIMULATION

• Simulation should be part of SPE

• Calls for facilitators to be immersion trained and for ongoing evaluation

• Simulation cases based on curriculum

NCSBN Simulation Guidelines • Must have a supported

program• Budget must include

ongoing training of facilitators

• Calls for evaluation of components including learners and programs methods

Program costs related to faculty

• Initial immersion training?$1,000 - $5,000

• Biennial conference or other training?$550

• Certification?$350

• Travel? Hotel? Transportation?$$$$

Budget Questions

• How many faculty will you train?• What is your turnover rate for clinical faculty?• Are your faculty tenured?• Do you also need skills lab faculty?

Training and Certification for 1

3 year cost=

$6,900

Annual cost=

$2,300

Rotational Design at Work

• Increase size of all clinical groups to allow one faculty member to teach simulation

• Send a small number of students from each group to simulation each clinical week

• This gets all students through simulation over the semester without hiring additional faculty

Simulation N=8

Clinical 1Hospital =8

Simulation =2

Clinical 2Hospital =8

Simulation =2

Clinical 3LTC =8

Simulation =2

Clinical 4LTC=8

Simulation =2

Clinical 5Hospital =0

Simulation =0

N1505, Fundamentals

• Two faculty cover all simulation experiences• Two hundred students enrolled• Course divided into three rotations– Simulation– Long term care– Acute care

• Simulation faculty have 70 students per week, in groups of seven (five sessions per week)

N1505, Fundamentals

• One group of seven is in scenario with a faculty running two mid-fidelity simulators

• Each simulator has an SP as a family member• Twenty minutes in scenario and forty to debrief• The other seven students are working on skills

with the other faculty• Both groups will be present for three hours,

once a week for four weeks.

2420 Peds 3 FTEs

• Current enrollment n=61• Without simulation – 8 clinical groups needed (8:1) ratio is state mandated. – 6 Adjuncts needed for the Spring 2016 Term $20,500 ($4,100

each, for the half term)• With simulation program – 5 clinical groups needed (12:1) but State ratio max still applies– 3 Adjuncts needed $12,300– 4 learners rotate out to simulation per week from each group

(1FTE and 1 Simulation director)

Facilitator Workload (typical)

Student Workload (6.5 hours)

• Student prepares for one of three simulation cases for a clinical day– Reading about an 1 – 1.5 hour(s)

• Student must complete 3 flat simulations before the full scale simulation day, and earn a score of at least 85%– Online system, takes about 2.5 to 3 hours

• Full scale simulation-based cases– 2 hours on campus

• Post-test and reflection after the day event– 10 to 15 minutes per case

Contact Information

• University of Arkansas at Little Rock Department of Nursing

• Jeff Carmack 501.682.8620 jkcarmack@ualr.edu

• Sara Fruechting 501.371.7627 skfruechting@ualr.edu