Fundamentals of Simulation Based Education

Dr. Nikki Schiebel Consultant Emergency MedicineMayo Clinic

Carol J. Fahje MS, RN, BCNursing Education SpecialistEmergency Department

Basic Assumption

“We believe that all participants at the Mayo

Multidisciplinary Simulation Center are intelligent, well

educated, and want to improve so they can provide

high quality and safe patient care.”

Foundation PrinciplesPower of experiential learning

Practice without risk

Standardization of curriculum

Experiential Learning“Instead of learning by osmosis, simulations can change behaviors and teach people certain principles about how to avoid mistakes through the simulation experience.” David Gaba MD, Stanford Professor of Anesthesiology

Practice without risk“Practice on simulators before practicing on people”.

Jeff Cooper, PhD, Director of the Center for Medical Simulation

Standardization of curriculum

“Patient simulation helps to ensure that learners are exposed to many different types of illness. Currently students see cases based on random opportunity in their hospital or clinic and many graduate without being exposed to various important conditions.”James Gordon MD, MPA, Emergency Medicine at Massachusetts

General Hospital.

Making Learning Meaningful“Experience the chaos” making learning more meaningfulNeed emotional engagement to develop deeper cognitive levels and foster complex thought (Gordon, 2004; JAMA,2002)Provide unlimited opportunity for things to go wrong and “see” the consequences (McGuire)Design scenarios of potentially dangerous situations w/o full penalties of mistakes (McGuire)

Modalities Used in SimulationHigh fidelity mannequinsTask trainersStandardized patientsCombinations of modalities

1. High Fidelity MannequinsComputer driven full size mannequins

Blinks, speaks, breathes, pulse, heartbeat, responds to therapies (e.g. CPR, intubation, ventilation)Strengths are in the ability to accurately mimic physiological conditions and respond to interventions

Examples1. Use when hemodynamics are needed

for assessment2. Intubation with patient response

desired3. Pupil reactions are important4. Patient verbal response important

2. Task TrainersFocus is on specific skill acquisition

Laparoscopic SimulatorAirway managementPelvic mannequinsVascular interventions

3. Standardized Patients

Actors who simulate scenariosInteractabilityElement of surpriseCommunication techniques• Verbal and non-verbal

4. CombinationsTask trainer/high fidelity mannequin

Laparoscopic trainer with high fidelity mannequinPelvic exam simulator with standardized patientCystoscopy trainer with standardized patient

Mannequins with Standardized Patient

Multiple Objectives

Crisis Resource Management PrinciplesClinical Topics

Low Volume/High Risk ConditionsConcentrated attention on a medical diathesesVarying diagnosesStandardized curriculum

Non Clinical Topics

Team Processes

Emergency Response Teams

Trauma Teams

Physician/Nursing Teams from a clinical area

Crisis Resource Management (CRM) Principles

1. Situational awareness

2. Leadership & role clarification

3. Communication

4. Error anticipation & containment strategies

5. Use of human, information & material resources

Safety InitiativesMedication Safety

Patient ID not correctDrug allergy or drug incompatibility

Equipment SafetyIV pump set up incorrectly

Physical Safety Patient supine when receiving a tube feeding

Documentation Safety Restraint order inconsistent with policy

Clinical TopicsLow volume/High risk

Bleeding Diatheses

Themes Presenting complaint is dyspnea

Updated practicesSepsis management

EthicsWithdrawing supportResuscitation wishes differs among family members

Other possibilities…

Chain of commandNoise/DistractionsPatient/Family InteractionsDelivering bad newsThe opportunities are limitless!!!!

ReferencesFacilitating LOS Debriefing: A Training Manual

http://ntl.bts.gov/lib/000/900/962/Final_Training_TM.pdf Friedrich, M. (2002). Practice Makes Perfect. JAMA 288(22) 2810-2812.Gordon, J. (2004). High-Fidelity Patient Simulation: A Revolution in Medical Education. Society for Critical Care Medicine, Simulators in Critical Care and Beyond.Kurtz, S. Silverman, J., & Draper, K (2005). Teaching and Learning Communication Skills in Medicine, 2nd ed. Radcliffe Publishing. ISBN 1-85775-658-4.McGuire, C. (1999) Innovative Simulations for Assessing Professional Competence; Simulation: Its Essential Nature and Characteristics. University of Illinois, Chicago. Department of Medical Education.Mort, T.C. & Donahue, S.P. (2004). Debriefing: The basics in Simulators in Critical Care and Beyond, Dunn, ed; (p76-81). Society of Critical Care Medicine.

Paparella, S.F., Mariani, B.A., Layton, K., & Carpenter, A.M. (2004). Patient Safety Simulation: Learning About Safety Never Seemed More Fun. Journal for Nurses in

Staff Development 20(6), 247-254.