L ESLIE G RAHAM RN MN CNCC CHSE U NIVERSITY OF O NTARIO, I NSTITUTE OF T ECHNOLOGY -D URHAM C OLLEGE N ICOLE H ARDER RN P H D U NIVERSITY OF M ANITOBA.
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LESLIE GRAHAM RN MN CNCC CHSE UNIVERSITY OF ONTARIO, INSTITUTE OF TECHNOLOGY-DURHAM COLLEGENICOLE HARDER RN PHDUNIVERSITY OF MANITOBA
Simulation in undergraduate education: The Canadian Perspective
Edulearn Conference 2014
LEARNING OBJECTIVES
1.Define the high fidelity, mid-level fidelity and low fidelity simulation.
2. Describe the use of simulation in undergraduate education in Canada.
3. Identify barriers to integrating simulation across the curriculum in Canadian undergraduate education.
CANADARESPONSE RATES
26 %18%
26%
3%
3%
3%
5%
PURPOSE
The purpose of this study was to examine the current state of simulation utilization within Canadian undergraduate education.
Simulation is emerging as both a patient safety initiative and a teaching /learning strategy.
METHODS
RESULTS
Different Modalities for Simulation
DEFINITIONS Low fidelity are ‘experiences such as case studies, role-playing, using
partial task trainers to immerse participant in a clinical situation…”
Midlevel fidelity are experiences that are more technology sophisticated such as computer based self-directed learning systems in which participant relies on a two-dimensional experience” ie a manniquin with breath sounds but the chest doesn’t rise
High fidelity “ are experiences using full scale computerized patient simulators, virtual reality or standardized patients that are extremely realistic and provide a high level of interactivity for the learner”
Meakim, C., Boese, T., Decker, S., Franklin, A., Gloe, D,. Loice, L., Sando, C, Borum, J. (2013). Standards of Best Practice: Simulation Standard I: Terminology. Clinical Simulation in Nursing, 9(6S), S3-S11
WHAT TYPE OF PATIENT SIMULATION TOOLS ARE USED AT YOUR
INSTITUTION?
Response Chart Percentage Count
Task trainers (low-fidelity mannequins)
95% 37
Standardized patients 64% 25
High-fidelity mannequin 85% 33
Hybrid (combination of mannequins and standardized patients)
38% 15
Virtual or computer simulation activities
36% 14
Other, please specify... 5% 2
Total Responses 39
Other response Count
mid-fidelity 2
IN WHAT CAPACITY ARE THESE USED?
Response Chart Percentage Count
Replacement for clinical hours 36% 14
Adjunct to clinical hours 69% 27
As part of the psychomotor skills lab
90% 35
As part of a theory course 59% 23
As part of a seminar 28% 11
Other, please specify... 8% 3
Total Responses 39
Other Response Count
As part of a clinical course (lab hours) 2
Open practice & case study reviews 1
DO YOU CONDUCT INTERDISPLINARY SIMULATIONS? IF SO, PLEASE INDICATE ALL DISCIPLINES THAT ARE INVOLVED.
Response Chart Percentage Count
Nursing 44% 17
Medicine 18% 7
Pharmacy 8% 3
Occupational and/or physiotherapy
13% 5
Respiratory therapy 10% 4
Social work 10% 4
Other, please specify... 15% 6
I do not conduct interdisciplinary simulations
56% 22
Total Responses 39
DO YOU CONDUCT INTERDISPLINARY SIMULATIONS? IF SO, PLEASE INDICATE ALL DISCIPLINES THAT ARE INVOLVED.
Other Response Count
Support workers 4
Paramedics 3
Dental 2
Pharmacy Tech, Lab Tech 2
Police 1
HOW DO YOU SHARE BEST PRACTICES IN SIMULATION WITH
YOUR COLLEAGUES IN YOUR INSTITUTION?
Response Chart Percentage Count
Simulation committee 18% 7
Faculty/staff meetings 31% 12
Share articles/resources with colleagues
15% 6
Presentations to colleagues 13% 5
We do not share best practices. It is an individual activity.
13% 5
Other, please specify... 10% 4
Total Responses 39
HOW DO YOU SHARE BEST PRACTICES IN SIMULATION WITH
YOUR COLLEAGUES IN YOUR INSTITUTION?
Other Response Count
Simulation faculty member involved in all teaching teams
1
Simulation committee (including students)
1
Various ways from examples provided
1
HOW DO YOU OBTAIN YOUR INFORMATION REGARDING
SIMULATION?
Response Chart Percentage Count
Read simulation articles in academic journals
90% 35
Attend conferences related to simulation
92% 36
Belong to a simulation organization (e.g. INACSL, ASPE, SSiH, etc.)
79% 31
Other, please specify... 21% 8
Total Responses 39
HOW DO YOU OBTAIN YOUR INFORMATION REGARDING
SIMULATION?
Other Response Count
Network with local programs/organizations using simulation
4
Conduct research in simulation/MSN projects in simulation
2
Self-directed 1
Interested faculty members 1
WHAT ARE THE AVERAGE HOURS PER WEEK THAT YOUR SIMULATION
CENTRE IS USED?
Response
Range 4 – 80 hours per week
Average 30 hours per week
WHAT IS THE AVERAGE NUMBER OF HOURS PER WEEK THAT YOU SPEND
PREPARING FOR SIMULATION?
Response
Range 2-20 hours per week
Average 10 hours per week
WHAT IS THE AVERAGE NUMBER OF HOURS PER WEEK THAT YOU SPEND
CONDUCTING SIMULATION?
Response
Range 1.5 – 32 hours per week
Average 13 hours per week
WHAT DO YOU CONSIDER THE BIGGEST BARRIERS TO USING SIMULATION? DO
YOU HAVE ANY SUGGESTIONS ON HOW THESE CAN BE OVERCOME.
Response Count
Lack of trained technicians/simulator operators/IT support
14
Lack of space/resources 12
Faculty time 11
Faculty has limited knowledge regarding simulation and debriefing
11
Expense 10
Faculty resistant to using simulation 4
Lack of equipment/equipment breakdown 3
Not integrating into curriculum 2
WHAT DO YOU CONSIDER THE BIGGEST FACILITATORS TO USING SIMULATION?
CAN YOU THINK OF WAYS TO CAPITALIZE ON THIS?
Response Count
Involve students, report student learning/student feedback 11
Identify simulation champions 4
Incorporate simulation into curriculum, address gaps in curriculum (e.g. IPE, patient safety, lifespan)
4
Institutional and administration support (including funding) 4
Ongoing faculty development activities around simulation 4
Include simulation development into faculty workload 3
Facilitate faculty buy-in 2
Have trained simulation operators/technicians 2
Ensure simulation is theoretically based/ use standards of best practice
2
Develop simulation network/liaise with other schools and programs
1
WHAT PERCENTAGE OF HOURS WOULD YOU CONSIDER ACCEPTABLE FOR
CLINICAL REPLACEMENT?
Response Chart Percentage Count
10% 32% 12
25% 34% 13
50% 0% 0
Other, please specify... 34% 13
Total Responses 38
WHAT PERCENTAGE OF HOURS WOULD YOU CONSIDER ACCEPTABLE
FOR CLINICAL REPLACEMENT?
Response
I don’t believe simulation is the replacement of clinical hours. It should de developped with objectives that compliment clinical hours.In x province, 0% is allowed, however I would fully support 25 %
0%
Dependant on the focus - med surg or pediatrics?
Simulation prepares for clinical, it is NOT a replacement for it. Would anyone accept such a model to replace a surgeon's experience in the OR???Other percentages listed: 5%, 15%, 30%
Various as the student progresses through the program
The clinical fields do not accept the replacement of clinical hours.
We do not support it as a replacement for practice hours
DO YOU USE SIMULATION FOR SUMMATIVE OR FORMATIVE
EVALUATION?
Response Chart Percentage Count
Summative 11% 4
Formative 18% 7
Both 50% 19
Neither 21% 8
Total Responses 38
DO YOU EVER USE SIMULATION TO REPLACE CLINICAL HOURS DUE TO STUDENT ABSENCE IN
SITUATIONS SUCH AS CLINICAL FACULTY ILLNESS OR AGENCY OUTBREAKS (E.G. C-
DIFFICILE?)
Response Chart Percentage Count
Yes 44% 17
No 56% 22
Total Responses 39
DOES YOUR SIMULATION LAB RECEIVE ADEQUATE RESOURCES TO FACILITATE MEANINGFUL AND QUALITY SIMULATED
LEARNING EXPERIENCES?Response Chart Percentage Count
Yes 39% 15
No 29% 11
Comments 32% 12
Total Responses 38
Other Response Count
Lack of adequate understanding in the pedagogy of simulation and debriefing
5
Lack of funding 4
Lack of adequate human resources 4
Lack of adequate space 1
Lack of adequate ancillary equipment (e.g. AV equipment)
1
Lack of opportunity to use simulation meaningfully
1
WOULD YOU OR YOUR DELEGATE JOIN A NATIONAL CONSORTIUM TO
ADVANCE THE SCIENCE OF SIMULATION?
Response Chart Percentage Count
Yes 95% 37
No 5% 2
Total Responses 39
HOW IS FACULTY PREPARED FOR DELIVERING SIMULATION?
Response Chart Percentage Count
Self-taught 77% 30
Train-the trainer 62% 24
Advanced credit courses 18% 7
Conferences 69% 27
Workshop 72% 28
Other, please specify... 31% 12
Total Responses 39
HOW IS FACULTY PREPARED FOR DELIVERING SIMULATION?
Other Response Count
In-house faculty development / in-house expertise
6
Simulation committee part of faculty structure
1
Faculty do not use simulation – technicians only
1
No qualified faculty to deliver workshops 1
CONCLUSIONS
Faculty development and financial barriers identified as barrier to fully integrating simulation across the curriculum
Other barriers included lack of IT support, lack of space, expense, and limited knowledge about simulation
Professional development and faculty support are required to fully implement simulation
THANK YOU FOR YOUR TIME
Leslie Graham, MN, CNCC, CHSE
Leslie.Graham@durhamcollege.ca
Tel: 905.721.2000 x3716
Nicole Harder, RN, PhD
Nicole.Harder@umanitoba.ca
Tel: 204.474.6714
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