High Fidelity Simulation for Healthcare Education. Time to move forward? Helen Wood Nursing Education Specialist Mayo Clinic Health Systems Rochester Minnesota
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