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.

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?


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


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.


Nursing 44% 17

Medicine 18% 7

Pharmacy 8% 3

Occupational and/or physiotherapy

13% 5

Respiratory therapy 10% 4

Social work 10% 4


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.


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?


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


Total Responses 39

HOW DO YOU SHARE BEST PRACTICES IN SIMULATION WITH

YOUR COLLEAGUES IN YOUR INSTITUTION?


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?


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


Total Responses 39

HOW DO YOU OBTAIN YOUR INFORMATION REGARDING

SIMULATION?


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


WHAT IS THE AVERAGE NUMBER OF HOURS PER WEEK THAT YOU SPEND

CONDUCTING SIMULATION?

Response

Range 1.5 – 32 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?


10% 32% 12

25% 34% 13

50% 0% 0


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?


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?)


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


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?


Yes 95% 37

No 5% 2

Total Responses 39

HOW IS FACULTY PREPARED FOR DELIVERING SIMULATION?


Self-taught 77% 30

Train-the trainer 62% 24

Advanced credit courses 18% 7

Conferences 69% 27

Workshop 72% 28


Total Responses 39

HOW IS FACULTY PREPARED FOR DELIVERING SIMULATION?


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

[email protected]

Tel: 905.721.2000 x3716

Nicole Harder, RN, PhD

[email protected]

Tel: 204.474.6714

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.

Documents

simulation slide

clinical simulation

low fidelity simulation

anitoba simulation

simulation standard

ethods slide

use of simulation

total responses39 slide