Simulation Simulation technology in technology in critical care: critical care: 1000 deaths for 1000 deaths for medical education medical education Technology for teaching Technology for teaching and evaluating critical and evaluating critical care knowledge, skills care knowledge, skills and attitudes and attitudes Randy S. Wax, MD, FRCP(C) Technology Application Unit and Critical Care Unit, Department of Medicine, Mount Sinai Hospital Lecturer, Department of Medicine, University of Toronto
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Simulation technology in critical care: 1000 deaths for medical education Technology for teaching and evaluating critical care knowledge, skills and attitudes.
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Simulation technology Simulation technology in critical care: in critical care: 1000 deaths for 1000 deaths for
medical educationmedical education
Technology for teaching Technology for teaching and evaluating critical care and evaluating critical care
knowledge, skills and knowledge, skills and attitudesattitudes
Randy S. Wax, MD, FRCP(C)Technology Application Unit and Critical Care
Unit, Department of Medicine, Mount Sinai Hospital
Lecturer, Department of Medicine, University of Toronto
Learning objectivesLearning objectives
Why simulation?Features of a simulatorApply simulation technologyLimitations and resource
requirements
A traditional approach to learningA traditional approach to learning
Problem #1Problem #1
Just because students learn a task in the classroom doesn’t mean they can demonstrate successful performance during a crisis.
Problem #2Problem #2
Some clinical experiences are so life threatening that students are not going to be involved in the management.
Problem #3Problem #3
Some are so rare that the student may not ever experience the situation until they are in the midst of caring for the patient.
Different simulation Different simulation formatsformats
Patient management problems (paper/pen)
Computerized simulation– Internet-based
Role playing/standardized patientsMannequin-based (e.g., CPR BCLS
trainer)Virtual reality
Why simulation?Why simulation?
Used in many “high reliability” fields– Aviation
– Nuclear power
– Military flight operations
Why simulation?Why simulation?
No risk to patients Many scenarios can be presented,
including uncommon but critical situations in which a rapid response is needed – E.g. malignant hyperthermia 1:40,000 cases
Participants can see the results of their decisions and actions; errors can be allowed to occur and reach their conclusions
Why simulation?Why simulation?
Identical scenarios can be presented to different clinicians or teams
The underlying causes of the situation are known
With mannequin based simulators clinicians can use actual medical equipment– examine limitations in the human-machine
interface
Why simulation?Why simulation?
Re-create clinical environments– Assess interpersonal interactions with other
clinical staff
– Evaluate and improve teamwork, leadership, and communication skills
Why simulation?Why simulation?
Intensive and intrusive recording of the simulation session is feasible– Audiotape
– Videotape
– Physiological monitoring of participants (EEG, ECG, etc.)
Why simulation?Why simulation?
There are no issues of patient confidentiality
Recordings can be preserved for research, performance assessment, or accreditation
How can we use How can we use simulation?simulation?
Skills trainingEvaluation
Epidemiology and modification of errors (and their consequences)
Crisis resource management
What can you What can you teach/evaluate?teach/evaluate?
Specific skills– Intubation– Bronchoscopy– Defibrillation
Integration of knowledge, skills and decision making– Resuscitation– Refractory hypoxemia
Level 1 Level 2 Level 3
Skill Integrate High-fidelity
Medical Student
Bag ventilation
Hypoxemic patient
Ward team
Resident Intubate Hypoxemic patient
ER/ICU RN, RT
Fellow/
Staff
LMA, surgical airway
Difficult airway management
Full ER/ICU team
CME
Evaluation of the evaluation toolEvaluation of the evaluation tool
Type of simulator– Low to high fidelity
Type of simulation– Full theatre environment or real location– Training device for specific tasks