Essential In SIMULATION-based Education(SBE)

Poom Tritrakarn

Introductionshare your experience

ObjectivesAfter finish this lecture, you will

•Understand basic principle of simulation based education.

•Generate idea in your own way how you will use simulation.

•Able to write the objectives of your own simulation scenario and made plans according to them.

•PS: This lecture will be interactive as much as possible.

What is Simulation?

• SIMULATION IS THE IMITATION OR REPRESENTATION OF ONE ACT OR SYSTEM BY ANOTHER.

• HEALTHCARE SIMULATIONS CAN BE SAID TO HAVE FOUR MAIN PURPOSES. • EDUCATION

• ASSESSMENT

• RESEARCH

• HEALTH SYSTEM INTEGRATION IN FACILITATING PATIENT SAFETY

Credit: Society for simulation in healthcare

What is Simulation?

• It is a technique ;not a technology, to replace and amplify real experiences with guided ones, often “immersive” in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion.

• Simulation is a technique for practice and learning that can be applied to many different disciplines and types of trainees.

David M. GabaAnesthesiologist, Associate Dean for Immersive and Simulation-based Learning, Stanford University School of Medicine (2004 - Present)

•Teaching technique – just like an act or drill

•Turn into medical scenario for teaching.

•Made into medical scenario for teaching.

Engage learner to active problem based learning

Why simulation?

Group questionWhat is the problem when you teach?

Why do you wish to learn about Simulation?

My reason is…….

Let’s start

Learning theories related to simulation based education

How can adults learn?

Adult learning

• Self-directed

•Problem centered

• Eager to learn what is meaningful to them.

• Eager to learn what they can apply.

• Learn best when they are engaged in activity which involve cognition and emotion.

Our students are adult!!!!

Sustainability of learning

Doing

Learning principle related to simulation

Experiential learning cycle : How we learn when we doing thing.

Learning principle related to simulation

SIMPLY

Experiential learning cycle : How we learn when we doing thing.

The way we learn from working in real situation

However?

may HARM real patients

Use SIMULATION instead

Guided experiential learning

STEPS of simulation based education

1. Have relevant knowledge

2. Simulation

3. Debrief – AAR

4. Apply to real clinical practice or redo

Advantage of simulation

•Patient SAFETY

•Free to make mistake & learn from it

•Repeatable

•Controllable

•Well-matched with adult learning

•Correlate with current education GOALs.

•Fun : Learners love it.

•Evidence support and still going on• A critical review of simulation-based medical education research: 2003–2009

William C McGaghie,1 S Barry Issenberg,2 Emil R Petrusa3 & Ross J Scalese. Medical Education 2010.

• Does Simulation-based Medical Education with Deliberate Practice Yield Better Results than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence. William C. McGaghie, S. Barry Issenberg, Elaine R. Cohen, Jeffrey H.

Barsuk, Diane B. Wayne. Acad Med. 2011 June.

• Simulation-based learning: Just like the real thing. Fatimah Lateef. J Emerg Trauma Shock. 2010

• Training and simulation for patient safety. Rajesh Aggarwal,1 Oliver T Mytton,2 Milliard Derbrew et al.

Qual Saf Health Care 2010

• Simulation-based training in anaesthesiology: a systematic review and meta-analysis G. R. Lorello, D. A. Cook, R. L. Johnson6 and R. Brydges. British Journal of Anaesthesia 2014.

Good at teaching Skill and Behavior process

SimulationCompared with other methods.

•Skills

•Attitude

•Non-technical skills eg. communication

•Team training

•System checking; audit, drill

•Not well-matched with teaching knowledge

Zone of simulation matrix

The zone of simulation: situations where healthcare simulation may be advantageous over other instructional media

• NEW : personnel, tools, techniques, guidelines, wards or hospital etc.

• Crisis management

• Rare cases

• Patient safety issues

• Teamwork

• Assessment

• Research

• Ethics, non-technical skills

Which topics that simulation is good matched?

and more….

ImportantDangerous – high risk

Hard to find, uncommon

Limitation

Limitation•Real experience is better in some context.

•More time-consuming than traditional teaching. Effectiveness is important.

•Costly : Quality over quantity. Also depend on level of technology.

• Teach with Simulation - Need learning & practice

Important things to understand

Facilitationis a way to create learning

Meaning: act of assisting or making easier the progress or improvement of something

Important Terminology

Facilitation VS Traditional

Traditional teaching •Outside in•Give information•Provide right answers

Facilitation VS Traditional

Facilitation teaching• inside-out (constructivism)•Guide process•Provide right questions and environment.

Facilitation teaching (with simulation)will be effectively used only with

suitable learner level.Select learner and time wisely

How do we know that it’s suitable?

From deliberate practice theory

Best learning occur in the right ZONE

Comfort zone

Learning zone

Panic zone

Step of Scenario-based Simulation education

OVERALL Steps of Teaching with Simulation Remember : using Facilitation

1. Before teaching – design & preparation

2. Briefing – Introduction: set the rules, create trust and tell the process.

3. Simulation exp. – Guide them through

4. Debriefing – learning

Next,

the most Importantis the start

Most Important

Goals, Outcome &Objective

•First thing to do is set goals

GOALs or Outcome

•Desired result or end-point

•Help planning in a big picture

• Examples:• We win the race.

• Learner pass the exam.

• Learner able to manage common emergency cases.

Objectives

• Objectives is more pin-pointed than goals.

• Objectives lead to achieve Goals.

GOALReal ObjectivesTraining objectives

Objectives

Goal or Outcome

Objectives

Technique-Simulator, Scenarios

Any questions so far?

• Learning theories – adult learning, experiential learning

•Advantage & Limitation of simulation

• Facilitation

•Goals & Objectives

Important Terminology

Simulator- is a tool

Important: Simulation or Simulator

Simulation is a Technique while Simulator is a Tool.

Important: Simulation or Simulator

Simulation is a Technique.• Lecture• Small group discussion•PBL• Simulation•Bedside teaching

Simulator is a Tool.•PowerPoint•Worksheet• JPEG,MP4,media file• Simulator•Patient

Another word need to be understood

FidelityRealism – Does it feel REAL?

Do we always need high fidelity-realistic?When do we need high fidelity?

History of simulator

Debut in 1911Mrs.CHASE, the first manikin using in nursing education

Can this be a simulator?

YES, how about you?

Simulators

• Like variation of tools.• Model• Computer-based game• Part task trainer• Cadaver• High-fidelity manikin(fidelity = realism)• Human actor – Standardized patient• Hybrid• Self created

•Model • Is it high fidelity?

•Computer-based

•Part task trainer

Cadaver

•High-fidelity manikin

•Actor – Role play - Standardized patient

•Hybrid (SP Actor + manikin)

Self created simulator - MOD

Modified

MOD – Covid 19

MOD – Covid 19

Choosing simulator

•Important: Simulator should match with your objectives.

•Need Fidelity? – Depend on objectives

•Know the advantages and limits of simulator.

Learning exercisesPlease select simulator for these goals.

1. Primary school student understand about anatomy of human heart.

2. Nursing students improve their skill in baby care.

3. Medical student can properly manage patient with heart failure.

4. Resident properly give advice to an end-stage cancer patient and his relative.

Conclusion

• Simulation is an advance teaching techniques based on adult and experiential learning theory which require

Clear objectives “SMART”

Well-matched simulator

Suitable learner and

Skilled FACILITATOR That will be YOU

- prepare- briefing- give exp.- debriefing

Next : Scenario design

• If we want to create a drama show, What do we need?