fundamentals of simulation based education dr. nikki schiebel consultant emergency medicine mayo...
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Fundamentals of Simulation Based Education
Dr. Nikki Schiebel Consultant Emergency MedicineMayo Clinic
Carol J. Fahje MS, RN, BCNursing Education SpecialistEmergency Department
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Basic Assumption
“We believe that all participants at the Mayo
Multidisciplinary Simulation Center are intelligent, well
educated, and want to improve so they can provide
high quality and safe patient care.”
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Foundation PrinciplesPower of experiential learning
Practice without risk
Standardization of curriculum
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Experiential Learning“Instead of learning by osmosis, simulations can change behaviors and teach people certain principles about how to avoid mistakes through the simulation experience.” David Gaba MD, Stanford Professor of Anesthesiology
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Practice without risk“Practice on simulators before practicing on people”.
Jeff Cooper, PhD, Director of the Center for Medical Simulation
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Standardization of curriculum
“Patient simulation helps to ensure that learners are exposed to many different types of illness. Currently students see cases based on random opportunity in their hospital or clinic and many graduate without being exposed to various important conditions.”James Gordon MD, MPA, Emergency Medicine at Massachusetts
General Hospital.
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Making Learning Meaningful“Experience the chaos” making learning more meaningfulNeed emotional engagement to develop deeper cognitive levels and foster complex thought (Gordon, 2004; JAMA,2002)Provide unlimited opportunity for things to go wrong and “see” the consequences (McGuire)Design scenarios of potentially dangerous situations w/o full penalties of mistakes (McGuire)
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Modalities Used in SimulationHigh fidelity mannequinsTask trainersStandardized patientsCombinations of modalities
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1. High Fidelity MannequinsComputer driven full size mannequins
Blinks, speaks, breathes, pulse, heartbeat, responds to therapies (e.g. CPR, intubation, ventilation)Strengths are in the ability to accurately mimic physiological conditions and respond to interventions
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Examples1. Use when hemodynamics are needed
for assessment2. Intubation with patient response
desired3. Pupil reactions are important4. Patient verbal response important
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2. Task TrainersFocus is on specific skill acquisition
Laparoscopic SimulatorAirway managementPelvic mannequinsVascular interventions
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3. Standardized Patients
Actors who simulate scenariosInteractabilityElement of surpriseCommunication techniques• Verbal and non-verbal
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4. CombinationsTask trainer/high fidelity mannequin
Laparoscopic trainer with high fidelity mannequinPelvic exam simulator with standardized patientCystoscopy trainer with standardized patient
Mannequins with Standardized Patient
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Multiple Objectives
Crisis Resource Management PrinciplesClinical Topics
Low Volume/High Risk ConditionsConcentrated attention on a medical diathesesVarying diagnosesStandardized curriculum
Non Clinical Topics
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Team Processes
Emergency Response Teams
Trauma Teams
Physician/Nursing Teams from a clinical area
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Crisis Resource Management (CRM) Principles
1. Situational awareness
2. Leadership & role clarification
3. Communication
4. Error anticipation & containment strategies
5. Use of human, information & material resources
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Safety InitiativesMedication Safety
Patient ID not correctDrug allergy or drug incompatibility
Equipment SafetyIV pump set up incorrectly
Physical Safety Patient supine when receiving a tube feeding
Documentation Safety Restraint order inconsistent with policy
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Clinical TopicsLow volume/High risk
Bleeding Diatheses
Themes Presenting complaint is dyspnea
Updated practicesSepsis management
EthicsWithdrawing supportResuscitation wishes differs among family members
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Other possibilities…
Chain of commandNoise/DistractionsPatient/Family InteractionsDelivering bad newsThe opportunities are limitless!!!!
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ReferencesFacilitating LOS Debriefing: A Training Manual
http://ntl.bts.gov/lib/000/900/962/Final_Training_TM.pdf Friedrich, M. (2002). Practice Makes Perfect. JAMA 288(22) 2810-2812.Gordon, J. (2004). High-Fidelity Patient Simulation: A Revolution in Medical Education. Society for Critical Care Medicine, Simulators in Critical Care and Beyond.Kurtz, S. Silverman, J., & Draper, K (2005). Teaching and Learning Communication Skills in Medicine, 2nd ed. Radcliffe Publishing. ISBN 1-85775-658-4.McGuire, C. (1999) Innovative Simulations for Assessing Professional Competence; Simulation: Its Essential Nature and Characteristics. University of Illinois, Chicago. Department of Medical Education.Mort, T.C. & Donahue, S.P. (2004). Debriefing: The basics in Simulators in Critical Care and Beyond, Dunn, ed; (p76-81). Society of Critical Care Medicine.
Paparella, S.F., Mariani, B.A., Layton, K., & Carpenter, A.M. (2004). Patient Safety Simulation: Learning About Safety Never Seemed More Fun. Journal for Nurses in
Staff Development 20(6), 247-254.