the integrated simulation center: lessons learned tony errichetti, patty myers, tom scandalis...
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The Integrated Simulation Center:Lessons Learned
Tony Errichetti, Patty Myers, Tom Scandalis
American Association of Colleges of Osteopathic Medicine4th Annual Meeting – “Challenges and Opportunities”
Baltimore, MD - June 24, 2006
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Objectives
• Describe the state-of-the-art simulation center
• Discuss curricular, political and logistical issues in setting up a simulation center
What are the key issues, decisions?
• Review major simulations technologies, and their integration
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Simulation = reality substitution
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Increased use of simulations Increased use of simulations because….because….
Shrinking patient base, shorter staysShrinking patient base, shorter stays
COMLEX-PE, USMLE-CSCOMLEX-PE, USMLE-CS
DO School Sim Center Program SurveysDO School Sim Center Program Surveys - 2001 - SP Programs: 62%- 2001 - SP Programs: 62%
- No robotic sim programs - No robotic sim programs (JAOA)(JAOA) - 2006 - SP programs: 82%, 8% under development- 2006 - SP programs: 82%, 8% under development - Robotic sim programs: 57% - Robotic sim programs: 57%
(submitted to JAOA)(submitted to JAOA)
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Increased use of simulations Increased use of simulations because….because….
Simulation industrySimulation industry (SPs, patient simulators, (SPs, patient simulators, virtual reality)virtual reality)
High medical error rates, lawsuits and public High medical error rates, lawsuits and public demands for higher qualitydemands for higher quality - -
Patient safety!Patient safety!
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Classroom Work
How do simulations “work”?
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How do simulations “work”?• Practice / repetition in a patient- and trainee-
safe environment (sim center)
“Confidence builds competence”
• Arousal, increase of productive anxiety, “nightmare” scenarios
• Feedback / debriefing – the essential element
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Simulations ….Simulations ….
……solve training logistical problemssolve training logistical problems
““We prescribe illnesses”We prescribe illnesses”
……provide control of the clinical training provide control of the clinical training and skills assessmentand skills assessment
……do not harm or leave patients untreated do not harm or leave patients untreated as a bi-product of medical educationas a bi-product of medical education
Simulation Center Elements
Simulation TechnologiesSimulation Connectivity System
Simulation Technologies
Simulation Triad
Simulated and standardized patients: What’s the difference?
Simulated Standardized
More realistic More standardized
Less standardized Less realistic
Training Assessment
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Early Mechanical Simulator
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1700s“Venus Médica”
La Specola Collection, Firenze
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1700s“Venus Médica”
La Specola Collection, Firenze
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Gross Anatomy
Animal Models
e.g Suturing Practice
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Part-task / Part body trainersBasic conceptsPsychomotor skills training
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Patient simulators (manikins) Teamwork, procedures e.g. codes, ACLS
Procedure simulators Psychomotor skills, e.g.
laproscopic surgery
Virtual Reality and Computer-Based ProgramsPC/Mac – Patient “in the computer” (DxR)Haptic – Feel and touchFull immersion – Haptic plus virtual environment
Full-Immersion Virtual Reality
Diana – University of Florida
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Easy storageUsers (trainees, faculty) retrieve videos
through the webSP / Sim training / quality assuranceDebriefing / precepting / feedback – locally
and remotely
Digital AV
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Paperless PC / PDA data collection - ROI: saves time and human resourcesData analysis / scoring / score reportingEvaluation of trainees, facultyLongitudinal studies of competency acquisition
Data Collection
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Managing schedules (e.g. students, SPs) - ROI: saves time and human resourcesExam managementAutomated announcementsAutomated DV camera movements
Program Management
Planning / Financial Issues
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Training areas (rooms)
Permanent Mobile
Simulators, equipment (stuff)
Faculty Staff (people)
Curriculum SPs, trainers,techs, coordinators
$im Center Element$
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# 1 Problem
Building first, then planning
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Problems• Budgeting and
purchasing out of synch with planning and operations.
• Users aren’t consulted in design process.
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Lesson Learned
Planning =
Really good planning =
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# 2 Problem
Buying more manikin than what’s needed, and / or not budgeting for
other simulation equipment
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Lesson Learned
• Manikin just one of hundreds of pieces of equipment needed
• Develop a program first (planning again) before committing to a manikin
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Lesson LearnedSim Centers are expensive!
“We’re in a medical education arms race!”- Ken Veit, D.O. - PCOM
Collaborate when possible Establish regional sim centers
Sell your services
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# 3 Problem
Decentralized management of simulation services
Administrative Problem
Family Medicine
Surgery / ED
MIS
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Lesson Learned
Centralized management of all sim services, under a dean (vs. e.g. family medicine), to
maximize efficiency, and program integration
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Lesson Learned
Program director = an expert in performance test development (usually a Ph.D.) who can
work with and develop clinical faculty to: create formative and summative assessment
set pass-fail standards design research
Have a consultation line in your budget to bring in experts
How Simulations Are Changing Clinical Learning
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From Learning Silos…
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To integrated curriculum
Basic Sciences / Clinical
Knowledge / Skills
Because the work requires integration of knowledge, skills, attitudes
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…and integrated health care delivery
DOCTORS
NURSES, PAs
PTs
…because healthcare requires team work
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“Cardiology” Scenario
Students encounter a cardiology complaint (manikin) and discuss physiology /
pharmacology issues with a science teacher
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“Gross anatomy - SP” Scenario
Students in gross anatomy dissect the abdomen and then watch a video, in the lab, of a patient (SP) presenting with abdominal
complaints.
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“Suturing” Scenario
Students practice suturing (p/task trainer) attached to a “conscious patient” (SP)
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“Conscious - Comatose” Scenario
Students encounter a hospital patient (SP), then that same patient in a comatose state
(manikin)
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“Pre-Encounter” Scenario
Students prepare for a sim encounter by meeting a web-patient (PC-VR), then meet
the “actual patient” (manikin) in an ED setting, and / or live patient (SP)
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“Patient Management” Scenario
Students encounter a patient (SP), then that same patient in a acute state
(manikin), then manage the patient’s treatment post-discharge (PC-VR)
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“Simulator-Audience Response” Program
Students encounter a patient in an acute state (manikin), and through a live DV feed,
an audience participates via an audience response system
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“Death and dying” Scenario
Students encounter “dying patient”(manikin), then counsel “grieving family
member” (SP)
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Death and Dying Scenatio: Objectives
• Combine clinical training and behavioral medicine
• Verisimilitude: Using the manikin to get students (MS1) into the “death and dying” scenario, to practice couseling
• Integrate PA, DO and psychology faculty
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Steps
• Developed manikin case
• Developed 5 SP cases, i.e. 5 SPs representing 5 different grief reactions
• Trained SPs
• Ran the program
• Debriefed the students
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Videos
Summary:State-of-the-Art Sim Center
Integrates the Simulation TriadIntegrates knowledge and skills
Simulation connectivity system that integrates everything together
Plan before you build -
Consult the users! Faculty development – the hardest
job
For InformationTony Errichetti, Ph.D.
Chief of Virtual Medicine
Director, Institute For Clinical Competence
516.686.3928