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SIMULATION IN MEDICAL EDUCATION

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Learnt on patients under anaesthesia. No special consent ... Anaesthesia. Emergency medicine. Family Medicine/GP. CCU/ICU. Trauma/retrievals. Paramedics/EMT ... – PowerPoint PPT presentation

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Title: SIMULATION IN MEDICAL EDUCATION


1
SIMULATION IN MEDICAL EDUCATION
  • Professor Harry Owen
  • and
  • Val Follows
  • Flinders University School of Medicine
  • simulation_at_flinders.edu.au

2
Simulation in Medical Education
  • Simulation technologies used in Medical Education
    in Australia, the US and Europe
  • Setting up the Flinders University Medical School
    Clinical Skills and Simulation Unit
  • Fundamentals of high-fidelity simulation
  • Where do we go from here? Some observations on
    the future of simulation

3
Whos who in medical education
  • Basic medical education
  • Medical students
  • Pre-vocational medical education
  • Interns, RMOs, PGY 12
  • Specialist training (discipline-based)
  • Registrars/Senior registrars/Fellows
  • Specialists and GPs (life-long learning)
  • CME, MOPS, IRM, etc
  • Teachers and trainers

4
AdelaideSouth Australia
(1)
(1)
1
1
1
2
5
Source Jones A (BMSC)
6
Simulation centres
11
9
10
20
195
25
2
10
6
5
2
2
7
Publications on patient simulation in clinical
care
Year
8
Simulation technologies used in medical education
  • Computer-based simulations (micro-worlds,
    micro-simulation)
  • Virtual environments /- haptics
  • Part-task trainers
  • Low-fidelity simulators/manikins
  • Simulated or standardised patients
  • Hybrid simulations
  • High-fidelity (full mission) simulation

9
Knowledge/Skills/Attitudes
  • Individual psychomotor skills
  • Appropriate application of skills
  • Communication / Team performance / Leadership
    skills (CRM)
  • Supervision/teaching
  • Assessment

10
Knowledge/Skills/Attitudes
  • Teaching best practice
  • learner centred
  • appropriate use of technology
  • Assessment best practice
  • Valid and reliable
  • Reproducible

11
The Flinders Clinical Skills and Simulation Unit
  • Grew from a project to improve airway management
    teaching to medical students
  • Value to teaching other health professionals and
    other skills recognised
  • Funding generated from teaching outside the
    medical school

12
Endotracheal intubation
  • Learnt on patients under anaesthesia
  • No special consent
  • Duty of care to protect patient from harm
  • Increased risk when performed by a student or
    trainee

13
Endotracheal intubation
  • ETI needed by many health professionals,
    including anesthesiologists, paramedics/EMTs,
    rural GPs, emergency physicians, ICU staff,
    respiratory therapists, etc.
  • Competence requires practise

14
When and how should ETI be taught?
  • Animals
  • Small, e.g. cats
  • Large, e.g. dogs or monkeys
  • Unconscious patients
  • In the OR
  • In ICU
  • Newly dead/recently deceased
  • Cadavers
  • Simulators

15
The learning environment
  • Quiet, few distractors
  • Clinical equipment
  • Expert tutors
  • Realistic models
  • Many different models
  • Easy ? difficult? very difficult

16
Adult A-A Female (Nasco)
CPR Prompt (Compliant)
Fat Old Fred (Lifeform)
Little Anne (Laerdal)
David/Adam (Nasco)
CPR Pal (Ambu)
Basic Buddy (Lifeform)
Economy Saniman (Nasco)
17
The Flinders Clinical Skills and Simulation Unit
  • Computer-based Teaching
  • ResusSim
  • CathSim
  • PA simulator
  • ECG
  • Local anaesthesia
  • Part-task trainers
  • BLS ALS
  • IVI CVC
  • Trauma
  • Adult
  • Gynae Obstetric
  • Neonatal
  • Premature (28wks)
  • Paediatric (age range)

18
The Flinders Clinical Skills and Simulation Unit
  • Several whole body manikins including
  • ResusciBaby
  • ALS baby
  • ResusciAnne with SkillReporter
  • Mr Hurt
  • Nursing Anne
  • Megacode Kid
  • etc
  • SimMan UPS
  • Postoperative care modules
  • Trauma modules
  • Severe Trauma modules
  • Local produced dental trauma modules

19
Anatomy of a simulation (1)
  • Components
  • Student/trainee/health professional
  • Procedure/task/skill/test/treatment or equipment
  • Patient and/or disease process
  • Trainer/supervisor

20
Anatomy of a simulation (2)
  • Function of components
  • Passive
  • Enhance setting for realism
  • Active
  • Change in a programmed way
  • Interactive
  • Responds to action or event

21
  • Trainees learning cricothyrotomy on a part-task
    trainer
  • (Note educational aids in background)
  • Trainee performing an emergency cricothyrotomy in
    a full-mission simulation.
  • (Note more realistic setting)

22
High fidelity simulation (1)
  • Determine educational needs and choose most
    efficient and effective
  • Need to balance resource availability and student
    demand
  • May need to promote low-tech solutions

23
High fidelity simulation (2)
  • Confirm teaching goals can be achieved using
    simulation
  • Develop scenario, acquire equipment needed and
    prepare associated materials
  • Test and validate the simulation

24
Options for running simulations
  • Free-form
  • Easy but poor learning
  • On the fly
  • Scripted but intensive for the controller and
    some variables may appear discontinuous
  • Programmed trends
  • More sophisticated simulations possible
  • Trends and event handlers
  • Facilitates high-fidelity simulation with most
    realistic response to interventions

25
Resources needed
  • Equipment
  • Simulators, monitors, defibrillator, trolleys,
    etc
  • Disposables
  • Appropriate for scenario, setting and
    participants, re-use w/o compromising fidelity
  • Faculty
  • Trained, available, practised
  • Support staff
  • Technician/bio-medical engineer essential!

26
Before and after simulations...
  • Set-up scenario
  • eg. make blood, set up area, X-rays, notes, etc
  • Load simulation program
  • Check everything works
  • Cameras, VCR, communicators
  • Afterwards...
  • Check simulator (replace or repair parts)
  • Clean everything used and put away
  • Replace/reorder all used items

27
High fidelity simulation (3)
  • Allow time for briefing and familiarisation with
    the patient simulator and equipment
  • Brief participants on
  • Broad objectives
  • The scenario
  • How to get help

28
High fidelity simulation (4)
  • Always follow the script but...

have alternative outcomes planned and rehearsed
Simulation control room
29
High fidelity simulation (5)
  • Using simulation situations can be re-run to
    explore outcome with different treatments

Mission critical tasks can be performed by
learners without putting patients at risk
30
High fidelity simulation (6)
  • Facilitated debriefing with an expert
    practitioner. Participants reflect on their own
    performance and discuss this with the group

31
How we use the SimMan UPS
  • Anaesthesia
  • Emergency medicine
  • Family Medicine/GP
  • CCU/ICU
  • Trauma/retrievals
  • Paramedics/EMT
  • Specialist nurses
  • Medical Imaging
  • Paediatrics
  • Rural health workers
  • Sim Centre settings
  • OR, PACU, ER, Imaging suite, post-op ward,
    clinic, aircraft, ambulance, home, roadside,
    terrorist incident, etc
  • Outreach settings
  • Regional hospitals, rural settings, etc

32
Medicine A High-Risk Industry
  • Harvard Medical Practice Study (1991) identified
    a serious error rate of 3.7
  • (serious error leads to prolonged hospital stay
    or disability)
  • Vincent (2001) NHS 11 error rate with 50
    preventable
  • 50,000 patients pa die from medical error or
    accident. Litigation cost 44billion
  • Australian data - adverse event rate of 17

33
Successful strategies for crisis management
  • Use of written checklists to help prevent crises
  • Use of established procedures in responding to
    crises
  • Training in decision making and resource
    co-ordination
  • Systematic practise in handling crises including
    part-task trainers and full-mission realistic
    simulation

34
The future of simulation...
  • Skills training tool for all disciplines
  • Acute care
  • Try new techniques and/or equipment
  • Patient safety initiatives
  • Retraining
  • Multi-disciplinary training
  • inter-professional communication
  • team performance
  • Training in decision-making/resource co-ordination

35
Simulation technologies used in medical education
  • Computer-based simulations (micro-worlds,
    micro-simulation)
  • Virtual environments /- haptics
  • Part-task trainers
  • Low-fidelity simulators/manikins
  • Simulated or standardised patients
  • Hybrid simulations
  • High-fidelity (full mission) simulation

36
Simulation research must address healthcare
training needs
  • Improved outcomes
  • Fewer adverse events, fewer preventable
    incidents, fewer near miss events
  • Increased efficiency of training
  • Improved outcomes in same or (preferably) less
    training time
  • Improved use of resources
  • Fewer failures, more efficient training, quicker
    performance
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