Designing a Simulation based course

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Designing a Simulation based course

• Neal Jones RN, Dip He, PGCTLCP
• Manager Cheshire Merseyside Simulation centre
• President National Association of Medical
  Simulators

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• History of simulation
• Educational formats of human patient simulation
• Meeting educational goals
• Simulation linked educational theory
• Putting it all together
• Course examples

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• Sim One
• Introduced in 1967, University of Southern
  California.
• Life sized manikin connected to computer,
  instructor console, interfacing unit and
  anaesthesia machine

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• Originally developed for anaesthesia based
  education.
• Evidence as to the efficacy of simulation based
  training available from 1969 (A.Denson, J Med
  Education 196944515-510)
• Cost proved prohibitive to the expansion of
  simulation based education until 1996 when Meti
  introduced a cost effective solution with their
  Human Patient Simulators.(HPS)

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• 1996-2007
• Has seen the development of simulation based
  technologies within the education of all
  professional groups within healthcare.
• New technologies have made simulation affordable
  and accessible to all, the future of simulation
  lies with us!!

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• Types of Human Patient Simulation
• Knowledge based
• Human factors based
• Combination of both Knowledge Human
  Factors

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• Knowledge based
• Patient simulation is ideal for imparting
  theoretical knowledge in a manner that is
  contextual with clinical practice.
• The manikin physiology can be controlled to allow
  the demonstration of normal and abnormal
  physiological conditions

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• Drug effects and interactions can be shown.
• Response to interventions can be studied
• Each and every patient can be paused, re-wound
  and re-played to support questioning and
  re-in-force the learning objectives.
• Provides a contextualised learning environment
  and avoids the limitations of abstract theory for
  learners that require an experiential foundation.

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• Human Factors
• The study of human behaviour
• Allows team dynamics to be deconstructed and
  individual performance enhanced.
• Is only possible if the level of simulation
  fidelity permits the suspension of disbelief.
• Health care is a high risk industry with up to
  80 of the est 980,000 clinical errors recorded
  each year attributable to human factors

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• Knowledge/ Human factors course
• The coming together of knowledge and behaviour in
  a real world environment that provides no risk to
  patient or learner.
• Cements clinical practice and appears to reduce
  the theory- practice gap through the improved
  psychological fidelity of full environmental
  simulation, thus enhancing future clinical
  practice.

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• Elements of Human factors-
• Communication
• Leadership
• Followership
• Situational awareness
• Anticipation and Planning
• Distribution of workload
• Utilisation of information
• Error recognition

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• You are about to view a video clip please count
  the number of times the ball is passed from
  person to person (There will be a test afterwards)

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Did you spot the Gorilla?

• If not why not?

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• Educational theory behind our simulations

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Objectives

• To gain an understanding of learning styles
• To gain and understanding of how simulation can
  meet the varying learning styles
• To identify the strengths of experiential
  learning theories and how they apply to
  simulation

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• Learning style is the way in
• which each learner begins to
• concentrate on, process and
• retain new and difficult
• information.
• Dunn

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Why Is It Important to knowStudent Learning
Styles?

• Students process information differently
• If educators teach exclusively to one style
  students comfort level may be diminished
• If only taught in one style students may lose
  mental dexterity to think in different ways.
• We should address the learning needs of all
  students

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• How we learn

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• Preferences for retaining new and complex
  information-
• Auditory
• Visual
• Tactile/Kinaesthetic
• Verbal.

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Tactile and/or Kinesthetic Learners
Visual Picture Learners
Auditory Learners
Verbal Learners
Remember best when they LISTEN to a lecture, a
presentation, or an audiotape.
Remember best when they DISCUSS with others the
new and complex information they are learning.
Remember best by DOING rather than sitting and
listening, reading, or thinking about the
information.
Remember best when they SEE (create) mental
images of what they hear or read.
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Learning Types

• Activists- respond most positively to learning
  situations offering challenge, to include new
  experiences and problems,excitement and freedom
  in their learning.
• Reflectors- respond most positively to structured
  learning activities where they are provided with
  time to observe, reflect and think, and allowed
  to work in a detailed manner.

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Learning types

• Theorists- respond well to logical, rational
  structured and clear aims, where they are given
  time for methodical exploration and opportunities
  to question their intellect.
• Pragmatists- respond most positively to
  practically based, immediately relevant learning
  activities, which allow scope for practice using
  theory.

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• Activists-Respond to Scenario based learning
  opportunities,the physical simulation
• Reflectors-Respond to Observing the simulated
  scenarios, utilising the de-brief to clarify
  themes

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• Theorists-Respond to post scenario PowerPoint,
  management discussions within the de-briefing
  process
• Pragmatists- Enjoy physical scenarios, appreciate
  de-briefing value, must have second scenario to
  allow them to experiment with new ideas

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• Intellectual comprehension requires an
  experiential foundation
• (David A Kolb 1984)

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Kolbs experiential learning theories
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The simulation

Second scenario/ Observing other groups
Live video observation/de-brief sheets
The de-brief
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• Putting it all together and creating a course

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• Questions-
• Who is the course for?
• How many people do you need to train?
• What are you trying to teach?
• Is Simulation the best way to achieve your
  objectives?

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• Who is it for?
• Single speciality
• Multi-professional?
• Under/post graduate?

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• How many students do you have?
• Your simulation should mirror real life practice
• Real life staffing numbers should be maintained
• Each student should be given a second scenario to
  allow for active experimentation
• With clinical management and HF de-brief, four
  scenarios can last from 0900 to 1600

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• What are you trying to teach
• Theory based simulation.
• Environmental fidelity not essential
• Allows more scenarios as no requirement for
  human factors de-brief.
• Allows more students per scenario as you can have
  groups observing the simulators physiology
  without a need for them to manage the patient.

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• Human Factors course
• Max 6 per scenario
• Environmental fidelity must be high
• Requires trained human factors instructors
• Does not formally cover clinical management

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• Combined-knowledge/ Human factors
• Requires high environmental fidelity
• Requires trained human factors instructors
• Covers all aspects of clinical practice/team
  resource management

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• A course day at the Cheshire Merseyside
  Simulation centre

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The Day begins in the De-brief room Introduction
to the centre and sets learning objectives for
the day
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The Simulation Followed by the de-brief
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• Examples of courses.
• Knowledge based
• Fluids course-
• Explores the use of various types of intravenous
  fluids in the treatment of Hypovolaemia, Sepsis,
  dehydration etc.
• Allows for experimentation of administering
  different fluids to the same pt at the same point
  and observing the resulting physiological
  response.

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• Human Factors-
• PICU-
• Drug error scenario, whilst the nursing staff are
  receiving hand over, a senior medic administers a
  bolus to an unsettled ventilated pt. Unknown to
  the staff is that the dilution of the drug is
  neat, however the volume given stated by the Dr
  is the familiar volume. The pt the deteriorates
  as a result of the error.

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• Combined Human factors/knowledge
• Medsim course (final year medical students)
• The students must work together to diagnose an
  allergic reaction to a previously administered
  antibiotic, they must manage the pt clinically
  and demonstrate effective team working and
  appropriate professional behaviors.

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• The CMSC Model
• Intro
• Tour
• Scenario
• Power point presentation
• Human factors debrief

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• Golden Rules of Course design-
• Do not ask students to work within a clinical
  setting that is alien to them.
• Do not ask students to undertake a role that is
  outside their real life scope of practice.
• Do ensure that the scenario is achievable by the
  team that is undertaking the training

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• Any Questions
• Please feel free to contact me via-
• (0151-529-6227) EXT -6227
• www.neal.jones_at_aintree.nhs.uk
• www.simulationcentre.com
• www.namsonline.com
• www.patientsimulation.co.uk

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Society in Europe for Simulation Applied to
Medicine
SESAM Flyer
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ImportantDates