Hospitals: Low Dose, High Frequency Training Using Simulation Wednesday 22 June, 2011 Dr Robert O’Brien Director, Medical Education and Training St Vincent’s Hospital, Melbourne

Objectives At the completion of this session it is expected that participants will have: Increased understanding of the relevance low dose high frequency (LD/HF)simulation versus high dose Low frequency Simulation (HD/LF) to hospital training. Understanding of some of the common pitfall and advantages of LD/HF & HD/LF simulation. Increased understanding methods of developing a simulation program utilising of LD/HF & HD/LF simulation. 2 2

Why Use Simulation? Kerr and Bradley (2007) suggest that influences include: Society and patient expectations have changed, Healthcare practitioners are expected to be competent before performing on a patient. Changes to healthcare delivery reducing opportunities for gaining experience Reductions in working hours for healthcare practitioners impacts on learning. The safety movement has raised awareness of adverse event management and the need for training. New technologies require different approaches to training e.g. endoscopic surgery. Criticisms of the more traditional educational methodologies. 3 3

What does simulation offer? There is a decreased risk to patients Ability to learn from mistakes Ability to practise skills repeatedly Scenarios can be created to suit the learning objectives Practise rarely occurring critical incidents Environment can be manipulated Suits learners of different levels and with different learning needs. Some simulators can provide objective measures of performance. Ability to provide immediate feedback Provides opportunities for team training and interdisciplinary learning Provides an opportunity to assess “vulnerabilities in health care delivery” and system analysis (Ziv et al, 2003) (Ker & Bradley, 2005, Maran & Glavin, 2003, Good, 2003, Kneebone, 2003, Ziv et al, 2006, Peteani, 2004, Wallin et al, 2007). 4 4

Scenario based learning Advantages of scenario based learning including:   Ability to minimise the boundaries between the clinical skills laboratory and the real world (Kneebone et al, 2005) Ability to link technical training and communication skills training (Kneebone et al, 2002) Provide a patient focus to the education (Owen et al, 2007) Link theoretical knowledge to practice (McFetridge and Deeny, 2004) Opportunity to reflect, critically analyse and question (Stockhausen, 1994). 5

Conundrum Low dose, High frequency V High dose, low frequency Clinical Needs V Educational Needs 6 6

Experience Low dose, High frequency lower fidelity, BLS training Case studies Team training Retention? 7 7

Flow of learning Preparation Experience Reflection ?

Experience . High dose, Low frequency Registrar and Consultant specialist training EMAC - Anesthetics ACME – Emergency GP Training ICU Registrars EMERGENCY TRAINING 9 9

Flow of learning Preparation Experience Reflection

Educationally sound .Regardless of frequency and level of dose there needs to be a level of education underpinning the session. What are your objectives? Are they clearly communicated? What is the level of experience, knowledge, and skills of the participants? What is your mode of delivery? 11 11

Learning Theories Reflective learning is the process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self, and which results in a changed conceptual perspective. Behaviourist approach to instructional design promotes knowledge acquisition and automated response formation. This approach advocates stimulus/response and reinforcement strategies. It also employs strategies such as rote learning and didactic teaching. This approach is often effective for the mastery of content but is not appropriate for more complex skill acquisition.

Learning Theories Cognitive instructional design theory relies on restructuring understanding through repetition, reinforcement and feedback. It is based on the theory that people have “schema” or understandings of certain concepts etc, and these schema need to be modified for new skill acquisition. Constructivist Learning theory advocate real-world, case-based learning environments, reflective practice, context and content-dependent knowledge construction, and supports social negotiation rather than competition among learners. Tasks demand higher levels of processing and problem solving. Constructivist teaching methods such as high fidelity simulation are especially suited to dealing with ill-defined problems through reflection-in-action. They are more suited to engaging and meeting the learning needs of experienced learners. There is greater scope for integrating complex skill development such as teamwork, leadership, effective communication, and decision-making into the curriculum.

Benefits for participants LD/HF Scaffolding of learning when in conjunction with other teaching methods Constant contact and tracking of progress Opportunities to demonstrate development Varied focus for sessions Actions and Reactions Debriefing methods Pause and discuss Plus delta pendelton 14 14

Benefits for participants HD/LF High Stakes Training Ample opportunity for reflection and discussion Thought processes (frames) Build on previous clinical experiences Debriefing methods Frames pendelton 15 15

Keys to success Well trained instructor group – Education basis Various levels of experience and expertise, clinical backgrounds Moving into a greater range of modalities for delivery of education using simulation Continual faculty development ***** Established research program that uses both LD/HF & HD/LF 16 16

Advantages costs accessibility Numbers (throughput) Faculty development and training opportunities Further refinement of cases 17 17

Common pitfall Planning Piloting / Testing of cases Burnout of faculty Ensuring the starting point for the participants is clearly understood Appropriately trained instructors Budget Model 18 18

QUESTIONS ?

Hospitals: Low Dose, High Frequency Training Using Simulation Wednesday 22 June, 2011 Dr Robert O’Brien Director, Medical Education and Training St Vincent’s Hospital, Melbourne