Adult learning and the role of simulation Stefan Mönk

Overview Who am I? How do we learn? What exactly is debriefing? Does it work? Examples of experiential learning. Models? Very nice, but what is their role in simulation? How can we use simulators effectively?

Past...

...Present

Stefan Mönk Anesthesiologist, emergency physician, intensivist HPS in 1996 (Mainz University, Germany) Co-founded 2 centres University  AQAI  METI  CAE Former president of SESAM Simulation & learning committee, DGAI Training, research & development Project management Manager Medical Programs

Where is Mainz? Frankfurt Mainz

CAE Global leader in aviation Simulation Center operation Content development Military, civilian

Patient simulators Surgical Simulators Imaging Simulators Course ware CAE Healthcare Patient simulators HPS METIman Caesar Surgical Simulators EndoVR CathLab Imaging Simulators Vimedix Course ware ICCU Learning Applications Center management METIVision Learning Space

Overview Who am I? How do we learn? What exactly is debriefing? Does it work? Examples of experiential learning. Models? Very nice, but what is their role in simulation? How can we use simulators effectively?

5 + 5 = 10 Yes! Convince me!

I have prove that the new drug is great! I need to try it myself

How do we learn? As adults, we make experiences. We trust these experiences. Rarely, we have time to digest the experiences in a professional way. It is very difficult to self-analyze.

Overview Who am I? How do we learn? What exactly is debriefing? Does it work? Examples of experiential learning. Models? Very nice, but what is their role in simulation? How can we use simulators effectively?

Debriefing? A guided conversation The facilitator encourages reflection Debriefing uncovers problems Facilitators state facts and ask questions Conclusions are drawn by the learners Video is helpful Ideal behavior Debriefing Observed behavior

Overview Who am I? How do we learn? What exactly is debriefing? Does it work? Examples of experiential learning. Models? Very nice, but what is their role in simulation? How can we use simulators effectively?

Example: Schön Hospital Neustadt Baltic coast Improve trauma care Care for staff

Example: DGAI German Society for Anesthesia and Intensive Care Goals: Improve undergraduate education Improve role of anesthesia 2003: 35 Medical schools receive ECS Simulators Cost shared by DGAI + universities Recipients promised to improve education

Example: DGAI - Results Simulation centers < 10  ca. 40 Curriculum integration of simulation 0%  100% Money available for education “very littlle”  “a lot” Education interest in anesthesia Largest fraction of MME graduates Simulation in Germany Becomes a standard, e.g. Schön Hospital Curriculum integration Undergraduate students Residency training

Example: Helios Hospital chain Ca. 60 hospitals, ~30.000 employees Every anesthesia employee is trained on a simulator every year Goals: Workplace affiliation Patient safety Treatment quality ~75 days in 2009

Example: PACT

http://www.esicm.org/

Example: Onderwijs anesthesie Dutch program 5 years of residency training for anesthesia Annual compulsory simulation training National curriculum Individual training budget 300 residents p.a. Groningen, Nijmegen, Leiden, Rotterdam…

Overview Who am I? How do we learn? What exactly is debriefing? Does it work? Examples of experiential learning. Models? Very nice, but what is their role in simulation? How can we use simulators effectively?

Models at work

Model? Story telling! Head Body Unconscious Patient

Disadvantages of storytelling The facilitator will concentrate on the simulation instead of the student (=lack of attention) The patient’s behavior will depend on the facilitator (=lack of standardization) The patient’s behavior may be wrong (=lack of quality)

Modeling Sá Couto et al. Pediatr Res 2010; 67(2): 158-165

Advantages of modeling Standardization Realism Unforeseen behavior possible Knowledge transfer Facilitator focus on students

Overview Who am I? How do we learn? What exactly is debriefing? Does it work? Examples of experiential learning. Models? Very nice, but what is their role in simulation? How can we use simulators effectively?

L L S L L F L L Lecture + Advantages: Low cost High volume Good for specific topics Good for specific cultures - Disadvantages: Limited use of simulator capabilities Limited interaction Passive learners No feedback S L L F L L

Demonstration L L F L L S L L F

Demonstration with learner F

„Bed side teaching“ L L L L S L F L

Observation F L L L S L L L

Experiential learning S F L L „Simulated Clinical Experience“ Debriefing F

Closing remarks Experiential learning in medicine is a global phenomenon NOW is the time be become a player in this field Simulation is a bit of a challenge The feedback is very rewarding Once you start, there is an “obligation for success” Come to Mainz in November! www.hpsn.com