1 Rachel Yudkowsky MD MHPE Simulation for Patient Safety Slideset 2 Designing instructional programs with simulation

2 What’s ahead… Teaching with simulation  Partial vs Whole-task scenarios  SPs, feedback and debriefing  Some educational frameworks: Kolb: experiential learning Ericsson: acquisition of expertise

3 Experiential Learning (Kolb / Dunn) Concrete Experience (an event) Active Experimentation (what is done differently) [Planning for Implementation] (what will be done differently) Reflective Observation (what happened) Abstract Conceptualization (implications)

4 Becoming an expert: Deliberate Practice (Ericsson) Repeated practice Of elements of the task With feedback and coaching

5 Simulations afford practice on isolated elements of a task  Information gathering  Data Interpretation  Decision making  Implementing action, treatment, procedure  Communication with patient  Communication with staff Standardized patients Part-task trainers Mannequins

6 “Hybrid” Simulations with Standardized Patients SPs and part- task (procedure) trainers Mannequins and SPs / Standardized Families Mannequins and Standardized Colleagues SPs and clinical findings simulators

7 Hybrids increase fidelity by increasing the task elements included in the simulation It depends on the stage of the learner But is this a good thing?

8 How do you move up the ladder? Unconscious Incompetence Conscious Incompetence Conscious Competence Unconscious Competence Expertise Deliberate Practice with isolated task elements

9 How do you move up the ladder? Unconscious Incompetence Conscious Incompetence Conscious Competence Unconscious Competence Expertise Deliberate Practice with holistic scenarios

10 Errors and Expertise Unconscious Incompetence Conscious Incompetence Conscious Competence Unconscious Competence Expertise Lack of knowledge or psychomotor skill Distraction / Lack of available attention Fixation errors

11 Moving up the ladder, Becoming an expert: Deliberate Practice Repeated practice Of [an isolated element of] the task With feedback and coaching

12 More Experience (alone) = Better Performance Concrete Experience (an event) Active Experimentation (what is done differently) Planning for Implementation (what will be done differently) Reflective Observation (what happened) Abstract Conceptualization (implications)

13 Does Feedback  Better Performance? Concrete Experience (an event) Active Experimentation (what is done differently) Planning for Implementation (what will be done differently) Reflective Observation (what happened) Abstract Conceptualization (implications) Feedback

14 Sources of Feedback  The self  The simulator  Peer observers  Expert observers I know what I did and what happened… But what should I do differently?

15 Debriefing: Public reflection and analysis Concrete Experience (an event) Active Experimentation (what is done differently) Planning for Implementation (what will be done differently) Reflective Observation (what happened) Abstract Conceptualization (implications) Debriefing

16 Recap Developing competence and expertise Experiential Learning Deliberate Practice Feedback, Debriefing, Coaching Simulation Safe Controlled Errors

17 Developing competence quickly and safely What are other ways that simulation can promote patient safety?

18 Next: Assignment 2