Fundamentals of Simulation Based Education Dr. Nikki Schiebel Consultant Emergency Medicine Mayo Clinic Carol J. Fahje MS, RN, BC Nursing Education Specialist Emergency Department

Basic Assumption “We believe that all participants at the Mayo Multidisciplinary Simulation Center are intelligent, well educated, and want to improve so they can provide high quality and safe patient care.”

Foundation Principles Power of experiential learning Practice without risk Standardization of curriculum

Experiential Learning “Instead of learning by osmosis, simulations can change behaviors and teach people certain principles about how to avoid mistakes through the simulation experience.” David Gaba MD, Stanford Professor of Anesthesiology

Practice without risk “Practice on simulators before practicing on people”. Jeff Cooper, PhD, Director of the Center for Medical Simulation

Standardization of curriculum “Patient simulation helps to ensure that learners are exposed to many different types of illness. Currently students see cases based on random opportunity in their hospital or clinic and many graduate without being exposed to various important conditions.” James Gordon MD, MPA, Emergency Medicine at Massachusetts General Hospital.

Making Learning Meaningful “Experience the chaos” making learning more meaningful Need emotional engagement to develop deeper cognitive levels and foster complex thought (Gordon, 2004; JAMA,2002) Provide unlimited opportunity for things to go wrong and “see” the consequences (McGuire) Design scenarios of potentially dangerous situations w/o full penalties of mistakes (McGuire)

Modalities Used in Simulation High fidelity mannequins Task trainers Standardized patients Combinations of modalities

1.High Fidelity Mannequins Computer driven full size mannequins Blinks, speaks, breathes, pulse, heartbeat, responds to therapies (e.g. CPR, intubation, ventilation) Strengths are in the ability to accurately mimic physiological conditions and respond to interventions

Examples 1.Use when hemodynamics are needed for assessment 2.Intubation with patient response desired 3.Pupil reactions are important 4.Patient verbal response important

2. Task Trainers Focus is on specific skill acquisition Laparoscopic Simulator Airway management Pelvic mannequins Vascular interventions

3. Standardized Patients Actors who simulate scenarios Interactability Element of surprise Communication techniques Verbal and non-verbal

4. Combinations Task trainer/high fidelity mannequin Laparoscopic trainer with high fidelity mannequin Pelvic exam simulator with standardized patient Cystoscopy trainer with standardized patient Mannequins with Standardized Patient

Multiple Objectives Crisis Resource Management Principles Clinical Topics Low Volume/High Risk Conditions Concentrated attention on a medical diatheses Varying diagnoses Standardized curriculum Non Clinical Topics

Team Processes Emergency Response Teams Trauma Teams Physician/Nursing Teams from a clinical area

Crisis Resource Management (CRM) Principles 1.Situational awareness 2.Leadership & role clarification 3.Communication 4.Error anticipation & containment strategies 5.Use of human, information & material resources

Safety Initiatives Medication Safety Patient ID not correct Drug allergy or drug incompatibility Equipment Safety IV pump set up incorrectly Physical Safety Patient supine when receiving a tube feeding Documentation Safety Restraint order inconsistent with policy

Clinical Topics Low volume/High risk Bleeding Diatheses Themes Presenting complaint is dyspnea Updated practices Sepsis management Ethics Withdrawing support Resuscitation wishes differs among family members

Other possibilities… Chain of command Noise/Distractions Patient/Family Interactions Delivering bad news The opportunities are limitless!!!!

References Facilitating LOS Debriefing: A Training Manual Friedrich, M. (2002). Practice Makes Perfect. JAMA 288(22) Gordon, J. (2004). High-Fidelity Patient Simulation: A Revolution in Medical Education. Society for Critical Care Medicine, Simulators in Critical Care and Beyond. Kurtz, S. Silverman, J., & Draper, K (2005). Teaching and Learning Communication Skills in Medicine, 2 nd ed. Radcliffe Publishing. ISBN McGuire, C. (1999) Innovative Simulations for Assessing Professional Competence; Simulation: Its Essential Nature and Characteristics. University of Illinois, Chicago. Department of Medical Education. Mort, T.C. & Donahue, S.P. (2004). Debriefing: The basics in Simulators in Critical Care and Beyond, Dunn, ed; (p76-81). Society of Critical Care Medicine. Paparella, S.F., Mariani, B.A., Layton, K., & Carpenter, A.M. (2004). Patient Safety Simulation: Learning About Safety Never Seemed More Fun. Journal for Nurses in Staff Development 20(6),