1. Physicians Resistance to Simulation- what can we learn from Aviation? Dr. med. Burkhard Milde Immersive Simulation & Training Bückeburg, Germany

2. Dr. Milde, Immersive Simulation & Training, Germany Burkhard MILDE, Dr. med., Born in Berlin, Hildesheim, University of Ulm, GER Educator/ Trainer: Human Factors, Crew Resource Management Post grad “Management in Healthcare” TU Kaiserslautern, GER 2004-2006 Family Medicine, Occupational Health, Aeromedical Examiner CAE Healthcare Adjuct Faculty Member since 2011 (CAESAR) Founder of the first regional multiprofessional network for simulation in healthcare (2015) First a little about me

3. Berlin Munich Frankfurt Bückeburg Dr. Milde, Immersive Simulation & Training, Germany Hannover, 50 miles, „the Scorpions“

4. Impressions of Bückeburg Dr. Milde, Immersive Simulation & Training, Germany

6. Familiar ? Dr. Milde, Immersive Simulation & Training, Germany

7. Familiar ? Dr. Milde, Immersive Simulation & Training, Germany

9. Simulation in Healthcare North America Dr. Milde, Immersive Simulation & Training, Germany

10. Simulation in Healthcare (Germany)- outside Medical Schools Dr. Milde, Immersive Simulation & Training, Germany -no certification -no accreditation

11. Why ? Dr. Milde, Immersive Simulation & Training, Germany

12. Why? Dr. Milde, Immersive Simulation & Training, Germany Never learned leadership Never learned decision making Never learned situational awareness BECAUSE they were raised and treated like a „prince/ princess“ Always supported Always served Developing a „rock star“-/ „center of the world“-mentality (no Albert Schweitzer/ Florence Nigthingale anymore) Problems were solved by third party Always were lead

13. Dr. Milde, Immersive Simulation & Training, Germany The pilots / physicians novice view of „team“? I am !

14. Dr. Milde, Immersive Simulation & Training, Germany The pilots / physicians similiar historic background Both professions and there developments were very much influenced by the military the wars of the 19th/ 21st century – Heroism – Egoism/selfishness /survival – Posttraumatic disstress?

15. Turning point in commercial aviation? 1919 Shooting trainer Edwin “Link Trainer”, New York, USA 1929 1950 PanAm (no motion) 1954 United Airlines bought 4 Sim (3 million US$) 1972 Out of the cockpit window Dr. Milde, Immersive Simulation & Training, Germany Development of Computers Modern airplanes Commercial airlines Fatalities/ crashes Flight Safety „SimOne“ Laerdal „Sus. Anne“

16. Civilian / Military Physicians Military Mandatory – less resistance Dr. Milde, Immersive Simulation & Training, Germany

17. Physicians Resistance to Simulation „ We do not have to practise with „dolls“, we are everyday professionals!“ Patientsafety? Yes, we use checklists in our OR! Dr. Milde, Immersive Simulation & Training, Germany

18. Same statements, about 30 years ago Dr. Milde, Immersive Simulation & Training, Germany Pilots resistance to simulation!

19. Do (professional) pilots love to fly simulators? No, they do not! But: they do! (big airlines up to 4*a year) What happens, if they refuse/ resist? – They do not fly! – And: no flying – loss of liscence! Dr. Milde, Immersive Simulation & Training, Germany

20. What has to be changed in the healthcare sector? Human factors- / CRM - trainings mandatory simulator training (TeamSTEPPS) Accreditation Certification Assessment of the individual? Safety Culture of the organization Learning/education-culture Dr. Milde, Immersive Simulation & Training, Germany

21. Accreditation / Certification

22. What has to be changed? Safety/Risk Culture of the organization Learning/education- culture of all members (mandatory -including physicians) Certification/ accreditation Development of strategic patient safety goals (financially valuable! ROI) Ressource the adequate simulator for your goal! (for your physicians,too) Dr. Milde, Immersive Simulation & Training, Germany

23. Thank you! Questions and discussions welcome! Dr. Milde, Immersive Simulation & Training, Germany