1. 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

2. 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

3. 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

4. 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

5. 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

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

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

8. Flow of learning
Preparation
Experience
Reflection ?

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

10. Flow of learning
Preparation
Experience
Reflection

11. 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

12. 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.

13. 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.

14. 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

15. 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

16. 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

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

18. 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

19. QUESTIONS ?

20. 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