1. Hands-on-experience in learning: Use of simulation tools to increase competency
Yvonne George
Daniel McDermott
Sandy Robinson
Cuyahoga Community College

2. Forum Agenda Introductory PowerPoint
Video of students learning with use of simulation
Feedback practice session
Impact of simulation on Physician Assistant Program
Developing a simulation lab
Questions

3. Definition of terms
Simulation: “Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.” (Gaba, 2004)
Gaba discusses "immersive simulations". In an immersive simulation, the realism of that setting or task make it easy for participants to suspend their disbelief and to speak and act as they would in real life.

4. Simulation tools
Injection pads, simulated wounds, anatomical mannequins, screen based or virtual reality systems, props, computerized human patient simulators, standardized patients, etc. These tools help us to create what Gaba referred to as "immersive simulations". In an immersive simulation, the realism of that setting or task make it easy for participants to suspend their disbelief and to speak and act as they would in real life.

5. Standardized Patients
Standardized patients (SPs) are specially trained individuals who accurately portray patients for the purpose of educating students.
SP's were first used in the 60’s by Dr. Howard Barrows. (Reed et al. n.d.)
Help create a "near-real-to-life", safe and supportive environment conducive for learning.
Used for the USMLE
Medical Schools 90%, unique in 2 year schools

6. Standardized Patients
Uses
Patient communication
History taking
Physical exam
Skills practice
Skills assessment

7. Standardized Patients
Where do we get SPs?
How recruited?
How are they trained?
What is the cost?

8. Does simulation increase competency?
Simulation is effective in measuring competency (Nehring, et al., 2001).
Requires learners to demonstrate proper technique, decision making, and critical thinking necessary to perform tasks (Gaba, 2004).
Simulation aids in the acquisition of the "skills needed to provide competent safe patient care" (Gaba, 2004).
Use of simulators improves clinical performance (Steadman, et al., 1999).
"Simulated learning opportunities that integrate feedback, debriefing, or guided reflection have demonstrated the ability to facilitate the link between theory and practice, increase learners’ ability to synthesize knowledge, and promote insight."

9. Application of Knowledge
Preliminary Data
Interpersonal Skills
Application of Knowledge
Surveyed 237 students

10. Preliminary Data
Value of Feedback
Overall Experience

11. Next Steps Continue data collection Survey Lab Instructors
Has competency improved?
Survey clinical instructors
Are students better prepared?
How do students compare to previous students?
How do students compare to those of other institutions?

12. Learning With Simulation
VIDEO

13. Developing a simulation session
Determine your goals (What do you want to accomplish?)
Feedback
Write scenario if required
Determine how much time for each student to complete encounter
Determine location
Assemble equipment and simulation tools (SPs, props, etc.)
Conduct dry run
We have a simulation lab, which houses our infant, child and 2 adult simulators and our SP rooms (hospital and pt exam). One of the challenges when starting a program such as this is getting faculty to incorporate it into their curriculum. One thing I do to encourage this is to give the faculty ideas about how using the sim lab can enhance what they are already doing. I let them know that it will not require as much effort on their part as they think. My experience has usually been that after one experience in the sim lab, they are hooked. The transition to the lab was easier than they thought and the students love it. After that they usually come to me with ideas about how they can use the lab. Most of those who say that it takes a lot of time, haven't tried it or they are so busy just the mention of something else makes them nervous.

14. Daniel McDermott, M.S., PA-C Program Manager Physician Assistant Program
Cuyahoga Community College

16. References
Bruce, S., Bridges, E. J., & Holcomb, J. B. (2003). Preparing to respond: Joint Trauma Training Center and USAF Nursing Warskills Simulation Laboratory. Critical Care Nursing Clinics of North America, 15(2),
Decker, S., Sportsman, S., Puetz, L., Billings, L. (2008). The evolution of simulation and its contribution to competency. The Journal of Continuing Education in Nursing, Vol 39, No 2.
Ende J. (2000). Feedback: A key feature of medical training. Radiology 2000; 215:
Gaba, D. M. (2004). The future vision of simulation in health care[Electronic version]. Quality and Safety in Health Care, 13(Suppl.1), i2-i10.
Howley LD, Martindale J. The efficacy of standardized patient feedback in clinical teaching. A mixed methods analysis. (2004). Medical Education Online 2004;9:18. Available from:

17. References
Pinsky LE, Wipf JE. (2000). A picture is worth a thousand words. Practical use of videotape in teaching. Journal of General Internal Medicine, November 2000; Volume 15.
National Council for State Boards of Nursing. (2005). Business book: NCSBN 2005 annual meeting. Chicago, IL: Author.
Reed G. W. (n.d.). Makoul, G., Hawkins, R., Hallock, J.A., Scoles, P., Reichgott, M. J., n.d. Standardized/simulated, patients in medical education.
Tilley, D. S. (February 2008). Competency in Nursing: a concept analysis. The Journal of Continuing Education in Nursing, February 2008; Volume 39, No. 2.
Yudkowsky, R. (2002). Should we use standardized patients instead of real patients for high-stakes exams in psychiatry? Academic Psychiatry 26: , September 2002, Academic Psychiatry.

18. Contact information
Sandy Robinson, M.Ed., RRT, RCP
Associate Dean, Health Careers
Daniel McDermott, M.S., PA-C
Program Manager
Physician Assistant Program
Yvonne George, B.B.A., RRT, RCP
Preceptor, Health Careers
Presentation Plan
(15 min) Presentation will begin with an introductory PowerPoint discussing how simulation can increase competency.
(9 min) A brief video will follow showing allied health students learning with use of simulation. Students are observed on video practicing skills with simulators and standardized patients in various labs.
(3 min) Presenters will go through the process of how a simulation session is developed from start to finish.
(7 min) Participants will observe a simulation session and participate in video review and providing feedback to a student, using provided handouts. (This is to show the benefit of a feedback session.
1. Explain desired feedback from instructor view (small increments about specific, observed, modifiable behavior) and from SP view (how you felt about the interaction). 2. Pass out video review forms and SP feedback forms and ask participants to make note of items they would like to give feedback on as they watch the video. Don’t critique the groups feedback just identify as instructor or SP type. 3. Sum up by asking how they see students could benefit from a feedback session.
(10 min) Ask for participants to share feedback and comment. Leads into next bullet…
(5 min) Participants will be asked to reflect and share how they might use simulation at their facility.
(5 min) Physician assistant Program Manager will share how the use of simulation has impacted the effectiveness of the program.
(5 min) The Associate Dean will discuss opening a simulation lab and the support that is required.
Session will end with question and answer period.