1. Pro Con - A Discussion Dr Agnes Ng KK Women’s and Children’s Hospital
Medical Simulation
Pro Con - A Discussion
Dr Agnes Ng
KK Women’s and Children’s Hospital
Thank Prof Dinker and AIMST U and Cybron METI
2 tasks , one running the paed station and second entertain you whilst the field casualty exercise is being set up

2. First Impressions “Actors” Debriefing Set-up Manniquin
A patient with HI for emergency craniectomy, the problem was equipment malfunction after intubation
One of the trainee was in the hot seat and we were team members
He was so devastated that during the debriefing the trainer was so gentle

3. The following year I moved to KKH to form the first and only paed AN in singapore and it was not until
After 10 years,stepping down as HOD to turn my attention to children’s tower, improve acute management of care and sedation
enhancing patient safety especially in children’s tower

4. KKH PSTC
What motivated me was patient safety in children’s tower pushing for this centre and training anaes’ trainees was not my priority

5. Jackie pedisim and Baby Sam, simbaby

6. Pro Con - A Discussion (Debate)
Medical Simulation
Pro Con - A Discussion
(Debate)

7. Medical Simulation
Doctors Trained On Patient Simulators exhibit Superior Skills
Beth Israel Medical Centre
New Virtual Reality Surgery Simulator hones Surgeons' Skills, Improves Patient Safety
Oregon Health & Science University School of Medicine
Naturally one turns to the internet and I found this american website with screaming tiles as above
Clinical Simulation Technology Used To Improve Communication Of Medical Teams
Washington University School of Medicine
Science Daily

8. Pro Con - A Discussion (perhaps a debate)
Medical Simulation
Pro Con - A Discussion
(perhaps a debate)
And after further trawling of the internet, wondered if I had made a wise decision after all
How to approach? It’s true when prof wang said that there’s really no outcome studies

9. Medical Stimulation
Simulation is a technique, not technology, to replace or amplify real experiences with guided experiences……. in an interactive fashion
Obviously I must to some extent be a believer or I will not be invited here or spent my effort in pushing for it in kkh
Gaba Qual Saf Health Care 2004; 13

10. Role Playing Task trainers Computer patient Manniquin simulators
Medical Simulation
Role Playing
Task trainers
Computer patient
Manniquin simulators
Imitate real patients, anatomic regions or clinical tasks or mirror real life circumstances in which medical services
are rendered

11. Limitations Over-expectations
Medical Simulation
Limitations
Over-expectations
Cons are the result of limitations and over-expectations, relatively rich experience in children’s tower
In one stroke medical simulation is a panacea of all ills in health care
Enable clinical competency without putting real patient at risk
Improve patient safety
Reduce medical errors

12. When one first decides to set up a med sim centre one desires a setup similar to ones above
In fact it is now so desirable to own a sex new toy
Individuals or Teams

13. Medical Simulation Hardware & Infrastructure
Money can be easy to come by or difficult and both can bring certain problems, need forward thinking and honest evaluation of what you actually need

14. Medical Simulation Manpower and Training “Chicken and egg”
Funds allocation
e.g. high end computer to find that we only 10% of function

15. Manpower Singapore has at least 7 on last count $610,000 $568,000
METI PediaSim and Laerdal babysim

16. Teacher……. Trainer, Medical Educator
Guided experiences

17. Medical Educator
“SODOTO”
See One
Do One
Teach One

18. Standards & Commitment
Medical Stimulation
Standards & Commitment
Tired to ensure trainers undergo course, have a common philosophy of teaching, maintain a required number of hours
Before they are allowed to use the medical simulator
To a large extent most due

19. “In the Hot-Seat” Medical simulation Communications
Medical Educator
“In the Hot-Seat”
Medical simulation
Communications
What about time spent in doing medical simulation education?

20. Clinical skills Psychological skills (Situation awareness)
Medical Educators
Clinical skills
Psychological skills
(Situation awareness)
Situation awareness; perception of elements, comprehension of current situation and projection of future status
Sensitive, Draw out from trainees learning points, don’t out-talk the trainees
Seniority does not take a priority

21. Simulation Based Medical Education: an opportunity to learn from errors
Provide professionals with the correct attitude and skills to cope competently with those mistakes that could not be prevented
Reduce occurrences of errors in real life
As your participants getter more senior
Medical Teacher Vol 27, Issue 3 May 2005

22. Medical Simulation in professionals
Balance between the emotional load associated with the experience and the professional lessons that can be learned.

23. Medical Simulation
“Sharing the Load”

24. Trainees “Suspension of Disbelief”
Medical Simulation
Trainees
“Suspension of Disbelief”

26. Blurring the boundaries: scenario-based simulation in a clinical setting
quasi-clinical scenarios, where inanimate models attached to simulated patients
Med Education Vol 39:6, 2005

27. Not a problem for generation weaned on computer games

28. Looking at the monitors to prompt next move Monitor focused
That’s what worries me as the patient becomes an after sight !
Looking at the monitor to prompt the next move!

29. Medical simulation Crises Driven Crises after Crises
Preventing a Crises
Does conquering a crises becomes a game, point scoring game
The participants come expecting a crises

30. Resource Intensive and Time consuming Trainers & Trainees
Medical Simulation
Resource Intensive and Time consuming
Trainers & Trainees
How much training does a trainer need? How much should he spend on medical simulation
How much time is needed to make not only an impact but a clinical difference
UG vs PG vs professionals
Skills training e.g. laparoscopy

31. Medical Simulation Initial exposure raises awareness
Repeated exposure to simulation improves performance
It has been shown that trainees get better with repeated exposure

32. High Impact But does it translate into improved clinical outcomes?
Medical Simulation
High Impact
But does it translate into improved clinical outcomes?
If I am not supported by studies for and against because I cannot find convincing data either way

33. Assessment of Medical Competency
Medical Simulation
Assessment of Medical Competency
Awareness
Improve with time

34. Medical Simulation Competency Assessment
Reliability
Validity
Predictive validity
Reliability, yes the manikin is able to reproduce the same signs
Validity, no the range of signs may not always be the only signs
Will performance on a given assessment predict future performance in actual practice?

35. Defining Systems Expertise: Effective Simulation at the Organisational Level- Implications for Patient Safety, Disaster Surge Capacity, and Facilitating the Systems Interface
2008 Academic Emergency Medicine Consensus Conference on the Science of Simulation

36. 2008 Academic Emergency Medicine Consensus Conference on the Science of Simulation
Objective methods and measures to demonstrate simulator training actually improves patient safety
Effective feedback of information from error reporting systems into simulation training to improve patient safety
Methods and outcome measures to demonstrate teamwork improves disaster response
……………..

37. No official instruction manual with the human body
Medical simulation cannot replace the primacy for training and apprenticeship system on real patients
No official instruction manual with the human body

38. The Patient is complex organism
Physical
Psyche
Behavioural
Environs
Right mix of traditional, simulation based learning and actual patient care

39. The Health Care Professional
Physical
Psyche
Behavioural
Environs
Right mix of traditional, simulation based learning and actual patient care

40. Reduction of Human errors Patient safety Medical Competence
1999 IOM, USA report on medical errors
Panacea to all that’ wrong with our health care problems

41. Medical Simulation A tool, powerful teaching tool
We should wield this tool and not the industry !