1. 1 What is Simulation in Healthcare? Jeffrey B. Cooper, Ph.D. Professor of Anaesthesia, Harvard Medical School Department of Anesthesia and Critical Care Massachusetts General Hospital Executive Director, Center for Medical Simulation, Cambridge, MA

2. Disclosures No commercial interests related to simulation Leader of a non-profit education and research organization that promotes simulation 2

3. 3 Objectives Introduce simulation and the breadth of its uses in healthcare

4. 4 Patient Safety and Medical Education Challenges Addressed by Simulation l Training clinicians in risky procedures on real patients is no longer acceptable l Apprenticeship-based learning depends on chance events l There are limited opportunities to experience rare events and crises l The 80-hr week has reduced contact hours for physician trainees l Training for teamwork is atypical

5. 5 Using Simulation for Patient Safety and Culture Change What is “simulation”? What are the ways simulation is used? What is the role of debriefing?

6. 6 What is Simulation in General? A “technique” not a “technology” for interactive and often “immersive” activities that re-create experiences of a real-world environment, to amplify or replace actual experiences

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8. 8 Spectra of Simulation & Immersive Learning in Health Care Simulation and immersive learning can apply to health care in many different ways There is a spectrum of applications across each of ten (or more) aspects of simulation From Gaba DM: The future vision of simulation in healthcare, Qual Saf Health Care. 2004; 13 (Suppl 1):i2-10.

9. 9 Spectra of Simulation 1: Purpose of simulation Education (Knowledge) Training (Skills, Tasks, Behaviors) Testing Formative Summative High-stakes Recurrent Research Pedagogy Hum Factors Physiology / Pharmacology Patient Care Surgical case planning Protocol design Equipment procurement Gaba: Q&SHC, 2004

10. 10 Spectra of Simulation 6: Knowledge, skills, behaviors Conceptual Understanding Knows Technical Skill Knows how Shows how Does Masters Attitudes & Behaviors Teamwork Patient-centric Ethics Professionalism Decision Making Cognition Meta-cognition -Static -Dynamic Gaba: Q&SHC, 2004

11. 11 Spectra of Simulation 8: Technology applicable to simulation Verbal “what if” Role- playing Multimedia Standardized patient (Actor) Electronic Patient Simulation Replica Clinical Site; Physical (mannequin); Full VR Patient Simulation Computer- screen Screen-based virtual world Part-task Trainer Physical VR Gaba: Q&SHC, 2004

12. 12 Hybrid Patients Standardized Patients Computer Simulation

13. 13 Procedural Simulators/Part Task Trainers Central Line Placement Intubation

14. 14 Simulators /Part Task Trainers Ultrasound Laparoscopic skills Colonoscopy

15. New cardiac surgery training devices Chamberlain Heart U North Carolina 15

16. 16 Trauma Sim Mannequin Simulators

17. 17 Control Room

18. 18 Full Team Training with Simulation

19. 19 Debriefing: The key to learning from simulation

20. 20 More Information at These Web Sites WWW.bris.ac.uk/depts/bmsc (Good link to other simulation facilities) WWW.SSIH.ORGWWW.SSIH.ORG (Society for Simulation in Healthcare) www.harvardmedsim.orgwww.harvardmedsim.org (Center for Medical Simulation)