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23Episodes
Education

A podcast dedicated to the discussion of healthcare simulation. Debunking dogma, demystifying jargon and translating knowledge. Hosted by Dr Victoria Brazil and Jesse Spurr

Episodes

Norma Robinson leads an interprofessional simulation program involving medical students from University of Queensland Rural Clinical School and nursing students from the University of Southern Queensland. 

The program is based in Toowoomba but has now been scaled up to include students from many part of rural southern and central Queensland

Interprofessional education and teamwork training at the student level has been a challenging area, although with some excellent programs, and I think simulation is at least part of the solution. 

Norma was kind enough to host me for a visit and I spoke to her afterwards about the program, the motivations for interprofessional education, and how to really build a healthcare workforce to serve a community. 

 

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Sara-Catrin Cook joined me for short chat about all things sim at smacc.  

Sara is part of a group who has put together a comprehensive simulation theme woven through the conference, including the SIMHaus – a showcase within the Tempdrom where attendees can meet and talk to other simulation enthusiasts ad experts. 

The SimHaus will be physically set up next to the main arena, and Sara tells us what to expect. Simulcast will be there covering the event for those who can’t make it.  

See you in Berlin

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In an effort to streamline blog posts, we are continuing a merged Journal Club Podcast and monthly wrap post.pdf

Please read our pdf summary of the May Journal Club article, the month’s discussion and our expert commentary here

 


JOURNAL CLUB

In our May journal club podcast Ben and Vic discuss the papers of the month – a duo on Rapid Cycle Deliberate Practice and the approach to debriefing in this format

Structuring feedback and debriefing to achieve mastery learning goals Eppich WJ1, Hunt EA, Duval-Arnould JM, Siddall VJ, Cheng A. Acad Med. 2015;90:00–00.  First published online doi: 10.1097/ACM.0000000000000934

Pediatric resident resuscitation skills improve after “Rapid Cycle Deliberate Practice” training Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, Bradshaw JH, Diener-West M, Perretta JS, Shilkofski NA. Resuscitation. 2014 Jul;85(7):945-51. doi: 10.1016/j.resuscitation.2014.02.025. Epub 2014 Mar 4.

 

We then reviewed some recent papers

  1. Theilen, Ulf et al.Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings. Resuscitation , Volume 115 , 61 - 67

A nice segue from Hunt et al – translating outcomes from individual performance improvement to patient and systems level outcomes

 

  1. Maicher, Kellen et al. Developing a Conversational Virtual Standardized Patient to Enable Students to Practice History-Taking Skills. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: April 2017 - Volume 12 - Issue 2 - p 124–131

One for the technology enthusiasts – using AI/ natural language processing to create patients we can have conversations with. Make sure you watch movies like Ex Machina and Passengers for your background reading 

 

And Ben introduced next month’s paper on peer coaching.

Cheng, Adam et al. “Coaching the Debriefer: Peer Coaching to Improve Debriefing Quality in Simulation Programs” Simulation in Healthcare : The Journal of the Society for Simulation in Healthcare. Publish Ahead of Print, POST AUTHOR CORRECTIONS, 20 May 2017

 

Looking forward to another great discussion

Vic

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This month we turned our focus to simulation delivery formats, and in particular a novel approach described recently. 

Sunga K, Sandefur B, Asirvatham U, et al. LIVE. DIE. REPEAT: a novel instructional method incorporating recursive objective-based gameplay in an emergency medicine simulation curriculum BMJ Simulation and Technology Enhanced Learning 2016;2:124-126. 

We were fortunate to be joined by 2 authors of the paper 

Kharmene Sunga (@Kharmene) is an emergency physician at Mayo Clinic in Rochester, Minnesota, where she is also lead for simulation in the ER residency. Daniel Cabrera (@CabreraERDR) is also an emergency physician at Mayo, a social media enthusiast and @smaccteam speaker. 

Their paper, and original blog post,  challenges our traditional approach to simulation delivery – often ether a scenario followed by long(ish) debrief, or  ‘pause and discuss’ where the scenario is paused at intervals for discussion and then continues on. 

Using gamification principles, and a fair bit of movie watching – Kharmene and Daniel have devised a sim format that involves ‘recursive objective based gameplay’ – where participants attempt to reach higher stages in the ‘game’ but have to repeat the level if they die. Seen from an educational theory perspective – this is deliberate practice in action. It’s a fast paced and engaging format, and provides a chance to practice again after a short and directive debrief. 

Inspired by the idea of forgoing some of the long debrief after a scenario in favour of a chance for participants to practice, I’ve adapted the principle to our final year student sims, which have been similarly well received.  

Comments and other ideas for adaption welcome. 

 vb 

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In our April journal club podcast Ben and Vic discuss the paper of the month – a classic debriefing article.  

Jenny W. Rudolph, PhD, Robert Simon, EdD, Ronald L. Dufresne, MS, and Daniel B. Raemer, PhD There’s No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment. Simulation in Healthcare • Volume 1, Number 1, Spring 2006 

 

We then reviewed some recent papers 

  1. The Simnovate series - all FREE for now

Rajesh Aggarwal. Simnovate: simulation, innovation and education for better healthcare. BMJ Simulation and Technology Enhanced Learning Mar 2017, 3 (Suppl 1) S1-S2; DOI: 10.1136/bmjstel-2016-000184 

Philip H Pucher, et al. Simulation research to enhance patient safety and outcomes: recommendations of the Simnovate Patient Safety Domain Group. BMJ Simulation and Technology Enhanced Learning Mar 2017, 3 (Suppl 1) S3-S7;  

Wayne Choi, et al. Engagement and learning in simulation: recommendations of the Simnovate Engaged Learning Domain Group. BMJ Simulation and Technology Enhanced Learning Mar 2017, 3 (Suppl 1) S23-S32; DOI: 10.1136/bmjstel-2016-000177 

  1. Simulation Fellowship Programs: An International Survey of Program Directors

Natal, Brenda MD, MPH; Szyld, Demian MD, EdM; et al. Academic Medicine April 4, 2017 

  1. An Innovative Approach: Using Simulation to Teach Primary Care Gynecologic Procedures.

Hellier, Susan D. et al. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare January 9, 2017 

 

And Ben introduced next month’s 2 papers – a complementary duo focused on Rapid Cycle Deliberate Practice. 

Structuring feedback and debriefing to achieve mastery learning goals Eppich WJ1, Hunt EA, Duval-Arnould JM, Siddall VJ, Cheng A. Acad Med. 2015;90:00–00.  First published online doi: 10.1097/ACM.0000000000000934 

Pediatric resident resuscitation skills improve after “Rapid Cycle Deliberate Practice” training Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, Bradshaw JH, Diener-West M, Perretta JS, Shilkofski NA. Resuscitation. 2014 Jul;85(7):945-51. doi: 10.1016/j.resuscitation.2014.02.025. Epub 2014 Mar 4. 

 

Looking forward to another great discussion  

Vic 

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This episode was a ‘mix tape’ of moulage and other techniques to achieve physical realism in simulations – including procedural and anatomy teaching


Clare Scott offered her considerable expertise in moulage and making bespoke manikins for trauma simulations. She emphasized keeping in simple, keeping it real and doing your research – online and through networks of interested sim moulage folks (like Behind the sim curtain).

IMG_4998

Clare offered some practical examples for making ‘Schkin’ for moulding wounds and other skin defects, bile from coke green food colouring, and more. She has a fabulous handout here:  pdf


Keri Shafer shared her plans for using 3 D printing hearts to learn about congenital heart disease. Keri (@kerizozo) is a cardiologist from Boston whose clinical and educational work is focused on those tricky plumbing issues. Using a process designed to help surgeons operate better, she went to the 3D printing group within the Boston Childrens Hospital Simulation program and developed models of various forms of congenital heart disease. Fabulous collaboration between clinician educators and engineers. We wait with interest to hear the outcomes of her research in evaluating this educational technique.


We asked Andy Buck, of ETM course fame, about his favourite home made part task trainer, and how he makes it. Andy cited better functional task alignment and lower cost as key reasons to ‘make your own’. We chatted about whether 3D printing is ready for prime time for the average simulation educators? For those superkeen Andy is happen to be contacted on Twitter via DM (@edexam)


Finally, we spoke to Jessica Stokes-Parish in her minimal spare time between work and convening this year’s Australasian Simulation Congress. She’s just published an article that asks us to reflect of how much ‘bang for buck’ we get from the moulage efforts we make as sim educators.

Does Appearance Matter? Current Issues and Formulation of a Research Agenda for Moulage in Simulation. Stokes-Parish, Jessica B. M. Nurs (Adv Prac); Duvivier, Robbert MD, PhD; Jolly, Brian PhD. Simulation in Healthcare February 2017 - Volume 12 - Issue 1 - p 47–50

I enjoyed this article so much I wrote a blog post about it for the International Clinical Educators Network blog.

 

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Simulcast Journal Club podcast March episode 

 

In our March journal club podcast Ben and Vic discuss the paper of the month Marshall, S. D. (2017) “Helping experts and expert teams perform under duress: an agenda for cognitive aid research.” Anaesthesia, 72: 289–295. doi:10.1111/anae.13707. We shared some highlights from the online discussion, and Ben’s pdf summary is also included here. There’s more to a good checklist thean we realise. 

We then reviewed 3 recent papers (links below)   

Greig PR, Darbyshire JL, Richards E ‘The most useful exercise of medical school’: simulated death can be successfully incorporated into undergraduate simulation. BMJ Simulation and Technology Enhanced Learning Published Online First: 07 March 2017.  

Kessler DO, Chang TP, Auerbach M, et al Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments BMJ Simulation and Technology Enhanced Learning 2017;3:17-22.  

Cheng et al.  Conducting multicenter research in healthcare simulation: Lessons learned from the INSPIRE network. Advances in Simulation (2017) 2:6 

 

And Ben introduced next month’s paper – a classic 

Jenny W. Rudolph, PhD, Robert Simon, EdD, Ronald L. Dufresne, MS, and Daniel B. Raemer, PhD There’s No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good JudgmentSimulation in Healthcare • Volume 1, Number 1, Spring 2006 

Looking forward to comments from across the range of simulation debriefing experience 

Vic 

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I shifted to the other side of the mic a couple of weeks ago - as interviewee. I had spoken at a breakfast meeting of the Australasian College of Health Service Management, and was then interviewed by Anthony Frangi of @popupradioAU about Translational Simulation – my take on how we might think about using sim for quality improvement.

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There is increasing use of ‘in situ’ simulation (ISS) – conducted in the actual care environment – as a healthcare simulation modality. This method supports teamwork training, process improvement and the identification of safety threats related to the environment or care systems within that real clinical environment.1,2  

The shared reflective experience during simulation promotes transfer of lessons back to the workplace. Debriefing achieves improved operational performance across a range of fields, including outside healthcare.3 Most guidance on debriefing strategies4-6 comes from theoretical frameworks developed within and outside healthcare, and from educationally focused simulation. An exploration of self reported expert debriefing practice revealed that factors such as values and artistry may be as important as specific techniques.7  

Optimal debriefing strategies for ISS remain unclear, and current practice has not been reviewed systematically. Most published reports of ISS programs lack detail as to how debriefing is conducted. How expert and experienced in situ debriefers adapt their practice for this context has not been previously reported, nor have measures of effectiveness been developed or tested. This exploratory study will use survey and interview methods to identify the characteristics of debriefing currently conducted within in situ simulation programs in healthcare.  

Specifically: -  

What are the features of currently practiced debriefing approaches following in situ simulation (ISS) in healthcare? 

  • Characteristics of the ISS 
  • Characteristics of the debriefer and participants 
  • Characteristics of the debriefing process 
  • Characteristics of any evaluation of the debriefing 

Our aim is that identification of effective debriefing strategies will have implications for design of in situ simulation programs, faculty development for simulation educators and could inform further research questions related to measures of debriefing effectiveness. 

If you are someone with experience of in situ simulation debriefing (ie in the real clinical environment, rather than skills lab), we’d like to invite you to participate in a survey based study, with an option to also participate in a subsequent interview. 

If you are interested, please click here to provide your details for study recruitment or write an email to ISSdebreifing@gmail.com 

Victoria Brazil, Walter Eppich, and Margaret Bearman 

 

References 

  1. Guise JM, Mladenovic J. In situ simulation: identification of systems issues. Seminars in perinatology. 2013;37(3):161­5.
  1. Rosen MA, Hunt EA, Pronovost PJ, Federowicz MA, Weaver SJ. In situ simulation in continuing education for the health care professions: a systematic review. The Journal of continuing education in the health professions. 2012;32(4):243­54. 
  1. Tannenbaum SI, Cerasoli CP. Do team and individual debriefs enhance performance? A meta­analysis. Human factors. 2013;55(1):231­45. 
  1. Cheng A, Eppich W, Grant V, Sherbino J, Zendejas B, Cook DA. Debriefing for technology­enhanced simulation: a systematic review and meta­ analysis. Medical Education. 2014;48(7):657­66. 
  1. Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc. 2015;10(2):106­15. 
  1. Sawyer T, Eppich W, Brett­Fleegler M, Grant V, Cheng A. More Than One Way to Debrief: A Critical Review of Healthcare Simulation Debriefing Methods. Simulation in Healthcare. 2016;11(3):209­17. 
  1. Krogh K, Bearman M, Nestel D. “Thinking on your feet”—a qualitative study of debriefing practice. Advances in Simulation. 2016;1(1):1­11. 
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Learning to be an effective simulation educator is a challenge. Education theory and practice, technical aspects and leadership are just some of the knowledge and skills involved. 

In this episode of Simulcast we were joined by Demian Szyld, (pronounced ‘shield’…….. “like the weapon” he told me).  Demian (@demianszyld)  is the Senior Director of the Institute for Medical Simulation at CMS in Boston, where he works with previous Simulcast guests Jenny Rudolph and Walter Eppich. 

He is involved in many aspects of simulation, including  as Chair of the Formal Training programs Affinity Group with the Society for Simulation in Healthcare, so we thought he’d offer some great insights into this question of how to train to be an effective simulation educator. 

Demian is also a simulation podcaster – in Spanish. Check out Simulacion de Sur a Norte (Simulation from South to North)  

So we structured our discussion around 2 case studies 

Case study one 

An experienced ED nurse has been given some protected time to ‘do sim’. He doesn’t have much formal education background, but is into ‘tech and toys’ and has helped run sims in the past at his previous job. He’s enthusiastic, and has a couple of docs in the department keen too. Keen to learn more so he can run the sims better and considering is doing a formal course 

Where should he start? 

We discussed the importance of making friends – locally and across simulation networks - and getting an idea of the knowledge and skills required. Going to conferences like IMSH (in Los Angeles next year), the Australasian Simulation Congress, SESAM and the INACSL (International Nursing Association for Clinical Simulation and Learning) conference – and joining workshops and networking. 

Online resources like NHET Sim and practically focused websites like HealthySimulation.com and even You tube can be great resources. SSIH now runs formal certification programs.  

 

Case study 2 

An anaesthetic trainee is nearing the end of her clinical training, and wants to make sim a big part of her career, and is prepared to invest time and money in gaining qualifications. She may have opportunity to be deputy sim director of her local sim program in a year or so. 

What options does she have? 

There are many options for Masters programs and simulation Fellowships. Demian reinforced just how important it is to be a great educator to be an effective simulation leader. He strongly supports formal structured training, and described some the work of his group in looking at the common domains of practice of formal programs. 

We were grateful Demian could spare the time to chat and would welcome other suggestions and resources in the comments. 

 vb 

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