Simulcast

Simulcast Journal Club Podcast 3

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 Judgment. Simulation in Healthcare • Volume 1, Number 1, Spring 2006 

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

Vic 

Pause & Discuss - Translational Sim (VB as Guest)

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.

Pause & Discuss - Are you Experienced? Recruiting for ISS Debriefing Study.

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. 

Ep. 6 - Fellowship of the Sim - Training to be a Simulationista

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 

Simulcast Journal Club Podcast 2

In our February journal club podcast Ben and Vic discuss the paper of the month “Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training”. We shared some highlights from the online discussion, and Ben’s pdf summary is also included here. In short, it seems there’s more to communication skills training than recipes!  

We then reviewed 3 recent papers (all Open Access, and links below)  #FOAMsim [Symbol]  

Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation.  Sørensen et al. BMC Medical Education (2017) 17:20 

Observer roles that optimise learning in healthcare simulation education: a systematic review O’Regan et al. Advances in Simulation (2016) 1:4 

A systematic review: Children & Adolescents as simulated patients in health professional education. Gamble et al. Advances in Simulation (2016) 1:1 

And Ben gave us a taster for next month’s paper - 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 

Lots of practical points in the podcast for simulation practitioners, and also lessons for those of us embarking on research looking for methods expertise. 

 

Simulcast Journal Club Podcast 1

Happy New Year from Simulcast

We’ve really enjoyed the Journal Club at Simulcast over the last 6 months. A great array of articles, insightful comments from readers and nice perspectives from expert contributors, and brilliantly curated by Ben Symon.

We hope it’s another way to bring the healthcare simulation community together, and discuss and dissect the increasing volume of published literature in our field.

We want to make it even better, and in 2017 we’ll be doing a monthly podcast wrap of the JC – with a summary of the online discussion of our paper, and a brief review of some of the latest papers from the sim literature.

Th podcast will come out in the regular Simulcast iTunes feed, so if you already subscribe – there’s nothing to do.

In our first episode of ‘Simulcast JC’ Ben and Vic run through some highlights from Journal club over the last 6 months, and give a sneak preview into what’s ahead in 2017.

We give a quick shout out to #IMSH2017 highlights in Orlando, and how to follow on social media, including the Twitter handle @ssih.

11 - APMSH Day 2 with Lance Baily

Day 2 of the Asia Pacific Meeting for Simulation in Healthcare (APMSH) with Lance Baily 

 

On Day 2 of APMSH I attended a fascinating workshop with Lance Baily of SimGhosts and Healthy Simulation fame. Lance works in Las Vegas and has established a global reputation in the technical aspects of conducting simulation, for maximal learning effect.  

Some of these skills are drawn from his previous life working in Hollywood, and our workshop was based on some of those  

• Getting the right camera angle  
• Using tripods 
• Thinking about sound 

Lance explains more in his brief chat with me after the workshop 

The short workshop was eye opening and I suggest you go to Healthy Simulation and Sim Ghosts (subscription required) to see the resources on offer. There are details of workshops there if you are interested.

10 - APMSH Day 1

Day 1 of the Asia Pacific Meeting for Simulation in Healthcare (APMSH) with Kathy Adams and Jesika Gavilanes 

 A couple of weeks ago, I went to the Asia Pacific Meeting for Simulation in Healthcare (APMSH) in Singapore. I gave a talk on some of the in situ ‘translational’ simulation work I’ve been involved with, and it was great to see what other sim educators are doing in our region, and to network across geography and culture. 

In this pause and discuss episode I spoke to Kathy Adams, the Director of Continuing Education at the Society for Simulation in Healthcare.  If you haven’t looked before – their website has many resources for simulation educators, and membership of the society (which is reciprocal with the Australian Society) offers even more. 

I also spoke with  Jesika Gavilanes, one fo the co-Chairs for the upcoming IMSH meeting in Orlando Florida in January 28 – Feb 1st. 

9 - Put the Rubber to the Road - In Situ Simulation

Be open and honest with the team about the true objectives you are trying to achieve. When these are focused on doing better for the patient, people will join the ride.

Case:

You’ve been running fortnightly scenarios in the nearby simulation centre. These are part of the resident training program and from time to time may get a nurse or two along depending on how busy the department is. While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. They can’t find equipment, struggle to coordinate the multidisciplinary team and seem much slower to achieve critical actions in the real resus. You approach the Department director and the nurse manager and suggest starting to conduct one of the sim sessions in the department in a real resus bay once a month. This is met with resistance, “we’re too busy theirs not enough staff or time”, “the staff have done mock codes before, they really disrupt things and they hated them”. You go back to your office and try to come up with how you will make this happen.

Welcome to Episode 5 of Simulcast. In this episode we discussed how moving some simulation efforts out of the lab and into the workplace can yield big benefits and get some tips on how to drive change management and make a sustainable in situ simulation program.

Our guest for episode 5 was Andrew Petrosoniak, an emergency physician and trauma team leader at St. Michael’s Hospital, and Assistant Professor in the Department of Medicine at the University of Toronto. Petro has a strong grounding in the sim lab, but is a vocal advocate for point of care or in-situ simulation. Petro is the taller, better looking, and all round more refined co-lead on TRUST, an in-situ simulation-based study examining design ergonomics, human factors and latent safety threats in trauma resuscitation. Petro and his colleagues have also recently published a great article on in situ sim in Emergency Medicine Australasia.

Through this episode we give a brief overview of in situ simulation, what can you get out of it that isn’t possible in the lab and how would you assess the functional alignment of in situ versus sim lab. We also look at some functional domains that can help better understand objectives for in situ sim.

We picked Petro’s brain about the TRUST study and try to answer the big question – how hard has the change management process been in bringing sim out of the lab and into the department?

More resources:

Spurr, Gatward, Joshi and Carley EMJ Article –Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments - http://emj.bmj.com/content/early/2016/03/11/emermed-2015-204845.full.pdf

A process tracking video from TRUST simulation - https://www.youtube.com/watch?v=itLtqAAwe_w&feature=youtu.be

8 - The Safe Container for Simulation

 In this episode we discuss psychological safety in simulation.  Harvard professor Jenny Rudolph, PhD joined us for the discussion, taking time out form her busy schedule as the Director of the Center for Medical Simulation in Boston. 

We considered this all too familiar case study…… 

You’re facilitating a sim session in your ED. The junior docs and the nurses arrive,  a few straggle in late. You do a nice RTR (Round the room) but everyone seems a bit anxious and they are shifting in their seats. You really want them to relax.  

“You shouldn’t be anxious guys, this is what you do every day”.  

They look more worried.  

“I mean these will be sick patients, but this is the place to stuff up, rather than with a real patient”.  

One of the docs looks like he might vomit.  

“and remember what happens here, stays here, no you tube videos from what we are recording” - as you attempt to lighten the mood. “Its not like this is a test, we really just want to make sure you’re ok to be on nights on your own……”  

“so relax….”  

Two of the participants dash off for a toilet break before you start. 

 

The podcast gave us a wonderful opportunity to delve deeper into the philosophy behind Jenny et al’s excellent article on Establishing a Safe Container for Learning in Simulation.  

Most of our learners are pretty apprehensive about participating in sim. As Jenny explained to us – some people ‘come to life’ on stage with an audience, but most of us feel a sense of psychological threat if we are doing things in front of others and perceive this as evaluative i.e. a test of some sort. We may not know how an individual will be predisposed to respond, but as facilitators we can help everyone feel more psychologically safe.  

We can do this through some practical steps - clarifying expectations, discussing confidentiality, and telling stories/ sharing our own fears and vulnerabilities. Establishing the fiction contract is important - as described in the ‘safe container’ paper, and building on work by Peter Dieckmann here.  (beware -  a deep dive into theory!) 

The fundamental mindsets (of learner and facilitator behind these steps need to be understood.  

Jenny described some key concepts in the area, starting with helping to shift our learners to a ‘growth mindset’ (see Carol Dweck’s TeD talk here) in response to the challenge of a simulation activity. 

The idea of positive regard is crucial. We have to truly respect our learners and their efforts, and we need to demonstrate that. Well intentioned words suggesting this respect can be easily undone with ‘guess what I’m thinking’ questions that might make learners feel manipulated or unfairly judged.   

So how do we know if we have achieved psychological safety for our sim participants?  

Its complex. 

Experts like Amy Edmonson (another TeD talk to watch) suggests that seeing supportive responses when one puts oneself on the line, such as by asking a question, seeking feedback, reporting a mistake, or proposing a new idea. 

Sounds like our aspirations for our work teams….?  Again, simulation practice parallels our real world healthcare practice. 

Thanks again to Jenny Rudolph for an illuminating podcast.