Simulation in medical education and patient safety

See also:

• training through simulation of clinical scenarios and frameworks
• Debrief2Learn.org simulation debriefing resource website

• simulation training is a critical component of developing and maintaining the competence, confidence and efficiency required to optimise patient care and improve patient safety and as such it's goal and outcome measures should be patient safety - and not the provision of simulation itself
• simulation can be utilised to:
  • improve and maintain skill competency
    • a confident staff member unaware of a competence deficit is dangerous
    • assuming all staff have basic competencies is unrealistic and dangerous
    • critical for this to occur as part of onboarding of staff at orientation to detect skill deficits early and address them, and to educate standard process in the institution to minimise variability of practice which tends to cause confusion amongst the team and adverse outcomes as well as inefficiency
    • it is said that for optimal safety, one needs a herd competency of 85-95% - that is, one needs to ensure around 90% of the team are sufficiently competent
  • improve and maintain confidence
    • a skilled competent staff member who lacks confidence is a waste of opportunity and potentially dangerous if forced into performing their skill - or more likely, will use avoidance measures to put more burden on other team members
  • improve guidelines and protocols by running through them and identifying real deficits in the implementation of the guideline and detect unexpected issues
  • improve team work and team leadership factors

• establish resources
• consuder creation of pre-planned potential “escape routes” to avoid sim session failures of learners to end the session without optimal learning as an alternative to the usual Run Through model which allows the scenario to proceed uninterrupted
  • pause scenario and offer perfect management then allow learners to re-start and practice the perfect management
    • technician pauses scenario
    • instruct team leader to summarise their understanding of clinical problem and management to date
    • correct situational assessment and/or share observation of lack of clinical improvement
    • ask what else could we do ?
    • provide expertise
    • confirm agreed management plan
    • restart scenario and instruct team leader to:
      • Share mental model - announce the clinical problem
      • Project plan to team
      • Initiate tasks to team
  • use a confederate in the learner team to guide them to correct management eg. Suggest looking up a protocol, suggest a differential, etc

• briefing and orientation of learners
• structured environment

• developed by paed sim team at Bristol, UK and International Pediatric Simulation Society (IPSS)

• create a safe structured environment for debriefing
• non-judgemental conclusion of scenario avoiding contamination the performers' impressions of how they performed
• limit emotional scatter
• orientate learner to debrief structure

• aim to determine learners needs assessment and optimise engagement with learning
• open question to learner to elicit emotional impact - how did they feel they went how did they feel internally?
• de-fixation to ensure learner is not fixed on a single issue

• get the facts - learner review
  • engage learner with performance analysis
  • performance analysis by learner
• get the facts - faculty review
  • review expected performance
  • facilitated performance analysis
• feedback strategy decision
  • choose optimum strategy

• implement feedback strategy
  • address performance deficit

• reinforce learning
• review performance deficits identified and solutions
• review learning objectives