Educator interview

Interview with a simulated learning educator (SLE) – Chloe Lyons

What do you love about simulation for health care professionals?

I love seeing the students have invaluable learning experiences through practicing potentially life threatening and clinically relevant situations with no actual harm to human life.

How did you learn how to run a debrief?

Reviewing appropriate literature and frameworks, watching and listening to other educators, and then practicing these skills with supervision and reflection/analysis. 

What is a good opening question for a debrief?

"How did that go for you?" 

How important is a take home message?

Very, although there are usually multiple, students can have an individual one, depending on the learning objectives for the simulation. 

How do you get a debrief back on track after someone gets side-tracked?

Using a mapping system on the board I take it back to the goal for the simulation, and revise what was happening in order to achieve this. 

How do cope when a student gets upset?

It shows how powerful the simulation can be, and needs to be addressed outside the group to ensure the student has a positive learning experience. I usually let the student gather themselves in private and then debrief them after the group is finished.  

What do students get out of a debriefing session?

It allows them to exit the simulation space, no longer being involved in whatever clinical context they were in which is important,it then allows opportunities for high quality learning with self-reflection and analysis, ideally coming up with the answers to what happened within the simulation themselves through a good debrief, as opposed to being just told the answers, which is not as powerful. It also allows them to identify learning gaps in knowledge and skills, which is important for professional development and further practice. 

What can a simulated patient contribute to a debrief?

The patients perspective can be powerful as it is not often that in the real clinical setting nurses are “rated” and hear how they performed in providing care. It is good for the students to hear it from the patient themselves as it is honest and immediate feedback.  

Chloe is a registered nurse and simulated learning educator at La Trobe Rural Health School.

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Debriefing blog - part 1

Sim Ed  - “The Beginning” – A debrief blog.

Over the past two years or so, Simulation Based Education (SBE) has become a passion in my life. One component of SBE which I especially find both exciting and rewarding is debriefing.

Guiding and watching the learners reflect upon their actions within the scenario and explore the knowledge and thought processes which led to the actions is gratifying. So much deep learning can occur during such a short period of time if the debrief facilitator’s  questions asked are well thought out, the responses of the learners considered, and time is allowed for reflection, discussion and metacognition.

This blog will be the first in a series of three where I will share my experiences with the SBE debrief. “The beginning”, “the middle” and “the end” are my creative titles, with “the beginning” covering planning for debriefs and opening questions, “the middle” covering narrative sense making and tips for handling difficult debriefs, and “the end” discussing take home messages, faculty debrief and the importance of honest evaluation of  the debrief .

So, let’s start at the most logical place, the beginning.

I was initially presented with a framework for SBE debrief through an article which was presented in the NHET-Sim program. Arora et al.,(2012)  identified eight components of an effective debrief, “approach, learning environment, learner engagement, reaction, reflection, analysis, diagnosis and application” (p. 984).,  and I have used these features as a guide to my own practice.

This framework complemented the informal experiential learning I had acquired through years of daily debriefs with undergraduate nursing students. I cannot stress enough how much the facilitator’s approach to learning and the provision of a safe learning environment is essential to a successful debrief. If the goal of the debrief is deep, reflective learning then the absence of an informed, constructive, non-threatening and supportive debrief facilitator is nothing short of sabotage.

Planning

Another component I have identified which is not discussed in the above article is planning. Although this may seem obvious, planning for the debrief is often overlooked. I consider careful planning for the debrief just as important as any other aspect in SBE eg. learning outcome or scenario development. As I prepare for the SBE, I think about the characteristics of the learner group (age, level of education, discipline etc.) as knowledge of the individual learners or how the group works together can assist with the planning of strategies for possible challenges eg. how will I encourage the quiet learner to contribute or how will I deal with the verbose learner?

A great idea is to meet with simulation faculty prior to the simulation to discuss the learner characteristics and possible strategies which may be employed within the debrief to facilitate learning eg. ground rules, debriefing outline, possible questions and how to and who will deal with the not uncommon learner reactions such as crying and defensiveness.

Reflecting

I also reflect upon past debriefs, especially similar delivered scenarios, evaluating what worked well, what didn’t and why. I also try to prepare a list of questions which relate to the learning objectives. These questions are very handy to start up discussion amongst the learners and are also a great tool to get the debrief back on track if it becomes side-tracked.

I usually ask the list to be reviewed by the content experts who are participating in the SBE to ensure the questions align with best practice guidelines / intended learning outcomes and I keep a hard copy of the questions beside me – excellent for when I have the occasional mental blank, don’t judge :-).

My opening line

I will get back to my opening question in a tick but prior to that I will share with you my opening line in the debrief.

The first and the last thing I say in the debrief is “thank you”. I thank the participants for “putting themselves out there so that not only can they develop their own skills and knowledge but through their participation they are enabling learning for their colleagues who are observing the scenario and participating in the debrief”.

Participating in a scenario is stressful and for some participants, being placed in such a transparent situation, nothing short of excruciating. Saying thank you and acknowledging the stressful environment they have participated in is important for developing a respectful and safe learning environment. A little bit of gratitude is also just good manners and the majority of people appreciate a simple, genuine gesture of thanks. Quite often this introduction gives the participants a chance to gather their thoughts and emotions.

I give a short outline of how the debrief will proceed and timeframe during the prebrief but a reminder of this as well as any ground rules which you want to present can also occur at the beginning of the debrief.

My first question always feels a little awkward (probably due to my own anxiety). I ask “how do you feel?” which in my experience is often ignored by the learners as they are keen to state what they believe “they did wrong”. I gently seek out any emotions and then pursue the reason behind the emotion.

Inquiring as to their emotional state gives an opportunity to the learners to “vent” so that they can then move forward in the debrief rather than being caught up in an unresolved emotional state. The debrief facilitator is given an opportunity to validate the participants present feelings which quite often revolve around the fear and stress participation in the scenario evokes. Once acknowledged, I have often seen the fear and stress miraculously disappear. Reflection upon the actions and thought processes of the participants can then be explored.

So this is the beginning of the SBE debrief I facilitate. I hope you gained some learning from this blog and look forward to any feedback you have to offer. Please be kind, as this is my first ever blog. #anolddogcanlearnnewtricks.

Emma.

References:

Arora, S., Ahmed, M., Paige, J., Nestel, D., Runnacles, J., Hall, L., Darzi, A., Sevdalis, N. (2012). Objective Structured Assessment of Debriefing. Annals of Surgery, 256 (6), 982 – 988. Retrieved from http://www.annalsofsurgery.com

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Scenario development templates

When using the scenario templates below, please make sure you acknowledge the source.

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Developing your own simulation faculty training course

By Lesley McKarney

Recently, I had the privilege of attending the International Meeting for Simulation in Healthcare (IMSH) in San Diego, CA in January 2016. This is the annual conference of the Society for Simulation in Healthcare (SSIH) and it was held over four days (plus three days of pre-conference activities) and attracted more than 2500 delegates from around 75 countries. It’s a key event in the calendar of healthcare simulation offerings.

Celebrating its sixteenth year, IMSH 2016 brought together practitioners, simulation educators, academics, innovators and developers from a wide spectrum of simulation-based healthcare disciplines. Attendees gathered to learn, network and share in everything exciting and new in the burgeoning field of simulation-based medical education and healthcare simulation training tools.

Faculty development, support and turnover were common issues cited in several sessions focussed on getting started on, or expanding simulation programs. There are many challenges associated with recruiting and retaining clinicians to be simulation faculty, particularly in regional areas of Australia. It follows that there’s a growing need for simulation programs to create an incentive for recruiting and retaining clinician partners by formalising their simulation efforts into promotable scholarly activities.

The key to keeping your simulation educator staff, it would seem, is to first define faculty needs in simulation education and provide the necessary support to enable that to happen; and secondly, provide some assurance to simulation faculty that their activities are recognised and appropriately incorporated into the fabric of the organisation.

As for professional development, there is an increasing offering of faculty development courses in simulation but it can quickly become a costly venture to send staff offsite (often interstate) for such training. For some organisations, a more sustainable model may be to design and deliver their own simulation instructor training, perhaps in collaboration with other sites.  

I took the opportunity to attend a pre-conference workshop at IMSH 2016, Build a Simulation Instructor Course.  It was run by the friendly folk at PennState University Clinical Simulation Center, who’ve had a good deal of experience at developing simulation instructor courses and helping others to do so. Effective use of simulation, they say, is part science, part art, part experience and a large part practice after reflective instruction.

Below are some of the take-home messages from the workshop:

  1. Conduct a needs assessment for simulation gaps in your organisation. Understanding the needs of your audience is obviously key to getting the right balance in content and creating something useful and that senior management sees the value in
  2. Who are your learners? Have a good understanding of your faculty experience using simulation when you are designing a course. Few trainees will have background in education and simulation theory
  3. You can’t teach everything in one course
  4. Keep the course coherent and focused. Know what you what to teach and what you don’t want to teach
  5. Be aware of the diversity of learners and learning styles and follow adult learning theoretical frameworks
  6. Set clear course expectations before and during the course
  7. Use a crawl, walk, run approach to build learner confidence. Be mindful of the level of your students and teach to that.
  8. Remind learners that debriefing is difficult and requires practice
  9. Use watchmen to assess flow, presentations and learner engagement
  10. Use smaller learner groups for collaborative, hands-on work
  11. Learner satisfaction and comfort is crucial: pay attention to room temperature, provide adequate space and food
  12. Finally, create the course knowing you will change it often. Simulation instructor courses should evolve over time but they will never be perfect in the experience of the PennState educators. Collecting and incorporating feedback from participants at the end of each day is vital for improving any course. Be prepared to cover off any ‘grey’ areas in the evaluation as your course goes along, if possible.  Accept that you’ll need to change the course before, during and after each rendition according to learner and instructor feedback.

The workshop highlighted for participants the complexity of designing a fit-for-purpose educational program, as we were tasked with deciding on content for a 1-day, 2-day, 3-day or 5-day course curriculum. Deciding on what topics should be given greatest weight and how should they be ordered was not an easy task, given the breadth of possible content. The workshop emphasized effective debriefing as the key to learning in simulation-based education. Overall, the workshop participants decided on the following list of the top ten topics for a simulation instructor course, ranked in order of importance.

  1. Debriefing
  2. Standards and guidelines
  3. Conducting needs assessments and gap analyses
  4. Evaluation (at the learner, instructor and program levels)
  5. Developing learning objectives
  6. Simulation modalities and methodology
  7. Scenario design
  8. Facilitator roles and responsibilities
  9. Learning theories
  10. Curriculum integration and program design

For more information on designing a simulation instructor course, check out the Resources below.

Resources

The University of Washington CHSIERP has produced a series of e-learning modules for simulation faculty development, which can be accessed for free (but with registration)

PennState have published a suggested reading list for simulation instructors

Zigmont J et al. (2015) Chapter 8.1: Educator Training and Simulation Methodology Courses. In Defining Excellence in Simulation Programs. Edited by J. Palaganas, JC Maxworthy, CA Epps and ME Mancini. Published by Wolters Kluwer.

Jeffries PR et al. (2015) Faculty Development When Initiating Simulation Programs: Lessons Learned From the National Simulation Study. Journal of Nursing Regulation 5(4):17–23. Available athttp://www.journalofnursingregulation.com/article/S2155-8256%2815%2930037-5/pdf

Sinz e et al. (2014) Teaching Simulation Literacy in Adult Healthcare Education: A Qualitative Action Research Study. Available at http://www.adulterc.org/Proceedings/2014/papers/Sinz.pdf

Cheng A et al. (2015) Faculty Development for Simulation Programs: Five Issues for the Future of Debriefing Training. Simulation in Healthcare 10(4):217-22.

Paige JT et al. (2015) Debriefing 101: training faculty to promote learning in simulation-based training.  American Journal of Surgery 209(1):126-31.

Kim S et al. (2011) Halting the revolving door of faculty turnover: recruiting and retaining clinician educators in an academic medical simulation center. Simulation in Healthcare 6(3):168-75

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Postgraduate certificate and diploma level simulation courses

Graduate certificate clinical simulation – Monash University

Graduate certificate healthcare simulation – Queensland Health Clinical Skills Development Service (CSCS) Queensland Health Clinical Skills Development Service (CSCS)

Graduate certificate in healthcare simulation education – Australian Catholic University (ACU)

Graduate certificate in Flexible learning and Simulation for health professionals  - University of Tasmania

Graduate certificate of clinical education and simulation – Macquarie University

Graduate certificate in clinical education and teaching - University of New England

Graduate certificate in clinical education – Flinders University

Graduate diploma in clinical education – University of Melbourne (UOM)

Graduate diploma in clinical education – Flinders University

Graduate diploma in health professions education – University of Western Australia (UWA)

 

Know of a course that isn't on our list?  Let us know by contributing to SimEd.  

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Masters level simulation courses

Australia – These courses include at least one unit on simulation

Master of Clinical Education (Coursework) – Flinders University

 

Master of Clinical Education – University of Melbourne

 

Master of Health professional education – Monash University

 

Master of Health Professions Education(research or coursework and dissertation)  – University of Western Australia

 

International

UK

Masters of Medical and Healthcare Simulation – National University of Ireland

 

Master of Science in Medical and Healthcare Simulation – University of Hertfordshire

 

Master of Science in Simulation Based Education – University of Dundee

 

Master of Science in Simulation and Patient Safety – Plymouth University

 

USA

Master of Education in Teaching and Curriculum with Specialization in Medical Simulation – Pennsylvania State University

 

Master of Science in Healthcare Simulation – University of San Francisco

 

Master of Science in Medical and Healthcare Simulation – Drexel University

 

Master of Science in Medical and Healthcare Simulation – New York Institute of Technology

 

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Online simulation/education courses

MOOCs - Massive Open Online Courses

These are free courses offered by universities from all over the world. 

Teaching and assessing clinical skills

Instructional methods in health professions education

Here you will find a summary of MOOCs courses for simulation professional development that might be helpful when looking to further your knowledge and career.

 

Online courses 

 Sim-One online course: Simulation Research: Best Practices for Planning a Research Study.

Simulation Research: Best Practices for Planning a Research Study is facilitated and led by leading simulation and health care education researchers across Ontario. Facilitators will coach course participants through the process of building a research study based on their research question or interest. They will provide guidance on practical issues such as method planning, grant applications, knowledge mobilization planning, and team building. 

This eight-week course includes video-recorded lectures, short assignments, interactive live webinars with expert researchers, and review & questions periods.  Cost is $495 (+tax) US

The next course runs from September 30 to November 18, 2015.

 NHET-Sim

NHET-Sim is a federally funded program that has delivered training to over 6000 simulation educators across Australia. The programme is a free nationwide training programme for healthcare professionals aimed at improving clinical training capacity and consists of online learning modules on simulation-based education. NHETSim an Australian Government funded initiative.

CSDS e-learning courses

The Queensland Health Clinical Skills Development Service (CSDS) is the one of the world’s largest providers of healthcare simulation.  They offer face-to-face learning in Queensland, Australia, or e-learning courses are also available.

Webinars

The 4 hour webinar offered by John Hopkins is approx $375 US.  This webinar is ideally for experienced simulation educators interested in learning how to rigorously assess the quality of debriefing using the Debriefing Assessment for Simulation in Healthcare (DASH)

You can find out more information by visiting the John Hopkins website.

 

Contribute to SimEd here.

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The case for virtual patients/serious games

We live in an increasingly tech-savvy and connected world. Globally there are approximately 1.9 billion smartphone devices, and 1.7 billion desktop computers. In the USA, the average user spends over 5 hours per day using one of these devices [1]. A significant portion of these devices are commonly used for recreational purposes, with around 1.8 billion people playing computer games [2]. 

It is no wonder then that there is a growing trend to leverage this huge market of gamers to try and achieve outcomes beyond simple entertainment. The field of “Serious Games” has emerged, and is tipped by many to be a major “game changer” in the way we educate and train [3][4].

Simulation based learning modalities are underpinned by the theoretical premise that students learn better through experience. The skills and knowledge they absorb through practice based activities are widely thought to be both more comprehensive than those gained through traditional instructional mediums, as well as better retained. In healthcare and other high-risk professions it is seen as a necessary way to allow students to practice their skills, without putting anyone in harm’s way.

Unfortunately, traditional simulated learning experiences are very high cost. Mannequin based simulations come with a very high entry cost, as well as the ongoing costs of maintenance and skilled operators/technicians. Standardized patients require demonstrators/actors, which must be paid. The recording setups required for review and assessment/feedback after these simulations are both expensive and complex to operate, again requiring maintenance and frequent attention from audio-visual technicians. These kinds of experiences are also logistically challenging to coordinate. The students must all attend the session face to face, at the same time as the demonstrators/technicians/actors. Access to the equipment must also be booked, and students generally must share the experience in groups, as there is simply not enough resource available to let all students have their own turn.

Serious games offer a meaningful new way of providing a simulated based practical learning experience to students, which can avoid most of these issues.

  • Instead of students interacting with an actor and physical equipment, they can interact with a virtual patient in a virtual computer environment, using virtual copies of equipment.
  • Instead of needing to record the simulation session every action the student performs can be logged and sent to a server for the purpose of learning analytics.
  • Instead of reviewing a simulation session and assessing it manually, the various actions taken in the simulated scenario can be automatically assessed, and students can be given feedback immediately.
  • Instead of needing to book time with equipment and personnel, each student can simply download their own copy of the simulated scenario to their personal device, and run through it in their own time.

It is not all good news though; there are still drawbacks to providing a virtual simulated experience.

The initial cost of development is still quite high, ranging from the tens of thousands for smaller, constrained simple experiences, up to the millions of dollars for more complex and realistic simulations. The game development and artistic skills required to create these experiences are also in short supply in most academic institutions, typically necessitating some degree of external collaboration or outsourcing.

There are also some skills that a virtual environment simply cannot simulate. Despite promising developments in the area of haptics [5] , it is still not really possible for a student to physically examine the virtual patient with any meaningful sense of touch. To an extent this kind of examination can be simulated through descriptive, audio and visual feedback, but there are obviously limits. Describing what a broken bone feels like is not the same as actually feeling it for yourself.

Despite this, the pros seem to outweigh the cons. In recent years the costs of development have been massively reduced through an improvement in technology and the ready availability of cheap and powerful development tools. At the same time the potential scope and fidelity of these experiences has been vastly increased.

Historically, attempts at creating virtual patients, virtual worlds, and other computer-based simulated learning experiences have been quite underwhelming. However, times have changed. The development tools are better and cheaper, the skills are better and more readily accessible, and the market is larger and better prepared.

case study virtual patients

Figure 1 Pharmacy Simulator is one of the simulated learning experiences we've been developing at the University of Tasmania.

At the University of Tasmania we’ve been developing a range of serious games/simulated learning experiences, built upon a common framework we call our “Simulation Platform”. By building each simulation on top of this general purpose framework, we are able to substantially decrease the total costs of the development of each simulator, while at the same time improving the quality and scope of the experience.

We believe that these serious games offer a meaningful and engaging simulated learning experience for students which can replace some traditional simulated experiences more cheaply and effectively, and can augment or complement others. Importantly, by creating these experiences students will be more readily able to access simulation based training, which has previously only been available within the rigid confines of a classroom setting.

Perhaps now is the time to consider investing in the use of serious games and virtual patients as part of your curriculum?

References:

[1] http://www.smartinsights.com/mobile-marketing/mobile-marketing-analytics/mobile-marketing-statistics/
[2] http://www.statista.com/statistics/293304/number-video-gamers/
[3] http://www.uu.nl/en/news/game-companies-and-researchers-see-potential-of-serious-games
[4] http://www.forbes.com/sites/danieltack/2013/09/12/serious-games-and-the-future-of-education/
[5] http://link.springer.com/chapter/10.1007%2F978-3-319-12057-7_5

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