Debriefing

The 2016 Australasian Simulation Congress held in Melbourne on the 26th-29th of September was one event not to be missed.

I attended the Pre-Congress SimHealth Masterclass, "Promoting Excellence via Augmented Reflective learning in Simulation (PEARLS) - A Blended Approach to Debriefing." This session was facilitated by Dr Adam Cheng, the director of research and Development of the KidSIM Simulation program at Alberta Children’s hospital and Associate Professor, Department of Paediatrics at eh University of Calgary.

The masterclass delivered a novel framework for debriefing blending three existing methods of debriefing into one cohesive approach. Adam and the incredible faculty created a dynamic environment for participants to practice the PEARLS approach to debriefing. The use of trigger videos to practice debriefing and the opportunity for experts to meta-debrief participant’s techniques was invaluable.

Learning to debrief is seen by many as the most difficult part of the simulation. Reflect on your debriefing practices, consider different debriefing styles and please be brave.

To find out more please visit Debrief to Learn: The resource Simulation educators have been waiting for - www.debrief2learn.org

My pearl from this masterclass is to orchestrate the post simulation debrief to be learner centred not educator centred!

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Academic, Simulation Educator, Nurse

La Trobe Rural Health School

Reviewed by Emma Horsfield - Albury Wodonga Heath simulation education coordinator 

In early July I attended the SimGHOSTS (Gathering of Healthcare Simulation Technology Specialists)2016 conference in Melbourne. This was the second year that I have attended the event and as expected, and again I was impressed with the learning and networking opportunities the conference offered.

The conference last year was recommended by a friend who had attended a SimGHOSTS conference in America and although I was a little apprehensive as I do not see myself as a technology savvy person I attended the symposium in Brisbane. I left Brisbane with an increased confidence in my techy ability, knowledge of resources which can assist me in my role as a Simulation Education Coordinator and an increased passion for all things related to simulation.

Although the name SimGHOSTS refers to simulation technology specialists, the conference offered a wide range of plenary presentations and workshops that were relevant to my educator role. I particularly enjoyed workshops which were focussed on leadership and project management, the power of collaboration, setting up a simulation centre in Karachi, Pakistan and creating virtual patients for education with the use of Open Labyrinth software.

I also co-facilitated a workshop with Dr. Kirrian Steer which demonstrated  how features within Microsoft Excel such as user forms, pivot tables, pivot charts and data dashboards can be used to benefit a simulation program. Writing the code which is required to enable these functions was also explained and demonstrated.  The Excel features can be utilised to produce robust data and analytics which reflect the current activity of a simulation centre and valuable evidence which can inform decisions related to the current and future direction and needs of a simulation program.

The workshop was well received and provided a lot of learning to not only the session participants but also myself as I prepared for the presentation. Enormous credit and thanks to Kirrian on doing a huge amount of work to develop the majority of the workshop content.

The final personal highlight of the conference was winning the conference “Bug-Busters” competition. This is a trouble shooting competition that requires participants to use their expertise across a range of simulation technology, IT, AV, moulage, clinical and education challenges. The competition consisted of four rounds (the first round being a small group round, the remaining round individual challenges) where participants had ten minutes to diagnose and resolve a number of issues in a simulation room. The final round between myself and another simulationist was live-streamed into the main auditorium (no pressure!!!).  “Bug-Busters” provided me with not only a wonderful prize (free registration to a 2017 SimGHOSTS event) but more importantly a chance to develop relationships with other simulation enthusiasts and share valuable knowledge and skills.

I highly recommend not only the SimGHOSTS conference but also subscription to the SimGHOSTS website which offers online resources, training, forums, databases and a HUGE online video library including presentations from previous SimGHOSTS events.

Visit the SimGHOSTS web page for more information about upcoming events.

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

SimHealth and SimTecT are a combined event run by Simulation Australasia and this year it was held from August 17-21 at the Adelaide Convention Centre.

The program boasted an impressive line-up of guest speakers and I was really looking forward to a couple of sessions in particular. The highlights for me were the keynote presentations from Mica Endsley, Ken Catchpole and Phaedra Boinodiris.

Interprofessional Education Masterclass

I was also fortunate to be able to attend a pre-conference master class on IPE debriefing with Janice Palaganas, although there were so many great master classes on offer it was really difficult to choose between them.The focus of the master class was to empower de-briefers when debriefing members of a profession other than one’s own. It concluded with a panel discussion and panel members addressing questions from the audience.The most common fear or perceived barrier among participants was not knowing enough about the other professions or the content of the simulation. The advice of the panel was to be transparent about your level of expertise and to invite contribution from each profession or content expert rather than pretending to have all of the answers yourself.Other issues that were raised are relevant to all debriefs – dominant participants and engagement difficulties. The responsibility of the facilitator to maintain an environment of respect was an important solution to both of these.

Janice Palaganas continued on the topic of IPE in her plenary address, and shared one of the unexpected findings in her research. In the process of learning how to participate in an IPE debrief, participants were also learning how to communicate in an IPE team.

Sitational Awareness

Mica Endsley was the keynote presenter for the opening plenary address and spoke about situational awareness. Dr Endsley has significant experience in this area across many different sectors, having published over 200 papers on the topic.Situational awareness is defined by Endsley as the perception of elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future. In other words, situational awareness is key to good decision-making and good performance.

The situational awareness model developed by Endsley describes three stages: perception, comprehension and projection.   The presentation also covered the topics of team situational awareness (the degree to which every team member possesses the situational awareness required for his or her responsibilities) and shared situational awareness (the degree to which team members possess the same situational awareness on shared situational awareness requirements).

Human Factors

Ken Catchpole delivered a fantastic presentation about human factors and how human factors research is being applied in different industries. He spoke about the myth of low-hanging fruit – if the problems in healthcare safety were really obvious they would have been addressed already. The reality is that the causes are complex and we cannot simply translate solutions from other industries directly into healthcare.A better solution is to understand why solutions have worked for other industries and to apply this information to healthcare.

Dr Catchpole also revealed his top 10 FALSE beliefs about accident causation in healthcare:

1. Process and outcome are directly related
2. Our systems are safe
3. People are the weak link in the system
4. Accident causation is a linear sequence of events
5. Incidents have a root cause
6. Root cause leads to a single solution
7. Not following rules is negligent
8. Problems can be fixed
9. Somebody should be held accountable
10. Safety is the priority that governs all decisions

For more information about this presentation, a slideshow is available here http://www.fitwise.co.uk/files/8114/1831/3435/Ken_Catchpole.pdf

Serious Games

My favourite presentation of all was from Phaedra Boinodiris on the potential of serious games and gamification. Phaedra is the global lead for gamification and serious games at IBM and spoke about how gaming presents a solution to the issue of engagement and is capable of influencing behaviour change in users. With reference to Daniel Pink’s book “Drive”, Boinodiris made the point that to maintain engagement in knowledge-workers, an understanding of motivational factors is vital, and for this population the primary motivating factor is self-direction. The three keys to this sense of self direction are autonomy, mastery and purpose. This presentation contained many examples of how serious games and gamification are being used to assess individual and team behaviour, solve complex problems, and improve systems.

All the keynote presentations featured a panel discussion in the second half of the session, which was a great way of presenting a broad application of the content. It was also a great way of exposing attendees to many experts while managing time constraints.

I found all of the sessions I attended had engaging speakers whose passion for simulation was clearly evident. These speakers were equally approachable and willing to share their wisdom and experience with attendees.

Kirrian Steer

Senior Simulation Coordinator

La Trobe University

Kirrian Steer, La Trobe Rural Health School, Albury-Wodonga

SimGHOSTS Executive Director James Cypert (Left) and Founder/Development Director Lance Baily (right) at the Clinical Skills Development Service, Brisbane.

This was my third SimGHOSTS training event and I must say that the content just keeps getting better. This year for the first time we had 3D printing, casting and molding workshops and demonstration of the Oculus Rift virtual reality headset. I still learn so much about simulation methodology and technology at each event and in the week since I have been back at the office I have been able to apply my new skills and knowledge straight away.

One of the highlights for me was Dr Kenneth Gilpin’s presentation on physiology modelling and the risk of negative learning in simulation which you can read about here. It is also great to see the momentum of SimGHOSTS continuing with a focus on professional development models for simulation technology specialists. Of course you can’t spend a week at CSDS without being blown away by their incredible facilities, progressive business model and amazing team of simulation professionals who were the perfect hosts throughout the event.

SimGHOSTs are now affiliated with ASPiH (Association for Simulated Practice in Healthcare), IPSS (International Pediatric Simulation Society) which will lead to some exciting developments and opportunities in 2016.

Kirrian Steer is the Officer of the Board (Australia) for SimGHOSTS and Simulation Coordinator at La Trobe University Albury-Wodonga. For more information about SimGHOSTS training events go to www.simghosts.org 

 Nick May, La Trobe Rural Health School Albury-Wodonga

I was asked to attend SIMGOST 2015 by my workplace as a training opportunity. As a science technician who had only started in simulation a few weeks ago, I thought it was a great opportunity to be thrown in headfirst and to learn as much as possible in the shortest amount of time.

The Queensland Clinical Skills Development Service (CSDS) were the host for the event, and have a wonderful facility. My background is from a regional university with a small teaching space and 10 mannequins. CSDS covers two floors of a building, has over 3000 simulation apparatus, performs all in-house maintenance, and much more. It is one of the world’s largest providers of healthcare simulation.

Day 1:    Comprehensive Moulage Workshop

Nola from Trauma Sim conducted this full day workshop and she was great. Moulage was not something I had encountered before except for what had been shared with me from a colleague and I searched for on the internet. We learnt many tips and tricks and spent hours using many different products to create many different wounds and injuries. My take home message from the moulage workshop was about high fidelity or reality. I realised that with the highest fidelity comes more engagement in training and better learning outcomes.

Day 2:    Keynote address  - “Communicating and Negotiating to Advance Your Simulation Program”

Dr. Carolyn Yucha,  Dean of the Schools of Nursing and Allied Health Sciences at the University of Nevada, Las Vegas

Interesting to hear about a large scale shared simulation facility and very engaging and thought provoking.

Plenary -Rules for Simulation Radicals –

Dylan Campher, Director of Simulation Clinical Skills Development Service

Interesting to hear about how CSDS was developed into the model it is today: once again, engaging and thought provoking.

Advanced Video Editing Techniques

This was well out of my comfort zone, I have had very little experience editing video before now. We used a video editing program that the presenter was very familiar with, and he moved through the program with ease and pace. I can see how learning to use video editing could be used to create great blended learning subjects and learnt an incredible amount about how much work goes into planning shooting and editing a video to make it of sufficient standard for teaching.

In-situ Simulation- Anytime Anywhere

This workshop was about being able to set up basic AV for simulation anywhere quickly, however what it taught me was that people can spend a great deal of time and money trying to develop such a system. I can see the future this workshop was aiming for, a 1 button portable system, but unfortunately they are not quite there yet. CSDS have developed a very simple and easy to use portable AV system, unfortunately it is quite big and not so portable. If it were miniaturised in the future it will a great product.

Common Troubleshooting Techniques for SimMan 3G – Basic

This is my strength, I am an experienced science lab technician and very much enjoyed this workshop. It was great to see the mannequins pulled apart and where all the componentry is hidden within the body. I would have had no issue dismantling a mannequin but this workshop allowed me to see internal components without having to troubleshoot the assembly myself. I learnt a few tips and tricks from other experienced technicians who have far more experience with SimMan 3G than myself.

Day 3:    Plenary -The Benefits of Advanced Physiology Modelling to Simulation

Dr. Kenneth Gilpin Senior Lecturer, School of Rural Medicine, University of New England

Far too clinical for me and I understood only parts of this plenary speech. I am sure those clinically trained technicians got more from it.

Plenary -How to Train Your Simulation Staff (or yourself) for Free 

Kirrian Steer, Simulation Coordinator, La Trobe University

This plenary was great but I do have to be honest and let you know that Kirrian is my boss. That aside I believe it was the most engaging plenary of the conference. I was already a fan of MOOCS (Massive Open Online Courses) having done them in the past and really enjoyed and benefited from them. I believe they are a fantastic way to increase skills and knowledge for simulation and they’re free. It was great to walk out of the auditorium afterwards and here everyone inspired about their new found learning tool.

Programming Laerdal Manikins: 3 Methods

I found this workshop fascinating, and discovered that it is relatively easy to program Laerdal mannequins. However due to my lack of knowledge in any clinical aspect of simulation I don’t believe the scope for me using this knowledge in the future is great. For clinically trained technicians this workshop would have been great.

How to Train Your Dragon! Part 1 and 2

This workshop was run by the technicians from CSDS and was a great extension to the full day moulage workshop on day 1. We ventured away from the quick in-situ moulage of the workshop and learnt to use two part silicone in plastic moulds. It was a technique discussed earlier in the week but was great to get hands on. This technique could be valuable for our teaching into the future because of the longer lasting and reusable nature of the silicone products made.

Day 4:    CSDS Trauma Workshop

This workshop was a chance for CSDS to show off both their staff and facility, and it was great. We were thrown in the deep end and tasked with developing a scenario for a competing team. Once both scenarios were finished being written we were asked to act each other’s out. This is where the different strengths and weaknesses of the teams were played out in front of one another, the teams were selected to have balanced clinical and technical people where possible. We had use of one of the CSDS simulation trauma emergency department rooms and given free rein with their moulage kits and a SimMan 3G. To be immersed into all aspect of a scenario was great and gave me great appreciation to what goes into developing a scenario from scratch.

In summary, if anyone has the opportunity to attend a SimGHOSTS conference in the future I would highly recommend attending. It was particularly helpful to me as a technician and tailored towards the technical side as opposed to clinical in my opinion.