SIMULATION LABMaking Us Better One Student at a Time

Alexandra C. Snyder, B.S.Division of Cardiovascular PerfusionMedical University of South Carolina

November 9, 2011

Disclosures

I have nothing to disclose

I have no relationship with commercial supporters

Objectives

To examine the use of simulation in other industries

To examine the current role of simulation in perfusion

To discuss the advantages of training students using simulation

To consider what the future possibilities of perfusion simulation may be

To present students’ perspectives of simulation in their perfusion education

Simulation in Other Professions

Routinely used in aviation, the nuclear industry, NASA & in many medical specialties

Initial qualifications and beginning training Ongoing training and assessment/certification process Remedial training Add-on training for new techniques and skills

Simulation in Perfusion

No high-stakes assessment of competency using simulation is required by the ABCP for certification, re-certification, or professional development

Used primarily by perfusion schools and for research Investigation of human factors

Few high-fidelity Orpheus perfusion simulators available worldwide*

*ULCO Technologies, Sydney, NSW, Australia

Traditional Perfusion Training

Basic science background

Academic instruction with some lab sessions and hands-on experience

Clinical training as an apprenticeship process under supervision of an instructor

“see one, do one, teach one”

Perfusion Simulator-A New Paradigm in Student Learning

Learn by Doing

Orpheus Perfusion Simulator

(Sim- Central Pty Ltd, Earlwood, New South Wales, Australia)

Orpheus Perfusion Simulator

“The easy to use, intuitive software allows the Perfusionist Trainer to control the simulator and execute the training session manually, or use a set of predefined scripts”

http://www.ulcotechnologies.com/products/orpheus/orpheus.pdf

“The fidelity of the physiologic monitoring is so realistic that our students will not be simulating bypass, they will be doing bypass on a simulated patient”

-Bruce Searles

Simulation-Based Curriculum

Initial skill development

Skill Refinement

Performance Assessment

Emergency Procedures

SUNY Upstate’s Simulation Lab

Routine Bypass Patient Emergencies Equipment Malfunctions

Initiation of bypass Blood loss Aortic cannula obstruction

Weaning from bypass LV dysfunction Oxygen supply failure

Cooling/Rewarming Cardiac Arrhythmias Pump power supply failure

Use of centrifugal pumps

Failure of anticoagulation

Heat exchanger failure

Variations in patient resistance

Air embolism Monitor failure

Variations in patient coagulability

Anaphylaxis Aortic cannula displacement

Use of vasodilators/constrictors

Protamine reaction Oxygenator failure

Use of vasoconstrictors Transfusion reaction Venous air entrainment

O2 consumption changes Blood gas abnormalities Circuit leaks

Benefits of Simulation Training

Improved performance of individuals

Long-term maintenance of proficiency

Provides a real-time, safe setting without harming patients

Instructors can devise training scenarios that will test certain skills (“trigger events”)

Coaching and Debriefing

Improved patient safety

Sim Lab vs. Operating Room

Sim Lab Operating Room

*Student-focused *Patient-focused -No room for mistakes

*Reinforces lectures *Determined by random case for the day

*Exposure to low volume, high- *Experience determined risk events frequently by cases

*Can demonstrate corrective *No re-dos action

*Unlimited experience *Limited case load

*Clinical variety *Experience based on rotation and surgeon

Future Applications

Human factors training Interprofessional education CPB for MDs

Continuing medical education

Simulation-based competency test

Recertification (Re-CCP)

Rehearse new procedures & devices Product development

Patient Safety Research

Barriers to Simulation in Perfusion

Limited number of high fidelity perfusion simulation centers

Lack of validated & standardized evaluation instruments

Lack of trained simulation facilitators

Lack of agreed standards for simulation-based education

Lack of simulators used for training in pediatric perfusion

The Student Perspective

Fernandez A. Simulation in perfusion: where do we go from here?. Perfusion. 2010;25(1):17-20.

The Student Perspective

Thought simulation was beneficial prior to doing clinical work

Thought that the simulator was a good alternative to doing a clinical case

Thought that simulation should be used from the first day of class through graduation

Want more simulation!

Conclusions Simulation is commonly used to train professionals in

equally risky industries to improve critical skills and patient safety

Implementation of simulation into perfusion training is currently in its infancy, but is proving worthwhile

This modality has been used in the academic setting to develop basic perfusion skills, gain experience, and practice emergency procedures

There is a role for simulation in the future of perfusion beyond academics

Student opinion supports full integration of simulation training into their perfusion education

Acknowledgements Ashley Hodge, MBA, BS, FPP, CPP Joseph J. Sistino, CCP, MS, MPA Adam Fernandez, MPS, CCP Nicole Michaud, MSP, CCP Medical University of South Carolina

Division of Cardiovascular Perfusion The American Society of Extracorporeal Technology

References Fernandez A. Simulation in perfusion: where do we go from here?. Perfusion.

2010;25(1):17-20.

Issenberg SB, McGaghie WC, Hart IR, et al. Simulation technology for health care professional skills training and assessment. JAMA. 1999;282(9):861-866.

Ray RN. Simulation: its application in the nuclear power industry. Proc Indian Acad Sci C1(4):345-59.

Gaba DM. The future vision of simulation in health care. Qual Saf Health Care. 2004;13(Suppl 1):i2-i10.

Sorensen B, Crane P. Cardiopulmonary bypass simulation training adapted from air force flight simulation.

Sistino JJ, Michaud NM, Sievert AN, Shackelford AG. Incorporating high fidelity simulation into perfusion education. Perfusion. 2011;26(5):390-394.

SUNY Upstate Medical University. "Upstate Leads Internationally in Perfusion Simulation Training." SUNY Upstate Medical University. Web. 01 Nov. 2011. <http://www.upstate.edu/chpalumni/>.

References Darling E, Searles B. Oxygenator change-out times: the value of a written

protocol and simulation exercises. Perfusion. 2010;25(3):141-143.

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Thank you for your time