DESIGN YOUR OWN

SIMULATION Presenters: Reem Alyoubi, Jo Jo Leung, Ali Mehdizadeh

Instructor: Dr Helen Batty

Which one is more cute?

1 2 3

Introductions

Definition

Simulation is the imitation of the operation of

a real-world process or system over time.

Applications to Medical Education:

Teaching basic science and clinical

knowledge

Procedural skills

Practicing

Teamwork and communication

Assessment

Video

http://www2.abc2news.com/web/wmar/news/h

ealth/video-young-doctors-tested-by-baltimore-

actors-makeup-artists-at-shock-trauma

Type of simulations

Low-fidelity

Basic written case studies, role playing,

Medium-fidelity

Manikins or trained actors ( more realistic but not automatic)

High-fidelity

Computer-based manikins, cadavers or animal tissue

Advanced clinical techniques ( surgery, anaesthetics, etc.)

Types of simulation in medical

education

Most of them can be categorized as:

Standardized patients: trained actors

Partial-task trainers: high risk low prevalence procedures (CV-line, intubation)

Manikins: mimic medical condition managed by computers

Screen-based computer simulators: computer program scenarios on screen

Virtual-reality simulators: surgical field (3D images)

Wake up!

Simulation Time

Design your own simulation!

Peer Review!

Time management

Time management

Introduction

Steps for time management

Strategies

Video

https://www.youtube.com/watch?v=TyTKFGSuO

nQ

Quote of the day

“To get what you want, stop doing what is not working”

Introduction

Time is valuable

Once you lose it , can not be retrieved (Adair,

1987)

Once you master the skills , it can be one of

the most satisfying forms of self fulfilment

3 steps in time management

Identify the learner needs

Teach rapidly

Provide feedback

Strategies to identify learner’s

need

Ask question

Teach rapidly

5 models :

1. ‘One-minute preceptor’

2. Aunt Minnie

3. SNAPPS( summarize , narrow down DD,

analyze , probe, plan, select)

4. Case presentation at the bedside

One-minute preceptor

One- minute preceptor

1. Get a commitment

2. Probe for supporting evidence

3. Teach a general principle

4. Reinforce what was done well

5. Correct errors and/or make a

recommendation

Provide feedback

Commenting on strengths and making

recommendation for improving

Debriefing

Debriefing

Background

Preparation

Elements of Debriefing

Phases of Debriefing

Techniques

Assessment

Background

3 Branches

Military

Critical Incident Stress

Experimental Psychology

Preparation

Prebrief -the facilitator illustrates the purpose

of the simulation, the learning objectives, the

process of debriefing, and what it entails

Facilitator sets the atmosphere

Participants bring their knowledge, skills and

experiences

7 Elements of Debriefing

1. Debriefer

2. Participants to debrief

3. An experience (simulation scenario)

4. The impact of the experience (simulation

scenario)

5. Recollection

6. Report

7. Time

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-

based learning. Simulation in Healthcare : Journal of the Society for

Simulation in Healthcare, 2(2), 115-125.

3 Phases of Debriefing

Description

Analogy/analysis

Application

Outline of Debrief

What went well?

How did the team function?

What else happened?

Closed loop communication, shared mental

model

Process analysis

How would you do it differently?

How would you apply this to real life?

Madhok, M. Debriefing in medical simulation.January 22, 2015, from

www.laerdal.com/usa/sun/ppt/regions/debriefing.pptx

Techniques

Techniques – Plus-Delta model

+ Δ Things that

went well

Things you’d

like to change

Techniques

Funneling - where the facilitator guides or

funnels the participants, but refrains from

commenting

Framing - introducing the experience in a

manner that enhances its relevance and

meaning

Frontloading - using punctuated questions

before or during an experience to redirect

reflection

Solution-focused facilitation – how do we apply

this to improve

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in

simulation-based learning. Simulation in Healthcare : Journal of the

Society for Simulation in Healthcare, 2(2), 115-125.

How did the debriefing go?

1. Were the learning objectives met or enhanced through the debriefing?

2. How was the debriefing conducted considering situational constraints (eg, time, finances, and group structure)?

3. Was the correct strategy used to accomplish the learning objectives given the situational constraints?

4. How uniformly, if at all, was the stated debriefing strategy actually implemented in practice?

5. What, if any, quality management of the debriefing process took place?

Debriefing Assessment for Simulation

in Healthcare (DASH)

1. Sets the stage for an engaging learning

environment

2. Maintains an engaging context for learning

3. Structures debriefing in an organized way

4. Provokes interesting and engaging

discussions and fosters reflective practice

5. Identifies performance gaps

6. Helps close performance gaps

Center for Medical Simulation, Harvard University

Example of Debriefing

How did the debriefers do?

Your turn!

How did the simulation participants

do?

Evaluation tools

Why do we Evaluate??

Program/ Project Improvement

Maximize the impact of limited resources

Project Accountability

Understand and Work Effectively within Context

Improve group dynamics and processes

Build support for programs/projects

Deal with uncertainty and change

Evaluation

Not only to critically analyze but to provide a positive contribution

that helps make programs work better /

allocates resources to better programs.

Questions!

Think back to experience you have had being

evaluated?

Have you ever had a negative evaluation

experience?

If yes, what made it so?

Negatives points

Not knowing or understanding context of a

program

Poor evaluation tools

Inaccurate questions and emphasis

Top-down – having an evaluation done to

you, not with you

Positive Evaluation Experiences:

Knew context in which evaluation was taking place (culturally, regionally)

Familiarity with the discipline

Asked for input from all stakeholders

Inclusive versus exclusive

Asked good questions that get to the heart of the program or project

Supportive environment – success as goal, not punitive punishment

Main types of evaluation

Evaluators and evaluation

methodologies have tended to focus on

three broad purposes:

1.Formative Evaluation

2. Summative Evaluation

3. Accountability Evaluation

Formative Evaluation

Is used to help improve a program or policy.

Formative evaluation produces information

that is fed back during the course of a

program

Main purpose to provide information to

improve the program under study.

E.g. a pilot program is developed at the Calgary

Zoo, implemented to school groups or the

public, and staff collect feedback as to how it is

working from participants and observers.

Summative Evaluation

Used to judge the merit of a program or

policy to determine whether it should be

sustained, discontinued or scaled up.

Done after the program (or a phase of it) is

finished, to determine extent to which

anticipated outcomes were produced.

Intended to provide information about the

worth of the program - its effectiveness.

So – should that Zoo program be continued

next year? Why/ Why not?

Clarification!

Scriven simplified this distinction, as follows:

“When the cook tastes the soup, that’s formative evaluation;

when the guest tastes it, that’s summative evaluation.”

Now – just to get a sense of the experiences

we have in the room:

Have you done a program evaluation?

Yes or No

Is it any one of - or all of ?

Formative

Summative

Accountability

Accountability Evaluation

used to assess the extent to which an

organization or group is ‘implementing a

detailed model with fidelity’ to an already

approved – often rigid – blueprint.

e.g. often what we have to provide to our

funders…. Following our proposal

methodologies to meet their goals

(e.g. “the program will reduce carbon emissions

of Grade 12 high school students by X%...”)

could you evaluate your own simulation

scenario ?

Summary

Summary

Definition

Application in medical education

Debriefing

You designed your own simulation

Time management

Evaluation tools

Strength

Quick & Accurate

Modifiable based on the application

Technology-based

Compatible with adult learning principals

Provide safe environment for practice and

error

Weakness

Lack of evidence based support

Indication

design

Task dependent

Lack of exposure to real challenges

Future Directions

Impact of simulation on patient care, safety,

and satisfaction

More advanced programs and equipment

References

Nelson, B. L., Carson, J. S., & Banks, J. (2001). Discrete event system simulation. Prentice hall.

Okuda, Y., Bryson, E. O., DeMaria, S., Jacobson, L., Quinones, J., Shen, B., & Levine, A. I. (2009). The utility of simulation in medical education: what is the evidence?. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 76(4), 330-343.

Chakravarthy, B., ter Haar, E., Bhat, S. S., McCoy, C. E., Denmark, T. K., & Lotfipour, S. (2011). Simulation in medical school education: review for emergency medicine. Western Journal of Emergency Medicine, 12(4), 461.

Debriefing assessment for simulation in healthcare© (DASH©) Retrieved January 22, 2015, from https://harvardmedsim.org/debriefing-assesment-simulation-healthcare.php

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare : Journal of the Society for Simulation in Healthcare, 2(2), 115-125.

Gardner, R. (2013). Introduction to debriefing. Seminars in Perinatology, 37(3), 166-174.

Jaffrelot, M., Touffet, L., Ozier, Y., & Gueret, G. (2012). What's going on during the debriefing of a simulation session? Minerva Anestesiologica, 78(8), 863-864.

Levett-Jones, T., & Lapkin, S. (2014). A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Education Today, 34(6), e58-63.

Madhok, M. Debriefing in medical simulation.January 22, 2015, from www.laerdal.com/usa/sun/ppt/regions/debriefing.pptx

References

Perkoff, G. T. (1986). Teaching clinical medicine in the ambulatory setting. An idea

whose time may have finally come. The New England journal of medicine, 314(1),

27-31.

Irby, D. M., & Bowen, J. L. (2004). Time‐efficient strategies for learning and

performance. The Clinical Teacher, 1(1), 23-28.

Irby, D. M., & Wilkerson, L. (2008). Teaching when time is limited. BMJ, 336(7640),

384-387.

Akaike, M., Fukutomi, M., Nagamune, M., Fujimoto, A., Tsuji, A., Ishida, K., & Iwata,

T. (2012). Simulation-based medical education in clinical skills laboratory. The

Journal of Medical Investigation, 59(1, 2), 28-35.