Sticking with the Immersive Scenario Design

A core theme in simulation-based education and training is standardization. That is, when a scenario designed and planned, all trainee groups go through the same designed experience. Why? Consistency, fairness and a clear standard of expected competency.

If a scenario is designed with specific learning objectives, all teams must meet those objectives and participate in the debriefing process. The competency and standards are the same for everyone. If the scenario is designed according to Advanced Cardiac Life Support (ACLS) guidelines, the protocols apply to everyone, equally.

Working with thousands of simulation trainee groups, I remember a specific experience when an instructor was kind of showing off. This particular day, we had several observers in the control area. We had run through and completed a simulation experience and the scenario was announced “Complete. Proceed to the debriefing area”. The instructor turned to everyone and said “watch this” (which in my humble opinion the equivalent of “hold my beer”). The instructor crashed the simulator and the EMS trainee team looked at each other, said “seriously?” and went into another ACLS scenario that was not part of the plan. Afterwards, I asked the instructor what was with the departure of the planned design, the response was “well, anything can happen in EMS”. True, however, this presented a teachable moment with the instructor for several reasons.

I completely understand and appreciate the instructor’s viewpoint that anything can happen in EMS and we had a great professional exchange. We discussed items that might not have been considered such as the added time that the impromptu ACLS scenario added, the extra debriefing for the group and discussed what the added value was of the experience. There were other items that weren’t accounted for. The added time had delayed the operations and administration team in their workflow, other centre users that were delayed, the extra resources that were used, and that we did not have the adequate time to discuss the experience with the observers who also needed debriefing. Also, the other EMS trainee groups asked why they did not get the extra simulation experience and expressed their frustration. The group was right, they did not receive the same standard as others. The deviation of the design plan had a massive rippling effect.

Remember, simulation-based education is about standardization, consistency and sticking with the design. It’s important to be mindful that deviating from the plan can have unforeseen impacts. With clear learning objectives, trainees will shape the experience through their actions and response. It’s about the learning experience.

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Cheers,

Matthew

About the Author: Matthew Jubelius is a subject matter expert in healthcare simulation. He is a consultant, educator and wants to change the future of people development, education, and training. Matthew has championed the design, implementation, and evaluation of simulation-based education and training programs, including quality improvement measures for post-secondary institutions, private industry, and the federal government.

Matthew can be reached through www.amoveotraining.ca for simulation consulting, program development, employee training and speaking engagements.

#simulation #education #patientsafety #leadership

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Simulation-based Education Matters

It’s been nearly a decade and I can still recall the day that simulation-based education and training made sense to me and witnessed the profound benefits for healthcare practitioners, workers, and patient safety.

I had never observed a simulated training event and was curious what was going to happen. The concept of using patient simulators was intriguing and I was optimistic about how the learner was going to perform.  The cohort had completed their traditional lecture and lab-based education and was “ready” to deliver care.

The simulation experience was based on Advanced Cardiac Life Support (ACLS) guidelines and the learning objectives were:

  1. Recognize a life-threatening ECG rhythm
  2. Activate emergency system and call for assistance
  3. Administer appropriate ACLS medications and perform CPR

Before the experience, I observed the learner’s behavior and they appeared very confident. “Let’s see what happens,” I thought to myself. The lights went out and the simulation began.

The patient simulator was breathing, showing signs of distress and the software performed spectacularly according to the preset programming (shout out to engineers). The learner entered the event area and began to assess the simulated casualty. The ECG was set up and displayed a life-threatening rhythm that needed defibrillation and immediate drug therapy. Something wasn’t right; the learner interpreted the incorrect ECG rhythm and started giving the wrong medication.  The simulator responded in real-time, vital signs became more complicated and the patient simulator condition worsened.  Within a very short time, the situation became unmanageable for one person, yet there was no call for support. There was no call for help. The scenario continued and ultimately the experience had concluded. In this case, things did not end well.

In the debriefing phase, the facilitator went into more detail about what happened; based on the learner’s performance and connected the pieces to a meaningful learning experience. The scenario was repeated and the learner’s performance was dramatically improved, resulting in better outcomes for the simulated patient. Truly remarkable learning.

Why does this matter? The immersive experience in a controlled environment provided an additional layer of safety, where potential errors could be addressed and corrected well out of harm’s way.

Simulation-based experiences have the ability to positively impact patient safety, help people and teams deliver appropriate interventions.  Simulation – the replication of an experience, can also expose system weaknesses and provide opportunities for healthcare quality improvement.

By designing and facilitating experiences based on models of current and best practices, we have the opportunity to address current challenges and impact the future of healthcare delivery.

Even after thousands of simulation experiences, I remain passionately curious about how people interact with complex systems. Failure can be an enormous learning experience, especially in a setting where there is absolutely no risk to patients.

I believe that we can make a difference in creating safer and effective systems.

Matthew

About the Author: Matthew Jubelius is a subject matter expert in healthcare simulation. He is a consultant, educator and wants to change the future of people development, education, and training. He has championed the design, implementation, and evaluation of simulation-based education and training programs, including quality improvement measures for post-secondary institutions, private industry, and the federal government.

Matthew can be reached through www.amoveotraining.com for simulation consulting, program development, employee training and speaking engagements.

Building on Strengths

People are awesome! Think about it. I really believe that individuals and teams are capable of accomplishing great things. Flight, capturing and storing electricity, the creation of the internet, advances in modern medicine… Yes, people can do great things.

We often hear about these successes from a distance through media and can list numerous famous individuals because we see their name in the highlights. Have you ever wondered what made them successful and strong? Although I will never know the true answer, this causes me to reflect on several questions a little closer to home: What are my strengths? What makes me successful? What am I most proud of?

There are many things that contribute to our strengths and we all have varying degrees. Some people are physically gifted with an abundance of muscle mass or athletic talent, some have outstanding intellect, while others carry enough empathy to completely understand and calm one’s soul. Whatever our strengths are, how much time do we devote to building on them?

There are different theories of how long it takes to become excellent or master a subject; for example, Malcolm Gladwell and the 10,000 hours concept. However, what about the personality traits that make us amazing, is there a time requirement? Does the learning stop after 10,000 hours?

I believe that we continually evolve as we grow from our experiences. One of my strengths is that I love to educate and inspire others. Another is that I’m very passionate about creating safer communities and know that we can do more to train effective healthcare and safety personnel. I truly believe that we can make a difference. For me, there is no time requirement. This is me, every single day and I know that I’m not alone. My passion doesn’t have an off switch.

We all have the capacity for greatness. We’re also given 24 hours in a day and we know that it takes time to work on our strengths. This week, think about what you’re amazing at. What are your strengths and passions? How will you build on them?

Have a great week,

Matthew

About the Author: Matthew Jubelius is a subject matter expert in healthcare simulation. He is a consultant, educator and wants to change the future of people development, education, and training. He has championed the design, implementation, and evaluation of simulation-based education and training programs, including quality improvement measures for post-secondary institutions, private industry, and the federal government.

Matthew can be reached through www.amoveotraining.ca for simulation consulting, program development, employee training and speaking engagements.

Simulation and Safety

Absolutely. It’s very clear that simulation and safety go together and in previous articles, we’ve discussed how quality improvement fits in as well. But how do simulation and safety go together? More research is being conducted in Medical and healthcare simulation and this is a good thing. Here’s some literature about simulation and why it’s needed in healthcare training and education.

The hallmark To Err is Human was released in 1999 and healthcare has made progress. In 2015, the National Patient Safety Foundation released a report entitled Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human and outlined eight key recommendations:

  1. Ensure that leaders establish and sustain a safety culture
  2. Create centralized and coordinated oversight of patient safety
  3. Create a common set of safety metrics that reflect meaningful outcomes
  4. Increase funding for research in patient safety and implementation science
  5. Address safety across the entire care continuum
  6. Support the healthcare workforce
  7. Partner with patients and families for the safest care
  8. Ensure that technology is safe and optimized to improve patient safety

So, how are we doing? There’s room for improvement. Another alarming statistic that medical error is the third leading cause of death in the United States. Let that sink in for a moment. Third. In the United States. Further, Makary and Daniel (2016) suggest that there may be over 251,000 deaths annually as a medical error is not recorded on US death certificates.

There are many factors that can lead to a medical error including working conditions, patient load, distractions at work, resource shortages, personal stress, employee disengagement, unanticipated conditions such as natural or man-made disaster and the list goes on. Healthcare is a very complex system that has many moving parts at any given moment.

However, what if we had the opportunity to make a difference? What does that look like? Some might say “Yeah, but what can you do about it? The system is just too big to make a change”. Rather than give in, what if you reframed the conversation?

What if today, you observed a potential error and said something to someone about it (in a nice way, of course)? Maybe you noticed some unsupervised medications on a hospital unit. Perhaps, you noticed how an IV paralytic medication and a blood pressure medication have similar packaging. Maybe your simulation program relies on the good graces of expired medications that were donated and the school uses them for demonstration purposes.

What would it look like if you brought the potential of error forward to your supervisor or a senior management team? It takes courage to speak up, it really does. I implore you to say something if you see something that needs changing. The safety of people depends on your courage. We talk about patient safety a lot; but consider your personal safety, the safety of your colleagues, the safety of students. Critics may say “Sounds like too much work” or “That’s above my pay grade” and other complaints. Don’t be afraid to step up and speak up.

Safety is about doing what is right. At the end of the day, the most important thing is to go back home to our loved ones, our friends, our pets, our lives.

Be safe. Be awesome.

Matthew

I want to help raise awareness for simulation-based education, patient safety, and quality improvement and I need your help. Please share the link with people that you feel would enjoy what we’re about. If you really enjoy the content, subscribe for free at the bottom of the page to get the good news delivered straight to your inbox.

About the Author: Matthew Jubelius is a subject matter expert in healthcare simulation. He is a consultant, educator and wants to change the future of people development, education, and training. He has championed the design, implementation, and evaluation of simulation-based education and training programs, including quality improvement measures for post-secondary institutions, private industry, and the federal government.

Matthew can be reached through www.amoveotraining.ca for simulation consulting, program development, employee training and speaking engagements.

Referenced Material:

Institute of Medicine (1999). To Err is Human: Building a Safer Health System. Courtesy of the National Academy of Sciences (2000). Accessed through www.nap.edu/catalog/…/to-err-is-human-building-a-safer-health-system

James, J. (2013). A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety, Vol 9(3). P122-128 Accessed through http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx

Makary, M.A., Daniel, M. (2016). Medical Error – The Third Leading Cause of Death in the US. BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2139

National Patient Safety Foundation (2016). Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human. Accessed through http://www.npsf.org/?page=freefromharm

 

Developing People

Have you ever started a new job? Of course! We all have. Depending on your surroundings, it can be pretty intimidating. While learning your new role in addition to (but not limited to) break schedules, Human Resources info, Occupational Health and Safety policies, organizational processes, getting to know your supervisor, names of the administrative staff, colleagues and so on… how do you develop in the role?
There are many approaches to people development and perhaps the one that we are most familiar with is the “sink or swim” mentality. Personally, I believe that this approach is antiquated and does not set people up for success. Work cultures are changing and we can take an approach from simulation training and apply it to employee development.
Simulation can be defined as the replication of a system. An immersive scenario or event is designed and modeled according to objectives and expectations and an accurate simulation reflects the fidelity or reality of the system. With this in mind, how do we use simulation to develop new hires? Modeling. No, not the runway and catwalk in New York or Milan type; model the behaviors and reality of the job. Here’s why modeling is important – it sets the nature or tone of the working relationship and the first 90 days are critical to employee development.
The most important development tool during the modeling phase is the mentor, buddy, senior staff or whatever the common term is in your workplace. This mentor should be someone who is great at their job and who demonstrates or models the key characteristics that you want to see in the new employee. Consider the example of someone who is happy at work, who lends a helping hand to colleagues and does a good job. Alternatively, think about the mentor who was “told” that they are mentoring a new staff member 15 minutes before a shift begins. There can be two very different experiences and outcomes for the new employee and mentor. Either way, the result reflects the working culture and expectations of the new hire.
Bringing new employees on board can be an exhilarating experience and is a critical piece in employee development. The use of modeling key behaviors and expectations through mentors that we see in a simulation can help alleviate stress for new employees, help build positive relationships, impact work culture and most importantly, set the person up for success.
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Create an outstanding week,
Matthew
About the Author: Matthew Jubelius is a subject matter expert in healthcare simulation. He is a consultant, educator and wants to change the future of people development, education, and training. He has championed the design, implementation, and evaluation of simulation-based education and training programs, including quality improvement measures for post-secondary institutions, private industry, and the federal government. Matthew can be reached through www.amoveotraining.ca for simulation consulting, program and people development opportunities.