1. Gateway to Education – 2008 Symposium Sept. 11, 2008, St. Louis, MO Medical Simulation: Learning in Immersive Environments Michael Armacost, MA, NREMT-P Banner Health Simulation & Innovation Frederick, CO David L. Rodgers, Ed.D., NREMT-P Healthcare Simulation Strategies Charleston, WV

2. Disclosure Dr. Rodgers is a employed as a private curriculum and instruction consultant. Laerdal Medical is one of his clients. Mr. Armacost has no disclosures

3. Objectives • Participants will be able to: • Discuss the development of modern full-bodied manikin-based simulators to • its current state-of-the-art. • Differentiate between the meanings of low-, mid-, and high-fidelity simulation. • Explain the various types of simulation realism and how each impacts on the • learner. • Apply modern learning theory to simulation-based teaching. • Discuss a process to integrate a simulator into EMS curriculum. • Define the process of designing cases for simulation. • Discuss the role of simulation in team training and competency assessments. • Discuss several strategies to be used when facilitating a simulation session.

4. Welcome What do you want to get out of today’s program?

5. Video-based simulations Three-dimensional static models Virtual reality Full-bodied manikin-based Audio simulations Task-specific simulators Standardized patients Written (paper) simulations Animal models Human cadavers Computer-based clinical simulations

6. Video-based simulations Three-dimensional static models Virtual reality Full-bodied manikin-based Audio simulations Task-specific simulators Standardized patients Written (paper) simulations Animal models Human cadavers Computer-based clinical simulations

7. Full-bodied Manikin-based Simulation

8. Gateway to Education – 2008 Symposium Sept. 11, 2008, St. Louis, MO From Beginnings to State-of-the-Art: A Brief History of Medical Simulation David L. Rodgers, Ed.D., NREMT-P Healthcare Simulation Strategies Charleston, WV

9. The history of Patient Simulation Other domains have used simulation with success First aviation simulator developed in 1928 by Edwin Link 1942 Link C-3 Simulator

10. The history of Patient Simulation Patient simulation is not new! Animal models for medical simulation have been used for over 2,000 years

11. The history of Patient Simulation First commercial manikin-based simulator was introduced in 1911 – Mrs. Chase

12. The history of Patient Simulation 1960 – First manikin specifically built for resuscitation was introduced – Resusci Annie Asmund Laerdal and Bjorn Lind demonstrate CPR on the original Resusci Anne

13. The history of Patient Simulation 1969 – SimOne developed as the first computer controlled patient simulator Abrahamson, S., Wolf, R. M., & Denson, J. S. (1969, October). A computer-based patient simulator for training anesthesiologists, Educational Technology, 55-59..

14. The history of Patient Simulation Computer-controlled patient simulators 1986 – Gainesville Anesthesia Simulator 1986 – MedSim Eagle 1969 - SimOne 1996 – METI HPS 2000 – Laerdal SimMan 1970 1980 1990 2000

15. Questions?

16. Gateway to Education – 2008 Symposium Sept. 11, 2008, St. Louis, MO Simulation Taxonomy: Understanding Fidelity and Realism in Patient Simulation David L. Rodgers, Ed.D., NREMT-P Healthcare Simulation Strategies Charleston, WV

17. Simulation Terminology The simulation literature has not provided a consistent definition for many of the terms vital to using simulation. Manikin vs. Mannequin Gaba, D. (2006). What’s in a name: A mannequin by any other name would work as well. Simulation in Healthcare, 1, 64-65.

18. What is patient simulation? “Simulations are created experiences that mimic processes or conditions that cannot or should not be experienced firsthand by a student because of the student’s inexperience or the risk to the patient (Morton, 1997, p. 66).” “Simulation is a technique…to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p. i2).” “Simulation is a generic term that refers to the artificial representation of a real-world process to achieve educational goals via experiential learning (Flanagan, Nestel, & Joseph, 2004, p. 57).”

19. What is patient simulation? “Simulations are created experiences that mimic processes or conditions that cannot or should not be experienced firsthand by a student because of the student’s inexperience or the risk to the patient (Morton, 1997, p. 66).” “Simulation is a technique…to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p. i2).” “Simulation is a generic term that refers to the artificial representation of a real-world process to achieve educational goals via experiential learning (Flanagan, Nestel, & Joseph, 2004, p. 57).”

20. What is patient simulation? “Simulations are created experiences that mimic processes or conditions that cannot or should not be experienced firsthand by a student because of the student’s inexperience or the risk to the patient (Morton, 1997, p. 66).” “Simulation is a technique…to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p. i2).” “Simulation is a generic term that refers to the artificial representation of a real-world process to achieve educational goals via experiential learning (Flanagan, Nestel, & Joseph, 2004, p. 57).”

21. What is patient simulation? “Simulations are createdexperiences that mimic processes or conditions that cannot or should not be experienced firsthand by a student because of the student’s inexperience or the risk to the patient (Morton, 1997, p. 66).” “Simulation is a technique…to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p. i2).” “Simulation is a generic term that refers to the artificial representation of a real-world process to achieve educational goals via experiential learning (Flanagan, Nestel, & Joseph, 2004, p. 57).”

22. What is patient simulation? “Simulations are createdexperiences that mimicprocesses or conditions that cannot or should not be experienced firsthand by a student because of the student’s inexperience or the risk to the patient (Morton, 1997, p. 66).” “Simulation is a technique…to replace or amplify realexperiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p. i2).” “Simulation is a generic term that refers to the artificial representation of a real-world process to achieve educational goals via experiential learning (Flanagan, Nestel, & Joseph, 2004, p. 57).”

23. What is patient simulation? Createdguided experiencesthat mimicreal-world processes or conditions to achieve educational goals

24. Fidelity “Fidelity is the extent to which the appearance and behaviour of the simulator/simulation match the appearance and behaviour of the simulated system (p. 23).” Maran, N. J., & Glavin, R. J. (2003). Low- to high-fidelity simulation - A continuum of medical education? Medical Education, 37 22-28.

25. Fidelity Low-fidelity simulators are focused on single skills and permit learners to practice in isolation. Medium-fidelity simulators provide a more realistic representation but lack sufficient cues for the learner to be fully immersed in the situation. High-fidelity simulators provide adequate cues to allow for full immersion and respond to treatment interventions. Yaeger, K. A., Halamek, L. P., Coyle, M., Murphy, A., Anderson, J., Boyle, K., et al. (2004). High-fidelity simulation-based training in neonatal nursing. Advances in Neonatal Care, 4, 326-331.

26. Fidelity a “system that presents a fully interactive patient and an appropriate clinical work environment (p. i5).” Gaba, D. (2004). The future vision of simulation in health care. Quality and Safety in Health Care, 13, i2-i10.

27. Fidelity Equipment/Physical Over 365 facilities in 48 states/provinces in the US and Canada, Germany, Brazil, and Japan are participating in the NRCPR.

28. Fidelity Equipment Over 365 facilities in 48 states/provinces in the US and Canada, Germany, Brazil, and Japan are participating in the NRCPR. Task

29. Fidelity Equipment Over 365 facilities in 48 states/provinces in the US and Canada, Germany, Brazil, and Japan are participating in the NRCPR. Task Environmental

30. Fidelity Equipment Over 365 facilities in 48 states/provinces in the US and Canada, Germany, Brazil, and Japan are participating in the NRCPR. Task Environmental Psychological

31. Which is more important for most learning events …? 12% A high-fidelity simulator 88% A high-fidelity environment Dieckmann, P. (2008). How much realism is needed in medical simulation? Presentation at the International Meeting on Simulation in Healthcare, San Diego, Ca.

32. Same simulation device, but completely different learning experiences

33. Suspension of disbelief

34. Questions?

35. Gateway to Education – 2008 Symposium Sept. 11, 2008, St. Louis, MO Learning Theory and Simulation: Knowing the “Why” Behind Your Teaching David L. Rodgers, Ed.D., NREMT-P Healthcare Simulation Strategies Charleston, WV

36. Learning Theory in Patient Simulation There is no “Simulation Learning Theory” But, simulation can benefit from broader learning theories

37. Experiential Learning Theory Dominant learning theory in simulation David Kolb – Chief proponent Based on Kurt Lewin’s Experiential Learning Cycle Kolb, D. A. (1984). Experiential Learning: Experience as the Source of Learning and Development. Prentice-Hall, Englewood Cliffs, NJ.

38. Experiential Learning Cycle Concrete Experience Observation and Reflection Testing implication of concepts in new situation Formation of abstract concepts and generalizations

39. Adult Learning Theory Adults have an intrinsic need to know Adults have self-responsibility Adults have a lifetime of experiences Adults have an innate readiness to learn Adults have a life-centered orientation to learning Adults have internal motivators Knowles, M., Holton, E., III, & Swanson, R. (1998). The adult learner (5th ed.). Woburn, MA: Butterworth-Heinemann.

40. Brain-based Learning • Three key instructional techniques for Brain-Based Learning: • Orchestrated immersion in complex experience • Relaxed alertness • Active processing Caine, R. N. & Caine, G. (1994). Making Connections. Addison-Wesley, Menlo Park, CA.

41. Brain-based Learning • Three key instructional techniques for Brain-Based Learning: • Orchestrated immersion in complex experience • Relaxed alertness • Active processing Learning environments designed to fully immerse students in the learning experience

42. Brain-based Learning • Three key instructional techniques for Brain-Based Learning: • Orchestrated immersion in complex experience • Relaxed alertness • Active processing Eliminate fear in the classroom while also maintaining a challenging educational climate

43. Brain-based Learning • Three key instructional techniques for Brain-Based Learning: • Orchestrated immersion in complex experience • Relaxed alertness • Active processing Allow time for the student to process and internalize new information

44. Questions?

45. Gateway to Education – 2008 Symposium Sept. 11, 2008, St. Louis, MO Break Time!

46. Gateway to Education – 2008 Symposium Sept. 11, 2008, St. Louis, MO It’s All About Objectives: Integration of Simulation into Your Curriculum Michael Armacost, MA, NREMT-P Banner Health Simulation & Innovation Frederick, CO

47. Objectives/Curriculum Integration • Science of Expertise • Types of Learning & Evaluation • Examples

48. Objectives/Curriculum Integration • Science of Expertise • Prior Knowledge and Learning • Novice to Clinical Expert All knowledge is based upon what you already know. The more you know – the easier learning and instruction will be.

49. Objectives/Curriculum Integration Advanced Beginner Novice Competent Proficient Expert

50. Objectives/Curriculum Integration Advanced Beginner Novice Competent Proficient Expert • Prior knowledge lacking • Needs rules free of context – Cognitive Load • Difficulty with prioritization • Little situational awareness • Lacks communication skills • Vulnerable