How to Build a Successful Cost Effective Simulation Program

1. How to Build a Successful Cost Effective Simulation Program Louis P. Halamek, M.D. Associate Professor Division of Neonatal and Developmental Medicine Department of Pediatrics Stanford University Director, Center for Advanced Pediatric and Perinatal Education Lucile Salter Packard Children’s Hospital

2. Disclosure: In the past 12 months the speaker listed below has had the following financial relationships with manufacturers of commercial products and/or providers of commercial services:Louis Halamek: Consultant, Laerdal Medical and Advanced Medical Simulation; Grant Recipient, Laerdal Foundation

3. Learning Objectives • Understand what simulation is… or should be. • Appreciate the fact that building a simulation center and building a simulation program are distinct activities. • Know the steps in building a successful simulation program. • Know the potential sources of revenue that can support a simulation program.

4. Part I

5. What is the difference between teaching and learning?

6. Teaching something that is done by an instructor to trainees active endeavor for the instructor passive activity for the trainees trainees accept little responsibility for learning

7. Learning something that is done by trainees active exercise for instructor and trainee trainees bear most of the responsibility for their own learning

8. Teaching vs. Learning • Whom do we teach? ---> • Who are the learners? • What do we teach? ---> • What can be learned? • How do we teach? ---> • How is learning best facilitated? Halamek LP. J Pediatr 2007;151:329-330

9. The Learners • adults • independent • self-directed • internally motivated • seek immediate applications for their knowledge

10. Today’s Learners are Different from Yesterday’s • first year medical students in 2009 • were born 17 years afterman first walked on the moon • have no visual memory of vinyl records or rotary dial phones • have never been without laptop computers or the internet

11. What Can Be Learned • acquisition, recall, and application of content knowledge • serves as an essential foundation • yet is inadequate preparation for the complexity of real-life Bloom BS, et al. Taxonomy of Educational Objectives. 1956.

12. What Can Be Learned • cognitive skills • what we know: drug dosing • technical skills • what we do with our hands: intubation • behavioral skills • how we use our cognitive and technical skills in working with patients and colleagues: communication

13. Behavioral Skills • allocate attention wisely • utilize all available information • utilize all available resources • call for help early enough • maintain professional behavior • know your environment • anticipate and plan • assume the leadership role • communicate effectively • distribute work load optimally

14. Facilitating Learning

15. Facilitating Learning • tailor the training to meet the needs of trainees as adult learners • emphasize active rather than passive learning methodologies • require trainees to do more than write and answer questions • integrate cognitive, technical and behavioral skills into comprehensive learning opportunities

16. Facilitating Learning • provide relevant, challenging, immersive learning experiences • develop and stay focused on learning objectives • conduct in an environment with high fidelity to the real domain • utilize technology to optimize not overshadow the learning experience

17. Facilitating Learning • don’t dominate the learning process • ask questions rather than make statements • listen rather than talk • be comfortable with silence • allow time for reflection • debrief rather than lecture

18. Part II

19. What is simulation-based learning?

20. Simulation-based Learning • re-creates key visual, auditory and tactile cues • engenders authentic responses in trainees • allows practice of cognitive, technical and behavioral skills under realistic conditions (e.g. time pressure) • provides opportunity for self-reflection

21. Set clear expectations for your trainees. Tailor the training to meet the needs of your trainees. Facilitate, don’t dominate. Debrief, don’t lecture. Key Points for Instructors

22. Remember: It’s about the methodology, not the technology. It’s not about you as instructor, it’s about your trainees and ultimately their patients. Key Points for Instructors

23. Take responsibility for your learning. Behave during scenarios as you do in real life. Be willing to makes mistakes and learn from them. Maintain confidentiality. Key Points for Trainees

24. Remember: It’s not about you, it’s about your patients… Key Points for Trainees

25. Part III

26. How do you build a successful simulation program?

27. Steps in Building a Successful Simulation Program • identify the learners • establish learning objectives • identify the skills to be taught • cognitive, technical, behavioral • WHO needs to learn WHAT?

28. Steps in Building a Successful Simulation Program • determine the optimal learning methodology for achieving those objectives • cognitive: self-study • technical: task trainers • behavioral: simulation

29. Steps in Building a Successful Simulation Program • determine the curriculum • scenarios based on learning objectives • record scenarios for playback during debriefing • debriefings to follow each scenario • debriefing points follow from learning objectives

30. Steps in Building a Successful Simulation Program • develop instructors • content expertise • debriefing expertise • technical expertise

31. The Ideal Instructor • facilitates rather than dominates the learning process • utilizes technology to optimize the educational experience • provides relevant, challenging, scale-able immersive experiences • focuses on the learning, rather than the teaching, environment

32. Instructor Roles advocates scenario design confederates assistant instructors lead instructors employees investigators

33. How do you identify “the best”? • look for those who • are “early adopters” • they “get it” • are willing to let the learners assume responsibility for their own education • bring enthusiasm and passion

34. Steps in Building a Successful Simulation Program • secure the necessary physical resources

35. Steps in Building a Successful Simulation Program • “find*” space • * = trade your firstborn • “borrow**” working medical equipment • ** = steal • “secure***” a budget • *** = lie about what it will be used for • audiovisual equipment • human patient simulators

36. Borrowing Medical Equipment • working medicaldevices • monitors coupled with patient simulators • drivers for real monitors • bedside • fetal

37. Securing AV Gear • videotape is a tremendously powerful but vastly underutilized tool • creates an objective record of events • allows trainees to see what they do and hear what they say • essential for debriefing

38. Securing AV Gear • pan-tilt remote-control cameras • hidden under acrylic domes • multiple microphones • adjustable gain • a small camera on a tripod works, too!

39. Buying Patient Simulators • lower vs higher complexity simulators • higher fidelity typically comes with a price • more hardware • computers, wires, tubes • more software • someone must “run” the simulator • more training, more people • Sometimes simpler is better…

40. Buying Patient Simulators • lower fidelity “off the shelf” manikins used for • routine scenarios • routine interventions • “modified” manikins • external and internal alterations • richer training experiences

41. It’s the methodology, not the technology, that is at the heart of simulation-based learning.