Clinical Simulation An Overview

1. Clinical Simulation – An Overview School of Health, Nursing and Midwifery – Hamilton Campus

2. Outline What is clinical simulation? Drivers for development The evidence Advantages/disadvantages Our facility Integration into the curriculum The future

3. A Definition “ Simulation is a technique- not a technology- to replace or amplify real patient experiences with guided experiences, artificially contrived, that evoke or replicate substantial aspects of the real world in a fully interactive manner” (Gaba, 2004, p.2)

4. Clinical simulation An approximation of clinical reality Possesses mechanical, environmental and psychological fidelity Typology: Low, medium and high fidelity Technical and non-technical skills

5. Levels of simulation Low fidelity: No feedback - passive e.g. BLS manikins, injection pads Medium fidelity: Programmed feedback - active e.g. Sim Man AHPS High fidelity Non-programmed feedback - interactive e.g. METI AHPS

6. What can we simulate? Technical skills Psychomotor Non-technical skills Decision-making Cognitive rehearsal Teamwork Situational awareness Communication

7. Drivers Reduced learning opportunities in practice Ethics – is it ethical to practice on sick patients? Evidence from other high-risk industries – airline, nuclear, military Clinical risk management/patient safety DoH, NES, GMC, NMC Nurses are operating at higher and higher levels of clinical skills Advances in simulation technology

8. Advantages Safe learning environment Student-focused Patient safety not compromised Repeatable Rare situations can be replicated Useful for ‘fire drills’ Immediate structured feedback Assessment possibilities Flexible teaching methodology

9. Adaptable to multiple learning strategies

10. Disadvantages High capital cost Staff development intensive Mechanical, environmental and psychological limitations Suspension of disbelief Hyper vigilance Evidence base?

11. The Evidence In excess of 1000 published papers Systematic review of literature (Issenberg et al., 2005) “ we should no longer be asking if simulation works, but rather how it works” (Jolly, 2006)

12. Clinical Simulation Suite 3-bedded acute ward with ICU bed space 3-bedded core skills ward Resuscitation room Part-task skills room Midwifery Skills Room Primary Care Skills Room Communication Skills Room Microsim Computer Lab

14. Integration of clinical simulation into the adult branch

16. Semester 3 Introduction to medium-fidelity simulation Clinical skills (surgical) Problem-based Learning Surgical patient scenarios Resuscitation training: BLS & airway management

17. Semester 4 Clinical skills (medical) Medical patient scenarios Microsim licence for 1 year Resuscitation training: BLS , AED use and rhythm recognition

18. Semester 5 (trauma) Clinical skills (trauma) Trauma patient scenarios Resuscitation training: Trauma resuscitation, prevention of cardiac arrest.

19. Semester 6 Simulated patient scenarios Mock ward round. Resuscitation training Immediate Life Support (ILS) provider course

20. Future developments SMOTS high tech debriefing facility Summative assessment Assessment of competence Clinical error reduction - Human factors training Virtual Reality simulation

21. Any questions

22. Simulation in action!

24. Research

25. Psychomotor, cognitive, affective The effect of clinical simulation on psychomotor skills: Majority of published research Easy to measure (OSCE) Quantitative studies

26. Psychomotor, cognitive, affective Effect of clinical simulation on cognitive skills: Less published work Relatively easily measured (MCQ) Quantitative studies

27. Psychomotor, cognitive, affective Effect of clinical simulation on affective skills: Very little published work Difficult to measure Qualitative studies

28. Any questions