Simulation as a learning tool

1. Suzi Lomax BM BSc FRCA PGCert Consultant Anaesthetist Royal Surrey County Hospital Simulation as a learning tool

2. Introduction • What do we mean by “medical simulation”? • Why is simulation necessary? • How does simulation work as an educational tool? • Is there any evidence? • What features lead to effective learning?

3. What is Medical Simulation? • “…an instructional process that substitutes real patient encounters with artificial models, live actors, or virtual reality patients” Gaba DM 2004

4. Types of Simulation • Standardised Patient • Screen Based Computer • Partial Task Simulator • High Fidelity Mannequin Simulator

5. Non-Technical Skills “behaviours …not directly related to the use of medical expertise, drugs or equipment.” “They encompass both interpersonal skills eg. Communication, team working, leadership and cognitive skills eg. situational awareness, decision making…” ANTS System v1.0

6. The evolution of medical simulation

7. Why is simulation necessary ? • Reduced training hours (EWTD) • Less patient exposure • Competency based training • Safety • To Err Is Human: Building a Safer Health System Institute of Medicine 2000 • CMO 2009 Reportmachines manikins and polo mints

8. CMO 2009 Reportmachines manikins and polo mints • Simulation-based training should be: • within training programmes for clinicians at all stages. • adequately resourced by NHS organisations. • importance of human factors training should be widely communicated. • Medical Royal College should identify leads for simulation training.

9. Parliamentary Report into Patient Safety July 2009 • “lack of non-technical skills can have lethal consequences for patients. However, the NHS lags unacceptably behind other safety critical industries, such as aviation, in its respect. Human Factors training must be fully integrated into undergraduate and postgraduate education” House of Commons Health Committee. Patient Safety Sixth Report of Session 2009-2010, vol 1

10. KSS Standards for Leadership for Doctors: • Individuals as leaders • Values and principles:“ability to manage effectively differences within and across teams” • Reflective practice • Self-awareness • A balanced approach “manage competing priorities” • Personal commitment to professional standards • Responding to uncertainty • Leading and communicating change • Leading groups • Fostering learning • Leadership and follower ship • Organisational behaviour • Motivating others • Group amd team dynamics • Performance

11. How does Simulation work as an educational tool? • Adult learner principals that apply to the medical learner: • Need to know why they are learning • Are motivated by the need to solve problems • Previous experiences of learners must be respected and built upon • Educational approach should match the diversity and background of adult learners • Need to be actively involved in the process Bryan et al

12. Experiential learning • Kolb et al 1984

13. Learning Pyramid

14. What features of simulation lead to effective learning? • Mechanisms for repetitive practice (39%) • Ability to integrate into a curriculum (25%) • Ability to alter the degree of difficulty (14%) • Ability to capture clinical variation (10%) • Ability to practice in a controlled environment (9%) • Individualised, active learning (9%) • Adaptability to multiple learning strategies 10%) • Existence of tangible / measurable outcomes (6%) • Use of intra-experience feedback (57%) • Validity of simulation as an approximation of clinical practice (3%) Issenberg et al 2005

15. What’s the evidence? • “…no industry in which human lives depend on skilled performance has waited for unequivocal proof of the benefits of simulation before embracing it…” Gaba

16. Conclusion • Simulation • Huge potential in the way we deliver modern medical education for both technical and non-technical skills • Different types to suit different budgets • Opportunity to practice and develop skills in a safe environment whilst protecting patients

17. Royal Surrey County Hospital Suzi Lomax BM BSc FRCA PGCert Consultant Anaesthetist Mark Way MB ChB FRCA DiP Med Ed Consultant Anaesthetist Oliver Rawding RODP Head of Medical Clinical Skills Alice O’Neill MBBS FRCA Anaesthetic Registrar Gillian Foxall MA MB ChB FRCA ESRA dip Consultant Anaesthetist The use of Simulationfor Leadership training

18. Questions

19. References • Okuda Y, Bryson E, Demaria S, Jacobson L et al. The utility of simulation in medical education: What is the evidence? Mt SinaiJournal of Medicine 2009 (76) 330-343 • Issenberg S, McGaghie W, Petrusa E, Gordon D et al. Features and uses of high fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical teacher 2005(27) 1-28 • Gaba D. Crisis Resource Management and teamwork training in anaesthesia. British Journal Of Anaesthesia 2010 105(1):3-6 • Lighthall G. Crisis resource management in healthcare. Chapter 20. gManual of simulation in healthcare. Edited by R H Riley. Oxford 2008 • Ostergaard H, Ostergaard D, Lippert A. Implementation of team training in medical education in Denmark. Qual Saf Health Care 2004 13 (suppl 1) i91-95 • Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care 2004;13 (suppl 1) i80-84 • Lerner S, Magrane D, Friedman E. Teaching Teamwork in medical education. Mount Sinai Journal of Medicine. 2009 76 318-329 • R Flin, R Patey, R Glavin, Maran N. Anaesthetists’ non-technical skills. British Journal of Anaesthesia 2010 105 (1): 38-44 • Anderson, A. Team building and simulation. Chapter 16. Manual of simulation in healthcare. Edited by R H Riley. Oxford 2008