1 what is simulation in healthcare? jeffrey b. cooper, ph.d. professor of anaesthesia, harvard...

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What is Simulation in Healthcare?

Jeffrey B. Cooper, Ph.D.Professor of Anaesthesia, Harvard Medical School

Department of Anesthesia and Critical CareMassachusetts General Hospital

Executive Director, Center for Medical Simulation, Cambridge, MA

Disclosures

• No commercial interests related to simulation

• Leader of a non-profit education and research organization that promotes simulation

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Objectives

• Introduce simulation and the breadth of its uses in healthcare

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Patient Safety and Medical Education Challenges Addressed by Simulation

l Training clinicians in risky procedures on real patients is no longer acceptable

l Apprenticeship-based learning depends on chance events

l There are limited opportunities to experience rare events and crises

l The 80-hr week has reduced contact hours for physician trainees

l Training for teamwork is atypical

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Using Simulation for Patient Safety and Culture Change

What is “simulation”?

What are the ways simulation is used?

What is the role of debriefing?

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What is Simulation in General?

A “technique” not a “technology” for interactive and often “immersive” activities that re-create experiences of a real-world environment, to amplify or replace actual experiences

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Spectra of Simulation & Immersive Learning in Health Care

Simulation and immersive learning can apply to health care in many different ways

There is a spectrum of applications across each of ten (or more) aspects of simulation

From Gaba DM: The future vision of simulation in healthcare, Qual Saf Health Care. 2004; 13 (Suppl 1):i2-10.

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Spectra of Simulation

1: Purpose of simulation

Education(Knowledge)

Training(Skills, Tasks,

Behaviors)

Testing Formative Summative High-stakes Recurrent

Research Pedagogy Hum Factors Physiology / Pharmacology

PatientCare Surgical case planning Protocol design Equipment procurement

Gaba: Q&SHC, 2004

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Spectra of Simulation

6: Knowledge, skills, behaviors

Conceptual Understanding

Knows

TechnicalSkill

Knows howShows how

DoesMasters

Attitudes & Behaviors

TeamworkPatient-centric

EthicsProfessionalism

DecisionMaking

CognitionMeta-cognition

-Static-Dynamic

Gaba: Q&SHC, 2004

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Spectra of Simulation

8: Technology applicable to simulation

Verbal “what if”

Role-playingMultimedia

Standardized patient(Actor)

ElectronicPatient

SimulationReplica

Clinical Site; Physical

(mannequin); Full VR

Patient Simulation

Computer- screen

Screen-based virtual world

Part-task Trainer

Physical VR

Gaba: Q&SHC, 2004

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Hybrid Patients

Standardized Patients

Computer Simulation

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Procedural Simulators/Part Task Trainers

Central Line Placement

Intubation

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Simulators /Part Task Trainers

Ultrasound

Laparoscopic skills

Colonoscopy

New cardiac surgery training devices

Chamberlain Heart U North Carolina

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Trauma Sim

Mannequin Simulators

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Control Room

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Full Team Training with Simulation

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Debriefing: The key to learning from simulation

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More Information at These Web Sites

WWW.bris.ac.uk/depts/bmsc(Good link to other simulation facilities)

WWW.SSIH.ORG (Society for Simulation in Healthcare)

www.harvardmedsim.org (Center for Medical Simulation)