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Conducting Scenario-based
Simulations
Sandrijn van Schaik, MD PhDJenna Shaw-Batista, CNM PhDCynthia Belew, CNM MS
UCSF Center for Faculty Educators & Kanbar Center for Simulation
Workshop Objectives
• Explain the concept of fidelity and its different components
• Create an effective learning experience by enhancing fidelity
• Anticipate common pitfalls in conducting simulation sessions
Workshop Outline
• Introduction
• Preparing your learners for simulation
• The concept of fidelity
• Challenges in conducting simulation scenarios
• Wrap-up
• Evaluation
3
Ice Breaker
Pair-share with your neighbor (5 min):• If you have experience with simulation: 3
issues that you have struggled with during simulation sessions in the past
or
• If you’re new to simulation: 3 issues that you are worried about when thinking of conducting a simulation session
4
Preparing learners for simulation
• Exercise 1: In your small group, read the scenario on your handout and answer the following questions:1. Why do you think this happened?
2. What could have been done by the simulation instructors to prevent this?
5
Preparing learners for simulation
Ask for commitment
Clarify goals
Timing – make it explicit
Permission to make mistakes
Clarify roles
Clarify expectations
Normalize any anxiety
Orient to equipment
Set the stage for the scenario
6
Creating a safe learning environment
• Explicitly state the purpose of the simulation
• Clear expectations about roles and actions
• Establish respect for the learners and the learning process
• Orient to equipment and environment
• Describe potential challenges and solutions
• Explain debriefing and confidentiality
7
Dimensions of Fidelity
• Equipment Fidelity– Highest with physiology-based mannequins
• Environmental Fidelity– Highest with in-situ simulation
• Psychological Fidelity– Most important, dependent on instructor, can be very
high with standardized patients
– Physical resemblance
– Functional task alignment
9
BeaubienQual Saf Health Care 2004
Fidelity Requirements
Kern’s 6 steps to curriculum development
1. Problem identification
2. Needs Assessment
3. Goals and Objectives
4. Education Strategies
5. Implementation
6. Evaluation and Feedback
11
Fidelity and objectives
• Learning principles of physiology/pathology – Examples: Recognize ventricular tachycardia as a
cause of shock; Apply treatment algorithm for status asthmaticus
– Emphasis on equipment fidelity
• Learning to work in a particular setting– Examples: Locate resuscitation materials; Activate
rapid response team
– Emphasis on environmental fidelity
• Team work– Examples: Closed-loop communication; Task sharing
– Emphasis on psychological fidelity
12
Educational strategies
• Is simulation the appropriate teaching modality to reach the educational objectives?
• Is scenario-based simulation the appropriate modality?– Not so good for:
• Procedure training (partial task trainers)
• Patient-doctor interactions (standardized patients)
• Physical exam skills
13
Instructor and Confederates
• Instructor can be:– Facilitator
– Invisible observer
– Confederate
• Confederate:– Faculty, staff, actor, or learner who plays a role that
helps the scenario develop; for example: a parent, or a physician in a session with RN students, or an EMT is a scenario in which a patient is brought to the ED by an ambulance
14
Active Participation
• Large groups:– Rotating leadership
– (Active) observers
– Plus-delta or interim debriefing technique
15
Exercise 2: Challenges and Pitfalls
• Think about how you would address unexpected developments that may occur during a simulation scenario
16
TIPS: Be Prepared• Identify limited, attainable learning objectives
• Select level of fidelity based on equipment and objectives– Know what the mannequins can and can’t do
• Write out the scenario(s) using a scenario template– Set people up for success, not failure– Stick to learning objectives, don’t make unnecessarily complex – Realistic responses to actions– Realistic roles, use confederates if needed
• Run through the scenario(s) ahead of time with technical staff
• Think about worst-case scenarios– Equipment failure– “Learner” failure– Scenario failure
• Formulate plan for feedback and debrief
17
TIPS: conducting the session
• Set the stage: “Brief” or “prebrief” – Ground rules for safe and supportive learning
environment
– Describe expectations and feedback mechanism(s)
• Assign observers among your learners
• PAY ATTENTION and keep track of time
• Consider using video /B-line to augment feedback and debrief
18