Simulation Dating:

Matching the Appropriate

Technology with your Goals

Disclosure

• No financial disclosures

• The opinions expressed in this presentation is that of

the speaker and do not represent the opinion of the VA

Overview

• The VA & SimLEARN

• Simulation Dating - Cases

• Matching Goals with Technology

• Summary

• VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient centered and evidence based.

• This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement.

• It will emphasize prevention and population health and contribute to the nation’s well-being through education, research and service in National emergencies.

VHA Vision Statement

Veterans Health Administration • Who we are

• 262,000 staff

• 1400+ care sites in 21 Regions

• Care we provide

• Hospital, outpatient clinic, nursing home, counseling center

• Veterans we serve

• 2.8 million enrolled

• 11% women

SimLEARN Mission

To promote excellence in health care provided to America's Veterans through the use of simulation technologies for process modeling, training, education, and research and to establish VHA as the world leader in the application of simulation based strategies.

Matching your Goals with the

Appropriate Technology

Equipment

Learners

Hope for the best

mannequin simulator

task trainer – low fid

branched-outcome VP

virtual world

task trainer – high fid

standardized patient

hospital activation

disclosure & errors

improving codes

pharmacology

credentialing - CVL

disaster management

The Matching Game

gaming obstetrical triage

“If you’re a hammer, everything looks like a nail”

mannequin simulator

task trainer – low fid

branched-outcome VP

virtual world

task trainer – high fid

standardized patient

hospital activation

disclosure & errors

improving codes

pharmacology

credentialing - CVL

disaster management

The Matching Game

other non-simulation obstetrical triage

mannequin simulator

task trainer – low fid

branched-outcome VP

virtual world

task trainer – high fid

standardized patient

hospital activation

disclosure & errors

improving codes

pharmacology

credentialing - CVL

disaster management

The Matching Game

other non-simulation obstetrical triage

mannequin simulator

task trainer – low fid

branched-outcome VP

virtual world

task trainer – high fid

standardized patient

hospital activation

disclosure & errors

improving codes

pharmacology

credentialing - CVL

disaster management

The Matching Game

other non-simulation obstetrical triage

Case Scenarios aka

“ppt Simulations”

Which group do you identify with?

1 2 3 4 5 6 7 8 9

11% 11% 11% 11% 11%11%11%11%11%1. Student

2. Resident/Fellow

3. Nurse

4. Attending

5. Allied health

6. Pre-hospital

7. Simulation provider

8. Quality/Safety

9. Healthcare educator

Simulation Environment

1 2 3 4 5

20% 20% 20%20%20%

1. Medical School

2. Nursing School

3. Pre-hospital/Allied health school

4. GME (Residency/fellowship)

5. Hospital based (Clinical Staff)

CASE 1:

• The central line associated bloodstream infections in your 200 bed hospital’s ICUs has been less than the national average for the past 2 years.

• Unfortunately, over the past 6 months, there has been a significant increase in the SICU.

• A new team based checklist was implemented 3 months ago without improvement.

• The Chief of Quality Officer asks you to make it better using simulation.

What modality would you use?

1 2 3 4 5 6 7

14% 14% 14% 14%14%14%14%

1. mannequin simulator

2. task trainer – low fidelity

3. task trainer – high fidelity

4. branched-outcome VP

5. virtual world

6. standardized patient

7. other

Who is your target audience?

1 2 3 4 5 6

16% 16% 16%16%16%16%

1. nurses

2. attendings

3. fellows

4. residents

5. nurses, residents, fellows

6. all of the above

CASE 1 continued:

• You’re in a 6 hospital system with one simulation center based at the main hospital.

• The CQO has now asked you to deliver the training to all 6 hospital ICUs, Operating Rooms, and Emergency Departments.

• The hospitals are all 10-15 miles from each other in a large urban setting.

• Outcome – Completion of training within 1 year.

Does your target audience change?

1 2 3 4 5 6

16% 16% 16%16%16%16%

1. nurses

2. attendings

3. fellows

4. residents

5. nurses, residents, fellows

6. all of the above

Does this change your modality?

1 2 3 4 5 6 7

14% 14% 14% 14%14%14%14%

1. mannequin simulator

2. task trainer – low fidelity

3. task trainer – high fidelity

4. branched-outcome VP

5. virtual world

6. standardized patient

7. other

CASE 1 continued:

• Outcome – Reduction of CLABS by 2% within 1 year.

CASE 2

• The residency director of emergency medicine comes to you because her residents are not getting a lot of exposure to sick pediatric patients.

• She needs your help to develop a simulation training program that will give exposure to as many types of cases as possible, both management and skills.

What modality would you use?

1 2 3 4 5 6 7

14% 14% 14% 14%14%14%14%

1. mannequin simulator

2. task trainer – low fidelity

3. task trainer – high fidelity

4. branched-outcome VP

5. virtual world

6. standardized patient

7. other

CASE 2 continued

• The Dean of the School heard about the wonderful program you’ve developed and want

you to offer it to all of the 140 fourth year medical students by next year.

• He figures your center is funded through Medical School so it should be a priority.

• He says you can adapt as needed but want some form of simulation.

Would you change the modality?

1 2 3 4 5 6 7

14% 14% 14% 14%14%14%14%

1. mannequin simulator

2. task trainer – low fidelity

3. task trainer – high fidelity

4. branched-outcome VP

5. virtual world

6. standardized patient

7. other

Simulation Modality/Technology

Considerations

Identifying Clear Goals and Objectives

• Knowledge, Skills, Attitudes

• Patient Safety or Quality Issue

• Teamwork & Communication

• Training requirement

• Systems testing

• Assessment or Feedback

ACLS

• 3rd year medical students knowledge of ACLS algorithm

• ACLS certification for all new nurses and interns

• Code Blue team to function as a team in a cardiac arrest scenario to improve clinical outcomes

• Code Blue team to function as a team in a cardiac arrest scenario to improve clinical outcomes and the ability to deliver bad news.

Defining Learners

“Who”

• Students (Medical, Nursing, Allied Health)

• Nursing - RN, LPN, advanced practice nurse

• Allied Health

• Physician – resident, fellow, attending

• Other

Surgical Skills

• Practicing surgeons

• Fresh cadaver

• Animal lab

• Residents & Fellows

• Virtual trainer w +/- Haptics

• Medical Students & Interns

• Box trainer

Defining Learners

“How many” • Medical & Nursing Schools

• Hospital • Specialty

• Unit

• Discipline

• Team

• GME level

• Healthcare system • Hospital

• Clinics

Teams

• Code team

• Fixed team

• Rotating pager

• Shoulder Dystocia

• OB Attending

• L&D Nurse

• OB resident

• Anesthesia

• Pediatrics

• Admin

Depression Screening

• All primary care providers in the primary care clinic.

• All 4th year medical students, class of 140.

• All nurses in the hospital ED

• All clinical personnel across a 30 hospital system

Aware of their incentive

• Carrots

• Continuing Education

• Protected Time/Paid

• Required (Curriculum)

• Gap in knowledge

• Sticks

• Directive or Mandate

• Own Time

• Credentialing & Privileging

• Required (Curriculum)

Understand Learner Access

• Time

• None

• 1 hour vs. 1 day

• Scheduling

• Team vs. individual

• Distance

• Simulation center within the hospital

• Simulation center across the street

• Rural

• Ad hoc teams (DMAT)

Aware of your resources

• Space

• None

• Center

• Staff

• Funds

• Time

Technology Considerations

• Mannequin

• Wear and tear

• Consumable parts

• Virtual

• Software license

• Network bandwidth

• Task Trainers

• Consumable parts

• Learner : Trainer ratio

Summary

• Identifying Clear Goals and Objectives

• Defining Learners

• “How many”

• “Who”

• Aware of their incentive

• Understand Learner Access

• Aware of your resources

• Technology

Questions?