Sim Workshop at TTC Copenhagen

This post is a resource for the Sim Workshop being delivered as part of dasTTC – The Teaching Course Copenhagen.

Thursday 22^nd June 2017 – SOHO 0900-1200

Psychological Safety Resources – http://simulationpodcast.com/2016/10/14/ep-4-safe-container-simulation/

Breakout Group 1 – The In Situ Conundrum

Coach – Chris Nickson

You’ve been running fortnightly scenarios in the nearby simulation centre. These are part of the resident training program and from time to time may get a nurse or two along depending on how busy the department is. While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. They can’t find equipment, struggle to coordinate the multidisciplinary team and seem much slower to achieve critical actions in the real resus. You approach the Department director and the nurse manager and suggest starting to conduct one of the sim sessions in the department in a real resus bay once a month. This is met with resistance, “we’re too busy theirs not enough staff or time”, “the staff have done mock codes before, they really disrupt things and they hated them”. You go back to your office and try to come up with how you will make this happen. (Stimulus by Prof. Victoria Brazil, Simulcast)

Questions to address:

1. What domains are particularly relevant in considering the use of in situ versus simulation lab?
2. How do we manage the competing workloads and lack of buy in for in situ sim?

References:

Brazil, Spurr, Petrosoniak, Simulcast Episode 5, November 2016 – Put the Rubber to the Road

http://simulationpodcast.com/2016/11/22/ep-5-put-rubber-road-situ-simulation/

Life in the Fast Lane, Critical Care Compendium – In Situ Simulation, revised November 2016. https://lifeinthefastlane.com/ccc/situ-simulation/

Petrosoniak, A., M. Auerbach, A. H. Wong and C. M. Hicks (2017). “In situ simulation in emergency medicine: Moving beyond the simulation lab.” Emergency Medicine Australasia 29(1): 83-88.

Spurr J, Gatward J, Joshi N, et al Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments Emerg Med J 2016;33:514-516.

Breakout Group 2 – Communication and CRM through SIM, is it working?

Coach – Sandra Viggers

“McDonalds drive thru attendants are much better at Closed Loop Communication than health care professionals.”

David replayed the conversation in his head again, he had ordered the meal, she had checked what he’d ordered, there was a visual display of his order on the drive thru screen, he’d confirmed his order and she’d told him it would be available soon. It was textbook perfect. Call out. Check back. Confirmation. Completion.

“How do they do it so well?” he thought.

Maybe people get angrier when pickles turn up on their double cheeseburger than when we give their grandma the wrong drug? The world is a strange place when we can’t do something so simple when it’s critical, but we do it so well when the outcomes are meaningless.

“This demands more research.” he thought as he turned his car keys and backed out the car park.

“I’d better come back tomorrow.” (Stimulus by Dr Ben Symon, Simulcast)

Questions:

1. Are CRM and Closed-Loop communications reductionist when applied to health?
2. What explicit behaviours are we looking for and how can we functionally align our education strategies to achieve these?

References:

Härgestam M, Lindkvist M, Brulin C, et al

“Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training”

BMJ Open 2013;3:e003525. doi: 10.1136/bmjopen-2013-003525

Lorello, G, Hicks, C et al.

Mental practice: a simple tool to enhance team-based trauma resuscitation. CJEM. 2016 Mar;18(2):136-42. doi: 10.1017/cem.2015.4. Epub 2015 Apr 10.

Petrosoniak, A and Hicks, C

Beyond crisis resource management: new frontiers in human factors training for acute care medicine. Curr Opin Anaesthesiol. 2013 Dec;26(6):699-706. doi: 10.1097/ACO.0000000000000007.

Symon, B and Brazil, V. Simulcast Journal Club Podcast March 2017 http://simulationpodcast.com/2017/03/02/simulcast-journal-club-podcast-2/

Breakout Group 3 – Debriefing. Which way is best?

Coach – Jesse Spurr

Ellen felt anxious walking into the debrief room.

The ED team had just finished an in situ simulation where the focus was on rapid sequence intubation (RSI) in head injury, and using the new intubation checklist. This was the third sim session in a series the department had agreed to run following 3 patient cases where significant desaturation occurred during intubation attempts.

Ellen thought they’d done OK but had recognized a lot of the usual ‘bad habits’ that frankly irked her when she worked on the floor with these guys – no nasal prong O2, a pretty vague conversation about who was going to actually do the tube, and low level grumbles about the time it takes to do the checklist. She was particularly disappointed that those things had come up in the last sim, and that a couple of the nurses had participated in that previous sim. “How can we actually get this into their heads?” she thought.

Entering the debrief room, Ellen knew what she wanted to bring up, but felt her stress level rising. Reactions first, she thought, and then facts. What would be a good advocacy inquiry question? What else did they say in that debriefing course…..? Should she let the learners dictate the topics?

And she knew that the ED consultant who was in the scenario was not a big fan of sim, and anticipated he might be difficult. His performance is probably off limits for today, she thought.

Deep breath.

“OK guys that was great. Well done”…….. (Stimulus by Prof. Victoria Brazil, Simulcast)

Questions:

1. Is there one perfect way to debrief?
2. Produce a mind map for applying different debrief contexts.

References:

Brazil, V. Article review: Is there really more than one way to debrief? Debrief2Learn Sept 2016. https://debrief2learn.org/really-one-way-debrief/

Brazil, Spurr and Eppich, Simulcast Episode 2, August 2016 – Eppich Debriefing http://simulationpodcast.com/2016/08/17/eppich-debriefing

Cheng, A., K. J. Morse, J. Rudolph, A. A. Arab, J. Runnacles and W. Eppich (2016). “Learner-Centered Debriefing for Health Care Simulation Education: Lessons for Faculty Development.” Simulation in Healthcare 11(1).

Eppich, W. and A. Cheng (2015). “Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and Rationale for a Blended Approach to Health Care Simulation Debriefing.” Simulation in Healthcare 10(2).

Rudolph, J; Simon, R; Dufresne, R; Raemer, D (2006)

“There’s No Such Thing as Nonjudgmental Debriefing: A Theory and Method for Debriefing with Good Judgment”

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare., 1(1):49-55, Spring 2006

Symon, B, Simulcast Journal Club Summary August 2016 – Debrieifer Knows Best

http://simulationpodcast.com/wp-content/uploads/2016/08/SIM-Journal-Club-August-2016-Summary-version-4.pdf