Podcast Ep. 5 – Simulation Basics: Back to the Future

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In this episode we revisit a conversation I had with my good friend and fellow of the nursing brotherhood, Brian Ericson. Brian, a clinical lead emergency nurse, invited me to have a chat and brainstorm about some of the risks, benefits and logistics of getting a program of in situ simulation started in his work place. We got quite carried away and ended up with two podcast episodes. One year on and in the lead up to SMACC Chicago, where I will be working on two workshops, including ‘Leave the Sim Lab Behind: In Situ Simulation for Clinician Educators’, I asked Brian if I could remaster and re-release a trimmed down single episode version of our conversation. I am really keen to deliver a number of episodes dancing through some of the more nuanced topics in sim and wanted to start with a solid foundation of looking at the phases of a simulation teaching event and some of the benefits for the learner and the educator in using sim in the workplace. Quite frankly, I had used all my best material and it would have been a poor surrogate if I’d tried to record it myself, so hence we have the first erNURSEpro/Injectable Orange crossover effort.

 

erNURSEpro  http://www.ernursepro.com

INJECTABLE ORANGE PODCAST-2

Episode 5 – Simulation Basics: Back to the Future (37.10)

 

For more on Injectable Orange relating to Sim, follow this link – http://injectableorange.com/?s=simulation

Also be sure to check out these two brilliant offerings from the St. Emlyn’s team and one from Dr Tim Leeuwenburg at KI Doc:

1) Top Ten Tips for In Situ Sim at St. Emlyns (Blog and Podcast)

2) The SWEETest Sim – Real People, High Fidelity at #SWEETs15 (Blog)

3) Simulation Apps – Review (Blog)

 

If you are in the market for free awesome simulation resources, check out:

http://mobilesim.wordpress.com (Great site with loads of resources and scenarios from Dr Jon Gatward)

http://intensiveblog.com/resources/icu-sim/ (New and very slick offering of fully templated scenarios for ICU In Situ Sim from Dr Chris Nickson)

Debriefing: a Little Carrot, a Little Stick

Donkey analogies aside, with the growing uptake of immersive team simulation, there is certainly a risk of falling into the softly-softly debrief trap. Thanks for sharing this video Luke Wainwright (@lukie27). Although slightly tongue in cheek (only slightly), it elucidates some of the things that have sat uneasily with me when observing some recent debriefs. The goal in education is to generate change. Change in attitude; change in culture; change in skill; change in confidence. Be very careful to not let your students debrief themselves into poor practice, misconceptions or overconfidence.

It is only practise that truly develops the skill of debriefing for learning. Try it, practise it and have an open and honest conversation with your team/trainees/students. While I don’t profess to be an expert in any capacity, I have made some mistakes and learned from them and have also debriefed up the hierarchical gradient (having lead debriefs of consultant medical staff – very daunting as a nurse). Below I have thrown in some ideas for debriefing.

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Absolute rule – The scenario is not an entree for a lecture.

1) Have very focused learning outcomes (2-3 as absolute maximum. If you have more, split them into separate stages of scenarios or run a pause and discuss).

2) Be flexible. If they didn’t achieve the goal of the scenario, but committed thoroughly and correctly to a course of treatment based on an accidental incorrect cue, debrief the scenario you observed, not the one you intended.

3) Gain consent for the open and challenging conversation. I find, before the scenario, explaining to the participants that we are going to come back in on completion, and have an open and critical conversation about the strengths and challenges experienced in the scenario and ask the group “Is everyone OK with that?” It is amazing what this does to the group dynamic once permission is granted.

4) While a structure is good, don’t be a robot. Observe others’ debriefing style, but don’t try and replicate exactly, you’ll come off as insincere.

5) Play to your strengths and enlist help from the room. (There is often expertise beyond the facilitator in the room. If you get a challenging question throw it back to the group for comment/answer).

I find the two papers below to be really helpful and applicable offerings on the art and science of debriefing with good judgement.

Eppich and Cheng (2015)

Jenny Rudolph et al (2007)