SCCM Resource Library-Key Components of Running Simulation Sessions

Video Transcription

So, I'm going to get started. What this session is about is to kind of give you some idea about how we set up the sessions and what we did.  Can you guys tell me if there are any simulation instructors in here? A couple. So, some of this may sound very familiar to you, but for the rest of the folks, I'm going  to go over how we designed the scenarios, why we designed them the way we did and kind of how to run the skill stations.  So, the first thing to remember is that it's not about whether you have a high fidelity, you know, spanking new simulation center with lots of space and lots of equipment.  I think about it as medical theater and I think about it more as I'm going to try and bring my ICU or ward to a trainee so that they can practice in a safe environment, make  mistakes and I can teach them what needs to be done. So, giving you a personal example, I grew up and I graduated in India and I came to  the U.S. and I was an intern at Vanderbilt and my first day of my medical career at Vanderbilt was in the neuro ICU where I was asked to put in a central line which I'd never seen  before. So, I had a awake patient, me on one side and my upper level on the other side walking me on how to put that central line in.  I don't know who was more scared, me or the patient. So, that's kind of what you want to, you know, dispel. So, it's a technique. It's not really the technology.  You can and like you'll see today, we are in a conference center. We don't have our video cameras. We don't have our big equipments. If you have it, fine, go ahead and use it.  If you don't, what you want to do is right up front talk about suspension of disbelief and the fiction contract.  All that is is that I'm going to do the best I can to emulate or simulate the real world. I know there are lots of obstacles. I know this doesn't look like the real thing.  But if you want to learn, you've got to suspend disbelief. Imagine this is your real patient. If you do anything wrong, you're going to harm the patient.  And that way, you'll be able to walk away, you know, getting what I'm trying to tell you and learning what I'm trying to teach you. So, why do we do it?  Because, you know, the pilot knows where that intercom light is, but he thought for a minute this was the freo light.  So there's lots of data to show that if you practice over and over again, you know, if I teach you how to do the RAS, it's not the same as what the patient does in real life.  So when you see a RAS of minus 4, it may not match up with what you thought a RAS of minus 4 is or a minus 2 is or whatever.  So deliberate practice and exposing you to these challenging situations and then getting  you to do what you need to do and then letting you think about it and then coaching you through what you've made mistakes about is what makes you an expert.  And that's what basically simulation is, which is why we sort of added these skill stations in, in the sense that, you know, now you know what a RAS is.  So you're going to be training your, you know, participants. So you kind of teach them what or how to do a CAM-ICU, and then you take them to a skill  station and you show them how to do that CAM-ICU, make sure they're doing it right, and then coach them through whatever mistakes they're making.  Lots of modalities out there, which is why I bring this up over and over. If you have a simulation center and you have access to standardized patients or actors,  then set it up all the way. If you don't, do it low fidelity where you can at least get them to practice, pick up on the mistakes they're making and coach them through it.  So for today, for example, they're all actors. They'll be portraying some kind of a clinical scenario.  And then I always, if I'm using actors, I make sure I tell them they're not going to need Foley catheters or IV lines, please don't do ACLS on them, because that's not going  to be a good thing. Again, you know, to think about it, our most powerful learning moments are, it's these anecdotes we tell you, I did this and this is what I took away from it.  That's what you're doing with the skill set sessions. You're letting them do it so that they can walk away with the knowledge, the skills that  you want them to have, and then they can reflect on how they did it and then optimize it in their own practice. So how do you want to create a scenario?  You kind of have an educational rationale. So, you know, for the CAM-ICU station, I'm going to be teaching them CAM-ICU, what my educational goals are.  You start with a clinical vignette of a page 61-year-old hypertensive patient, blah, blah, blah. You figure out who your patient is, and then you set up your baseline vital signs.  Again, a small anecdote, we use these scenarios to do ICU orientation for our nursing staff.  And when we started these, one of the educators, nurse educators came to me and said, can you add restraints to it?  So, you know, if you have culture that needs to be changed, or if you have certain things in your own institution, adding those in to this to get a point across is really easy  and it'll probably get you more buy-in and will be more beneficial. The basic rules of simulation, and this is something you need to tell everyone, is that talk out loud.  I can't understand what you're thinking if you don't tell me what you're thinking. And if I don't know what you've done, I can't make the patient behave that way because,  you know, again, it's that suspension of disbelief. No magic drugs or treatments. In my simulation center, when I'm doing a full-blown session, I do not allow someone  to say, I gave five mics of fentanyl or 25 mics of fentanyl. They actually have to push the drug.  On the other hand, today we're in a conference room where we don't have, you know, mocked up IVs and things like that.  So if you take a step back and say, I'm going to be verbalizing the vital signs to you and you will tell me what you did and we'll do it more as a role-playing exercise, that's  fine. Getting them to do the things which is more important. One of the other things that people think about a lot in simulation that you want to  clarify up front is that they're going to try and trick me. They're going to try and, you know, fool me. They're going to try and make me trip.  That's not what the purpose of this is. The purpose of this is to make sure that you get how to do a KMICU assessment. And that's what we're going to focus on.  So no one's going to give you wrong information. And if there is a scenario where you want, you know, the nurse made a medication error  and your, you know, participant has to pick up on that, that's different. But most of our scenarios today, they're skills.  So there'll be no factual fooling or, you know, factual information that will be deliberately delivered wrong. Now to take a step back and say why we do this, this is very old.  It's the cold adult learning cycle. And what people will tell you is that people learn differently. And not only do they learn differently, they all have different learning styles.  I'm not going to go into like the nitty gritty of this, but if you sort of think of that first box up there, which says concrete experience as a simulation session.  So you took your trainees and you did a scenario with them and actually had them kind of walk through it.  Then once they're done, you come out and you talk about what they did right, what they didn't do right.  And you give them some pointers about this is how it should have been done or this is how I would do it. Then you're giving them the tools for reflection.  They can sort of go like, OK, so I need to reflect on my practice and then I'm going to conceptualize, think about it and conceptualize what it is that I want to do to change my  practice. So when I have that doing phase again, whether it's again in the simulation center or in the real world, I have all of these tools that now I can apply.  So that's the power of the skill sessions or exercises. Those four boxes that you see, the accommodating, diverging, those are the different learning styles.  And what you'll see is that simulation can fulfill all of those. For me, I think debriefing is way more important than what you did.  So the purpose of debriefing is to kind of reflect on your practice and say, these are the things I did really well, but these are the things that I didn't do as well.  Let someone point those out to me or discover for myself that I didn't do that well. And then it gives me practice improvement opportunities.  And that's what I want to kind of focus on and get better in my, you know, in my practice. So when you're debriefing the scenario, you kind of want to think about this is how a  mind thinks, that I experienced the event, then I kind of think about the event, discuss it with others, and then reflect and change my behavior.  And it doesn't matter whether it's a medical event or it's a personal event that's happened to me in my life.  So if you think about the simulation scenario, you're doing exactly the same thing. They're experiencing the events and then the three other things, so 75% of the time is  spent on reflecting, on discussing it with others, and then changing my behavior, which is what you're going to be doing with the skill sessions.  So going into this real quick, once the simulation session's done, you want to focus on pretty much letting them vent. So what exactly happened?  Because sometimes it could be crisis scenarios that you've got in your ICU. So you want to let them think about what exactly happened and let them react and get their feelings out.  And while they're doing that, you're gathering at least three to five key points of what they've identified to be things which are either good or bad.  At the same time, you've got another three to five points that you've observed while they were doing it, then decide which ones you want to talk about and find out what they  were thinking and why they did what they did. So you can then help them understand and reflect and change their behavior.  So in the summary phase, then you've kind of got it all together and said, okay, this is what happened, this is what we did, and this is what we want to do in future.  So again, you know, the skills get completed.  The important thing to realize is that we all come with our own biases.  So let's say the result is X, Y, or Z that you don't agree with.  Telling someone that I don't agree with the result and I don't agree with the way you did it is not going to be helpful.  You want to find out what their frame of mind was, which drove that action, which came to that result, because unless you can change the frame, you won't be able to change the  action or the result. So there's lots of methods out there. The one I'm going to point out today, and it's on the slides, is called the advocacy  inquiry, where you kind of say, I observed you doing this, and this is what I thought you did. So explain to me what you really did, and then let's talk about why you did it or if  there's a better way of doing it. And that's to put it simplistically. The references are on here. There's a debriefing with good judgment article that you guys can pull up.  If you can't find it, email me and I'll send it to you. So the important things to remember about debriefing is that you don't want to say  what the heck were you doing or why didn't it occur to you? You want to figure out why they did what they did and then help them kind of get better.  This is how we've done it at the ICU liberation conferences in the past. So it's a high-fidelity simulation center.  So I've had an actor on the bed who's got an endotracheal tube in, who is connected to the ventilator.  We do have vital signs, which progress based on what the participants are doing. And then we have the participants come up and kind of, you know, if it's a SAT, SVT,  then we have them drop the drug, see what that does, and then walk through the entire scenario.  Like I said, if you don't have it, you can bring it down to a conference room. If any of you are wanting to do the high-fidelity simulation, reach out to me and I can tell  you how to trick the ventilator with a awake actor who really doesn't have an endotracheal tube in and make the vent dis-synchronous and things like that.  I'd be happy to share all of those with you. A small video from one of our first SCC conferences. Hey, do you know where you're at? You're in the hospital.  You weren't breathing so well, so we had to put a tube down your throat. Can you work with us and we'll try and get that tube out of your throat?  Yeah? Can you squeeze my hand?  Can you give me a thumbs up? That's better.  That's his rasp now. Okay. What would you call his rasp now? Tiny. Pretend you just got passed by. He seems like a raspy little girl. Mm-hmm. Yeah.  Do you want to try to do Sam again?  Can you squeeze my hand?  I'm going to say some letters, and when I say, hey, can you squeeze my hand again?  That's even better.  Hey, do you know where you're at? You're in the hospital.  I don't know why it's not forwarding to the next slide.  Okay.  So this is just to give you an idea of how we did it and what the skill stations are like. We do have scripts that we will have available for all of the scenarios that  are associated with the skill sessions.  Because we are training you to do these skill stations, the way we will do it today is  divide you up into your groups, and I think we've got you divided into five groups.  And then each of those groups, we'll further divide you into two groups. And have you actually set up the patient for the simulation  and instruct with the scenario, instruct the other folks on how to run that simulation. They'll be your participants.  We've got two scenarios today, and then we'll flip you around. Let the other group set up the patient, and then have you be participants.  It'll be a little bit more clear as we do it. But we wanted you to go away with the idea of how to set the station up, what the script looks like, how to run through the script,  and then how to teach your participants what to do.  Okay.  Questions for me before we get started?

Video Summary

This video transcript discusses the setup and design of simulation sessions for medical training. The speaker emphasizes that simulation is not about the technology or equipment, but rather creating a safe environment for trainees to practice and make mistakes. The goal is to teach trainees what needs to be done in real-life medical situations. The speaker shares personal experiences and highlights the importance of deliberate practice and exposure to challenging situations. Different modalities for simulation are discussed, including high-fidelity and low-fidelity setups, depending on resources available. The speaker also explains the importance of debriefing sessions to reflect on performance and make improvements in practice. The transcript concludes by mentioning the practical aspects of running simulation scenarios and the importance of understanding the trainees' frame of mind to effectively guide their learning. The session includes hands-on skill stations where participants will set up scenarios and instruct others on how to run them.

Asset Subtitle

Professional Development and Education, Administration, 2020

Asset Caption

This is a presentation from the 2020 Critical Care Congress precourse, ICU Liberation. Key Components of Running Simulation Sessions was presented by Patricia Posa, BSN, MSA, CCRN-K.

The course covered knowledge developed to improve ICU patient care through the implementation of the ICU Liberation Bundle based on the pain, agitation/sedation, delirium, immobility, and sleep disruption (PADIS) guidelines.

Meta Tag

Content Type Presentation

Knowledge Area Professional Development and Education

Knowledge Area Administration

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Simulation

Tag Education

Year 2020

Keywords

simulation sessions

medical training

safe environment

deliberate practice

simulation modalities

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