Sim Team Shines at the Canadian Sim Summit

The Simulation Division recently traveled to Toronto, Canada to give presentations at the 2014 Canadian Simulation Summit hosted by the Royal College of Physicians and Surgeons of Canada, held September 11-12, 2014.

Dr. Jessica Parsons gave an impressive oral presentation on Randomized Controlled Trial Using Simulation Education to Introduce and Engineered Safety Device to Prevent Needlestick Injury.  Many attendees stated that they thought her presentation was the best of the series.

Drs. Srikala Ponnuru and Jessica Parsons along with Jami Smith, John Erbayri and Michele Spotts presented a workshop, to an international audience, on Plus Delta Discuss - a new Twist on Debriefing.  The team created two video cases and presented their debriefing method live.  Special thanks to Jamie Teufel who helped prepare the videos used in workshop.

The Summit also gave the team an opportunity to highlight the new Master of Science in Medical and Healthcare Simulation Program with a booth at the conference. There was a lot of interest in the program and the team is hopeful that they will see some of their faces in the next class.

MSMS Faculty, Suzie Kardong-Edgren Gives the Keynote Presentation at The Laerdal Japanese Simulation Users Network

The Laerdal Japanese Simulation Users Network almost doubled in size from last year. One hundred thirty people from around Japan attended last year in Osaka. This year in Tokyo, 200 people attended. Some of my questions about how simulation translates to an Eastern culture were partially answered by this SUN meeting. I was invited to participate as a keynote, to present the results of the National Council of State Boards of Nursing  (NCSBN) National Simulation Study. Very unexpectedly, the question I thought that would be asked in Chicago at the unveiling of the NCSBN results was not, but it was the first questions asked here after I finished my presentation, if simulation was not better, then why do it?  I think it was a physician who asked…this led to a discussion of rapidly deteriorating clinical opportunities for students and rising patient complexity. Japanese nursing faculty may take care of between 5-20 students a piece at times in Japan. I cannot even imagine this myself; a 1:10 ratio is bad enough. 

This is a culture that has valued rote memorization. Simulation is an outside the box teaching modality, for them, but the Japanese faculty and attendees were very enthusiastic and seemed to be outliers themselves…more animated and outgoing than I was anticipating.

Simulations, on average, seems to be run for about ten minutes and then debriefed for about 20 minutes, as a norm in Japan, at this time. Simulations tend to be one profession only. The loss of face in front of others and other disciplines in a hierarchical culture is a huge issue, so western style inter-professional education is not occurring very often, at least as we know it. Overlaid on the loss of face issue is the same scheduling issue we have in the US, between different programs and courses of study.

Because of the loss of face issue, I wonder if adopting expert modeling as a rule of thumb or a group the fist time, might help to mitigate this issue. I would do a modeling scenario with all appropriate players, then have participants do it debrief, then do a similar but different transfer scenario, so that learners could try their kills in a similar situation but enough of a difference that they could build some competence, but with face saving scaffolding.

The debriefing session I attended seemed to indicate that the facilitator provides feedback on the learner performance using the gather, analyze, synthesize (GAS) model. However, the GREAT model, developed or used by Dr. Harry Owens at Flinders University was also discussed. As was Goal Oriented Debriefing the (god model), something I had not heard of before.  The Japanese culture at this time seems to favor a more teacher centered style of debriefing rather than learner centered. This course faculty member used the clicker system and did some self-reflection questions with his audience. People did speak in this session on occasion, but not much. The clicker question results indicated that attendees were not confident in their debriefing skills and that they did not notice a large change in behavior of their students post simulation. It looks like much work to do still.  I suspect they are not using a lot of simulation and students are still figuring how to learn in simulation.

I got to try out the QCPR system that gives fabulous feedback while performing practice CPR…oh my gosh!  What fun, how tiring, this is the first time I have practiced on a feedback manikin with the 2010 American Heart Association guidelines programed in, compressing at 51 mm rather than 48 mm is tough! Note to self, get CPR renewed.  The ironic thing is, the next big CPR study we are getting ready to do includes learning Japanese phrases…here I am in Japan, with my very few Japanese phrases, doing CPR!

The Japanese culture values face,  so admitting that one has made a mistake alone is almost unheard of, CRM as we know it will not work, as it is not ok to question anything a higher up is doing. Currently, there is almost no interprofessional team training, partly because if this problem…and all of ours in the US, trying to mesh schedules, etc.  I tried an exercise to demonstrate simulation as a teacher for psych-social issues, I am thinking it did not work well.

I think I learned more than I shared, across my many talks and the Sim Health conference. Happy to share with you also.

MSMS Faculty will attend INACSL Conference in Orlando June 18-20, 2014

Representatives from the Drexel University Master of Science in Medical and Healthcare Simulation Program will be at the International Nursing Simulation Learning Resource Centers Conference in Orlando, Florida on June 18-20, 2014.  

Come and visit us at booth # 334 or 

at the breakfast coffee break on Friday morning!

To find out more about the MSMS program check out our website atdrexelmed.edu/mssim and follow us on twitter @mssimdrexel

Drexel Simulation Team Competes at Lehigh Valley SimWars

                                                        

Lessons learned from Daring Greatly. ¹

Dr. Brene Brown begins her book with a quote from Theodore Roosevelt:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; . . . who at best knows in the end the triumph of high achievement, and who at worst, if he fails, at least fails while daring greatly.” —Theodore Roosevelt

It isn't often that we boast about times when we don't come away with the “win”.  Yet, this is the time to make an exception.  Yes, I do like to “win” but it is true that winning isn’t everything. It is so important to highlight the times and events in life when we can say that we came away from an event learning an incredible amount about ourselves, our purpose in healthcare education, and the efforts we've been pouring into a simulation program over the last several years. 

On April 9^th and 10^th the Drexel simulation team participated in a SimWars® event hosted by Lehigh Valley Hospital in Allentown, Pennsylvania. As someone who has participated both on stage and as a judge of SimWars® competitions, I can honestly say that SimWars® experience has challenged me to Dare Greatly.  After each experience from both sides of the fence, I find myself carefully reflecting upon the aspects of our simulation curriculum.  It takes an incredible amount of courage to get up on stage and effectively communicate with colleagues, take care of patients and manage chaos in front of an audience.  Yet, James Connelly, MD, John Erbayri, NREMT-P, Greg Owsik, MD, Melissa Fox, RN, Jami Smith, PA-C, Casey Hand, MD, Barry Mitchneck, RN and Russell Goldstein, MD readily rose to the challenge.  They comprise a group of healthcare providers with experience ranging from finishing the first year of residency to over 20 years of patient care experience. 

I was overwhelmingly proud of our Sim Wars Teams as they drew upon deep pools of knowledge, used effective crisis resource management communication skills, and truly delivered great examples of healthcare delivery.  Their simulation performances reminded me that most healthcare errors can be traced back to poor communication or lack of provider knowledge or skills.  Simulation allows the opportunity to practice, make mistakes and learn from them in a safe environment away from patients.  Athletes, musicians, pilots, hairdressers and chess players practice -- why isn’t it a standard in healthcare provider training?

Our trainees know that the more I learn, the more I realize I don’t know.  I learn something each time I have the opportunity to participate in a simulation session.  I am grateful that our program has been fortunate to invest in the advancement of simulation education and I thank all of our Sim Team, participants and educators for stepping into the ring with me as they dare greatly.

References

1.          Brown B. DARING GREATLY: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. New York, NY: Gotham Books published by the Penguin Group; 2012.

To find out more about the MSMS program check out our website atdrexelmed.edu/mssim and follow us on twitter @mssimdrexel

MSMS Faculty Scott Lind, MD Discusses Simulation Use at Drexel University College of Medicine

Dr. Scott Lind, chairman of surgery at Drexel University College of Medicine, has partnered with Operative Experience Inc. to change the face of surgical accreditation in the United States by introducing a competency-based assessment of surgical skills using the lifelike dummies created by OEI.
Currently, surgical residents need to pass both a written and oral exam in order to certify as surgeons. Similarly, surgeons looking to recertify need to take a written exam every few years. “Nowhere in there do you have to demonstrate that you can operate,” Lind said.

The lack of a hands-on skills assessment is exacerbated by a developing problem in surgery today. Surgeries are trending toward minimally invasive procedures that rely on small incisions and technology to reduce postoperative pain, scarring and recovery time.

While this method benefits the patient, it also means that residents have little experience with open surgery. When complications arise and the body cavity needs to be opened up further, residents must employ a skill set they have hardly practiced before.

From the Triange Newspaper at Drexel University: http://thetriangle.org/news/hands-test-comes-med-school/
To find out more about the MSMS program check out our website at drexelmed.edu/mssim and follow us on twitter @mssimdrexel

Thoughts About Upcoming Courses in the MSMS Program by faculty member Suzie Kardong-Edgren

I cannot tell you how hard I have prepared for the theory lectures for the MS.701S for this fall 2014. I know there is a split between medicine and social sciences that happened way back in the 1700-1800s , having to do with theory…I know this because I found a fabulous book about this in the airport bookstore one day  (I only shop in the most discriminating of places).

Hopefully everyone in the course may have had some exposure to theory and why it is important…but maybe not. I WANT everyone to understand the point and why theory is important. When we conduct a study, we are not hopefully doing it up without some background, observation, previous study, etc. Deciding to do something out of the blue with no rationale is not usually fundable (not the only reason to do research, but often a driving force in research) …”the progress of any discipline is measured by the scope and quality of its theories and the extent to which its community of scholars is engaged in theory development” (Meleis, p. 188).  We should ask ourselves, what are the central questions in the field of simulation? What is it we still don’t know that would make our scenarios more memorable, have bigger impact, allow participants to carry what they have learned into the field…provide better patient care, work better as a team…if you want to study ahead  and get ready for fall and the first practicum course, I suggest reading some of the articles in the monograph published by Simulation in Healthcare 6(6) supplement in 2011. When people call me and ask what needs to be studied, I refer them to this journal and the articles therein. Some of these articles refer to theories commonly used in medical simulation…bravo!  Hopefully you will know some before you get to this class. You will be joining a community of scholars in simulation, no matter what your intended job in simulation will be. So, be ready to come with open minds and think about those questions you have wondered about when you see or participate in simulation. The field is new…there are many open questions. However, theory will link the questions we ask into a coherent whole to move the discipline forward.

See you soon!

Suzie Kardong-Edgren

To find out more about the MSMS program check out our website atdrexelmed.edu/mssim and follow us on twitter @mssimdrexel

MSMS Faculty Member Jami S. Smith, PA-C Travels to Guatemala as Part of Surgical Jornada

For the second year, an interprofessional group of healthcare providers traveled from Philadelphia to Santiago Atitlan, Guatemala to provide surgical care to the this lakeside community. 

The Interprofessional Group in front of Hospitalito

 In addition to Jami, the Academic Director at the Drexel University College of Medicine, Medical and Healthcare Simulation Program and a practicing physician assistant, the 16 member team was compromised of 2 surgical attendings, an anesthesiologist,  3 surgical residents, 3 CRNAs, and 6 CRNA students from the University of Pennsylvania.  

CRNA student provides post-operative care to a patient

Over a four day period the group performed 27 surgeries including procedures such as subtotal thyroidectomy, cholecystectomies, and hernia repairs. 

 

 

In addition to providing perioperative care, the group transported and donated much needed medical supplies to the hospital.  The group also visited a local school where they spent some time playing with the school children and then donated school supplies and toys.

The hospital is located beside a lake among a chain of volcanoes.

To find out more about the MSMS program check out our website at drexelmed.edu/mssim and follow us on twitter @mssimdrexel