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Medical Simulation

Medical Simulation. Daniel Greenwald. Objectives. Define Medical Simulation Summarize current trends in simulator hardware and software List available hardware and software Evaluate usability of Code Team!® Describe and evaluate information system used in medical simulation

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Medical Simulation

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  1. Medical Simulation Daniel Greenwald

  2. Objectives • Define Medical Simulation • Summarize current trends in simulator hardware and software • List available hardware and software • Evaluate usability of Code Team!® • Describe and evaluate information system used in medical simulation • List advantages and disadvantages • Describe Informatics Competencies required

  3. Medical Simulation • Practice in lifelike circumstances using models or virtual reality • Feedback from observers and peers • Computer based patient simulator (Eder-Van Hook , 2004)

  4. Medical Simulation • Used in high risk occupations • Crew Resource Management • Applications in both medicine and surgery (Pizzi, Goldfarb, Nash, 2001)

  5. Hardware

  6. Partial Human Patient Simulators • Torsos for CPR and defibrillator AED training • Arm models that teach suturing and IV catheterization • Hand and foot models that teach suturing • Head and lung models to teach intubation and airway rescue (Anesoft, 2008)

  7. Human Patient Simulators • Lifelike computer controlled manikins • Interactive software controlled scenarios (FEMA 2008)

  8. Virtual Reality Simulators • Computer generated 3-D graphics that dispense both audio and visual directives for specific medical procedures • Some devices are interactive using a tactile interface when manipulated

  9. Model-Driven Simulators • BabySim - Medical Education Technologies, Inc (METI) • Emergency Care Simulator (ECS) - Medical Education Technologies, Inc (METI) • Human Patient Simulator (HPS) - Medical Education Technologies, Inc (METI) • I-Stan - Medical Education Technologies, Inc (METI)

  10. Model-Driven Simulators • PediaSim - Medical Education Technologies, Inc (METI) • PediaSim ECS - Medical Education Technologies, Inc (METI) • Sydney Perfusion Simulator - ManbitTechnologies

  11. Instructor-Driven Simulators • AirMan -Laerdal • Code Blue III - Gaumard • HAL - Gaumard • Noelle Obstetric Simulator – Gaumard • PatSim-1 • SIMA -Math-Tech • SimMan - Laerdal

  12. Human Virtual Reality HapticFeedback Trainers • AccuTouch Endovascular Simulator - Immersion Medical • AngioMentor - Simbionix • CathSim Intravenous Training System - Immersion Medical • Endotower - Verefi Technologies • ENT Surgical Simulator - Lockheed Martin Tactical Defense Systems

  13. Human Virtual Reality HapticFeedback Trainers • Pulmonary artery catheter simulator • GI Mentor – Simbionix • MenticeMedicSurgical Simulator: The LaparoscopyVR Virtual-Reality System • Surgical Simulator: The LaparoscopyVR Virtual-Reality System

  14. Meti Human Patient Simulator™

  15. Meti Human Patient Simulator™ • Alifelike simulator that depicts the clinical environment • Permits accurate representations of physiology and pharmacology • Supports training relating to all physiologic systems • Realistic body secretions and heart and bowel sounds • Reconstructs critical events for analysis (Medical Education Technologies, 2009)

  16. Software

  17. Software Components • Simulation Engine • Graphical user interface • Automated record keeping • Expert management help system • Automated debriefing system (Schwid, 2001)

  18. Simulation Software • SimCube ™ for capturing simulation encounters • Ventism Visual 1.0™-Ventilation simulation software • Cardiac Arrest, Code Team, Trauma One • Chest Pain Simulator, MicroEKG and Blood Gases • Gas Man® for anesthesia uptake and distribution • ACLS Simulator, Critical Care Simulator and PALS Simulator, from Anesoft

  19. Code Team! • Self teaching tutorials • Airway management, IV techniques and cardiac drugs • Live EKG with sound for normal and abnormal heart rhythms • Multiple interactive simulations • Compatible with Windows® operating systems • MadScientist Software www.madsci.com

  20. Usability • Axiom 1: Users must be an early and continuous focus during interface design • Axiom 2: The design process should be iterative, allowing for evaluation and correction of identified problems • Axiom 3: Formal evaluation should take place using rigorous experimental and/or qualitative methods (McGonigle & Mastrian, 2009)

  21. Code Team!-Usability • Usability-the ease at which people can use an interface to achieve a particular goal (McGonigle &Mastrian, 2009) • Code Team is user friendly, easy to learn and intuitive • Designed with the user in mind • Easy to install and configure • User satisfaction • Only compatible with Windows® (Staggers, 2003)

  22. OLEH Information System

  23. On Line Electronic Help (OLEH) • Interactive electronic textbook for anesthesia simulators • Real time access to critical information • Point of care information system • Proven value in patient care (Royal Philips Electronics, 2009)

  24. Point of Care System Evaluation • Definition-Laboratory and other services provided to patients at the bedside. • Effective method of data collection • Minimize documentation time • Reduces inaccuracies • Unobtrusive, user friendly and intuitive (Bogard, 2007)

  25. Information System Evaluation in Simulated Malignant Hyperthermia Crisis • Using human patient simulator in fully equipped simulated operating room • Quality of treatment was improved • Fast information retrieval times • Rapid, accurate clinical decision making (Berkenstadt, Yusim, Ziv, Ezri & Perel, 2006)

  26. Information System Evaluation in Simulated Malignant Hyperthermia Crisis • A Clinical Decision Support Information System • Used by Anesthesia Providers and Students • An Electronic Textbook Available on the Patient Monitor Screen • Point of Care Configuration with touch Screen Navigation

  27. Information System Evaluation in Simulated Malignant Hyperthermia Crisis • Data Standards Healthlevel 7 (HL7) International Organization of Terminology (IOTA) Anesthesia Subset/Systematized Nomenclature of Medicine-Clinical Terms (SNOMED)

  28. Advantages of Simulation • Reduction of Medical Errors and Adverse Events • Patient Safety-Safe practice environment • Reduced Health Care Costs • Better Trained Providers • Experience and Repetition develop skills (Eder-Van Hook , 2004)

  29. Advantages of Simulation • Practice on simulators without consequences to real patients. • Enhance critical thinking and decision making skills • Apply knowledge in appropriate context • Immediate feedback with repeated review. (Delprado, 2007))

  30. Disadvantages of Simulation • Investment of federal and private sector funds • Time investment is significant • Cannot develop emotional and intuitive awareness • Can be difficult to fit into a curriculum. • Intimidating having to “perform” (Delprado, 2007)

  31. Legal & Ethical Issues • Patients are no longer a commodity for training • Simulation fosters social justice • Manikins rarely initiate litigation (Small, 2004)

  32. Simulation & Informatics Competencies • Use of computerized patient monitoring systems • Uses data sources that relate to simulation scenarios • Uses applications to enter patient data • Operates peripheral devices • Uses operating systems (Staggers, Gassert, 2002)

  33. Simulation & Informatics Competencies • Uses computer technology safely • Is able to identify appropriate technology for capturing required data • Uses data to evaluate practice and perform quality improvement • Describes general applications to support nursing education • Perform basic troubleshooting (Staggers, Gassert, Curran, 2002)

  34. Simulation & the Informatics Nurse Specialist • Collects data to monitor effectiveness of simulation training • Integrates appropriate programs • Proficient in data recovery and system performance criteria • Demonstrates knowledge of informatics and simulation terminology • Evaluates simulation programs for users and clients

  35. Simulation & the Informatics Nurse Specialist • Develops guidelines for the purchase of simulation software and hardware • Defines and develops new simulator competencies • Teaches effective and ethical use of systems and applications • Assess limitations of technology

  36. Summary Advances in technology have created new and safer methods for teaching medicine and nursing. One of the most exciting, medical simulation is being incorporated into education and practice and is revolutionizing the way medical and nursing education is provided to students and experienced practitioners. It is helping to ensure clinical competence, reduce medical errors and lower health care costs. Simulation based training provides better trained providers and ultimately improves the overall quality of patient care.

  37. References Berkenstadt, H., Yusim, Y., Ziv, A., Ezri, T. & Perel, A. (2006). An assessment of a point-of-care information system for the anesthesia provider in simulated malignant hyperthermia crisis. Anesthesia & Analgesia, 102, 530-532. Bogard, P (2007). Definition of nursing informatics. Troy University. Retrieved March 20, 2009 from http://prism.troy.edu/~pbogard/nurseinformaticsdefined.pdf

  38. References Delprado, Andrea (2007). Simulation in Medical Education. Auckland District Health Board. Retrieved April 14, 2009 fromhttp://www.ahsl.co.nz/trauma/inj05talks/delprado/delprado.htm Eder-Van Hook, J. (2004). Building a national agenda for simulation-based medical education. Retrieved January, 18,2009 from http://www.medsim.org/articles/AIMS_2004_Report_Simulation-based_Medical_Training.pdf.

  39. References Effken, J. (2009). Improving the human- technology interface. In D. McGonigle & K. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (pp. 61-73). Sudbury, MA: Jones and Bartlett. Federal Emergency Management Agency. (September, 2008). Patient simulation technologies. Retrieved January 27, 2009 from https://saver.fema.gov/. Saver docs/medical/training/equipment/patient simulation technologies.

  40. References Medical Education Technology (2009). Retrieved February 3, 2009 from http://www.meti.com/downloads/HPS_Brochure.pdf. Pizzi, L., Goldfarb, N. & Nash, D. (2001). Crew resource management and its applications in medicine. Retrieved January, 19, 2009 from http://www.ahrq.gov/clinic/ptsafety/chap44.htm Royal Philips Electronics (2009). Clinical decision support. Retrieved March 19, 2009 from http://www.healthcare.philips.com/main/products/patient_monitoring/products/oleh/index.wpd

  41. References Schwid, H. (2001) Components of an Effective Medical Simulation Software Solution. Retrieved February 4, 2009 from http://sag.sagepub.com/cgi/content/abstract/32/2/240 Small, S. D. (2004). Thoughts on patient safety education and the role of simulation. Virtual Mentor, 6 (3). Staggers, N. (2003) Human Factors: Imperative concepts for critical care. AACN Clinical Issues, 14(3), pp 310-319.

  42. References Staggers, N, Gassert, CA, Curran C. (2002). A Delphi Study to Determine Informatics Competencies for Nurses at Four Levels of Practice. Nursing Research, 51, 383-16.

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