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The Integrated Simulation Center: Lessons Learned Tony Errichetti, Patty Myers, Tom Scandalis

The Integrated Simulation Center: Lessons Learned Tony Errichetti, Patty Myers, Tom Scandalis. American Association of Colleges of Osteopathic Medicine 4 th Annual Meeting – “Challenges and Opportunities” Baltimore, MD - June 24, 2006. Objectives.

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The Integrated Simulation Center: Lessons Learned Tony Errichetti, Patty Myers, Tom Scandalis

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  1. The Integrated Simulation Center:Lessons LearnedTony Errichetti, Patty Myers, Tom Scandalis American Association of Colleges of Osteopathic Medicine 4th Annual Meeting – “Challenges and Opportunities” Baltimore, MD - June 24, 2006

  2. Objectives • Describe the state-of-the-art simulation center • Discuss curricular, political and logistical issues in setting up a simulation center What are the key issues, decisions? • Review major simulations technologies, and their integration

  3. Simulation = reality substitution

  4. Increased use of simulations because…. • Shrinking patient base, shorter stays • COMLEX-PE, USMLE-CS • DO School Sim Center Program Surveys • - 2001 - SP Programs: 62% - No robotic sim programs (JAOA) • - 2006 - SP programs: 82%, 8% under development - Robotic sim programs: 57% (submitted to JAOA)

  5. Increased use of simulations because…. • Simulation industry (SPs, patient simulators, virtual reality) • High medical error rates, lawsuits and public demands for higher quality - Patient safety!

  6. Classroom Work How do simulations “work”?

  7. Childhood Training Through Simulation

  8. Childhood Training Through Simulation

  9. How do simulations “work”? • Practice / repetition in a patient- and trainee-safe environment (sim center) “Confidence builds competence” • Arousal, increase of productive anxiety, “nightmare” scenarios • Feedback / debriefing – the essential element

  10. Simulations …. • …solve training logistical problems “We prescribe illnesses” • …provide control of the clinical training and skills assessment • …do not harm or leave patients untreated as a bi-product of medical education

  11. Simulation Center Elements Simulation Technologies Simulation Connectivity System

  12. Simulation Technologies SPs Simulators VR Simulation Triad

  13. SPs Simulated and standardized patients: What’s the difference? Simulated Standardized More realistic More standardized Less standardized Less realistic Training Assessment

  14. Early Mechanical Simulator

  15. La Specola Collection, Firenze 1700s“Venus Médica”

  16. La Specola Collection, Firenze 1700s“Venus Médica”

  17. Simulators Gross Anatomy Animal Models e.g Suturing Practice

  18. Simulators Part-task / Part body trainers • Basic concepts • Psychomotor skills training

  19. Simulators Patient simulators (manikins) • Teamwork, procedures e.g. codes, ACLS Procedure simulators • Psychomotor skills, e.g. laproscopic surgery

  20. VR Virtual Reality and Computer-Based Programs PC/Mac – Patient “in the computer” (DxR) Haptic – Feel and touch Full immersion – Haptic plus virtual environment

  21. VR Full-Immersion Virtual Reality Diana – University of Florida

  22. Simulation Connectivity System

  23. Digital AV • Easy storage • Users (trainees, faculty) retrieve videos through the web • SP / Sim training / quality assurance • Debriefing / precepting / feedback – locally and remotely

  24. Data Collection • Paperless PC / PDA data collection - ROI: saves time and human resources • Data analysis / scoring / score reporting • Evaluation of trainees, faculty • Longitudinal studies of competency acquisition

  25. Program Management • Managing schedules (e.g. students, SPs) - ROI: saves time and human resources • Exam management • Automated announcements • Automated DV camera movements

  26. Planning / Financial Issues

  27. $im Center Element$ Training areas (rooms) Permanent Mobile Simulators, equipment (stuff) Faculty Staff (people) Curriculum SPs, trainers,techs, coordinators

  28. # 1 Problem Building first, then planning

  29. Problems • Budgeting and purchasing out of synch with planning and operations. • Users aren’t consulted in design process.

  30. Lesson Learned Planning = Really good planning =

  31. # 2 Problem Buying more manikin than what’s needed, and / or not budgeting for other simulation equipment

  32. Lesson Learned • Manikin just one of hundreds of pieces of equipment needed • Develop a program first (planning again) before committing to a manikin

  33. Lesson Learned Sim Centers are expensive! “We’re in a medical education arms race!” - Ken Veit, D.O. - PCOM • Collaborate when possible • Establish regional sim centers • Sell your services

  34. # 3 Problem Decentralized management of simulation services

  35. Administrative Problem SPs Surgery / ED Simulators Family Medicine MIS VR

  36. Lesson Learned Centralized management of all sim services, under a dean (vs. e.g. family medicine), to maximize efficiency, and program integration

  37. Lesson Learned • Program director = an expert in performance test development (usually a Ph.D.) who can work with and develop clinical faculty to: • create formative and summative assessment • set pass-fail standards • design research • Have a consultation line in your budget to bring in experts

  38. How Simulations Are Changing Clinical Learning

  39. From Learning Silos… Anatomy Histology Hematology Cardiology Physiology Urology

  40. To integrated curriculum Basic Sciences / Clinical Knowledge / Skills Because the work requires integration of knowledge, skills, attitudes

  41. …and integrated health care delivery DOCTORS PTs NURSES, PAs …because healthcare requires team work

  42. SPs Sims VR Simulation Integration

  43. “Cardiology” ScenarioStudents encounter a cardiology complaint (manikin) and discuss physiology / pharmacology issues with a science teacher Simulation Integration - e.g. Basic Science Sims

  44. “Gross anatomy - SP” ScenarioStudents in gross anatomy dissect the abdomen and then watch a video, in the lab, of a patient (SP) presenting with abdominal complaints. Simulation Integration - e.g. SPs Sims

  45. “Suturing” ScenarioStudents practice suturing (p/task trainer) attached to a “conscious patient” (SP) Simulation Integration - e.g. Sims SPs

  46. “Conscious - Comatose” ScenarioStudents encounter a hospital patient (SP), then that same patient in a comatose state (manikin) Simulation Integration - e.g. Sims SPs

  47. “Pre-Encounter” ScenarioStudents prepare for a sim encounter by meeting a web-patient (PC-VR), then meet the “actual patient” (manikin) in an ED setting, and / or live patient (SP) Simulation Integration - e.g. Sims SPs VR

  48. “Patient Management” ScenarioStudents encounter a patient (SP), then that same patient in a acute state (manikin), then manage the patient’s treatment post-discharge (PC-VR) Simulation Integration - e.g. Sims SPs VR

  49. “Simulator-Audience Response” ProgramStudents encounter a patient in an acute state (manikin), and through a live DV feed, an audience participates via an audience response system Simulation Integration - e.g. ARS Sims

  50. “Death and dying” ScenarioStudents encounter “dying patient”(manikin), then counsel “grieving family member” (SP) Simulation Integration - e.g. SPs Sims

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