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Simulation and Health Care: The METI Solution. Judy Johnson-Russell Ed.D., RN Clinical Educator Education and Training Services Medical Education Technologies, Inc Professor Emerita Texas Woman’s University - Dallas. It’s a new world!.

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Simulation and Health Care:The METI Solution

Judy Johnson-Russell Ed.D., RN

Clinical Educator

Education and Training Services

Medical Education Technologies, Inc

Professor Emerita

Texas Woman’s University - Dallas

Medical Education Technologies, Inc.


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It’s a new world!

  • Nation is facing a crisis in health care quality and safety presenting many challenges

    • Health care agencies

    • Schools preparing health care practitioners

Medical Education Technologies, Inc.


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Common Challenges

  • Shortage of Qualified Graduates and Faculty

  • Critical Thinking, Diagnostic Reasoning, Problem Solving

  • Prioritization

  • Safety

  • Teamwork and Interdependence

  • Communication and Collaboration

  • Skills, Technology, and Use of Resources

Medical Education Technologies, Inc.


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Meeting the Challenges with METI

  • All of these challenges can be addressed with the right simulators, the right simulated clinical experiences (SCEs) and the right equipment

    • METI family of simulators

    • Program for Nursing Curriculum Integration

    • Nurse Residency Program

    • METIVision

    • eDose

Medical Education Technologies, Inc.


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Emergency Care Simulators (ECS)

  • Adult patient mannequin (ECS)

    • Length: 5 feet, 11 inches (180 cm)

    • Weight: 75 pounds (34 kg)

  • Pediatric patient mannequin (PediaSIM-ECS)

    • Length: 4 feet (122 cm)

    • Weight: 38 pound (17 kg)

  • Infant patient mannequin (BabySIM)

    • Length: 26 inches (65 cm)

    • Weight: 16 pounds (7 kg)

Medical Education Technologies, Inc.


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METI Simulators

  • With these simulators you have a patient that:

  • Blinks, variable pupil size, chest moves with respirations

  • Normal/Abnormal Heart, Lung, Bowel Sounds

  • All Pulses, Blood pressure measurement

  • Waveform monitors can be used or disabled to include: ECG, SpO2, Temperature, NIBP, arterial Line, CVP, Pulmonary Artery Catheter, EtCO2, Thermodilution Cardiac Output.

Medical Education Technologies, Inc.


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METI Simulators

  • IV’s and IM Injections

  • Intubation, Tracheotomy, Chest Tube placement and maintenance

  • Use of various forms of O2 may be simulated

  • Pacing and defibrillation

  • Exchangeable Genitalia

  • Continuous or catheterized urinary output

  • Moulage with wounds, edema, emesis, stools, bleeding, cyanosis, all types of trauma, pregnancy and postpartum

Medical Education Technologies, Inc.


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iStan

  • Adult patient mannequin

    • Length: 5 feet, 10 inches (178 cm)

    • Weight: 100 pounds (45.5 kg)

  • Wireless & Tetherless

    • Controlled wirelessly and the mannequin is tetherless

  • Fully Self Contained

    • Blood, gases and fluids are 100% on-board the simulator

  • Realistic Suits of Skin

    • Ability to self-seal

  • True Articulated Motion

  • Fully Loaded

    • Same features as ECS

    • Realistic bodily secretions & sweating

    • Jugular distention

    • Trismus & Jaw thrust

Medical Education Technologies, Inc.


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METI Difference: The METI Family

  • METI Simulators contain modeled patients to represent the physiologic responses for:

    • Standard Man (woman), Healthy person, 33 yrs old

    • Unhealthy Middle Aged person (male or female)

    • Stannette: Normal full term pregnant female

    • Standard Elderly male or female

    • Soldier, extremely fit, hypermetabolic 20 year old

    • The child, PediaSIM

    • The infant, BabySIM

Medical Education Technologies, Inc.


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The METI Difference

  • Preprogrammed scenarios (simulated clinical experiences) for different levels of students

    • Program for Nursing Curriculum Integration (PNCI) v.4 100 Adult, Child, Infant

    • PNCI Choice Modules: limited number from the PNCI

      • Adult Nursing (20 SCEs)

      • Pediatric Nursing (16 SCEs)

      • Infant Nursing (8 SCEs)

    • Nurse Residency Program

Medical Education Technologies, Inc.


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Program for Nursing Curriculum Integration (PNCI)

  • 100 Simulated Clinical Experiences (SCEsTM)

    • 76 adult, 16 child and 8 baby

  • Patients are all ages, male and females

  • From various cultural backgrounds

  • Wide variety of conditions, acute and chronic, all stages of illness from emergency room to discharge

  • In a variety of settings, both hospital and non hospital (rehab, health fair)

  • Different interventions, skills, medications, safety issues, communications, health beliefs and ethical issues are imbedded in the SCEs

Medical Education Technologies, Inc.


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100 Simulated Clinical Experiences (SCEs)

  • Semester I

    Health Assessment - 9 SCEs

    Skill Validation - 1 SCE

  • Semester II

    Adult Medical Surgical - 18 SCEs

    Childbearing - 5 SCEs

Medical Education Technologies, Inc.


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100 Simulated Clinical Experiences (SCEs)

  • Semester III

    Chronic Care - 11 SCEs

    Community Care - 5 SCEs

  • Semester IV

    Adult High Acuity Medical Surgical - 9 SCEs

    Adult Critical Care - 17 SCEs

    Leadership/Management – 1

Medical Education Technologies, Inc.


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100 Simulated Clinical Experiences (SCEs)

  • Pediatrics

    PediaSIM - 16 SCEs

    BabySIM - 8 SCEs

  • Tools

    SBAR

Medical Education Technologies, Inc.


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Simulated Clinical Experiences

  • Components include

    • Synopsis

    • Learning objectives with cognitive taxonomy

    • Patient background information and history

    • Healthcare provider’s orders

    • Questions for learner preparation

    • Simulator set-up and instructor notes

    • Scenario including simulator enabled findings, minimum behaviors expected and prompts, questions and teaching points.

  • All evidence-based and updated every 3 yrs

Medical Education Technologies, Inc.





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All Inpatient Areas are Represented

Medical Education Technologies, Inc.


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Nurse Residency Program

  • Developed at Dartmouth-Hitchcock utilizing simulation

  • Graduate nurse residency orientation program focused on:

    • Skill-based learning

    • Critical thinking

    • Human factors engineering

    • Patient safety

Medical Education Technologies, Inc.


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Nurse Residency Program

  • Program includes:

    • Weekly didactic presentations

    • Weekly structured simulation experiences

    • Clinical time with a qualified preceptor

    • Self directed learning materials

  • Simulated clinical experiences include concepts of patient safety, including human factors, communication, resource management and situational awareness

Medical Education Technologies, Inc.


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Nurse Residency Program

  • Dartmouth-Hitchcock was able to:

    • Decrease orientation time of new nurses from 22-34 weeks to 12 weeks

    • Decrease turnover by 70%

    • Increase retention by 75% after 18 months

    • Decrease vacancy rate to 3%

    • Eliminate reliance on traveling nurses

    • Keep nurses for 18-24 months—”For Life”

Medical Education Technologies, Inc.


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Nurse Residency Program

  • “Found that a Nurse Residency Program that incorporates simulation increases new grads readiness for independent clinical practice and provides a more predictable process for acquisition of skills” Beyea, von Reyn, Slattery (2007). A Nurse residency program for competency development using human patient simulation. Journal for Nurses in Staff Development 23 (2) 77-82.

Medical Education Technologies, Inc.


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Meeting the Challenges with Simulation

  • A Simulator and the Simulated Clinical Experiences (SCEs) provide you with the opportunity to meet the needs of your learner, whatever they may be

    • Youdecide on the patient situation in need of interventions and the level of the students

    • Focus on learner’s needs, not the patient’s

    • You have the timeto facilitate critical thinking, diagnostic reasoning and problem solving

    • Patient safety is not an issue

    • Retention improvesas students see the results of their actions (experiential learning)

Medical Education Technologies, Inc.



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www.meti.com/mymeti_recipe.htm Objectives with Multiple Learners

  • Recipes for Disasters Cookbook

    • Blood RecipesCardiovascular RecipesEnvironment RecipesGastrointestinal Recipes Respiratory Recipes Sputum RecipesUrine RecipesWound Recipes

Medical Education Technologies, Inc.


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An Integrated Audio / Video Solution Objectives with Multiple LearnersDeveloped in collaboration with:

Medical Education Technologies, Inc.


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METIVision Objectives with Multiple Learners

  • Web-based system that fully integrates and synchronizes the simulation experience

    • Audio and video

    • Physiological data

    • Waveform display

    • Simulation event logs

    • Captured real-time annotations

  • Real time or recorded

Medical Education Technologies, Inc.


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METIVision Objectives with Multiple Learners


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eDose Objectives with Multiple Learners

  • Innovative, web-based learning and assessment environment that uses screen-based simulations to facilitate understanding and mastery of the skills needed to safely and accurately perform medication dosage calculations

Medical Education Technologies, Inc.


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Facilitating Competency in Nursing Numeracy: Objectives with Multiple LearnersA shift from abstract to authentic learning environments…


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eDose Objectives with Multiple Learners

  • Based on a sound theoretical base of research that identified three core skills required to understand and accurately solve medication dosage calculation problems

    • Understand and correctly set up the problem to be solved

    • Accurately compute the numerical calculation

    • Understand the design of the medication measurement and delivery device, and accurately measure the dose to be administered

Medical Education Technologies, Inc.


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X 2 = 2ml Objectives with Multiple Learners

eDose

  • Understand the design of the medication measurement & delivery device; accurately measure the dose to be administered

  • Understand & correctly set up the problem to be solved

  • Accurately compute the numerical calculation

Medical Education Technologies, Inc.


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eDose Objectives with Multiple Learners

  • Components of eDose

    • Medication Dosage Calculation Skills

    • Authentic Diagnostic Assessment

    • Authentic Assessment

Medical Education Technologies, Inc.


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eDose Objectives with Multiple Learners

Student Path

Practitioner Path

Exposure toAuthentic Assessment to audit level of competence

Authentic Assessment

Exposure toAuthentic Assessment prior to graduation

Entry

Exposure toAuthentic Diagnostic Assessment to identify specific areas of skill deficit

Exposure toAuthentic Diagnostic Assessment at pre-determined points in the curriculum

Authentic Diagnostic Assessment

Remedial skill development within the MDCS learning environment

Begin skill development within the MDCS learning environment

MDCS

Learning Environment

Entry

Identify start-point ability against which progress can be measured

Fundamental Numeracy Assessment


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Pre-Registration Medication Dosage Calculation Diagnostic Assessment Programme

Point of Graduation

Level Assessment

Graduation Level Assessment and Retrieval

Graduation Level Authentic Diagnostic Assessment:

Domain Specific Unit Dose/Sub & Multiple Unit Dose/

Complex Dose Problems/Conversion of SI Units

Diagnostic Assessments

Medication Dosage & Administration

Management Assessment

Medication Dosage & Administration

Management Assessment

Diagnostic Level Assessment

Authentic Diagnostic Assessment:

Generic Unit Dose/Sub & Multiple Unit Dose

Exposure to Structured and

Constructivist Centered Medication Dosage Learning

& Diagnostic Assessment Environments

Exposure Education

Program

Structured Education Program

Tablet &

Capsule

Tablet &

Capsule

Tablet &

Capsule

Liquid

Medicines

Liquid

Medicines

Liquid

Medicines

Injections

Injections

Injections

IVI

IVI

IVI

Entry to

Nursing

Program

Entry Level Assessment

Student Pathway within the eDose Medication Dosage Calculation Learning and Diagnostic Assessment Program

Medication Dosage

Assessment


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. Assessment Programme


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Easy to Administer Assessment Programme

METI eDose

Assessments are easy for faculty to set up and administer. Just develop your rubric and eDose does the rest.


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Well Structured & Diagnostic Rubric Assessment Programme

Medication Dosages

iV Volume & Rate

Total

Tablet & Capsule

Liquid Medicine

Injection

IV Infusions

Total

Ml per Hour

10

10

Conversion SI Units

2

2

2

6

Complex Arithmetic

2

2

2

6

Sub & Multiple Unit Dose

3

3

3

9

Drops per Minute

10

10

Unit Dose

3

3

3

9

Total

10

10

10

30

Total

20

20

Grand Total: Questions = 50

30 + 20 = 50

Grand Total: Questions = 50

30 + 20 = 50

Grand Total: Point Score = 100

Each question consists of two phases:

  • Problem Comprehension & Set-Up (1 Point)

  • Problem Computation (1 Point)

60 + 40 = 100

  • The assessment tool should:

    • Provide a unique set of questions with a consistent level of difficulty

    • Provide a structured range of complexity

    • Take place within a defined framework, at points by which students can be effectively prepared, while allowing time for supportive remediation. (Hodgen & Wiliam, 2006)


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Report Interpretation Assessment Programme


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"The difficulty lies not so much in developing new ideas as in escaping from old ones"

John Maynard Keynes

Medical Education Technologies, Inc.


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Questions and Discussion in escaping from old ones"

[email protected]

Medical Education Technologies, Inc.


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