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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
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.

it s a new world
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.

common challenges
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.

meeting the challenges with meti
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.

emergency care simulators ecs
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.

meti simulators
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.

meti simulators7
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.

istan
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.

meti difference the meti family
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.

the meti difference
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.

program for nursing curriculum integration pnci
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.

100 simulated clinical experiences sces
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.

100 simulated clinical experiences sces13
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.

100 simulated clinical experiences sces14
100 Simulated Clinical Experiences (SCEs)
  • Pediatrics

PediaSIM - 16 SCEs

BabySIM - 8 SCEs

  • Tools

SBAR

Medical Education Technologies, Inc.

simulated clinical experiences
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.

all inpatient areas are represented
All Inpatient Areas are Represented

Medical Education Technologies, Inc.

nurse residency program
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.

nurse residency program22
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.

nurse residency program24
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.

nurse residency program25
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.

meeting the challenges with simulation
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.

slide28

www.meti.com/mymeti_recipe.htm

  • Recipes for Disasters Cookbook
    • Blood RecipesCardiovascular RecipesEnvironment RecipesGastrointestinal Recipes Respiratory Recipes Sputum RecipesUrine RecipesWound Recipes

Medical Education Technologies, Inc.

an integrated audio video solution developed in collaboration with
An Integrated Audio / Video SolutionDeveloped in collaboration with:

Medical Education Technologies, Inc.

metivision
METIVision
  • 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.

edose
eDose
  • 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.

slide33

Facilitating Competency in Nursing Numeracy:A shift from abstract to authentic learning environments…

edose34
eDose
  • 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.

edose35

X 2 = 2ml

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.

edose36
eDose
  • Components of eDose
    • Medication Dosage Calculation Skills
    • Authentic Diagnostic Assessment
    • Authentic Assessment

Medical Education Technologies, Inc.

slide37

eDose

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

pre registration medication dosage calculation diagnostic assessment programme
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

easy to administer
Easy to Administer

METI eDose

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

well structured diagnostic rubric
Well Structured & Diagnostic Rubric

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)
slide46

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

John Maynard Keynes

Medical Education Technologies, Inc.

questions and discussion

Questions and Discussion

[email protected]

Medical Education Technologies, Inc.

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