In the next of our series with Advances in Simulation, we consider Dieckmann et al.  Variation and adaptation: learning from success in patient safety-oriented simulation training 

In their own words “we describe the learning from success (LFS) approach to simulation and debriefing. Drawing on several theoretical frameworks, we suggest supplementing the widespread deficit-oriented, corrective approach to simulation with an approach that focusses on systematically understanding how good performance is produced in frequent (mundane) simulation scenarios.” 

Peter Dieckmann and Mary Patterson joined us for the podcast, and we took a deep dive into Safety 2.0 and some theory underpinning this approach. 

Appreciative inquiry, “positive deviance” and “exnovation” are new ideas for most simulation debriefers, but ideas which we need in our toolbox for making the most of our simulation. 

We offer some practical examples for what this might mean for our scenario design, delivery and debriefing 

Thanks to our guests and to Advances for another great collaborative effort 

Victoria 

In our November journal club podcast Ben and Vic discuss the paper of the month – a classic debriefing article.  

Rudolph, J., Raemer, D. and Simon, R. (2014).  “Establishing a Safe Container for Learning in Simulation” Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 9(6), pp.339-349. 

We tried to summarise a fantastic, multifaceted discussion and admired the wonderful expert article commentary from Chris Nickson.  

We then reviewed some recent papers 

1. Cecilia Escheret al.  Method matters: impact of in-scenario instruction on simulation-based teamwork training Advances in Simulation 2017 2:25 

 - how should we provide ‘extra scenario information’ to close the gap between the simulator appearance and real life.? 

1. Coffey F, Tsuchiya K, Timmons S, et alAnalysing voice quality and pitch in interactions of emergency care simulation BMJ Simulation and Technology Enhanced Learning Published Online First: 06 September 2017.  

- interesting question, using sim as a ‘test bed’ 

1. Bean DM, Taylor P, Dobson RJBA patient flow simulator for healthcare management education BMJ Simulation and Technology Enhanced Learning Published Online First: 07 October 2017 

- learn about the factors affecting efficient patient flow through hospitals using computer simulation, but don’t go looking for an online game… 

1. Christopher Hicks, AndrewPetrosoniak, The Human Factor: Optimizing Trauma Team Performance in Dynamic Clinical Environments, In Emergency Medicine Clinics of North America, Volume 36, Issue 1, 2018, Pages 1-17, 

- a MUST READ landmark paper 

We’re taking a break now til February when we’ll be back with more great Simulcast Journal Club 

Vic 

In early November the Simulcast Team combined forces with the team behind the ALiEM MEdIC Series for a joint case discussion around “The Case of the Difficult Debrief”.  After a fantastic online discussion involving a number of simulation superstars, a summary of the case and the discussions were uploaded at the ALiEM Website here. 

For those who aren’t aware, the Academic Life in Emergency Medicine “Medical Education in Cases” series puts difficult medical education cases under a microscope through facilitating an online discussion about hypothetical educational dilemmas.  Their cases and expert responses were the original inspiration for the Simulcast Journal Club and their website is a tour de force of FOAMed role modelling that is well worth spending a lot of time in. 

In our inaugural crossover podcast, Ben Symon talks to Dr Brent Thoma (@Brent_Thoma) who is Emergency Medicine Research Director at the University of Saskatchewan and an Associate Editor of ALiEM, and expert commenter Dr Andrew Hall (@AKHallMD) who is an Assistant Professor in the Department of Emergency Medicine at Queen's University). 

Join us as we discuss what differences exist between the skills involved in clinical teaching and simulation debriefing, how to gain the trust of your learners, using “The Cheng Approach” to find a more learner centered structure to your debriefs, and wait in peril to see just what mysterious Canadian rodents are stalking Dr Hall in the air vents above his laptop. 

Faculty development – joint release podcast with debrief2learn 

A highlight of my recent trip to Canada was meeting many simulation experts and enthusiasts.  

Adam Cheng (@DocChenger) suggested we record a podcast on faculty development in simulation programs, as we also had Dawn Taylor Petersen from the University of Alabama and Ryan Brydges (@rbrydges) from the Wilson Centre at University of Toronto visiting. 

We’re very pleased to release this podcast jointly with debrief2learn – an amazing group of people and a rich online resource for all things simulation debriefing. 

Thanks again to Adam for his hospitality and generosity. 

vb 

Scenario design 

Kyla Caners (@drcaners) from emsimcases.com was our guest on this Simulcast episode on scenario design. She and Jesse shared tips on knowing what you’re trying to achieve, planning the scenario, using templates, finding ‘supporting objects and ‘road testing’ and peer review for sim cases. 

Design requires a lot of attention to detail and really sets up the educational event for success or otherwise.  There was a strong theme to keep it simple and not overburden participants with difficult diagnostic cases if simulator cues are relatively poor, which might add to cognitive load without effective educational effect. 

We also profiled Kyla’s EM simcases blog – a #FOAMed resource with pre-written cases, templates and more. Check out this resource and Kyla also encouraged listeners to send simulation scenario cases for peer review if interested. 

Simulcast Journal Club podcast October episode 

Two announcements to kick off our October Journal club podcast. 

1. Check out the great work ofKomalBaja and colleagues in producing a PEARLs debriefing infographic – a design informed presentation of the framework originally developed by Walter Eppich and Adam Cheng. All the materials free to download here and please provide feedback to the team in a 5 minute survey on the site. 

We then discuss the paper of the month. 

“The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP).” 

Lewis, K., Bohnert, C., Gammon, W., Hölzer, H., Lyman, L., Smith, C., Thompson, T., Wallace, A. and Gliva-McConvey, G. (2017). Advances in Simulation, 2(1). 

And a few other sim papers across a range of topics and research methods. 

The pillars of well-constructed simulated patient programs: A qualitative study with experienced educators. Shane A. Pritchard, Felicity C. Blackstock, Jennifer L. Keating & Debra Nestel. Medical Teacher Vol. 39 , Iss. 11,2017 

Simulation-Based Mastery Learning for Thoracentesis Skills Improves Patient Outcomes: A Randomized Trial. Barsuk, Jeffrey H. MD, MS; Cohen, Elaine R. MEd; Williams, Mark V. MD; Scher, Jordan; Jones, Sasha F.; Feinglass, Joe PhD; McGaghie, William C. PhD; O’Hara, Kelly MD; Wayne, Diane B. MD. Academic Medicine: Post Author Corrections: October 24, 2017 

Documentation framework for healthcare simulation quality improvement activities. Melanie Barlow, Robyn Dickie, Catherine Morse, Donna Bonney and Robert Simon. Advances in Simulation 2017 2:19 

Next month Ben offers us ‘clickbait’ ( his words) to join the November discussion of a classic paper  

Establishing a Safe Container for Learning in Simulation: The Role of the Presimulation Briefing 

Rudolph, Jenny W. PhD; Raemer, Daniel B. PhD; Simon, Robert EdD. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: December 2014 - Volume 9 - Issue 6 - p 339–349 

Looking forward to another great discussion  

Vic 

This epsiode, Victoria, Jesse and Ben share the airwaves for the first time. We track through the first 12 months. Put a lid on some things and to a bit of a plus/delta. What does the future hold? Hopefully more of what YOU want! Contact us, make suggestions and leave us a rating/review on iTunes. Also come over and chat at the website or on Instagram and Twitter @sim_podcast or on LinkedIn Simulcast page. 

Safety in simulation – the harms involved in trying to improve patient safety! 

Many healthcare simulation programs are aimed at improving patient safety, and yet these programs also carry their own safety risks – to participants, and to the institutions and patients whose safety we are trying to improve. 

Ann Mullen joined us in this episode of Simulcast to discuss the Foundation for Simulation Safety – an initiative that she and Dan Raemer from Center for Medical Simulation in Boston have developed. 

Ann is the Simulation Center program manager at Newton-Wellesley Hospital in Massachusetts, and a nurse by clinical background. 

We discussed the categories of risks inherent in simulation – learner psychological and physical safety, and patient and institutional risks from fake medications, or unintended triggering of hospital responses to simulation activities. Stu Marshall and Cate McIntosh authored a chapter on this topic1 in the Nestel et al textbook recently reviewed on Simulcast. 

The Foundation website provides details of incidents, and access to labels designed to prevent these errors. Ann and Dan are also trying to use social media to promote this cause and to facilitate sharing stories of adverse events in sim and best practices in preventing them. Check out #keepsimsafe on Instagram and Twitter 

We discussed how perhaps we needed a reporting system for these incidents, and looked at the role of safety criteria in accreditation standards.    

Thanks to Ann for talking to us about an important topic. 

Vic 

1. Marshall, S. and McIntosh, C. (2017) Strategies for managing adverse events in healthcare simulations, in Healthcare Simulation Education: Evidence, Theory and Practice (edsD. Nestel, M. Kelly, B. Jolly and M. Watson), John Wiley & Sons, Ltd, Chichester, UK. 

In our September journal club podcast Ben and Vic discuss the paper of the month  

Chung HS, Dieckmann P, Issenberg SB. It is time to consider cultural differences in debriefing. 

We then reviewed some recent papers 

Thomson FC, Morrison I, Watson WA ‘Going Professional’: using point-of-view filming to facilitate preparation for practice in final year medical students BMJ Simulation and Technology Enhanced Learning Published Online First: 30 June 2017. doi: 10.1136/bmjstel-2017-000224 

Davison M, Kinnear FB, Fulbrook P Evaluation of a multiple-encounter in situ simulation for orientation of staff to a new paediatric emergency service: a single-group pretest/post-test study BMJ Simulation and Technology Enhanced Learning Published Online First: 28 June 2017. doi: 10.1136/bmjstel-2016-000138 

Lovett S, Roche J, Hunter S, Symonds I, Tomlinson N, Gagnon R, Charlin B, Mattes J, Respective value of the traditional clinical rotation and high fidelity simulation on the acquisition of clinical reasoning skills in medical students – A Randomized Controlled Trial., MedEdPublish, 2016, 5, [2], 9,  doi:https://doi.org/10.15694/mep.2016.000037 

In our discussion we also talked about the Script concordance test and more reading here if interested. 

And gave a shout out to mededpublish.org as a potential destination for authors interested in open access and post publication peer review processes. 

And Ben introduced next month’s paper  

Karen L. Lewis et al. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Advances in Simulation 2017 2:10  https://doi.org/10.1186/s41077-017-0043-4 

Please add your comments on the website - looking forward to another great discussion  

Vic 

In the third of our series with Advances in Simulation, we discuss Tracing the prescription journey: a qualitative evaluation of an interprofessional simulation-based learning activity. 

Cooke et al. evaluated an interprofesional simulation activity involving medical and pharmacy students, using a qualitative analysis. The simulation involved followed a patient journey from presentation in a community setting, through an assessment and prescribing process, to the dispensing and patient education stages of the patient journey. 

Simulcast was fortunate to have Gerry Gormley (@DrGerryG) as our guest author, together with Christy Noble as a discussant. 

Gerry is an academic general practitioner and Senior Lecturer in the Centre for Medical Education (CME), Queen’s University Belfast (QUB). His roles there include the lead for educational research, including that relating to simulation based learning in healthcare.   

Christy Noble is a pharmacist and Principal Research Fellow (Allied Health) at Gold Cost Hospital and Health Service. Her PhD work reviewed focussed on undergraduate pharmacy curricula, and she is currently researching interprofessional co-supervision and practice-based learning. 

Our conversation canvassed the challenges in IPE activities, the specific opportunities afforded by simulation for IPE, and took a dive into some robust qualitative research methods employed by the study team.  

Thanks to our guests and to Advances for another wonderful collaborative effort 

Victoria