Webinar: Continue the Discussion on "Hybrid Simulation Scenarios: Mixing Standardized Patients with Simulation Technology"

4/4/2012 10:00:34 AM #

Excellent presentation. You mentioned the use of medical students and nursing students as SPs. Is Hybrid Simulation being used for interprofessional education on your campus regularly between nursing and medicine or nursing and other disciplines, and if so how?

Thank you.

Pamela

4/4/2012 10:00:53 AM #

One of the questions I asked was about evaluation. How do you gain access to greater insight into the nature and impact of the student experience of the simulation?

Mike Davis

4/4/2012 11:41:12 AM #

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4/4/2012 1:02:55 PM #

Interprofessional Education (IPE) is becoming more and more a part of our nursing and medical programs with plans to extend IPE into our other components of pharmacy and public health. At the current time, we conduct several OB hybrid scenarios with the Noelle birthing manikin using an SP at the head of the bed to provide the patient voice and communication while Noelle gives birth. One of our objectives is to promote and facilitate the use of IPE in the CLRC and we hope to see more progress toward that objective in the future.

Benny Holland

4/5/2012 4:29:04 AM #

Pamela,
Hybrid simulation is also used here in IPE pediatric simulations during which SPs play the parents of manikin babies, or children.  We also use hybrid simulations in our Annual IPE Disaster Training day during which hundreds of volunteers are trained to act as patients alongside various task trainers and manikins that can be used for procedures and ACLS. For example, one patient in the disaster simulation needed a lumbar puncture to rule out meningitis.  The patient answered all the history questions and participated in the physical exam, but the LP model was put into the bed beside the volunteer for the LP procedure (during which the volunteer was positioned, comforted, and talked to).  

Laura Livingston

4/5/2012 6:59:33 AM #

Thanks for your question, Mike.

Insight to the impact on students can be measured in several ways:
1. During debriefing (which should be done following every formative simulation) students are asked to share whether the experience was valuable and effective in their learning
2. Students are also asked to complete a short survey to offer feedback on their experience.  It is important to link their simulation experience to their clinical experience and ask them to share whether they think the simulation will help/has helped them in the clinical realm.
3. Another way to evaluate the impact of specific simulations is to survey clinical site supervisors as to the competency of the students when they are in the clinical environment (we have had extremely positive feedback from clinical supervisors as to the competency of our students)

Benny Holland

4/6/2012 12:47:13 AM #

Thanks for this Benny. I am familiar with the model you describe and have used it in my ongoing work as part of the evaluation of undergraduate medical students experiences of hi fi simulation here in Lancashire UK. However, I am aware of its limitations and would be interested to hear from colleagues who have used more systematic and robust methods of gathering evaluation data that would help make an strong case for the continued development of simulation.

Mike Davis

4/6/2012 5:40:26 AM #

This approach is appropriate for a range of clinical presentations where you can switch from the real to the simulated. Neurological presentations such as stroke and a deteriorating neuro-scenario where haemodynamic and pupil changes are important cues and clues really reinforces the overall presentation. The SP can set the scene (history of presentation, slurring of speech, floppy arm etc) and the manikin presents the pathophysiological presentations. You can come back to the SP (time/scene changes) to discuss outcomes of treatment, residual issues (physical/emotional).  IPE strategies / activities can be intertwined.

In terms of measuring how this type of intervention can be linked to improved clinical outcomes is problematic as it is an 'education' activity with all its variables. It can be a well designed, validated one with repeated observable and measured outcomes that guide the learner towards the real world. You can test / evaluate for knowledge/skill acquisition / attitude / team and organisational activities to gain informed insight into the increased probability of competence and competence  - but at the end of the day - in the clinical setting with all its own variables - it is hard to make a objective link.  Not impossible but a complex, time consuming, costly activity that requires the rigour of research. So it becomes important that the health care system and the learner are both organised / congruent to the point where clinical risk is mitigated - and desired patient outcomes are better ensured.

The use of clinical supervisors / mentors/ coaches / facilitators / preceptors / experienced clinicians help close the theory-practice - quality gap and help guide beyond competence, and can, using appropriate tools, provide another dimension of evaluation/assessment.
The ultimate gap closing exercise lies with the learner and simulation is a very positive learner-centred teaching and learning method that encourages / facilitates that. Hybrid simulation and other blended learning activities all help.
I would be interested in hearing if anyone is dealing with mental health issues in this way and if so, how. This is a growth area   requiring more focus and maybe simulation has a role.

Irwyn Shepherd