EmergencyPedia

New Simulation? Are we using a systematic approach?

Introduction

While simulation has been used for teaching in medicine since circa the 18th century (at least), it is viewed by some academics as ‘new‘.

While learning through simulation is long-established, the rapid expansion of new simulation methods and rising stakeholder expectations has been occurring since the 1980s.  This unparalleled expansion of simulation-based medical education has led to challenges with starting out in this area as an enthusiastic educator.

Getting started on the question of how and where to provide new simulation learning opportunities in our existing curricula is a challenge…

The 6-step Approach

David Kern from John Hopkins University outlines a ‘6 step approach‘ to curriculum development which can be applied to simulation development (AMEE 2017).

When starting out in the creation of new simulation content we often (are tempted to) start at ‘step 5’ of this model.  Step 5 (implementation) is the end-game.  Moving straight to step 5 may be due to our inexperience or perhaps over excitement at our newly acquired (or soon to arrive) technology toys.

A trial and error approach (starting at Step 5) is problematic due to potential catastrophic financial loss, faculty time-wasting and missed opportunities to target areas best served by simulation.

Applying the 6-step Model to Developing Simulation 

STEP 1: a needs assessment

• We should ensure that any new simulation curriculum is grounded on needs of our trainees and the wider benefit of patients
• We should build on what already exists and acknowledge that simulation may not always be required
• We should bring the current approach closer to and ‘ideal approach’ to education
• In step 1 we should use an agreed structured approach such as the Delphi process (i.e. brainstorming phase, surveying stakeholders, elimination and prioritisation)
• We should consider undertaking a systematic literature review

STEP 2: a targeted needs assessment

• Learners (who are they?  is there an opportunity to breakout of normal silos?)
• Learning (what are the objectives and priorities generated from STEP 1?)
• Facilities and Resources Available (are more required? what will the cost be?)

STEP 3: Goals and specific Measurable Objectives

• Broad Goals
  • Goals for organisation (e.g. University and Hospital)
  • Goals for the participants (e.g. the adult learners undertaking the new course)
• Measurable Objectives
  • *Galileo: ‘measure what is measurable, and make measurable what is not’
  • If there are no ‘measurable objectives’ we have no idea whether simulation has had an impact.  Where possible attach new courses to a research project.
• Kilpatrick-Phillips Model may apply to our systmatic analysis:

STEP 4: Select Educational Strategies

Decide whether simulation is the best method for the participants to learn…

Consider the following models when planning:

• ‘Mastery Learning’
  • a specific rigorous approach to achieving proficiency in a particular task
• ‘Deliberate practice’
  • ‘Experience does not = Expertise’
• ‘Directed Self Regulated Learning’
  • relatively ‘hand’s off’ for staff but left up to individual to access

STEP 5: Implementation (including political support and securing resources)

• The aim is an ‘efficient and strategic integration of simulation’ into the overall existing curriculum
• Things to consider:
  • Your Local Hospital and State politics
    • How does the current ‘climate’ affect your simulation centre and resources?
    • There may be opportunities in politics (simulation is a popular photo opportunity for politicians and hospital managers)
  • Administration – what secretarial and online support resources are needed?
  • What are the potential barriers to simulation?
    • Consider, what are the knock on effects of the new training?
    • Who will the new simulation courses effect (and upset)?
  • Consider small scale pilot-testing of new programs
  • Consider utilisation of students – either for employment (likely cheaper than consultants for opening up the lab or minor tasks) and also as volunteers.

‘To run a room that is fully booked all the time is better than an empty sim lab.’

STEP 6: Evaluation and Feedback

• Use a specific tool to get high quality feedback (OSAD)

‘Change NOTHING = NOTHING Changes’

Take Homes

• Got a fancy new simulation manikin?
• Choose wisely by following the 6-step approach for new simulation…
• Good planning prevents piss poor performance.