1. High Fidelity Simulation for Healthcare Education.Time to move forward? Helen Wood Nursing Education Specialist Mayo Clinic Health Systems Rochester Minnesota

3. More nurse educators

5. Towards Hypothesis Driven Medical Education Research: Task Force Report From the Millennium Conference 2007 on Educational Research Could simulated emergency procedures practiced in a static environment improve the clinical performance of a Critical Care Air Support Team (CCAST)?: CONCLUSION: For CCASTs to have a standardized training curriculum, they should undertake real-time missions in a flight simulator, supported by a human patient simulator programmed to respond to the physiological changes associated with altitude. Real scenarios could then be practiced, on demand, in a safe environment as an augmentation to the current training program. Consequently, those acquired skills could then be carried out with improved proficiency during real missions with a concomitant potential for improvement in the standard of patient care

6. Challenges to consider when diffusing SBME (simulation based medical education) into medical education. The right conditions: Mastery Learning and deliberate practice Skillful Faculty Curriculum Integration Institutional Endorsement Healthcare System Acceptance

7. Summit on Simulation Research Institute of Medicine studies/reports (1999 - 2003) strongly suggest that the traditional apprentice model” has not sufficiently prepared today’s health care providers. For example medical errors: Result in 44,000-98,000 deaths annually 8th leading cause of death (at 44,000) $37-50 billion for adverse events $17-29 billion for preventable adverse events

8. How does healthcare simulation work and what is it? http://youtu.be/I_NEsLXtuwI

9. Issenberg SB, McGaghie WC, Petrusa ER, et al. Eeatures and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10-28. McGaghie WC, Issenberg SB, Petrusa ER, et al. Effect of practice on standardised learning outcomes in simulation-based medical education. Med Educ 2006; 40: 792-797.

10. Elements of Diffusion There are four elements of diffusion (Rogers, 2003) AN INNOVATION COMMUNICATION TIME A SOCIAL SYSTEM.

14. 1. INNOVATORS

15. 2. EARLY ADOPTERS

16. 3. EARLY MAJORITY

17. 4. LATE MAJORITY

19. The Origins of Simulation in Nursing Education During the past decade, the use of simulations as a teaching-learning intervention in nursing curricula has increased greatly. Nursing students, clinicians, and educators alike appear to be strongly in agreement about the importance of incorporating simulations as a teaching practice because of several factors

21. Compatibility ( the degree to which an innovation is perceived as being consistent with the existing values, past experiences, and needs of potential adopters)

22. Complexity ( the degree to which an innovation is perceived as difficult to understand and use).

23. Trialability (the degree to which an innovation may be experimented with on a limited basis)

25. Faculty Observations: High Fidelity Simulation vs. Live Clinical Scenarios Shortridge, A., McPherson, M., Ellison, G. & Kientz, E. (2008). A Case Study Implementing High Fidelity Clinical Skills Education Using Innovation Diffusion Theory . In J. Luca & E. Weippl (Eds.), Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications 2008 (pp. 3054-3062). Chesapeake, VA: AACE.Retrieved from http://www.editlib.org/p/28804

26. Simulation-based education improves proceduralcompetence in central venous catheter (CVC) insertion. The effectof simulation-based education in CVC insertion on the incidenceof catheter-related bloodstream infection (CRBSI) is unknown.The aim of this study was to determine if simulation-based trainingin CVC insertion reduces CRBSI. Simulation-based education improves proceduralcompetence in central venous catheter (CVC) insertion. The effectof simulation-based education in CVC insertion on the incidenceof catheter-related bloodstream infection (CRBSI) is unknown.The aim of this study was to determine if simulation-based trainingin CVC insertion reduces CRBSI. There were fewer CRBSIs after the simulator-trainedresidents entered the intervention ICU (0.50 infections per1000 catheter-days) compared with both the same unit prior tothe intervention (3.20 per 1000 catheter-days) (P = .001)and with another ICU in the same hospital throughout the studyperiod (5.03 per 1000 catheter-days) (P = .001). An educational intervention in CVC insertionsignificantly improved patient outcomes. Simulation-based educationis a valuable adjunct in residency education. Barsuk, J., Cohen, E., Feinglass, J., McGaghie, W., & Wayne, D. (2009). Use of simulation-based education to reduce catheter-related bloodstream infections. Archives of Internal Medicine, 169(15), 1420-1423. doi:10.1001/archinternmed.2009.215

27. Conclusion “In Situ” Simulation as a Strategy Simulation training conducted on a hospital unit where real patient care is delivered and errors occur Allows clinicians to practice & problem solve patient issues with their team in their “real” work Environment Allows opportunity to uncover and identify latent safety threats and Micro-system deficiencies

28. The effects of a simulation-driven, patient safety program aimed at improving early detection & treatment of hospital-acquired complications will: PRIMARY OUTCOMES: Decrease Rate of hospital-acquired: Rate of unplanned transfers to higher level of care Risk-adjusted hospital mortality Severe sepsis/septic shock Acute respiratory failure SECONDARY OUTCOMES: Improve: Teamwork performance and communication skills Knowledge, critical thinking and decision-making Safety culture on involved units Nurses’ comfort & confidence in calling for help early Patterns of social interaction among nurses and residents

29. Summary facts found from Beacon Benchmarking: Success with simulation program largely due to :Buy-in from the CMO & CNO Strong partnerships with Unit Leadership Conducting frequent, in situ simulation exercises: Feasible Not dependent on “fidelity” Participants enjoy in situ simulation training Simulation training reveals deficiencies with teamwork; debriefing offers unique coaching opportunity A simulation-driven patient safety program holds serious opportunity in improving clinical outcomes _ ...

30. References Barsuk, J., Cohen, E., Feinglass, J., McGaghie, W., & Wayne, D. (2009). Use of simulation-based education to reduce catheter-related bloodstream infections. Archives of Internal Medicine, 169(15), 1420-1423. doi:10.1001/archinternmed.2009.215 Cannon-Diehl, M. (2009). Simulation in healthcare and nursing: state of the science. Critical Care Nursing Quarterly, 32(2), 128-136. doi:10.1097/CNQ.0b013e3181a27e0f Eleven Research Priorities developed by the Millennium Conference 2007 Retrieved http://journals.lww.com/academicmedicine/_layouts/oaks.journals/imageview.aspx?k=academicmedicine:2010:05000:00027&i=ttu3a Farfel, A., Hardoff, D., Afek, A., & Ziv, A. (2010). Effect of a simulated patient-based educational program on the quality of medical encounters at military recruitment centers. The Israel Medical Association Journal: IMAJ, 12(8), 455-459. Retrieved from EBSCOhost. Fincher, R., White, C., Huang, G., & Schwartzstein, R. (2010). Toward hypothesis-driven medical education research: task force report from the Millennium Conference 2007 on educational research. Academic Medicine: Journal Of The Association Of American Medical Colleges, 85(5), 821-828. Retrieved from EBSCOhost Gaba, D. (2004). The future vision of simulation in health care. Quality & Safety in Health Care, 13 Suppl 1i2-i10. Retrieved from EBSCOhost Issenberg SB, McGaghie WC, Petrusa ER, et al. Eeatures and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10-28. McGaghie WC, Issenberg SB, Petrusa ER, et al. Effect of practice on standardized learning outcomes in simulation-based medical education. Med Educ 2006; 40: 792-797 McGaghie, W., Issenberg, S., Petrusa, E., & Scalese, R. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education, 44(1), 50-63. Retrieved from EBSCOhost . McGaghie, W., Issenberg, S., Petrusa, E., & Scalese, R. (2010). A critical review of simulation-based medical education research: 2003-2009. Medical Education, 44(1), 50-63. Retrieved from EBSCOhost Towards Hypothesis Driven Medical Education Research: Task Force Report from the Millennium Conference 2007 on Educational Research http://journals.lww.com/academicmedicine/_layouts/oaks.journals/ImageView.aspx?k=academicmedicine:2010:05000:00027&i=TTU3A Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press Shortridge, A., McPherson, M., Ellison, G. & Kientz, E. (2008). A Case Study Implementing High Fidelity Clinical Skills Education Using Innovation Diffusion Theory. In J. Luca & E. Weippl (Eds.), Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications 2008 (pp. 3054-3062). Chesapeake, VA: AACE.Retrieved from http://www.editlib.org/p/28804 _ ...