In this second of two invited articles, John J. Schaefer, III, MD describes the operational and educational approach of HealthCare Simulation of South Carolina.
This is the second of an invited two-part series about the simulation collaborative that has developed in South Carolina. In 2006 South Carolina’s three state Universities established a collaborative and endowed chair to increase the utilization of simulation for the benefit of South Carolinian patients, students and healthcare workers. As of 2012, HealthCare Simulation of South Carolina has grown to include 10 collaborative and 20 affiliated partners, with a 20-fold increase use of simulation (about 50,000 sims/yr.).
The first article (MEdSim 4 2012) focused on the origin, development and infrastructure of the collaborative and its statewide office. Part two will focus on the specific educational and operational methodologies underlying the high volume, low cost simulation that has been a significant key to the success of the organization.
Defining “Practical Simulation”
There are three “Practical Simulation” elements supporting our organizational model: simulation as a teaching methodology that takes advantage of simulator tools where diverse and large numbers of Healthcare students and practitioners have individual and group access to training; healthcare teachers with reasonable training can adopt simulation training methodologies rapidly and the “value” of using simulation justifies the capital, operating and indirect costs associated with it.
How to make simulation practical?
At the heart of our approach is shifting the complexity from needing an expert operator running a simulator manually and expert instructor teaching the course towards an approach where any teacher can run the simulator using simple to run pre-programmed scenarios (that were complex to develop) and running the course using an “expert” curricula. By decreasing the complexity of teaching the course and running the simulator, the utilization can be increased. In some appropriate instances, one teacher can supervise multiple simulation stations where students are working in small groups running the simulators themselves. We call this approach an “Expert Curriculum-Competent Facilitator Model”.
Basic Emergency Airway Management course for medical students with one facilitator, 12 students using four simulators with students running simulator scenarios after five minutes of training (graded course).
Elements of a HCSSC “Practical Simulation Course”:
1. Internet-based “Participant Curricula”: To minimize dedicated instructor time away from clinical revenue generating activities, this self-paced discrete component is reviewed by motivated, responsible, adult learners prior to dedicated simulation training component of training.
2. Internet-based “Facilitator Curricula”: This component is required to provide critical standardization of delivered educational objectives (for any given educational topic, different instructors will teach different things without structure) and lower the threshold for training of instructors (most clinician teachers are not formally trained as educators).
3. Standardized, objective driven, highly automated simulator scenarios: The simulation exercise uses a well designed, pre-programmed simulation scenario run by the facilitator (teacher). This scenario incorporates semi-automated evaluation of key educational objectives embedded in the scenario that are automatically flagged for focused feedback specific to the individual or group's performance and additionally provides standardization of the whole evaluation/feedback process.
4. Automated grading incorporated in simulator “Debriefing Log”: The simulation exercise uses a well designed, pre-programmed simulation scenario run by the facilitator (teacher). This scenario incorporates semi-automated evaluation of key educational objectives embedded in the scenario that are automatically flagged for focused feedback specific to the individual or group's performance and additionally provides standardization of the whole evaluation/feedback process. The facilitator then uses this debriefing file as an educational diagnosis that when coupled with a standardized "reflection" process leads to a focused, standardized (yet individually specific) learning encounter with the student. The facilitator uses the flagged performance point in the debriefing log and guides the student through reflection to determine whether the lapse identified was secondary to a "knowledge", "skill" or "judgment" flaw. At this point the facilitator guides the student to the better or correct way to perform. During this process the facilitator also reinforces positive performance points identified automatically in the scenario and presented in the debriefing log. Depending on the equipment used, a video record is available and specifically tagged to each evaluation point for use as needed in the debriefing process.
5. Documented “Value Statement”: The saved debriefing files can later act as an objective record that with some administrative support can be used for creating a summary of the learning across multiple students or for research. With some of the additional technology available (i.e., B-Line Medical SimBridge), trainee and faculty portfolios can be made available over the Intran et for additional reflection.
Summary of Operational and Educational Pedagogy:
Operationally this approach is significantly cheaper to run in that one simulation specialist can support up to eight independent rooms where traditional approaches require an expert simulator operator for each simulator. As part of services available within the collaborative, support for training the trainer as it applies to: loading and running scenarios; accessing and using curricula; and a primer on debriefing with objective driven scenario logs is available. Within the statewide collaborative, approximately 30 courses/modules and 1,000 scenarios are supported for use within the collaborative applying these methodologies.
The operational and educational approach described in this article, is an applied example of commoditization of previously complex, costly approaches to simulation education and operation by making available broadly, at a lower cost, what previously only experts in simulation could offer at a much more expensive price. It is the mission of HealthCare Simulation of South Carolina to facilitate access to simulation based educational methods for healthcare educators throughout the state of South Carolina.
Editor’s Note: All imagery is credited to John J. Schaefer, III, MD.