MEdSim continued its presence at international conferences through July. Publisher & CEO Andy Smith, Editor Judith Riess, US Sales Representative Justin Grooms and Group Editor Marty Kauchak provide recurring themes from select conferences’ keynote addresses, breakout sessions and the exhibition floors.
Our editorial team continued to see common themes and challenges facing the healthcare community. All conferences highlighted patient safety and addressed ways to improve education and training through rigorous curriculum development and the use of simulation. While still faced with technological barriers, lack of resources they looked for solutions to the problems. International Simulation Center Directors talked about sharing curriculum across nations and surgeons around the globe highlighted the need to have international skills certification and standardization of medical procedures.
New Orleans was the venue for the May 8-10, 2013 15th Annual National Patient Safety Foundation (NPSF) Congress.
The key theme that resonated throughout the three-day event was simulation can advance the patient safety mission. But the road leading to improved levels of patient safety using simulation is often winding, with occasional hazards and roadblocks.
Wednesday morning and afternoon’s sessions on Advancing the Patient Safety Mission Through the Use of Simulation, provided insights on a number of foundational skills and knowledge sets needed to get simulation programs and processes up and running, and maintain their effectiveness. Not lost on the attending delegates at these sessions was the compelling need to get things right the first time, during the layout and design of simulation centers and in other activities. “Do overs” in adjusting simulation systems and processes are often costly in terms of resource expenditures, and may adversely impact patient safety.
Another impression from the three days of NPSF events is the increasing importance of team training and activities in simulation centers and other training venues. And while the S&T sector is providing simulation labs, and their enabling equipment and systems to allow teams to learn, refresh and rehearse their hands-on skills, there are also “soft skills” – communications, on-the-job behaviors and the like which if not mastered – may be distractors, or worse, among team members.
The Thursday Keynote Session: Bedside Manners focused on the effects of ineffective soft skills in hospital venues and served as a wake-up call for the healthcare community to build these capabilities.
Another trend in team training gleaned from the conference’s proceedings is the inclusion of expanded healthcare providers in scenarios and events. While training sessions continue to focus on surgeons and nurses, the addition of other staff, like pharmacist to validate medicine dosages, and scenarios with patients and family members to understand procedures and follow-up care are being used in many medical schools and hospitals.
A final, emerging topic of interest was the case for simulation center staff and faculty development. This requirement is frequently forgotten but is obviously crucial and often not covered in budgets.
Despite government miss-steps in funding and sequestration in the military, the VA and DoD continue to acquire training systems and devices. So while contract awards may “move to the right” by one or two quarters, government healthcare providers are still looking to buy technology enablers for their learning programs.
NPSF and this June’s SESAM (Society in Europe for Simulation Applied to Medicine) both raised the issue of “just” or “no fault found” reporting of incidents/ accidents – which the sector as a whole might not appreciate but the airline industry’s “no fault found” has improved airline procedures and safety, and is mandated reporting. Our viewpoint is that even if limited to a single hospital or group of hospitals, a “just” reporting system would highlight problems/shortfalls that could be addressed through education and training and could be embedded into medical education curricula.
Funding and obtaining other resources for curriculum development and education courses using simulation is a challenge around the globe.
SESAM, which convened this year in Paris, brought simulation directors, medical educators and healthcare providers together to brainstorm and come up with solutions to recurring problems. In the case of simulation centers in the EU, for example, although initial government funding for five years of operations can be achieved, what it can be used for is restricted. No commercial activity can be started by the center in those five years and there is no funding for curriculum development, maintenance and updates after that initial grant. Centers have a unique problem: sustainment! Sessions with EU nations’ simulation center directors highlighted each countries successes and problems and sought solutions for how they could collaborate on curriculum development, assessment, sustainment and return on investment strategies.
Listening to presentations throughout the conference season, the subject of patient safety was front and center with the crystal clear implication that better and ongoing training will improve patient safety. There was an elusive and critical “third link” that many presenters did not address – returns on investment, in particular those that lead to lower costs.
The 2nd SURGICON Conference held in Gothenburg, Sweden gave us a global perspective of medical education and training through the use of simulation throughout a surgeon’s training.
Other items of interest discussed at SURGICON were to use simulation to address critical errors during actual procedures. Conceptually, three months after an “event” a group would run an exercise in the ward or OR, closely modeled on the event, as a way of seeing if there were skills or other gaps that could be addressed to prevent a recurrence of “negative events” from that incident.
A second area was developing international standards and procedures and certifications so that medical doctors trained in one area of the world could perform procedures in a different world location. Ireland’s surgical program which incorporates simulation throughout a doctors training was discussed and they wanted to find other similar programs that could be used as models in other countries.
Australia and Ireland have very effective rural health programs through the use of traveling health coaches. In fact, Australia borrowed the idea from Ireland and both are quite effective in delivering health care to rural populations.
At this June’s 12th Annual International Nursing Association for Clinical Simulation and Learning conference in Las Vegas, evidence-based practice was a major theme throughout the sessions. One presentation highlighted the Patient Outcomes in Simulation-Based Medical Education: A Systematic Review (Zendejas et al, 2013). The academic endeavor noted the simulation community’s failure to provide adequate, timely, quality studies to document the benefits of using learning technology to prepare for actual medical procedures.
Of 10,903 articles screened, 50 reported patient outcomes for 3,221 trainees and 16,742 patients.
The presentation noted, “Simulation-based education was associated with small to moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical significance.”
Clearly the S&T sector has an opportunity and challenge to respond to the question: why simulation? Inter professional skills development was discussed in a number of sessions dealing with different levels of nurse training. Many schools are incorporating team training with medical students, nursing students and others at the beginning of their educational programs. Patient safety was an implied and explicit through many of the breakout sessions at this conference.
During discussions with delegates on the conference floor, we were impressed by their awareness of products which operate well in a standalone mode as well as networked, especially in a medical simulation center environment.
The Hamlyn Symposium on Medical Robotics held in London, ranged from keynote addresses by Intuitive Surgical’s CEO and Titan Medical’s CEO on robotic surgical advancements to surgical robots retrieving foreign bodies from a beating heart. Hamlyn grew from Imperial’s Cross Faculty Workshops to an international forum for clinicians, engineers and researchers to exchange ideas and explore new challenges in healthcare technologies. Presentation topics ranged from training and clinical outcomes, image guidance in robotic surgery, as mentioned above, to new clinical approaches and pilot studies on evaluations in the control of a flexible surgical robot. The number of countries involved in robotic surgical advancements was impressive.
At HPSN World, convened June 30-July 2 in San Francisco, Michael Bernstein, the President of CAE Healthcare, in his opening address, encouraged companies to form an alliance to improve healthcare much as the airlines did. He discussed the fact that medical error accounts for as many deaths as five jumbo jets crashing each week.
The conference keynoter gave an impressive presentation on the importance of team training. Presenters from around the globe highlighted best practices and new simulation technologies including a sneak peek at the CAE Childbirth Simulator that is due out in 2014.
A number of sessions talked about the art of debriefing and how important it was in simulation.
Throughout the conference simulations were conducted on the show floor as they were at NPSF.
Mobile rural healthcare simulation and training was a key issues that many US states have to deal with and developing realistic scenarios that meet the needs of a rural, almost all volunteer EMS team and limited hospital facilities, was a topic of interest as were the sessions on scenario development, team training, core skills training and effective evaluation.