On Wednesday, October 9, 2019, Halldale Industry Reporter Amanda Towner attended the Simulated Participant Workshop hosted by Avkin and the University of Central Florida (UCF) at the UCF campus in Orlando, Florida.

Attended by clinical educators and program directors, the event began with a presentation by Amy Cowperthwait, Avkin CEO, co-founder of Healthcare Theater and coordinator for the Adult Health Simulation Resource Center, University of Delaware, on the best practices for standardizing simulated participants (SPs). Standardization ensures that every simulation experience presents the same degree of challenge to meet the simulation objectives, so the SP performance does not change in difficulty with different performances or with different actors. Regardless of the team’s abilities, the objectives are not adjusted to help those that are struggling or to challenge those that are doing well.

Amy Cowptherwait, Avkin CEO, co-founder of Healthcare Theater and coordinator for the Adult Health Simulation Resource Center, University of Delaware, demonstrates tracheal suctioning on Simulated Participant Cory Haaf, MSN/RN, using Avkin’s Avtrach during an SP Showcase.

To ensure standardization, character descriptions need to be extremely detailed and thorough, so that SPs do not fill in the performance from their own knowledge or react in a way they think is appropriate. Any medical information used in the description should only be the essential information that the patient or family member already know. For example, a character description of a cystic fibrosis child would include the information parents would already know when caring for their child, so SPs/family members who are acting it out will have realistic interactions with the provider.

When coming up with the description, Cowperthwait advises, “The backstory is more important than medical jargon.”

Descriptions should focus on explanations of why and how a character feels or reacts.

Cowperthwait uses these techniques in the character descriptions for the University of Delaware’s Healthcare Theater program, an undergraduate course that teaches enrolled students to become SPs/family members for several healthcare simulations. About 90 percent of the students enrolled in the courses are in premed, nursing or physical therapy tracks, and to get them prepared for their roles, improvisation is also used. A student might ask an SP questions that are not anticipated like, “how did you break your arm?” if a fracture was involved, and an SP would have to respond appropriately. This can help the students become comfortable with improvisation and aid them in learning how to develop therapeutic relationships and communication skills.

A dress rehearsal is held one week before each simulation, where all SPs (and preferably a veteran SP), an SP educator, and facilitators from all disciplines run through the simulation together. An overview of the simulation is provided, and the Round Robin brainstorming technique is used so that every participant has an opportunity to discuss their roles. A quiz is given before the SP dress rehearsal and those that do not pass spend an extra hour in the control room giving feedback on other sims before they participate.

During the simulation, healthcare faculty and an SP educator prepare coaching notes to review with students.

When giving feedback, the facilitators and SP educators at the University of Delaware follow eight steps to make sure feedback is effective. Feedback is given in third person-patient perspective in a sandwich approach: 1 positive comment, followed by 1-2 negative, and lastly 1 more positive comment. Constructive feedback is also limited so only 1-2 comments are given. All comments given are about an action and not an entire simulation, and the actions relate to an emotion at a specific moment in time to avoid confusion. For example, “When you began washing Amy’s arm, she felt soaked because you didn’t wring out the sponge before you washed her arm.” Cory Haaf, MSN/RN, a former University of Delaware student, still remembered this comment he received in a simulation at Healthcare Theater, because the imagery and the emotion really made an impact and helped him remember the scene quite vividly.

When SPs give feedback, they should focus on how the patient felt instead of focusing on critical thinking of the performance from a medical perspective. The SPs should also avoid vague adjectives such as “appreciated” to avoid confusion, and should avoid general statements, which can be taken personally.

Cowperthwait also encourages that the SP educator end the session by verifying that the feedback given is understood, and to conclude by thanking the participants — not by saying they did a “good” job, so as to create a learning environment and not an evaluation.

Cory Haaf, MSN/RN, demonstrates Avkin’s Avtrach for the SP Showcase.

SP Showcase

After the presentation, attendees were invited to watch an SP Showcase using an Avkin Avtrach device. We gathered into the simulation room, which had several examination tables dressed with exam paper, a hospital bed with an electric headwall, and doors that led to “Exam Rooms.” Shelves held anything you would expect to find in a doctor’s office or patient room, such as gloves and alcohol wipes. Haaf, our SP, placed the Avtrach over his chest and put on a medical gown to give the illusion that the device was his own body. Cowperthwait turned on the suctioning device that was plugged into the electric headwall and placed the suctioning catheter into the plate to remove mucus. When Cowperthwait pushed too hard on the plate or the catheter was too deep, the straps on the Avtrach vibrated, which cued Haaf to react in pain and discomfort. We could see the mucus as it was suctioned out, and we were able to take turns suctioning it ourselves. We could also use a stethoscope to hear the patient’s heartbeat, which was broadcasted through the device according to the settings programmed in the Avkin app.

This approach of using an SP with the Avtrach evoked a lot of emotion from myself. It was difficult to watch as Haaf convulsed in pain in response to his treatment, even though it was only a simulation. Clinical educators discussed the importance of using SPs, and how they have observed changes in their students’ performances when they are used. One educator said that it gave a professional approach to procedures that dealt with lower genitalia. He observed that his students’ elbows would touch or rest on the legs of a manikin when inserting a urinary catheter. However, if students’ elbows touched the legs of an SP in the same kind of procedure, the response was to quickly and voluntarily tuck in their elbows to avoid making the patient uncomfortable.

UCF College of Nursing Study

Following the demonstration was a presentation of a study conducted by UCF College of Nursing staff including Laura Gonzalez, PhD, APRN, CNE, CHSE-A, Associate Clinical Professor; Desiree Díaz PhD, RN-BC, CNE, CHSE-A, ANEF Assistant Professor, Faculty Consultant to Simsations-4-Life Club; and Mindi Anderson, PhD, APRN, CPNP-PC, CNE, CHSE-A, ANEF, FAAN, Associate Professor and Program Director of the Healthcare Simulation Program. Their study, titled “Content Expert versus Expert Facilitators: Implications”, studied how much of an expert one had to be to create content for simulation scenarios. Results from the study will be released in the future.