Healthcare Simulation at a Glance E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: At a Glance
• Sprache: Englisch

Seitenzahl: 199

Veröffentlichungsjahr: 2019

Beschreibung

Healthcare Simulation at a Glance presents an accessible overview of everything you need to know about simulation in clinical practice and healthcare education.

From embedding simulation in programmes, to technical and non-technical features of simulation in a variety of contexts, to how simulation can be used in assessment and the provision of feedback to healthcare professionals, this practical guide is the perfect resource for developing the skills and knowledge required as both a student and an educator.

Healthcare Simulation at a Glance:

• Introduces the concepts and theories underpinning simulation practice
• Provides an understanding of the key terms and processes involved
• Includes a range of examples and tips for easy application in practice

Healthcare Simulation at a Glance is ideal for both those new to using simulation in education, as well as experienced academics.

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Healthcare Simulationat a Glance

Edited by

Kirsty Forrest

Professor of Medical Education and Research,

Dean of Medicine, Faculty of Health Sciences

and Medicine, Bond University, Gold Coast,

Australia

Judy McKimm

Professor of Medical Education and Director of Strategic Educational Development, Swansea University Medical School, Swansea, UK Visiting Professor, King Saud University, Riyadh, Kingdom of Saudi Arabia

This edition first published 2019

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Library of Congress Cataloging-in-Publication Data

Names: Forrest, Kirsty, editor. | McKimm, Judy, editor.

Title: Healthcare simulation at a glance / edited by Kirsty Forrest, Judy McKimm.

Description: Hoboken, NJ : Wiley-Blackwell, 2019. | Series: At a glance

 series | Includes bibliographical references and index. |

Identifiers: LCCN 2019017159 (print) | LCCN 2019018355 (ebook) | ISBN

 9781118871829 (Adobe PDF) | ISBN 9781118871836 (ePub) | ISBN 9781118871843

 (paperback)

Subjects: | MESH: Education, Medical--methods | Simulation Training | Handbook

Classification: LCC R837.S55 (ebook) | LCC R837.S55 (print) | NLM W 49 | DDC

 610.1/1--dc23

LC record available at https://lccn.loc.gov/2019017159

Cover image: © choja / Getty Images

Cover design by Wiley

CONTENTS

Cover

Contributors

Preface

Acknowledgements

Part 1 Overview and broad concepts

1 Simulation

Historical context

Drivers and rationale

Benefits for learners

Future directions

2 What is simulation education

A technique – not a technology

The simulation process

The safe learning environment

A need for quality educators

3 Fidelity

Simulation vs. manikin fidelity

Fidelity vs. learning outcomes

The solution?

4 Research in healthcare simulation

Ethics of simulation-based research

Research design

Summary

5 The evidence base for simulation education

Evidence for what?

Summary

Part 2 Simulation and education

6 Learning theories and simulation education: 1

Experiential learning theory

Behaviourism and deliberate practice

Automaticity

Cognitivism

Social learning theory

7 Learning theories and simulation education: 2

Constructivism

Social cognitive theory

Situated learning theory

Activity theory

8 Teaching with simulation

Simulators

What can be taught?

Debriefing

9 Embedding simulation in a programme

Identify

Learn

Quality

Assessment

Feedback for learners

Feedback for faculty

Summary

10 Developing scenarios

Planning scenarios

Patient involvement

Techniques for checking feasibility

Documenting scenarios

Templates for writing scenarios

11 Lesson planning

Curriculum integration

Learning outcomes

Structure

The brief

Scenario building and delivery

Matching tools to goals: fidelity to complexity

The debrief

Part 3 Simulation in practice

12 The simulation centre

History

Purpose

Structure

People spaces

The simulated environments

Technical provision

Summary

13 Technical skills simulators

Part task trainers

Animal training models and cadavers

Hybrid simulation

Virtual reality simulators

Haptic virtual reality simulators

Combining simulators to create a simulated clinical scenario

Summary

14 Manikins

Fidelity and technology

Hybrid simulation

Usage

Debriefing with manikins

Summary

15 Audio and video recording

Video cameras and audio capture

AV transmission

AV storage

AV playback

16 Learning technologies and simulation

Virtual patients

Immersive technologies

Serious games

Wearable technologies

Learning analytics

17 Distributed simulation

DS components

The evidence

Sequential simulation

18 Engagement and simulation science

Concept of engagement

Engagement space

Engagement through simulation

An example of care pathway modelling

Engagement and simulation science

19 In situ and mobile simulation

Mobile simulation

In situ simulation

Practical considerations

20 Human factors

Human factors and errors

Areas for improvement

Designing simulation with a human factors’ focus

Implementation

21 Non-technical skills

Historical perspective

Developing a taxonomy

Situational awareness

Decision making

Task management

Team working

22 Team working

Importance of teamwork and collaborative practice

Team training and simulation

Designing simulation-based team training

Interprofessional team working

23 Crisis management

Preparing for crises and crisis avoidance

Key activities of crisis management

24 Simulated and standardised patients

Definitions

History

Learning and teaching

Advantages of SPs

Disadvantages of SPs

Selection and training

Part 4 Assessment, feedback and remediation

25 Principles of assessment

What to assess?

How to measure performance?

Who should rate performance?

Where to assess?

When to assess?

Evaluation

26 Learner-centred assessment

Competency-based medical education

Simulation and learner centredness

Learner feedback

Portfolios of learning

27 Learning and assessing professionalism using simulation

Definitions of professionalism

Effect of external and internal stressors

Simulation learning and professionalism

Simulation, assessment and professionalism

28 The debrief

Structure origins

Outline

Summary

29 Recruitment and selection

Simulation in high stakes assessment

Simulation for recruitment

Simulation for recruitment in healthcare

Summary

30 Feedback

What is feedback and why is it important?

Feedback and the learning process

Principles of effective feedback

Receiving feedback

Barriers to effective feedback

When things go wrong

31 Ethics and simulation

Design and preparation

Implementation

Physical and psychological safety

Following simulation

32 Mentoring and supervision

Building relationships

Mentoring

Mentoring models

Supervision

33 Simulation and remediation

Remediation

Approach and mind set

Role of simulation

Summary

Part 5 Developing your practice

34 Developing your practice

Excellent teaching

Scholarly teaching

Scholarship of teaching

Research

Professional activities

References

Index

End User License Agreement

Guide

Cover

Table of Contents

Preface

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Contributors

Kash Akhtar Chapter 4

Senior Clinical Academic Lecturer, Barts and the London School of Medicine and Dentistry, QMUL and Consultant Trauma and Orthopaedic Surgeon, Barts Health NHS Trust, London, UK

Pamela Andreatta Chapter 6

Professor, University of Central Florida, Orlando, Florida, USA

Margaret Bearman Chapters 7, 10

Associate Professor, Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Australia

Fernando Bello Chapters 17, 18

Professor of Surgical Computing and Simulation Science, Imperial College, London, UK

Laurence Boss Chapter 28

Consultant Anaesthetist, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK

Victoria Brazil Chapters 5, 19

Professor of Emergency Medicine, Bond University, Australia

Arunangsu Chatterjee Chapter 16

Associate Professor, Director of Technology Enhanced Learning and Distance Learning, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK

Faiza Chowdhury Chapters 13, 14, 20, 21

Clinical Research Fellow, Imperial College, London, UK

Kirsty Forrest Chapters 2, 24, 30, 34

Professor of Medical Education and Research, Dean of Medicine, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia

Andi Fox-Hiley Chapter 11

Health Care Education Advisor, Leeds Teaching Hospitals, Leeds, UK

Thomas Gale Chapters 25, 26, 29

Clinical Associate Professor, Director of Clinical Skills and Simulation, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK

Jivendra Gosai Chapter 14

Consultant Cardiologist, Bradford Royal Infirmary, Bradford, UK

Mark Hellaby Chapters 1, 3, 15

North West Simulation Education Network Manager, NHS Health Education England, London, UK

Roger Kneebone Chapters 17, 18

Professor of Surgical Education and Engagement Science, Imperial College, London, UK

Andy Kordowicz Chapters 20, 21

Consultant Vascular Surgeon, York Hospitals NHS Foundation Trust, York, UK

Al May Chapter 28

Associate Director and Faculty Development Lead, Scottish Centre for Simulation and Clinical Human Factors, Larburt, UK

Michelle McKenzie Smith Chapter 8

Clinical Skills, Simulation, Resuscitation and Manual Handling Manager, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Doncaster, UK

Judy McKimm Chapters 24, 32, 33

Professor of Medical Education and Director of Strategic Educational Development, Swansea University Medical School, Swansea, UK

Nancy McNaughton Chapter 31

Director, Centre for Learning, Innovation and Simulation, Michener Institute of Education at UHN, Toronto, Ontario

Maggie Meeks Chapter 27

Clinical Education Advisor and Neonatal Paediatrician, University of Otago, Otago, New Zealand

Debra Nestel Chapters 4, 6, 7, 10, 31

Professor, Monash Institute for Health and Clinical Education, Monash University and Department of Surgery (Austin), University of Melbourne, Melbourne, Australia

Jane Nicklin Chapters 8, 9, 11, 12

SimSupport, York, UK

Martin Roberts Chapters 25, 26, 29

Lecturer in Assessment Psychometrics, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK

Ann Sunderland Chapter 9

Lead for Clinical Simulation/Senior Lecturer, Leeds Beckett University, Leeds, UK

Sharon Marie Weldon Chapters 17, 18

Senior Research Fellow, Faculty of Medicine, Department of Surgery and Cancer, Imperial College, London, UK

Jenny Weller Chapters 22, 23

Professor of Medical Education, University of Auckland, Auckland, New Zealand

Tim Wilkinson Chapter 27

Professor, Director MBChB, University of Otago, Otago, New Zealand

Preface

Welcome to the first edition of Healthcare Simulation at a Glance. This book was conceived as an introduction to key aspects of simulation education which would provide an accessible overview for those new to simulation education or a handy summary for those more experienced. The content and topics in this book are explored in more detail in the companion text (also published by Wiley): Essential Simulation in Clinical Education. A wider perspective on medical and health professions’ education is taken in other books produced by Wiley such as Understanding Medical Education (3rd edition 2018) and Researching Medical Education (2015).

Healthcare Simulation at a Glance will be relevant to doctors, dentists, nurses and other healthcare professionals at various levels, including students and those in postgraduate training, as well as to technical and support staff. The book is particularly appropriate for guiding academics, clinicians, supervisors and trainers who wish to learn more about and introduce simulation activities into their programmes. As well as the chapters written by ourselves, we have been fortunate in attracting additional international contributors with huge expertise and knowledge about simulation education in both the academic and clinical environments.

In the usual at a Glance style, the book is designed to summarise what are often fairly complex or substantial topics, so that readers learn some of the key concepts, language and key terms while gaining a broad understanding of the topic. What we have aimed to do is provide an introduction to key educational concepts as they relate to simulation in clinical practice and university-based education. The chapters are practically focused with examples of how concepts or approaches might be applied in practice. Each chapter (or group of chapters) is free-standing, although reading the whole book will provide a good grounding in simulation education theory and practice.

The book is structured into five sections. It begins with an overview and introduction to simulation, its purpose, the concept of fidelity and the evidence base for simulation education. Part 2 focuses on the learning theories that underpin approaches, teaching simulation (lesson planning and scenario development), and how to embed simulation into a programme. The next section looks at some of the technical and non-technical aspects of simulation in various contexts and how patients (real or simulated) can be involved in simulation education. Part 4 goes on to consider how simulation is used in assessing and giving feedback to health professionals, how it is used at various stages of education and training (such as recruitment) and in professional development and remediation activities. The last chapter considers how simulation educators can develop their own practice through various activities and approaches. A comprehensive reference list concludes the book. We hope that you enjoy the book, that you learn something from it, and that it stimulates you to try out new approaches and activities using simulation.

Kirsty Forrest and Judy McKimm

Acknowledgements

We would like to acknowledge all the contributing authors who have offered different perspectives on various aspects of simulation education. The book reflects our experiences over many years working with learners, teachers and patients in a range of international contexts, and we would also like to acknowledge their contribution to our understanding of simulation education for health professionals. Finally, as ever, we would like to thank our partners – Derek and Andy – for their unfailing support and patience.

Part 1Overview and broad concepts

Chapters

1 Simulation

2 What is simulation education

3 Fidelity

4 Research in healthcare simulation

5 The evidence base for simulation education

1Simulation

Simulations are used as a dress rehearsal to a real event where mistakes can be made and lessons learned, but no one comes to harm. Simulations include activities such as role play or team working tasks, use of manikins for life support training (Figures 1.1 and 1.2) and the use of computer-based simulators. Table 1.1 lists the range of simulated experiences in healthcare education. People from many occupations (including athletes, actors and pilots) routinely use simulation as part of their training. In these professions, in common with healthcare, people have to perform skills in what are often high pressure situations.

Historical context

The first recorded use of a medical simulator is that of a manikin created in the 17th century by a Dr Gregoire of Paris (Buck, 1991). He used a pelvis with skin stretched across it to simulate an abdomen, and with the help of a dead foetus explained assisted and complicated deliveries to midwives.

In spite of this early start, simulators did not gain widespread use in the following centuries, principally for reasons of cost, reluctance to adopt new teaching methods, and scepticism that what was learned from a simulator could be transferred to actual practice. All these reasons are still relevant today, but the combination of increased awareness of patient safety, improved technology and increased pressures on educators have promoted simulation as one option to address problems with traditional clinical skills teaching. Simulation has moved from the province of a few enthusiasts to a mainstream learning modality. As the American anaesthetist, David Gaba, comments:

No industry in which human lives depend on the skilled performance of responsible operators has waited for unequivocal proof of the benefit of simulation before embracing it. (Gaba, 1992)

Drivers and rationale

Most students and practitioners will be trained and assessed using some form of simulation and the use of clinical skills and simulation is now seen as routine in health professions’ education. Advances in technology have led to very life-like simulators for patients, surgery procedures and full-scale mock-ups of wards, theatres, delivery suites, ambulances and emergency departments. Many include software so that the simulator’s reactions depend on learners’ actions. There are many advantages to simulator training. The most obvious is that learners can practice as often as they like and whenever they want (within reason) without harming a patient.

Four key drivers for the widespread introduction of simulation are:

Public expectation and patient safety. The public not only expect health professionals to engage in appropriate skills and simulator training, but they often believe that professions already do.

Changes in working practice. The development of new professional roles, the growth of large and complex working environments, the move to more integrated service models and the rapid pace of modern healthcare require health (and other) professionals to develop effective leadership, team working and communication skills. Simulation has been at the forefront of the development (and assessment) of these skills.

Technological developments and opportunities. The technology available to support simulator training has progressed rapidly in recent years. Evidence exists that the educational value of simulators depends on learner engagement rather than the cost of the equipment. See

Figure 1.3

for how technology has gone hand in hand with simulator development.

Service pressures and reduced training time. The impact of service pressures, shorter hospital stays, the shift of care into community-based services and (in the EU) the European Working Time Directive have resulted in a reduction in the time available for clinical training in the workplace. To make the best possible use of available time in the clinical setting, learners must have prepared effectively away from the workplace.

Economic constraints and financial pressures. Maloney and Haines (2016) and Nestel et al. (2018) emphasise the importance of trying to evaluate the cost-effectiveness of simulation despite the difficulties of identifying long-term and high level impact on patient care and health outcomes.

Benefits for learners

The use of simulation in health professionals’ education has been shown to have benefits for learners, for the development of clinical practice and practical (technical) skills, and for patients and health systems (Riley et al., 2003). As well as facilitating the acquisition of routine skills, simulation also allows safe (for the learner and the patient) exposure to rare diseases/conditions, critical incidents, near misses and crisis situations. Reflecting the experience of the airline, nuclear and other high risk industries, evidence is accumulating that patient safety standards and non-technical skills (communication, leadership, etc.) improve following simulator training (McGaghie et al., 2010).

Østergaard and Rosenberg (2013) give the rationale, pedagogical and safety advantages of using simulation-based training as follows:

It provides a safe environment:

for learners without risk of harming the patient

that is fully attentive to learners’ needs

for training individuals and multiprofessional teams.

It can be adjusted according to learners’ needs.

It enables exposure to:

gradually more complex clinical challenges

rare emergency situations where time is an important factor.

It provides an opportunity for:

experiential learning

repetitive training and deliberate practice

individualised, tailored learning

formative assessment, debriefing and feedback

stimulating reflection

learning how to learn

summative assessment.

Future directions

Policy agendas from government and professional bodies have endorsed, promoted and funded patient simulation on a widespread scale. As well as helping to ensure patient safety and reduce error, simulation is also seen as an alternative means of learners acquiring clinical skills without spending time in an increasingly overcrowded clinical environment. Educators must therefore be attentive to such agendas and ensure that simulation is complementary to learning in the clinical workplace and that learning in each context is relevant to achieving defined outcomes and developing safe, competent practitioners.

Technological changes are now enabling more integrated multimedia simulations such as the use of handheld devices, portable simulators and further development of virtual reality simulators. With such technology, it is likely that simulation (in all its forms, including computer-based simulation) will become even more integrated into curricula and embedded into education and training programmes.

Opportunities for more interprofessional learning around non-technical skills and team working are also likely to increase as more centres offer such learning opportunities although more evidence is required as to the efficacy of such training. Simulation has also been used to support new ways of working (Forrest et al., 2013). As health and social services change toward more integrated, patient-led approaches, we may therefore see more use of simulation to support their introduction.

2What is simulation education