Download Clinical Simulation in Alaska: More than Mannequins, More than Centers

Clinical Simulation in Alaska:
More than Mannequins, More than Centers
Developing a Collaborative Model
Report to
Dan Julius
University of Alaska Vice-President of Academic Affairs
Funded by
University of Alaska Office of Workforce Development
University of Alaska Office of Associate Vice-President Karen Perdue
Submitted by
Alaska Center for Rural Health – Alaska’s AHEC, UAA
March 2008
Project Planners
Karen Perdue, Associate Vice-President for Health Programs, University of Alaska
Jan Harris, Associate Dean, UAA College of Health & Social Welfare
Mia Oxley, Project Manager, UAA Health Programs
Jackie Pflaum, Associate Director, UAA School of Nursing
Suzanne Tryck, Director Regional Programs of Alaska, Washington School of Medicine
Janice Troyer, Program Manager, UAA Alaska Center for Rural Health-Alaska’s AHEC
Beth Landon, Director, UAA Alaska Center for Rural Health-Alaska’s AHEC
Alaska Clinical Simulation Taskforce
Alaska Division of Public Health - Public
Health Nursing
Jerry Troshynski, Staff Develop Coord
Alaska Family Medicine Residency
Barbara Doty, MD, Associate Director of
Rural Affairs
Harold Johnston, Program Director
Alaska Native Tribal Health Consortium
Tom East, Chief Information Officer
Alaska Nurse’s Association
Debbie Thompson, President
Alaska Regional Hospital
Dona Townsend, Chief Nursing Officer
Alaska State Hospital & Nursing Association
Megan Wilmoth, Director of Programs
Bartlett Regional Hospital
Justine Muench, Staff Develop. Coord.
Bassett Army Comm Hospital, Ft. Wainwright
Lt. Col. Lisa Ingulli, Chief of Hosp Edu
Elmendorf AFB-3rd Medical Group
Maj. Marlene Kerchenski, Director,
Group Education & Training
Lt. Col. Ryan Shercliffe, Chief of
Emergency Services
Fairbanks Memorial Hospital
Liz Woodyard, Associate Administrator
Corlis Taylor, Education Dept Manager
Interior Region EMS Council, Inc.
Dan Johnson, Executive Director
Maniilaq Health Center
Wilma Goodwin, Director of Nursing
Providence Medical Services
Roy Davis, Chief Medical Officer
Shara Sutherlin, Chief Nurse Executive
Carrie Doyle, Directorof Nursing Practice
UAA Allied Health
Sally Mead, Division Director
UAA College of Health & Social Welfare
Cheryl Easley, Dean
UAA Kenai Peninsula College
Paul Perry, Paramedic Coordinator/Instru
Lynn Senette, Term Asst Professor
UAA Health Sciences Department
John Riley, PA Program Coordinator
UAA Mat-Su College Campus
Karen Carpenter, Term Asst Professor
UAA School of Nursing
Marianne Johnstone-Petty,
NRC/Lab/Distance Coordinator
Maureen O'Malley, Assistant Professor
UAF Medical Services & Paramedic Program
Chuck Kuhns, Coordinator
VA Healthcare System
Linda Boyle, Assoc Director of Nursing
Andrea Neuerburg, Infecton Control
Dennis Viloria, Assoc. Chief of Nursing
WWAMI Biomedical Program
Dennis Valenzeno, Director and
Associate Dean, UAA College of Arts &
Sciences
Table of Contents
Table of Contents ........................................................................................................................... i
Executive Summary ...................................................................................................................... ii
I.
Introduction ............................................................................................................................ 1
A. Background ...................................................................................................................... 1
B. Purpose .............................................................................................................................. 4
II. Findings .................................................................................................................................. 5
A. Use of Simulation Technology......................................................................................... 5
1. Use and Interest in Alaska ............................................................................................ 5
2. Current Uses of Simulation Technology and Perspectives of Potential Users ............. 5
B. Key Findings from Statewide Taskforce ........................................................................ 6
1.
2.
3.
4.
November 27th, 2007 .................................................................................................... 6
January 24, 2008 ........................................................................................................... 8
Summary of Key Small Group Findings ...................................................................... 8
Summary of Large Group Discussion .......................................................................... 9
B. Experience from Continental United States and Canada........................................... 10
C. Potential Uses in Postsecondary and Continuing Education ..................................... 13
III. Discussion ............................................................................................................................ 14
A. Plan Ahead! .................................................................................................................... 14
B. Preliminary Outcomes ................................................................................................... 14
C. Clinical simulation is more than skill-building ........................................................... 15
D. Curriculum Development and Training ...................................................................... 15
E. Partner Collaboration .................................................................................................... 15
F. Sustainability .................................................................................................................. 16
G. Delivery Models and Governance Structures ............................................................. 16
IV. Conclusion ........................................................................................................................... 17
Appendix A: Project Methodology ........................................................................................... 19
Appendix B: Simulators, Distillation of Advantages and Challenges, Bibliography .......... 21
Appendix C: Use of Human Simulation Technology in Alaska (A Snapshot) ...................... 26
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting .............. 36
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting .................. 50
Appendix F: A Sampling of Clinical Simulation Delivery Models ........................................ 68
Appendix G: Alaska Clinical Simulation Taskforce Training Topics ................................... 73
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
i
Executive Summary
Clinical simulation appears to be the newest technological innovation to enter the clinical
education environment. Far past the days of Resusci® Anne, clinical simulation embodies
advanced technology, and a new way of thinking about education. Simulations of real clinical
events generally employ learning tools which can range from practicing injections on oranges to
very sophisticated high technology computers. In the postsecondary and continuing education of
health care professionals, clinical simulation is increasingly recognized as a teaching resource to
possibly reduce pressure on limited access to live clinical exposures, increase confidence of
trainees, possibly improve patient safety and add rigor to the credentialing and precepting
process.
In September 2007, with resources from the University of Alaska’s Workforce Development
Office as well as the UA Associate Vice-President for Health’s Office; the Alaska Center for
Rural Health – Alaska’s AHEC (ACRH) at UAA was invited to determine the potential uses of
clinical simulation technology for postsecondary and continuing education. Tasks included:
1)
2)
3)
4)
Form and convene a Statewide Taskforce
Conduct an inventory of clinical simulation purchases in Alaska and lessons learned
Review experience at the national level with clinical simulation
Determine potential uses in postsecondary and continuing education
Based on lessons learned from clinical simulation purchases in Alaska and experience at the
national level, the following advantages and challenges of using human simulation technology
were identified.
Advantages
•
•
•
•
•
•
•
•
•
This technology can provide realistic clinical experiences without risk to patients and
learners; essentially, learners have “permission to fail” and learn from such failure in a
way that would be unthinkable in a clinical setting
Students can be exposed to clinical experiences they would rarely see and rare lifethreatening events can be scripted and practiced using simulators for experienced
residents and practitioners
Scenarios can be designed with increasing complexity and introduced in a controlled way
Skills can be practiced repeatedly, tailored to individual needs
Practicing teamwork skills in simulated crisis situations can improve a team’s ability to
function effectively
Simulation-based learning can help students bridge the gap between classroom and
clinical settings and support their ability to apply what they have learned
Learning is interactive and includes immediate feedback
Sessions can be videotaped for subsequent review and discussion, fostering reflective
learning
Several learners can benefit from a session and learn from each other’s successes and
mistakes
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
ii
Challenges
•
•
•
•
•
Equipment and associated costs for maintaining, troubleshooting and repairing it can be
expensive
Space is needed to house equipment, and location is important
Faculty development must be considered
Technical support is needed to maintain and run equipment
There is a need for more research to validate simulation as a teaching-learning strategy or
assessment/evaluation method that makes a difference in student learning and positive
patient outcomes
Throughout this project, the task force members heard from a number of experts and pioneers in
the employment of simulation in teaching situations. The net effect was to broaden our collective
appreciation of the tools and uses of simulation and to counter the tendency to equate simulation
technology with the most recently developed, high tech simulation tools. The task force learned
not to equate simulation with the technology. The following conclusions are a synthesis of the
Taskforce’s shared wisdom.
1. Needs Assessment/Curriculum Development: Technology is not an end in itself. The
outcome sought should drive the simulation acquisition. This requires developing very
specific outcomes, identifying curriculum needs, developing curricula, and understanding
what curricula can be better/best served with this technology.
2. Collaboration: There are benefits in collaboration at every level of clinical simulation
development, including but not limited to: governance and management, curriculum
development, acquisition, training, use, maintenance, sharing ideas, needs and
experiences, sharing resources, and benefits.
3. Student Outcomes: While the technology may not generally reduce demand for clinical
training space or enable the training of more students, several realistic education
outcomes were identified and include: improved clinical competency, improved critical
thinking skills, improved communication among professionals, and integration of theory
and practice placed in a practice context. It would also improve clinical exposure in rural,
low patient volume settings.
4. Professional Outcomes: There is no evidence that the technology would decrease costs,
but several promising education outcomes were identified and include: competency
demonstration, cross-training, reduced orientation time, specialty training,
standardization of training, improved team training, and training in chronic disease
management.
5. Sustainability: Costs of operation and maintenance should be known and sustainable
funding sources identified before acquisition of high fidelity simulation technology. This
should include the cost of technicians, simulation specialists, faculty, maintenance,
obsolescence of equipment, space demands, and upgrades.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
iii
6. UA could, if funding could be identified and secured, do any of the following:
•
•
•
•
•
•
•
•
•
Serve as a clearinghouse of curriculum for simulation training
Coordinate communication amongst interested Alaskan parties on resources,
outcomes data, and examples in the United States
Provide curriculum development leadership and serve as a resource by developing
curriculum templates and best practice standards for using simulation in education
and by disseminating in Alaska
Offer (or broker) simulation training for student educators and practitioners
Provide technical assistance
Conduct needs assessments for individual organizations or collaborative efforts
Collect data on the use of simulation in clinical education to document local
outcomes
Conduct research on some of the many unverified assumptions about use of
simulation in clinical education. A couple examples are: Is there a time (in any given
discipline) when simulation experience is better than live clinical experience?
Do we think simulation can substitute for clinical experience? Under what
circumstances is this true? If so, what percent of live clinical experience could be met
by simulation experience?
Explore hosting a Simulation Center, and/or other collaborative endeavors
7. Pilot Projects: Pilot projects should be encouraged and the results disseminated as a
means for expanding experience and expertise within Alaska. Some modest, communitybased endeavors would enable Alaskans to test hypothesized outcomes as well as develop
some comfort with the entire process and collaboration in this arena. Pre-hospital and
hospital-based simulation was of particular interest to Taskforce members.
8. Increase Awareness: Taskforce members should introduce the subject of clinical
simulation in various arenas and venues across Alaska, such as: Alaska Health Summit,
ASHNHA conferences, University of Alaska meetings, EMS Conferences, etc.
9. Delivery and Governance: This project only “scratched the surface” of available
governance and delivery structures. Myriad options exist and a collaborative model
should be customized to fit with each program’s intended purpose.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
iv
I. Introduction
A. Background
Clinical simulation appears to be the newest technological innovation to enter the clinical
education environment. In the postsecondary and continuing education of health care
professionals, clinical simulation is increasingly recognized as a resource to reduce pressure on
limited clinical exposures, increase confidence of trainees, possibly improve patient safety and
add rigor to the credentialing and precepting process.
Clinical simulation is defined as “an attempt to replicate some or nearly all of the essential
aspects of a clinical situation so that the situation may be more readily understood and managed
when it occurs for real in clinical practice”1.
Given the breadth of the definition, a nomenclature for organizing the universe of simulation is
needed. For the purposes of this report, the following description from a book by Dr. Jeffries is
used.
“Simulations are described along a continuum – from low-fidelity to high-fidelity – regarding
the degree to which they approach reality. On the low-fidelity end of the simulation spectrum
are experiences such as using case studies to educate students about patient situations or
using role-play to immerse students in a particular clinical situation. Farther along the
continuum are partial task trainers, such as IV cannulation arms or low-technology
mannequins, that [sic] are used to help students practice specific psychomotor skills that are
integral to patient care. More technologically sophisticated are computer-based simulations in
which the participant relies on a two-dimensional focused experience to problem solve,
perform a skill, and/or make decisions during the clinical scenario. Finally, full-scale, highfidelity patient simulators are extremely realistic and sophisticated and provide a high level of
interactivity and realism for the learner.”2
1
Morton, P.G. (1995). Creating a laboratory that simulates the critical care environment. Critical Care Nurse,
16(6), 76-81.
2
Jeffries, Pam. (2007). Simulation in nursing education: From conceptualization to evaluation. New York: National
League for Nursing.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
1
Table 1. Types of Simulators and Simulations
Type
Description
Examples
Task Trainers
Part of mannequin designed for specific
psychomotor skill
Passive full body mannequin with
exchangeable parts (e.g., wounds)
Full body simulator with installed human
qualities (breath sounds, childbirth)
Full body simulator that can be programmed to
respond to affective and psychomotor changes
Passive and interactive programmable software
Ear model, central/PICC line dressing
model, Leopold palpation model
Resusci®Annie, age-specific mannequins
(baby, geriatric)
VitalSim™ child and infant, Nursing Anne,
Noelle™ birthing simulator
SimMan®, Human Patient Simulator™
Virtual hospital/nursing home, IV
simulator, robotics, data gloves
Standardized
Patient (SP)
Complete simulated environment that includes
audio, visual, tactile, hardware, electronics, and
software
Individual who is trained to portray a patient or
teach students using the SP as a teaching model
Web-based
simulation
Multimedia and interactive information
accessed from around the world
Blended
Simulation
Use of multiple types of simulation to provide a
comprehensive learning experience
Mannequin
Basic simulator
Patient simulator
Computer Assisted
Instruction (CAI)
Virtual Reality
Fetal monitoring, ABG interpretation
Scenarios related to invasive and noninvasive physical examination, interview,
patient education, and discharge planning
Access via hyperlinks to virtual clinical
environments in action (e.g., time lapse
demonstration of the development of a
pressure sore)
SP: interview, simulator: physical
examination and intervention, SP:
education and discharge planning
Jeffries, P.R. (2007). Simulation in Nursing Education: from Conceptualization to Evaluation. (page
113). New York: National League of Nursing.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
2
The following diagram intends to clarify the range of fidelity and technology in simulation.
Fidelity – how well the simulator mimics or reproduces experience with a living patient
Technology – how intricate the simulator is, usually electronically or mechanically
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
3
B. Purpose
In September 2007, with resources from the University of Alaska’s SB-137 Workforce
Development Office as well as the UA Associate Vice-President for Health’s Office, the Alaska
Center for Rural Health – Alaska’s AHEC (ACRH) at UAA was invited to determine the
potential uses of clinical simulation technology for postsecondary and continuing education. The
initially identified activities included:
1.
2.
3.
4.
Form and convene a Statewide Taskforce
Inventory clinical simulation purchases in Alaska and lessons learned to date
Review experience at the national level with clinical simulation
Determine potential uses in postsecondary and continuing education
As with all projects entering uncharted territory, there were modifications. The Taskforce’s
enthusiasm and insights, fueled in part by the caliber of participating national experts, supported
a longer and broader view of the opportunities to consider and quagmires to avoid. This report
moves quickly past a listing of potential technological uses and attempts to paint a framework for
deliberate progress, a realistic role for the university, and realistic expectations for anyone
considering an investment in moderate to high-fidelity clinical simulation technology.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
4
II. Findings
This section provides aggregated data, with some analysis, for each of the project’s four sections.
The integration of those sections occurs in the subsequent Discussion section. A description of
the method is provided as Appendix A.
In the course of this project, ACRH identified information and resources for potential users
including types of simulators, a distilled listing of advantages and challenges of using human
simulation technology, and a bibliography. That document is provided at the end of this report as
Appendix B.
A. Use of Simulation Technology
1. Use and Interest in Alaska
ACRH interviewed 22 of Alaska’s 25 hospitals, ten UA programs, the Alaska Family Medicine
Residency, four Fire Dept/EMS units, Guardian Flight in Fairbanks, the Alaska Department of
Health and Social Services Section on Public Health Nursing, and the Community Health
Aide/Practitioner Program at the Alaska Native Tribal Health Consortium.
Of that group, many reported investments in mid-fidelity to high-fidelity clinical simulation
equipment, including six hospitals, four UA programs, four Fire Department/EMS units and
Guardian Flight in Fairbanks. Of the remainder, 11 hospitals and three UA programs expressed
an interest in using simulation technology. Another four hospitals and three UA programs
indicated they were “not sure.” All respondents saying “yes” or “not sure” were able to list
potential users and uses. The most frequently cited barrier to purchase was cost. The tables of
interview data are provided as Appendix C.
Several themes emerged from the interviews. It is interesting to note that many of these concepts
have been articulated throughout the project, both by Alaskans and by Continental United States
users.
2. Current Uses of Simulation Technology and Perspectives of Potential Users
Lessons Learned and Advice
•
•
•
•
Rather than just purchasing the latest and most expensive technology it is critical to think
through the users and the uses, and invest accordingly
It is important to have someone responsible for managing and maintaining equipment. It is
equally important to train more than one person for using/maintaining equipment in case the first
person leaves
High tech mannequins, such as SimMan, cannot be easily used outside for training (i.e. EMS)
Stick to reality for the scenarios employed and remember that debriefings are important
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
5
Comments and Perceptions from Those who are Interested in Using Simulation Technology:
•
•
•
•
•
•
•
•
•
•
Technology could cut down on overcrowding and overburdening of teaching facilities, especially
in Anchorage
Technology could free up faculty time, and get more students through the scenarios
Hiring standardized patients is expensive and they cannot reproduce pathology such as an
irregular pulse. And sometimes it is difficult to find someone to be a consistent patient
It is expensive and logistically problematic to get staff to urban Alaska for training
There are not enough patients for training in rural Alaska which makes for longer preceptorships
for new nurses/grads and harder to maintain skills for staff
Equipment is too expensive for a single rural facility to buy; many people in rural Alaska have
expressed interest in sharing or borrowing equipment
Some like the idea of having technology that is more realistic for Trauma Nurse Core Course and
ALS training
With less access to real patients for training because of confidentiality and liability issues;
simulators may be a way to address the need for access to patients
Current patient acuity is often too high for students to be able to practice on patients; this is a
mechanism for students to practice their skills before working on patients. Mannequins would be
a mechanism to practice using equipment before using equipment on patients
The technology could help people learn to cope with crisis situations
3. Advantages of Using Simulation Technology
Comments from those who have used the equipment:
•
•
•
•
Students and staff in rural Alaska do not get the same amount of exposure to multi-traumas or
invasive procedures as those in urban Alaska, so working with mannequins can help verify skills
and ensure skills are maintained
Patients do not like to be practiced on, and there are fewer opportunities to practice skills in low
volume hospitals
The technology adds a step of realism to trainings (i.e. can alter vital signs), and teaches students
to assess patients
You can re-run scenarios as many times as necessary
4. Other Comments and Thoughts About Simulation Technology
•
•
It takes time and effort to develop scenarios and practice to keep up your skills (this comment
was made the most by those who have used the equipment)
“It’s the wave of the future.” “It’s where we are going.”
B. Key Findings from Statewide Taskforce
1. November 27th, 2007
During the November 27th meeting, Dr. Brian Ross provided an overview to the ISIS Center and
provided insights to guide the Alaska Taskforce’s thinking.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
6
•
ISIS has approximately 15 departments involved in simulation training. This has enabled
them to standardize curriculum across those departments. They have also developed a peerreview process for developing curriculum. That has helped motivate clinical educators to
work for them in developing curriculum, as it can become part of their portfolio. Curriculum
development is an important piece of ISIS. They have a formal template for their curriculum
with 12 essential elements. This enables them to more easily share curriculum with partners.
•
Dr. Ross noted that medicine has, for the most part, used a silo approach to training and
delivery of care, such as OB, Anesthesia, Internal Medicine, and Surgery using a “see one, do
one, teach one” method. He talked about public demand for training “not on me for the first
time.” Simulation allows students to become proficient in skills before ever working on a
patient. It also allows for cross-discipline training.
•
Dr. Ross reviewed different types of simulation equipment and uses. There is an impressing
diversity of equipment available.
•
It was noted that he has seen a lot of simulation centers that have different rooms for
different disciplines, but many sit empty for large parts of the day. He believes it is more
efficient and a wiser use of space to have a more open model that can be used for multiple
disciplines. Dr. Ross mentioned a national study that noted that Simulation Center rooms are
only used 18% of the time. Dr. Ross repeatedly advised that “there is no reason to buy
something if someone is not taking intellectual responsibility for it and will make sure it is
going to be used.” “You need to do a formal needs assessment, and then develop curriculum.
The curriculum must start with how the patient presents and the entire process for moving the
patient through the system.” Dr. Ross also talked about high fidelity simulators that contain
modern functionality. “If you aren’t going to use all of the functions, it may not be the
smartest purchase. The purchasing decisions should be driven by curriculum needs. Don’t get
talked into equipment you don’t need!”
•
Dr. Ross recommended that a consortium have a mission statement or list their primary
goals. ISIS has three goals: provide leadership in use of simulation technology, improve
quality of health care education, and improve patient safety and outcomes.
Janice Troyer presented an overview of data collected on the current use of clinical simulation in
Alaska. This is described in Appendix C.
In the closing comments for the November 27th meeting, several members commented that their
eyes had been opened to the broad scope of simulations and technology and the possibilities for
clinical education. Many noted they had a very narrow view of simulation previously. Members
also noted they were beginning to see the value of collaborating with other disciplines and the
need for team development training. A decision was made at the end of the meeting for each
taskforce member to submit their top five to ten training needs to ACRH staff before the next
meeting to help continue the process of determining the potential use of clinical simulation in
Alaska.
A complete set of the minutes from the November 27th meeting are provided as Appendix D.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
7
2. January 24, 2008
This meeting opened with a series of video-conference presentations from simulation projects
outside of Alaska. A synthesis of those projects is provided in Appendix F.
The taskforce participated in a series of discussions throughout the afternoon. They worked in
three small groups: University of Alaska, Hospital/Providers, and Development and Delivery.
The discussion then continued in the larger group setting.
The University of Alaska group was asked to consider to what extent the use of simulation
technology could impact delivery of classroom education and clinical training. They were also
asked whether simulation technology would enable UA to train more students and what would be
realistic expectations for training outcomes.
The Hospital/Provider group was asked to consider to what extent the use of simulation
technology could impact delivery of continuing education and CME training. They were also
asked to identify realistic expectations for training outcomes and improving patient outcomes.
The Development and Delivery group was asked to think about development, delivery, and
organization of clinical simulation in Alaska.
The groups were also asked to comment on any preliminary conclusions that could be drawn
from the results of the Training Topics survey and to identify any important key concepts that
should be included in the final report.
3. Summary of Key Small Group Findings
The University of Alaska small group discussion members noted they would like to see
documented evidence for positive outcomes in the use of simulation technology. They
brainstormed both positive and negative impacts of using simulation technology as part of
curriculum. Some of the benefits cited included the opportunity for interdisciplinary training,
competency-based training, and increased skill development in professional communication.
Members agreed simulations expose students to the reality of practice and also pointed out that
students may soon demand technology and in that way lead the change.
The challenge of incorporating simulation technology into the curriculum is that faculty
development will need to be instrumental and additional personnel will be needed in terms of
technology support staff and simulation specialists. Overall the group did not believe simulation
technology would necessarily allow the training of more students, but would be a significant
impact on clinical competence and confidence of new graduates. It was also believed that the use
of simulation technology could take a load off clinical sites which are currently stretched to the
limit. Clinical sites/hospitals would benefit as students come better prepared and patient safety is
increased.
The group summarized a list of realistic expectations for training outcomes which included:
competency based improvement, confidence building in critical thinking skills, communication
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
8
between professionals, quality of learning experience improved, integration of theory and
practice placed in a practice context. The group concluded that they would like to see the
University be a clearinghouse of information even if they do not own simulation equipment. This
information, including curriculum, could be housed at UA for industry to access.
The hospital/provider small group brainstormed both positive and negative impacts of
incorporating simulation technology into their facilities. On the positive side, they noted the use
of clinical simulation could be a way for staff to demonstrate competency, to cross-train with
other staff, to be trained in specialty areas, to help standardize training, to improve team training
and as a means for working with staff in the area of patient complaints and also in dealing with
patients living with chronic diseases. The latter use was noted to be particularly important in
rural areas where the remote clinician has limited experience with a particular condition.
When thinking about negative impacts, the group expressed concern about the support needed
for using simulation technology and whether it would add to staff workload or divert money
from other areas. Other potential negative impacts included the space demands for technology
and the potential problem of equipment quickly becoming outdated. The group concluded it will
be important to initially identify a subset of needs that could be used for early successes such as
skills training for new graduates and orientation for new staff. Team-based training would also
be a good early focus. In order to spearhead the effort and keep the momentum going, dedicated
staff need to be identified as the early “champions” (or as Dr. Brian Ross said the “intellectual
owners”) and there needs to be a clearinghouse to broker the information on technology,
curriculum and expertise.
The development/delivery group noted that while many of the collected training topics were skill
based, the value of clinical simulation is that it allows learning of these skills to be enriched with
communication skills during a stressful event and helps learners develop and practice critical
thinking skills in appropriate contexts. In terms of thinking about the delivering of clinical
simulation in Alaska, the group noted it is important to consider the following: you cannot
assume the same level of availability of technology across the state, we need to explore the
mobility of equipment and the use of distance learning technology and there needs to be a
clearinghouse of information such as an Alaska user group for sharing curriculum scenarios and
data. This group also noted that training is almost more important than equipment in terms of
resources and rural community members need to be engaged in this training. In thinking past this
taskforce, this group could see the usefulness of developing subcommittees to address different
areas of simulation utilization.
4. Summary of Large Group Discussion
Once the large group came together, the discussion continued. There was general agreement that
people liked the idea of working together and continuing to collaborate. The advantages of this
are the networking aspect where partners can share best practices and avoid redundancy and an
investment strategy that brings more credibility to funders when more partners are involved.
There was some discussion about the need for a good business plan and sustainability model.
And prior to these items, a needs assessment would need to be conducted to help inform the
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
9
business plan. Participants made several comments regarding a needs assessment. The needs
assessment would need to define simulation; questions would need to be asked carefully, so it is
unbiased, and the assessment should be conducted at the administrator and training manager
level.
The need for a clearinghouse of information and Alaska user group (that included all the
disciplines) was mentioned several times. It was suggested that the University of Alaska might
play a role in this function to gather information about equipment and provide a resource library
of scenarios.
A complete set of the minutes from the January 24th meeting are provided as Appendix E.
B. Experience from Continental United States and Canada
The following section gives a brief overview of a sample of Continental U.S. and Canadian
simulation programs reviewed by ACRH staff. They include:
•
•
•
•
•
University of Washington’s ISIS Center – a university program with an expansive mission
to serve the entire WWAMI region in providing leadership in the use of simulation
technology, improving quality of health education and improving patient safety and
outcomes.
STARS – a mobile Canadian EMS-based training program within a larger organization that
is completely community and foundation-funded
Oregon Simulation Alliance (OSA) – A government-sponsored collaboration for the
purpose of developing simulation capacity statewide
ASTEC – Housed at the University of Arizona and more strictly focused in student
education is exploring the use of telemedicine equipment to provide education in remote sites
Wells Center – A nonprofit serving a collection of nursing schools through a hub and spoke
model that is looking at the potential uses of combining datacasting with simulation
technology
More details about each of these organizations can be found in Appendix F or in their respective
websites listed in this section.
The ISIS Simulation Center, located within the University of Washington Medical Center,
contains a skills lab area with a variety of laparoscopic simulators and a mock hospital room with
a high-fidelity mannequin. The mission of ISIS is to provide skills development and
interdisciplinary training to residents, medical and nursing students, and medical faculty. They
also serve as a simulation resource library and provide leadership in the area of simulation
technology, particularly in the WWAMI region. ISIS has a Governing Board and an Executive
Committee. The Executive Committee runs ISIS and develops the initiatives. Under this
committee there are three major committees: Faculty experts, Education, and Research and
Development. Website: http://www.isis.washington.edu/
The STARS Mobile Simulation Program uses two motor homes and a suburban to provide
simulation training to healthcare providers in rural facilities across Alberta. The motor homes are
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
10
each equipped with a permanently installed high-fidelity mannequin, while the suburban has
mannequins housed in mobile cases/bags. The STARS mobile program works with individual
healthcare facilities to determine their training needs. They conduct four simulation trainings a
month focused on critical care, emergency medicine and interdisciplinary team training. STARS
is a non-profit charitable organization. The STARS Foundation is the fundraising arm of the
organization. About 70% of the funds are raised through philanthropic donations and 30% are
raised through government partners. Facilities do not have to pay for training. STARS has two
boards: one is a foundation board which oversees all fundraising and the other is a society board
that helps make decisions about how money is spent. Website:
http://www.stars.ca/bins/index.asp (see What We Do, Education & Research, Mobile Simulation
Program)
OSA is a collaborative statewide group formed in 2003 to develop and expand simulation
capacity in all regions of the state for multi-disciplinary and interdisciplinary use for healthcare
workforce development. OSA is comprised of multi-disciplinary regional coalitions each with a
different model on how they use simulation and deliver training. Over 40 sites within OSA have
purchased their own equipment. There are over 20 simulation centers and some coalitions within
OSA are using a mobile delivery model. Initially OSA was funded through state, federal and
private grants. They are currently in the process of finding ways to make OSA sustainable. OSA
is coordinated by the Governor’s Office and serves both as an advisory group and provides
oversight. The Simulation Alliance Governing Council has representation from Oregon
community colleges, universities, healthcare provider organizations and other simulation users.
Much of OSA’s focus has been on providing trainings to their partners including a three day
Simulation Technician Training and a two day Foundations for Simulation Education Workshop.
Website: http://www.oregonsim.org/index.php
Two programs that have used and/or are planning to use simulation technology in conjunction
with distance education are the WELLS Center in Colorado and the ASTEC in Arizona. Both
have simulation centers, but deliver their simulation education with different methods.
ASTEC, housed with the University of Arizona Medical School, does a majority of its training
within the simulation center and primarily serves medical students and residents, though it does
provide some training to physicians, nursing and other allied health students. ASTEC is part of
the Dean’s Initiative with the Vice Dean overseeing staff. ASTEC hopes to use its telemedicine
equipment to provide education in remote sites. For example, doctors in rural areas have used the
equipment to observe scenarios done in the ASTEC simulation lab using one of the high fidelity
baby mannequins. The doctors in the rural sites observed the performed scenario and were able
to participate in the debriefing. Website: http://www.astec.arizona.edu/
The WELLS Center in Colorado is a non-profit currently housed within Colorado Center for
Nursing Excellence. Using a hub and spoke model, staff provides training in both their
simulation center and also travel to other sites for training. The WELLS Center partners with 26
nursing schools across the state and provides competency training for nurses in hospitals across
the state as well. They focus on simulation training, faculty development and information
dissemination. The WELLS Center has an Advisory Committee composed of statewide
members, as well as an Executive group, which oversees policies and procedures. Recently
WELLS has partnered with their local public broadcasting company to deliver high-speed
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
11
datacasting via satellites. This approach allows remote participation for observing and
debriefing. The datacasting allows large files to be sent to individual computers via satellites so
users can receive images without an Internet connection, an advantage to some of their rural sites
that only have access to dial-up. Live training events at the simulation center can be seen in real
time. The Center is about to begin a pilot program to look at potential uses for this technology in
conjunction with simulation technology. Website:
http://www.coloradonursingcenter.org/CurrentProjects/WellsCenter.html
More insight comes not from existing simulation projects, but from colleagues at the national
level. The two specific to this project are Dr. Jeffries, a consultant assisting in planning for the
UAA Health Sciences building, and Dr. Allen from the WWAMI Idaho office.
Dr. Pam Jeffries, author of Simulation in Nursing Education: From Conceptualization to
Evaluation, provided an overview of the current state of simulation from a nursing perspective at
the January 24th meeting. She began by identifying some of the current challenges in nursing
education such as faculty and clinical site shortages, pedagogical challenges and the demand on
health care providers for more complexity in the workplace. Dr. Jeffries outlined the purpose of
simulations and gave examples of how simulations are used as a teaching strategy, an assessment
method, and for practice. In addition she discussed some advantages and challenges/barriers for
using simulation as a teaching method.
In looking towards the future Dr. Jeffries predicts that clinical simulations will be incorporated
into all core curriculum courses. She sees the use of simulation, as a way to challenge students to
problem-solve, to make decisions and to provide a unique and critical experience students may
not be able to get on a clinical unit. Dr. Jeffries also foresees more interdisciplinary simulation
centers in the future where nursing and medical students are able to work and practice together in
an education setting before performing procedures and caring for real patients. The last half of
Dr. Jeffries’ talk focused on thinking about and planning for Clinical Simulation centers.
ACRH staff also spoke with Dr. Suzanne Allen of the WWAMI Idaho office. Idaho has a
statewide coalition-planning group that started about two years ago. She noted that many Idaho
groups have simulation technology, but are missing scenarios. That was one impetus for putting
the planning group together. The Northwest Physicians Insurance Company has taken the lead
for this group and paid for the teleconference and meetings. The coalition includes hospitals,
EMS and academic groups. Dr. Allen noted it took one and a half years of meetings to make sure
they had the right players at the table and to decide how to structure a coalition. The plan was for
the coalition to be temporarily housed under the Idaho Hospital Association. It may eventually
become its own entity. They have developed a steering committee to provide oversight and are
currently in the process of forming work groups, which may include: curriculum development,
equipment/scheduling, academics, hospitals and possibly EMS.
All of these programs shared lessons learned and advice. These lessons revolved around several
themes: planning ahead before buying equipment, thinking through which delivery models and
governance structure make the most sense for a region, advantages of collaborations, the
importance of both curriculum development and training and focusing on sustainability from the
beginning.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
12
C. Potential Uses in Postsecondary and Continuing Education
Seventeen taskforce members submitted a list of training and education topics that had potential
for the use of simulation. The topics covered a wide range from very broad to very specific.
Though the original intent was to find a handful of common topics, this became impossible as
over 150 training topics were submitted. An attempt was made to sort these into major
categories including:
•
•
•
•
•
•
•
•
Emergency airway management and cardiac life support
Disaster management/emergency scenarios away from the hospital
Codes/emergencies in the hospital
Physical exams
Technical skills
Deliveries/neonates/pediatrics
Communication
Health promotion/management
Examples of topics for each of these categories are included in Appendix G.
In some cases, instead of listing specific topics, members listed the types of learners that could
potentially benefit from the use of simulation technology. These included: ETT, EMTs,
Paramedic, CHAP, RN, PA, NP, MD, Resident, Medic, new staff, faculty and new graduates.
Types of training were also listed including:
•
•
•
•
•
•
•
•
Skills training for EMS providers
Continuing education
Re-credentialing
Continuing medical education
Deployment training and re-deployment training
Skills and procedure competency screening for students, new hires, interims, locums, travelers,
emergency responders
Faculty development
Training new staff for specialty areas
Taskforce members were invited to make comments about their satisfaction level of the current
training they provide and to make any additional comments regarding simulation technology. A
wealth of comments was provided and can be viewed in the individual charts in Appendix G.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
13
III. Discussion
A. Plan Ahead!
Dr. Brian Ross, the Executive Director of ISIS, stresses the importance of doing a needs
assessment before buying simulation equipment. Curriculum should drive the training needs and
these needs will drive the type of simulation equipment and/or center you create. Dr. Ross
suggests identifying essential elements of a curriculum and then figuring out which components
could have value added by simulation. Shirley Anderson, Executive Director of OSA, noted
they were in the process of conducting a series of site assessments designed to capture the state
of “readiness” for simulation in different locations in Oregon. Unfortunately OSA received grant
funds before this process was completed and they had a limited timeframe from which to
disburse funds. In retrospect they wish they could have completed that process before awarding
grants to the coalitions. Shirley Anderson also suggests that workforce issues should define the
needs for simulation, not the universities.
Mike Lamaccia, Director of the STARS Mobile Simulation Program, noted that it was a needs
assessment done with physicians in rural Alberta that drove the need for bringing the training to
the facilities. Physicians complained about not being able to come in for training because they
did not feel they could leave their communities. He also suggests discouraging individual
facilities from going out and buying their own simulation equipment before determining their
needs. Mike notes the “honeymoon” will be over quick when these same facilities realize the
time it takes to maintain and program the equipment.
B. Preliminary Outcomes
None of these experts could point to peer-reviewed outcomes data for clinical simulation, and all
mentioned the need for it. The three most common outcomes sought are: education that
improves patient safety, decreased demand for clinical training sites and a method to shorten
orientation time for new hires. Nevertheless, the contagious enthusiasm to develop this
educational modality continues to secure significant funding. Data are starting to emerge, with
two examples provided here.
A. Dr. Ross described a small, unpublished study done by ISIS that compared the training time
needed for eight students using the old resident training model (see one, do one, teach one)
with a group of eight students using simulation in their training. They found that the
simulation cohort was far advanced early on, but by the end of the training both were groups
were about the same level. He said the advantage of this is that you may be able to add more
skills training without increasing the amount of time covering the curriculum to include
simulation. He also noted he wanted to repeat the experiment the following year, but none of
the faculty was willing to go back to the old training method-they all wanted to continue with
the simulation training.
B. Dr. Jeffries shared a nursing study she had conducted that evaluated three different
educational methods using simulation from low fidelity to high fidelity. They looked at
learning outcomes for each of the “roles” across educational methods. They did not find a
significant difference in learning outcomes across roles. That means those who play the role
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
14
of “observer” in a simulation are learning as much as the other participants. Pam Jeffries was
surprised at this finding, but also encouraged by the ramifications.
C. Clinical simulation is more than skill-building
People can learn algorithms of skills via rote memorization from a textbook, a classroom lecture,
practice on a classmate, observation via videoconference or mid to high fidelity simulation. The
value of mid to high fidelity simulation, in addition to being ideal for experiential learners, is that
it also enables the development of communication skills in a stressful environment and critical
reasoning skills. The communication and critical reasoning are not afforded by the other teaching
modalities. Several invited speakers and Taskforce members articulated the importance of “handoff” skills and interdisciplinary communication, and that they are both inadequate in the current
educational environment. This is a significant niche that mid to high-fidelity clinical simulation
can serve.
D. Curriculum Development and Training
Dr. Ross emphasized the importance of curriculum development with simulation technology. He
commented that it takes a tremendous amount of work to write the curriculum for simulations.
ISIS is working towards standardizing their curriculum. They have developed a standardized
curriculum template, which all faculty are required to use. This has enabled ISIS to share their
curriculum with other partners. By sharing curriculum, training costs go down and patient safety
goes up. One example he used to illustrate this process is that ISIS worked with multiple
disciplines to develop a standardized way to do central line removal. All residents must be
certified at ISIS before performing this function on a real patient.
Dr. Ross also noted that it is important not to try and do too many things at once or be all things
to all users. Shirley Anderson noted that much of the work that OSA did revolved around
providing workshops for coalition partners on how to use simulation technology and develop
curriculum. Alyson Knapp, Coordinator of ASTEC, suggests that Alaska not limit its
imagination on how simulation can be incorporated into teaching. There are things she is
teaching with simulation now that she never would have guessed she would be doing a year ago.
E. Partner Collaboration
The examples provided in this report demonstrate the wide variety of collaborations that exist
even within this small representative sample of simulation programs, from partners within a
university to a network of rural facilities to regional coalitions. Shirley Anderson noted that the
most successful coalitions within OSA are those that had existing partnerships on other projects
and expanded to include clinical simulation.
The OSA collaborations have evolved over time. In areas with bigger populations, sometimes the
larger collaborations have split into smaller coalitions because there is not enough equipment to
support the entire group. Several organizations are breaking out of coalitions and merging with
organizations geographically closer to them. Jana Berryman, Director of the WELLS Center,
also gives advice regarding collaborating partners. She notes they work hard to not be seen as a
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
15
competitor with their partners. They strive to be transparent in what they do and look for funding
sources that will benefit their partners. They also encourage the participation of new partners.
Dr. Ross also encouraged the Alaska Taskforce to be as inclusive as possible when thinking
about partners in the planning stages. Dr. Allen sees advantages of coalitions to be: a) the ability
to buy equipment at a reduced rate, b) sharing equipment, and c) help with scenario building and
curriculum development.
F. Sustainability
Shirley Anderson noted that it is extremely important to develop a plan for sustainability of
funding and a succession plan for leadership. OSA has been grant-funded to date and they are
now looking at ways to sustain the Alliance. She noted in her presentation that OSA members
received free grant funded training and are now reluctant to pay for that training. Jana Berryman
of the WELLS Center also noted that they have primarily been grant funded and are now looking
at the issue of sustainability. They have recently started a fee for service. They hope this fee will
provide 30-60% of their funding in the future. Dr. Allen noted their recently formed Idaho
coalition is in the process of outlining a structure for how to pay for the simulation technology so
that it is self-sustaining.
G. Delivery Models and Governance Structures
As can be seen from the Continental United States and Canadian examples, delivery of
simulation education varies widely from simulation centers where learners come to the
simulation center to receive training to mobile units that deliver training to the local healthcare
facilities to the incorporation of distance technology into simulation training. Dr. Ross is a firm
believer in taking simulation technology to where the training needs are. He suggests a
“footprint” is needed in each partner facility. Each facility has very different kinds of patients
and needs and so by providing simulation training at the sites, the staff is able to use their own
equipment in a simulation, which ensures the training is as close as possible to what will really
happen.
The examples also demonstrate an array of governance structures. Shirley Anderson notes that if
you are going to form a similar alliance, it is important to have an Executive Director or someone
that is responsible for the day-to-day operations such as training and grant oversight. She also
suggests a succession plan for leadership as some of the early leaders in a planning process may
burn out.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
16
IV. Conclusion
Clinical Simulation is here. Independent of what happens to the Taskforce or its members,
clinical simulation has arrived in Alaska. Many investments have been identified and more are
inevitably on the horizon.
The following conclusions are a synthesis of the Taskforce’s shared wisdom.
1. Needs Assessment/Curriculum Development: Technology is not an end in itself. The
outcome sought should drive the simulation acquisition. This requires developing very
specific outcomes, identifying curriculum needs, developing curricula, and understanding
what curricula can be better/best served with this technology.
2. Collaboration: There are benefits in collaboration at every level of clinical simulation
development, including but not limited to: governance and management, curriculum
development, acquisition, training, use, maintenance, sharing ideas, needs and experiences,
sharing resources, and benefits.
3. Student Outcomes: While the technology may not generally reduce demand for clinical
training space or enable the training of more students, several realistic education outcomes
were identified and include: improved clinical competency, improved critical thinking skills,
improved communication among professionals, and integration of theory and practice placed
in a practice context. It would also improve clinical exposure in rural, low patient volume
settings.
4. Professional Outcomes: There is no evidence that the technology would decrease costs, but
several promising education outcomes were identified and include: competency
demonstration, cross-training, reduced orientation time, specialty training, standardization of
training, improved team training, and training in chronic disease management.
5. Sustainability: Costs of operation and maintenance should be known and sustainable
funding sources identified before acquisition of high fidelity simulation technology. This
should include the cost of technicians, simulation specialists, faculty, maintenance,
obsolescence of equipment, space demands, and upgrades.
6. UA could, if funding could be identified and secured, do any of the following:
• Serve as a clearinghouse of curriculum for simulation training
• Coordinate communication amongst interested Alaskan parties on resources, outcomes
data, and examples in the United States
• Provide curriculum development leadership and serve as a resource by developing
curriculum templates and best practice standards for using simulation in education and by
disseminating in Alaska
• Offer (or broker) simulation training for student educators and practitioners
• Provide technical assistance
• Conduct needs assessments for individual organizations or collaborative efforts
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
17
• Collect data on the use of simulation in clinical education to document local outcomes
• Conduct research on some of the many unverified assumptions about use of simulation in
clinical education. A couple examples are: Is there a time (in any given discipline) when
simulation experience is better than live clinical experience? Do we think simulation can
substitute for clinical experience? Under what circumstances is this true? If so, what % of
live clinical experience could be met by simulation experience?
• Explore hosting a Simulation Center, and/or other collaborative endeavors
7. Pilot Projects: Pilot projects should be encouraged and the results disseminated as a means
for expanding experience and expertise within Alaska. Some modest, community-based
endeavors would enable Alaskans to test hypothesized outcomes as well as develop some
comfort with the entire process and collaboration in this arena. Pre-hospital and hospitalbased simulation was of particular interest to Taskforce members.
8. Increase Awareness: Taskforce members should introduce the subject of clinical simulation
in various arenas and venues across Alaska, such as: Alaska Health Summit, ASHNHA
conferences, University of Alaska meetings, EMS Conferences, etc.
10. Delivery and Governance: This project only “scratched the surface” of available governance
and delivery structures. Myriad options exist and a collaborative model should be customized
to fit with each program’s intended purpose.
Clinical Simulations in Alaska:
More than Mannequins, More than Centers
18
Appendices
Appendix A: Project Methodology
The following describes specific activities which occurred in the course of this project.
Form and Convene a Statewide Taskforce
ACRH and the Project Planners developed a Clinical Simulation Taskforce with representatives
from the University of Alaska and interested industry partners. Industry partners primarily
included hospitals and EMS departments, both of which are recognized as relatively heavy users
of clinical simulation technology in the Continental United States. Some members were
identified through the October phone interviews of Alaskan users. The Alaska Department of
Health and Social Services selected a representative from Public Health Nursing and the Alaska
State Hospital & Nursing Home Association also sent a representative. The Taskforce convened
in-person, in Anchorage, on November 27th and January 24th. The final meeting occurred via
videoconference on March 5th.
In the November meeting, two important data sources were presented. First were the aggregate
findings from interviews of users and potential users across Alaska. These data had not been
collected previously and provided a useful perspective to inform potential new users or larger
scale investments. Second, Dr. Brian Ross from the University of Washington’s Institute for
Surgical and Interventional Simulation (ISIS) attended in-person to give a presentation on ISIS
and share wisdom on the thoughtful selection and structured use of clinical simulation
technology.
In the January 24th meeting, ACRH presented the aggregated training topics information from
Taskforce members. In addition, approximately half of the meeting was dedicated to video
presentations of significant clinical simulation projects in Oregon, Indiana, and Alberta
(Canada). In addition to providing an overview to their design, governance and simulation
capacity; each presenter shared wisdom and lessons learned. The remainder of the meeting
focused on discussion of information learned to date and the development of “key concepts” as
well as suggestions for the future of clinical simulation in Alaska.
The March 5th meeting occurred via videoconference and focused on discussion of the final
report’s content and suggestions for improvement.
Assessment of Use and Interest in Alaska
Between mid-October and November 21st, ACRH conducted a series of telephone interviews to
determine the current use of human simulation technology in Alaska. The Project Planners
developed the questions and assisted in the aggregation of resultant data.
Specifically, ACRH successfully interviewed 22 of Alaska’s 25 hospitals, ten UA programs, the
Alaska Family Medicine Residency, four Fire Dept/EMS units, Guardian Flight in Fairbanks, the
Alaska Department of Health and Social Services Section on Public Health Nursing and the
Community Health Aide/Practitioner Program at the Alaska Native Tribal Health Consortium.
Clinical Simulations in Alaska
Appendix A: Project Methodology
19
While a census of users was not feasible or appropriate, responses were sufficient to provide a
representative sample and snapshot of human simulation technology in Alaska.
For those facilities or UA programs who own moderate to high fidelity equipment, questions
were asked regarding the:
•
•
•
•
•
type of training the equipment is used for
who the primary users are
whether equipment is ever transported out of the main facility for training
maintenance issues to date
lessons learned about using this type of technology
For those facilities that did not own any moderate to high fidelity simulation equipment,
questions were asked about:
•
•
•
interest in using simulation technology for training in their facility
how they would envision using simulation technology
perceived advantages of using simulation technology
Select Examples and Experts from Lower 48
Members of the Clinical Simulation Steering Committee identified two initial resources from the
Continental United States: Dr. Brian Ross and Dr. Pam Jeffries. Based on communications with
those individuals, and recommendations from Taskforce members, ACRH identified a short list
of agencies to interview. Due to time and resource constraints, only a few programs were
interviewed. At best, they are a representative sample. Nevertheless, each has proven valuable in
informing the Taskforce’s dialogue on the diversity of delivery modalities and governance
structures feasible, as well as providing insights to Alaska’s planning.
Potential Uses in Postsecondary and Continuing Education
At the close of the November meeting, Taskforce members agreed to engage in a cursory
brainstorm of potential training topics of benefit to their organization that could be served by this
technology. Specifically, they agreed to identify their top training topics, to reflect on whether
the topic is currently addressed to their satisfaction, and to consider whether they see potential
for simulation technology use. This information would reflect the diversity of identified training
needs as well as the overlap. Shared training topics could be used by members in the
development of collaborations, either technology use or curriculum development. That
information was submitted to ACRH in mid-January for aggregation in advance of the January
24th meeting.
Clinical Simulations in Alaska
Appendix A: Project Methodology
20
Appendix B: Simulators, Distillation of Advantages and Challenges, Bibliography
The information in the following chart was taken from the website of the Penn State College of Medicine
Simulation Lab. More details can be found about the different simulation technology on their website:
http://www.hmc.psu.edu/simulation/available/mds.htm
Type
Model-driven simulators
(high fidelity simulators)
Instructor-driven
simulators (intermediate
fidelity simulators)
Virtual Reality Simulators
Computer Based
Simulators
Task Specific Models
Description
A mannequin body or part of body to physically represent
the patient, and have physiologic and pharmacologic
models that direct real time autonomous reactions to
interventions and therapies; these types of simulators
generally integrate multiple system models to produce a
realistic patient response; simulator usually sold separate
from monitors and ancillary equipment needed to provide
realistic setting
Partial or full body mannequin as a physical presence on
which to practice interventions. The simulators may
interact with the user in limited ways, but the bulk of
responses are created by the instructor. They often use
real interventional equipment (probes, IV lines,
ventilators, etc.) and may or may not use real monitoring
equipment. The output signals to their displays are
consistent with the patient anatomy and condition being
presented and are changed by the instructor to reflect
real-time changes in patient condition.
Use computer modeling and complex programs to cause
the user to believe that they are interacting with a patient,
when in reality, they are interacting only with the
imagination of the computer. The simulator has some
type of physical representation with sensing instruments
that inform the computer of the user’s movements. The
program then computes the changes that should take
place within the model and projects the correct response
onto the screen. Systems may include some sort of 3D
imaging to make the environment more realistic and
intuitive
Most contain an interactive patient vital sign screen
which responds to user interventions. Physical skills and
tasks cannot be taught on them. Educational content is
mainly focused on learning facts, using the info learned
to make treatment decisions, and evaluating the
effectiveness of that treatment.
Designed to teach a specific task, procedure, or anatomic
region. They often resemble anatomic sections of the
body, but this is not necessary. Some are automated, but
there is no adjustment based on the user’s actions.
Clinical Simulations in Alaska
21
Appendix B: Simulators, Distillation of Advantages and Challenges, Bibliography
Examples
BabySim, Emergency
Care Simulator, Human
Patient Simulator (HPS),
PediaSim, PediaSimECS,
Sydney Perfusion
Simulator
Airman, Baby Hal, Code
Blue III Interactive
System for ACLS
Instruction, HAL, Noelle
Obstetric Simulator,
PatSim-1, SIMA,
SimMan
AccuTouch Endoscopy
Simulator, AccuTouch
Endovascular Simulator,
Angio Mentor, CathSim
Intravenous Training
System, Endotower, GI
Mentor, Uro Mentor and
so on-more listed on
website
A few examples: ACLS
Simulator, Anesthesia
Simulator, Cardiac
Arrest, Critical Care
Simulator, Gas Man,
Sedation Simulator
Website lists all the
manufacturers
The following list of advantages and challenges was distilled from notes taken from some of the articles and books
listed in the Sources section. It is not intended to be comprehensive, but to give the reader a sense of what is being
discussed in the literature.
Compiled by Janice Troyer of the Alaska Center for Rural Health-Alaska’s AHEC.
Advantages of Using Human Simulation Technology
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
This technology can provide realistic clinical experiences without risk to patients and learners
Tasks/scenarios can be created on demand; the instructor controls the clinical situation, events, and
timing of learning
Students can be exposed to clinical experiences they would rarely see; rare life-threatening events can
be scripted and practiced using simulators for experienced residents and practitioners.
Tasks/scenarios can be designed with increasing complexity and introduced in a controlled way.
Skills can be practiced repeatedly, tailoring to individual needs.
Replaying scenarios allows several approaches to the same situation or event.
There is an opportunity for interactive, interdisciplinary health care team learning and team
performance assessment to practice important clinical, communication, leadership and interpersonal
skills.
Practicing teamwork skills in simulated crisis situations can improve a team’s ability to function
effectively.
Research shows students involved in active learning retain knowledge longer.
Learners have “permission to fail” and to learn from such failure in a way that would be unthinkable
in a clinical setting. It gives students an opportunity to explore limits of each technique rather than
having to remain within the zone of clinical safety.
Instructors do not have to take over as often as they would in a clinical unit when students are having
difficulty or mishandling a situation.
A training agenda can be determined by the needs of the learner, not the patient; learners can focus on
whole procedures or specific components, practicing these as often as necessary.
Simulation-based learning can help students bridge the gap between classroom and clinical settings
and support their ability to apply what they have learned.
Learning is interactive and includes immediate feedback.
Action can be paused for reflection and correction.
Sessions can be videotaped for subsequent review and discussion, fostering reflective learning.
Standards against which to evaluate student performance and diagnose educational needs are
enhanced.
Students accustomed to simulation experiences report decreased level of performance anxiety and
increased self-confidence in their psychomotor skills and critical thinking abilities.
Several learners can benefit from a session and learn form each other’s successes and mistakes.
Clinical teaching time can be decreased.
Challenges of Using Human Simulation Technology
•
•
•
•
•
Equipment and associated costs for maintaining, troubleshooting and repairing it can be expensive.
There is the potential cost of a simulation center coordinator and technical support personnel.
There are space needs to house equipment (including a control area where simulation is staged,
storage space for life-size simulator(s) and supporting equipment as well as a remote area to debrief).
Faculty development must be considered when implementing an education curriculum using human
patient simulation-they must learn new instructional skills and techniques.
Technical support is needed to maintain and run equipment.
Clinical Simulations in Alaska
22
Appendix B: Simulators, Distillation of Advantages and Challenges, Bibliography
Sources
BOOKS
Jeffries, P.R. (2007). Simulation in Nursing Education: from Conceptualization to Evaluation. New York:
National League of Nursing.
(Note: this book has been ordered by the UAA Consortium Library)
Dunn, W.F. (Ed.) (2004) Simulators in Critical Care and Beyond. Des Plaines: Society of Critical Care
Medicine.
(Note: a request has been put into the UAA Consortium Library to order this book.)
ARTICLES
Binstadt, E.S., Walls, R.M., White, B.A., Nadel, E.S., Takeyesu, J.K., Barker, T.D., et al. (2007). A
comprehensive medical simulation education curriculum for emergency medicine residents. Annals of
Emergency Medicine, 49(4), 495-504. (Describes a complete curriculum redesign to fully implement a
medical simulation model using adult learning principles, medical simulation learning theory, and
standardized national curriculum requirements for an emergency medicine residency curriculum.)
Buchanan, J.A. (2001). Use of Simulation Technology in Dental Education. Journal of Dental Education,
65 (11), 115-1231.(Discusses the potential use of simulation technology in dental education and gives an
overview for virtual-reality based simulation products-with a few photos and discusses potential uses for
virtual reality simulators.)
Good, M.L. (2003).Patient simulation for training basic and advanced clinical skills. Medical Education,
37 (Suppl 1), 14-21. (Includes a brief history of human patient simulator development, features of
contemporary simulators, as well as benefits, limitations and effectiveness of this learning modality.)
Harlow, K.C. and Sportsman, S. (2007) An Economic Analysis of Patient Simulators for Clinical
Training in Nursing Education. Nursing Economics, 25 (1), 24-29 (Evaluated the difference between three
stand-alone versus one regional center in terms of facility, equipment and faculty costs-study done in
Texas.)
Issenberg, S.B., McGaghie, W.C., Petrusa, E.R., Gordon, D.L. & Scalese, R.J. (2005).
Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic
review. Medical Teacher, 27(1), 10-28. (A literature review of articles from1969-2003 whose objective
was to answer the following question: What are the features and uses of high-fidelity medical simulations
that lead to most effective learning?)
Jeffries, P.R. (2005). A Framework for Designing, Implementing, and Evaluating Simulations Used as
Teaching Strategies in Nursing. Nursing Education Perspectives, 26(2), 96-103. (A good overview of
using simulations as a teaching strategy in nursing.)
Kneebone, R. (2003) Simulation in surgical training: educational issues and practical implications.
Medical Education, 37, 267-277. (Good background information on different kinds of simulators.)
Lathrop, A., Winningham, B., VandVusse, L. (2007). Simulation-Based Learning for Midwives:
Background and Pilot Implementation. Journal of Midwivery & Women’s Health, 52 (5), 492-498.
Clinical Simulations in Alaska
23
Appendix B: Simulators, Distillation of Advantages and Challenges, Bibliography
(Includes some good background information on the use of simulations-very little of the article is about
midwivery specifically.)
Maran, N.J. and Galvan, R.J. (2003). Low-to high-fidelity simulation – a continuum of medical
education? Medical Education, 37 (Suppl 1), 22-28.(Gives a good overview of types of simulation
equipment available)
Morgan, P.J. and Cleave-Hogg, D. (2005). Simulation Technology in training students, residents and
faculty. Anaesthesiology,18, 199-203 (An overview of the developments in medical education and
assessment using high-fidelity simulation-included descriptive and research papers)
Peteani, L.A. (2004) Enhancing Clinical Practice and Education With High-fidelity Human Patient
Simulators. Nurse Educator, 29 (1), 25-30. (Includes an idea for developing a business plan to outsource
SimMan to others for a charge to help with costs of buying equipment.)
Rauen, C.A. (2004). Simulation as a Teaching Strategy for Nursing Education and Orientation in Cardiac
Surgery. Critical Care Nurse, 24 (3), 46-51. (Great list of advantages and challenges of using simulation
as a teaching strategy-in Table 2)
Seropian, M.A., Brown, K., Gavelanes, J.S., & Driggers, B. (2004, April) An Approach to Simulation
Program Development. Journal of Nursing Education, 43 (4), 170-174. (Talks about components in
developing a simulation program-good concise article.)
WEBSITES-GENERAL
Society for Simulation in Healthcare: http://www.ssih.org/public/
(This society, established in 2004, was formed “to represent the rapidly growing group of educators and
researchers who utilize a variety of simulation techniques for education, testing, and research in health
care. The membership, now over 1,500, is united by its desire to improve performance and reduce errors
in patient care using all types of simulation including task trainers, human patient simulators, virtual
reality, and standardized patients.”)
UW-ISIS (University of Washington’s Institute of Surgical and Interventional Simulation):
http://www.isis.washington.edu/
Seattle University’s Nursing Clinical Performance Lab: http://www.seattleu.edu/nurs/lab.asp
WISER (The Peter M. Winter Institute for Simulation Education and Research) at the University of
Pittsburg: http://www.wiser.pitt.edu/ (includes a list of all the courses offered through the simulation
center.)
Oregon Simulation Alliance: http://www.oregonsim.org/
STARS: http://www.stars.ca/bins/index.asp (This Canadian organization has a Mobile Simulation
Program (using motor homes))
Penn State: College of Medicine: Simulation Development and Cognitive Science Lab:
http://www.hmc.psu.edu/simulation/ (includes a list of what is available equipment wise)
Clinical Simulations in Alaska
24
Appendix B: Simulators, Distillation of Advantages and Challenges, Bibliography
VIDEO LINKS TO DEMONSTRATION OF SIMULATORS
Pediatric Human Patient Simulator: http://www.cincinnatichildrens.org/ed/cme/ems/human-simulator.htm
Nursing Anne Simulator: http://www.uwec.edu/nurs/simulationlab/index.htm
PRODUCT WEBSITES
Laerdal: http://www.laerdal.com/Navigation.asp?nodeid=5736689
METI: http://www.meti.com/in_index.html
Gaumard: http://www.gaumard.com/customer/home.php
Clinical Simulations in Alaska
25
Appendix B: Simulators, Distillation of Advantages and Challenges, Bibliography
Appendix C: Use of Human Simulation Technology in Alaska (A Snapshot)
Background to the Method
ACRH conducted a series of telephone interviews between mid-October and November 21st to determine
the current use of human simulation technology in Alaska. An attempt was made to contact:
•
•
•
Hospitals in the state
UA health programs known to use human simulation technology and/or who are involved in clinical
education
EMS/fire departments across the state
While a census of users was not feasible or appropriate, responses were sufficient to provide a
representative sample and snapshot of human simulation technology in Alaska.
For those who own moderate to high fidelity equipment, questions were asked about the:
•
•
•
•
•
type of training the equipment is used for
who the primary users are
whether equipment is ever transported out of the main facility for training
maintenance issues to date
lessons learned about using this type of technology
For those facilities that did not own any moderate to high fidelity simulation equipment, questions were
asked about their:
•
•
•
interest in using simulation technology for training in their facility
how they would envision using simulation technology
perceived advantages of using simulation technology
Of the following tables, Table A lists those facilities/programs who currently own moderate to highfidelity simulation equipment. Table B lists those who do not. Following these tables is a thematic
organization of respondent comments regarding lessons learned, advantages of using simulation
technology and why people are interested in simulation technology.
Clinical Simulations in Alaska
26
Appendix C: Use of Human Simulation Technology in Alaska
Use of Human Simulation Technology in Alaska (a Snapshot)
Table A: Facilities that currently own moderate-to high-fidelity simulation equipment
Facility/UA Dept.
Contact
Position or Dept.
Type of
simulation
equipment own
When
equipment
was purchased
(if known)
UNIVERSITY OF ALASKA PROGRAMS
Kachemak Bay Campus
SimMan
Spring of
in Homer
2007
Carol Klamser
UAA nursing faculty
Chukchi College in
Nursing Anne
Summer of
Kotzebue
(from Laerdal) 2006
Dara Whalen
UAA nursing faculty
Kenai Peninsula College
Paramedic Program
Paul Perry
Faculty
Two SimMans;
one a newer
generation
First one
purchased 2
years ago,
second
SimMan
purchased one
year ago
Tanana Valley College
Paramedic Program in
Fairbanks
Chuck Kuhns
Faculty
One SimMan
and two ALS
mannequins
from Laerdal
Have owned
Sim Man for
about 2 years
and the ALS
mannequins
for about 1
year
Uses of Simulation Technology (current and/or
planned)
Is equipment ever
transported out &
used away from the
facility? If so, where?
Equipment
maintenance issues
Plans to use with nursing classes, CNA classes &
possibly with an EMT class
Probably not-too
cumbersome to do
this
No maintenance issues
to date; plans to use IT
department if problems
occur
No maintenance issues
to date with the
electronics; had to fix
some of the joints
herself
Used to date with nursing students to practice
fundamentals (i.e. BP, pulse, bowel sounds); MedSurg-catheters, IV intravenous, Peds/Ob-fetal heart
tones; hopes to eventually use as part of Trauma
Nursing Core Curriculum (TNCC) and for CEs with
CNAs
We build our paramedic and EMT programs around
the use of SimMan for cardiac assessments mostly.
On average we use SimMan about 8 hours a week.
I have also used it do ACLS scenarios with the
physicians at Central Peninsula Hospital; to practice
the more invasive skills with the Nikiski and Kenai
Fire Depts., and once with Central Emergency
Services who used SimMan to run scenarios for those
employees who were interested in becoming
paramedics; we have also shared SimMan with
associate nursing students at our college to do basic
airway management
These mannequins are primarily used with ALS
students-EMT level.
I use it primarily to simulate scenarios for my
students. For example a respiratory patient can
improve or decline depending on how the student
interacts with the mannequin. I have also used
mannequins for procedures or skills training, though
I usually fall back on the lower-fidelity mannequins
for this.
Clinical Simulations in Alaska
Appendix C: Use of Human Simulation Technology in Alaska
27
NO
YES, see previous
cell for examples of
sharing equipment at
other sites.
No, it would be too
hard to haul all the
pieces needed. I think
SimMan works best
in a lab setting, rather
than being hauled
around.
I do my own
maintenance.
Maintenance can be
potentially expensive,
but I keep a close eye
on the equipment and
make sure it’s used
properly. (Paul
attended 2 days of
SimMan training
which included
maintenance.)
I maintain the
equipment. We chose
not to carry the
warranty because of
the expense ($5000/yr)
I get help from the rep
when they are up or
call local people to
help when needed.
Facility/Contact
Equipment
When bought?
Prince William Sound
Have heard
Summer of
Community College in
that PWS
2007?
Valdez
recently
Julie Fronzuto
bought a
Faculty
SimMan
HOSPITALS OR AFFILIATE PROGRAMS
Maniilaq in Kotzebue
A METIOwned for
Brian Reiselbara
Emergency
about a year
Chief Flight Paramedic
Care Simulator
Uses of Simulation Equipment
Transported out?
Maintenance
We are the regional training center for EMT and ETT
classes. We have used METI for ACLS trauma and
other trauma training. We have also done mock codes
at the hospital with the staff there: physicians, nurses,
EMTs, and also the local fire department.
We plan to take it out
to villages to train the
CHAPs, but are
waiting on money to
fund those flights.
Last year we took it
to one of the CHAP
symposiums to help
in ALS training.
No maintenance issues
to date. All our EMS
staff went through 3
days of METI training
which included
maintenance.
Norton Sound Health
Corporation in Nome
Peter Pierson
Training Department
A METI man
Owned less
than a year
We have only used it once with an ACLS class;
because we have been so short-staffed since spring,
we have not really had the opportunity to fully use it
yet, but plan to soon. (Peter noted they had a
company rep come up for 2 days of training, but
because they were so short-staffed at the time & busy
with calls, most of the staff were unable to attend.)
I envision the mannequin will be used mostly for the
more invasive ACLS and BLS procedures and for
advanced assessments. With the METI mannequin,
we will be able to run scenarios where meds are
pushed and the mannequin responds appropriately.
Not sure yet if the
equipment will ever
be transported out
Because the equipment
is so new, this has not
yet been an issue.
Ketchikan General
Hospital
Val’ee Gray
Education Department
VitaSimKelly
& VitaSimKid
Received one
week before
interview
Plans to use for ACLS and PALS training
No, equipment will
stay in hospital, we
don’t want to risk
damaging it; we plan
to invite local fire
dept & others in
outlying areas to
come in for training
No maintenance issues
to date, anticipates
having to replace arms
and sections of skin
from time to time.
Was unable to complete this interview
Clinical Simulations in Alaska
Appendix C: Use of Human Simulation Technology in Alaska
28
Facility/Contact
Basset Hospital at Ft.
Wainwright;
Lt Col Lisa Ungulli
Head of Hospital
Education
Yukon Kuskokwim
Health Corporation
Glen Jorgensen
Former Clinical Nurse
Educator, now in OR
Equipment
They have an
older version
of SimMan &
plan to put in
request for a
SimBaby &
Noelle
(birthing
simulator)
One SimMan,
Providence Lifeguard
Air Ambulance
Charles Darnelle
Education Coordinator
Have one
SimMan and
one SimBaby
Providence Children’s
Hospital
Cindy Alkire
Asst Chief Nurse
Executive
Have a Noelle
Interactive
Childbirth
Simulator with
a fetal and
neonatal PEDI
mannequin
When bought?
Not sure how
long they have
had the
SimMan;
hopes to get
new
equipment
within 2 years
Uses of Simulation Equipment
1) Pre-deployment training for the soldiers going to
Iraq and Afghanistan-to train them for scenarios
they might see
2) Maintenance training
3) Post-deployment training-for example an
OBGYN physician coming back from Iraq may
need practice on a birthing simulator if they have
spent the past year working as a general physician
Transported out?
I don’t envision using
this equipment in the
field, but I could see
taking it to other
facilities such as Ft.
Rich or inviting them
here.
Maintenance
No particular
maintenance problems
to date; plans to have
Laerdal come up when
they get the new
equipment.
Bought
Summer 2007;
haven’t started
using it yetjust found a
designated
area to keep it
Have had this
equipment
about 3 years
Glen envisions using it for the high-risk/low volume
cases such as chest tubes and mock codes. He says
they plan to use SimMan for training of the fire
department, nursing program, providers and nurses,
as well as the upper levels of the CHA/P program.
SimMan will
probably stay in the
hospital and people
wanting training will
come here.
No maintenance issues
to date-equipment
brand new.
Use for training paramedics, the higher level EMS
courses and CE courses for difficult airway
management for nurses and residents
We have both driven
it to communities and
flown it on ERA. For
example we have
gone to Barrow and
Cordova. We have a
portable air
compressor that
allows us to use the
equipment in remote
locations.
Noelle has been used
for instruction of
emergency deliveries
by Providence
Seward, Providence
Valdez, Central
Peninsula EMS,
Willow EMS and
Palmer EMS (Note: it
has to be transported
by vehicle because of
size)
Normally we have had
no maintenance
problems, but recently
our SimMan was
damaged while left
unattended at a
conference and so we
will have to spend
quite a bit sending it in
to have it repaired.
Used for childbirth/delivery instruction, breech
extraction, shoulder dystocia drills, vacuum assisted
delivery, emergency c-section drills, mock codes
(advanced life support), neonatal advanced life
support and post partum hemorrhage management.
Noelle used to train nurses, physicians, residents and
EMTs all over Alaska
Clinical Simulations in Alaska
Appendix C: Use of Human Simulation Technology in Alaska
29
Facility/Contact
Equipment
FIRE DEPARTMENTS/EMS SERVICES
Homer Volunteer Fire
One SimMan
Dept.
and one ALS
Bob Painter, Chief
training
mannequin
When bought?
Uses of Simulation Equipment
Transported out?
Maintenance
Have had
SimMan for 3
years, first in
the state to
buy one
Used mostly for training with the EMTII and EMT
III and ACLS classes. Have also used it in EMT I
classes since you can modify the vital signs.
We haven’t had any
maintenance issues to
date. Occasionally I
have had to do some
cleaning and replacing
pieces/cover openings.
Central Peninsula EMS
John Evans
Training Officer
Have a METI
man not
currently being
used, would
like to buy a
SimMan; have
a Crash Kelly
for fieldwork
Was
purchased
about 5 or 6
years ago
We have a METI that we do not use anymore. We
found the software and equipment so complex that
we would have to hold up our simulations to
accommodate the software. The model we got was
one of the first models off the shelf.
If we had a SimMan, we would use it for ALS
training (we have about 40 paramedics-the biggest
EMS service on the peninsula)
Anchorage Fire Dept
Dave Wallace
SimMan
(Initially we
got a METI but
it was more
high tech,
expensive and
difficult to
program so we
traded it in for
the SimMan)
One SimMan
and a VitalSim
(another
SimMan was
sent to
Ketchikan)
Have had the
SimMan for
about 2 years
We use it to do ALS scenarios- used for higher level
EMT classes.
It’s not very portable,
but we have taken it
to Anchor Point.
Seldovia would love
to use it, but we
haven’t figure out a
way to fly it over.
The model we have is
not wireless which
means it’s tied to
cables.
If we had a SimMan I
would only consider
transporting it to
other communities on
a limited basis since
it would involve
moving a lot of
equipment, but it
would be nice to be
able to take it to
Cooper Landing
SimMan left our
building once, he can
be put into a car, but
he has to be on a
battery and you have
to take a compressor
so it’s not a
particularly easy
process.
Bought
Summer of
2007
I use SimMan to do skill reinforcement of lectures I
give, to reinforce problems or weaknesses. We are
able to reproduce scenarios that match a call we have
just done; we are also able to do airway management
from intubation to surgical cricothorotomy-we can
make the mannequin spasm
Yes, we have two fire
departments here, so
we plan to use
SimMan with both of
them for training.
No problems too date.
I plan to call Laerdal if
anything comes up, we
have had good support
from them to date.
Juneau Fire Dept
Charlie Blattner
EMS Training Officer
Clinical Simulations in Alaska
Appendix C: Use of Human Simulation Technology in Alaska
30
Our MetiMan was very
expensive to maintain
which is one of the
reasons we don’t use it
anymore. Also it used
Apple software and
was very finicky.
Pat Vincent, who is in
charge of all our
training does all the
maintenance.
Facility/Contact
Equipment
OTHER ORGANIZATIONS
Guardian Flight in
2 SimMan
Fairbanks
1 SimBaby
Don Wells
Training Director
When bought?
Uses of Simulation Equipment
Transported out?
Maintenance
Have had one
SimMan for 3
yrs; recently
purchased
other
equipment at
an auction Oct
2007
We do mostly pre-hospital and critical care training
like chest tubes, surgical criocs, airway management
I train my staff, nurses, and paramedics
If we are doing a pre-hospital scene, paramedics take
the lead; for a hospital to hospital scenario (i.e. ICU
to Seattle), the nurses take the lead in the scenario
Yes, we have shipped
SimMan out all over
the state. We bring an
air compressor and he
runs off a laptop. We
have 5 bases across
Alaska and do
training in Fairbanks,
Anchorage, Sitka,
Ketchikan &
Unalaska
Forgot to ask
Clinical Simulations in Alaska
Appendix C: Use of Human Simulation Technology in Alaska
31
Table B: Facilities that do not currently own moderate to high-fidelity simulation equipment
Facility/UA Dept
Contact
Position
Would you be
interested in using
simulation
technology?
UNIVERSITY OF ALASKA PROGRAMS
Kenai Peninsula
YES, we applied for
College
funding to purchase
Lynn Senette
SimMan, but did not
UAA nursing faculty
get it
UAA main campus
Not sure; though the
Marianne Johnstoneequipment, such as
Petty
SimMan, is nice,
UAA nursing faculty getting instructor
buy-in and the
instructors up to
speed might be too
much work.
UAA main campus
We have talked
Dennis Valenzeno
about it from time to
AK WWAMI Director time. In terms of 1st
yr students we have
not embraced the
technology. We use
cadavers and I don’t
see giving that up.
UAA Main Campus
John Riley
YES
PA Program, Director
UAA Allied Health
Sally Mead, Director
and staff
YES
Mat-Su Campus
Not sure
Potential uses for simulation
technology at your facility
To use in training BS/AAS nursing
students in Kenai and/or Anchorage; to
run clinical scenarios
I could see running different case
studies/scenarios. I don’t see doing code
situations, but doing the day-to-day
patient assessments. I don’t see it
replacing what we do now, but giving
students more practice time with their
skills.
I could envision using the simulations as
a way to bring the first and 3rd year
medical students together to work on
team approaches. Perhaps the 3rd/4th year
students could take on the role of the
physician while 1st year students play the
role of a resident or intern and then you
could bring in nursing students as well.
I could imagine using simulation
technology for many of the same things
medical or NP students would use it for:
procedures, exams, emergency
procedures, anything where you can’t
have a standardized patient (actor). I
envision using it mostly during the
student’s didactic year.
The Rad Tech and Dental Hygiene
program could envision having their
students participate in crisis scenarios
with other providers for teamwork
training and to provide an opportunity for
students to respond to a crisis. They see
using the equipment on a limited basis
each semester (ideally sharing equipment
with other programs). Medical Assisting
could use it for practicing taking blood
pressures, pulses and temperatures.
Note: A planned paramedic program may
also have a need for this equipment.
We could possibly use it for the nursing
and EMT programs. I believe they are
also trying to establish a paramedic
program here. It might also be used for a
vet-tech class-though I think the classes
here only introductory.
Clinical Simulations in Alaska
32
Appendix C: Use of Human Simulation Technology in Alaska
Would you envision
ever transporting
equipment for use away
from your facility?
Probably not
No, I would envision
SimMan having a home
and the students coming
to it.
That would depend on
what equipment we ended
up with and our capacity.
I could envision bringing
the equipment, if it was
portable, over to the
Residency perhaps.
I’m not sure where the
program will be housed,
but I imagine it would
make more sense to have
students go to a center
rather than duplicating
space/equipment.
With many students
enrolled in allied health
distance programs across
Alaska, staff wonder if
there are any virtual tools
that are being considered
for basic science course
like chemical labs and
anatomy/physiology
classes.
Perhaps simulation could
also be used to do
community outreach, for
example with the Red
Cross. Maybe we could
share equipment with
Mat-Su Regional Hospital
Facility
Interest?
Potential uses of Simulation Equipment
HOSPITALS and AFFILIATE Organizations
Petersburg Medical
ACLS and PALS classes and on-going
Center
YES, We would
training with the nurses; we are also
Sandy Tackett
love to have more
hoping to be approved for distance
Director of Nursing
lifelike mannequins
education for nursing, so I could see
using the equipment for those students
Wrangell Medical
I don’t really see any need for this type of
Center
NO
equipment at our center.
Janet Buness
(They currently have an ACLS CPR doll
Director of Nursing
that has different cardiac rhythms that is
used by the ER nurses and physicians for
continuing education)
Cordova Community
Practicing trauma, cardiac issues and
Medical Center
YES
CodeBlue situations
Gretchen Zollden
Director of Nursing
Bartlett Regional
Hospital
Justine Muench
Staff Development
Director
YES, all we
currently have is a
low-fidelity CPR
mannequin
-For new nurses and new graduates
-For continuing education for our staff
-Patient education
South Peninsula
Hospital
Laurin Painter & Ann
Marie Bailey
Former/Current
Education Directors
Central Peninsula
Hospital
Susan Shumaker
Staff Development
Yes, but we don’t
have the money to
purchase equipment.
Simulation technology would be useful
for doing advanced life support training
of physicians and allied health
practitioners, though the higher fidelity
equipment is not needed for BLS training
Not sure
For physicians to practice chest tube
placement and intubation; For RNs to
practice IVs, foleys, central line
placements, ACLS, assessment issues,
ostomies & wound care.
ANMC
Tom East, Chief
Information Officer
Sitka Community
Hospital
Tom Marthaller
JoAnn Clyde
Director of Nursing
Providence Kodiak
Island Medical Center
Darla Merrett
Education Department
Not sure at this time
Potentially for training and CMEs
The staff are
interested in using
simulation
equipment, but we
can’t afford it
Yes, but we can’t
afford to buy this
equipment
ourselves, we’re too
small
We could use for practicing more
invasive procedures and advanced trauma
like compressing pneumothorax.
We also have long-term care facilitiesI’m not sure if they would have a need.
We have been able to borrow a SimMan
from the Coast Guard base and from the
city fire dept to use for PALS and ACLS
training. I could also see using it for
airway management, TNCC, working on
newborns for intubation and so on.
Clinical Simulations in Alaska
33
Appendix C: Use of Human Simulation Technology in Alaska
Transported out?
NO
The EMTs at our local
fire department and the
community college,
which may be starting a
nursing program, may
have use for the
equipment as well.
Not sure. We might
consider sharing
equipment with UAS.
It would depend on how
portable the equipment
was and who has
ownership to see how it
could be shared.
No, the equipment is
expensive and I don’t see
lending it out. It is not
that easy to move around.
Likes the idea of a
collaborative venture
between university &
facilities where staff &
maintenance costs could
be shared; possibly a
“mobile classroom”
Our community has 2
hospitals, a fire dept and
air transport, so the
potential for sharing a
resource is there.
I could envision using
equipment for staff at our
senior center, the assisted
living facility, and the
area Native association.
Facility
BBAHC -Kanakanak
Hospital in
Dillingham,
Starla Fox, Deputy
Nurse Director
Dave Milligan with
EMS Dept.
Interest?
Yes, we are very
interested in
simulation
technology, but we
haven’t looked
seriously at buying
any yet, because we
don’t have the
money
Potential uses of Simulation Equipment
The EMS Dept does all the training for
the CHA/Ps and EMTs in the region (we
serve 32 villages); we have a PALS,
ACLS and pre-natal instructor here.
Starla also noted that hospital staff use
the EMS Dept for CE training like ACLS
and PALS training
Transported out?
The health aides come
into Dillingham for
training and we also have
a 2-year rotation where
we go to each village for
a 2-week training;
simulation equipment
could be used in both of
these instances.
Providence Valdez
Julie Silkett,
OR supervisor &
Lois Platt, Nursing
Manager
Our local college is
getting a SimMan
and I am sure we
will be able to
borrow it; we have a
good relationship
with them.
ACLS and TNCC training
Possibly for CNA training as well.
NO
Providence Seward
Alexis Klapproth
Associate Director of
Nursing
We don’t have the
money for the more
expensive
mannequins (we
currently only have
CPR mannequins
and an IV arm)
Yes, our regional
EMS Coordinator’s
Group has been
discussing
simulation
technology
We have no highfidelity simulator,
but have a Computer
Based Simulator
(ACLS Simulator)students interact
with people on the
computer
I could see using the fancier mannequins
for the Trauma Nurse Core Competencies
and ALS training.
No, we don’t loan out our
equipment, but I could
see if we borrowed
simulation equipment that
it could be shared with
our local fire department.
We have clinics all over Southeast and
training needs to be provided for health
aides, mid-levels, and physicians.
Yes, I would travel to all
the clinics to do the
trainings.
I could see using the technology for new
nursing graduates who need to go
through a core nursing skills course that
lasts 8 weeks; we have talked about
sharing equipment with the local
paramedic program.
We also have WWAMI medical students
and other medical students that do an OB
rotation that could use the equipment.
We would like to use it for training for
obstetric emergencies, starting central
lines, intubation, resuscitation, chest
tubes, advanced trauma life support,
simulations of thorasentesis, parasentesis,
venus cut-down, acute emergency
management.
I could see using it for training students,
advanced training of staff and maybe
some BLS type training for community
education.
I would think the
equipment would stay in
the hospital
SEARHC
Mike Motti
EMS Dept
Fairbanks Memorial
Hospital
Corlis Taylor
Education Department
Alaska Family
Residency
Harold Johnston
Program Director
Alaska Regional
Hospital
Dona Townsend
Chief Nursing Officer
Providence has been
researching the
possibility of putting
in a simulation
center, modeling it
after one in
Pennsylvania
I am not aware of
any simulation
technology here or
any research
currently being done
here for obtaining
equipment.
Clinical Simulations in Alaska
34
Appendix C: Use of Human Simulation Technology in Alaska
No, we would not need to
transport equipment
anywhere.
Probably not. We have
affiliations with Cordova,
so potentially we might
take equipment to be
shared out there. We
don’t have many outreach
programs here.
Facility
VA Hospital
Andrea Neuerburg
RN & Infections
Control Nurse
Interest?
YES
Potential uses of Simulation Equipment
We have a lots of student nurses that
affiliate with us in the BS program. The
VA has a program where student nurses
can work with us under a tech status. We
also have students in ambulatory surgery,
medical assisting and practical nursing,
so I see simulation technology as a way
for them to practice their clinical skills
before they start working on patients.
Transported out?
No, I don’t see a need for
transporting equipment
out of our facility.
Also when we get new equipment in, it
would be nice to be able to demonstrate
on a mannequin before they start using
the equipment on patients.
OTHER ORGS
CHA/P (Community
Health
Aide/Practitioner)
Program
Torie Heart
Alaska Dept of Health
and Social Services
Jerry Troshnyski
Staff Develop
Coordinator with
Public Health Nursing
Section
Has never
considered it.
Haven’t really
thought about it; our
focus is more
population based.
Our training sessions are 3-4 weeks long and already jam packed, so it
would be hard to add to the curriculum. Also much of the training
happens in the field. It is very difficult to get CHA/Ps together for
training as they are often the sole providers in their villages;
There might be a potential for doing lung assessments or blood
pressures with the mannequins.
We don’t really have need for the
mannequins. Our staff does CPR training
and a few immunizations. What I think
might be more effective for us are some
type of computer simulation; something
like the SimCity Societies program that
kids use.
Clinical Simulations in Alaska
35
Appendix C: Use of Human Simulation Technology in Alaska
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
10:30 am to 3:30 pm
Attendees:
Taskforce Members:
Karen Perdue
X
Jan Harris
X
Maureen O’Malley *
X
Dan Johnson
X
Corlis Taylor**
X
Lynn Senette
X
Jackie Pflaum
X
John Riley
X
Staff:
Beth Landon
X
Jennifer Risse
X
X
X
X
X
X
X
X
X
Andrea Neuerburg***
Dona Townsend
Karen Carpenter
Suzanne Tryck
Roy Davis
Paul Perry
Debbie Thompson
Tom East
X
X
X
X
X
X
X
Cheryl Easley
Harold Johnston
Chuck Kuhns
Dennis Valenzeno
Justine Muench
Jerry Troshynski
Sally Mead
X
X
Mia Oxley
Lori Ehrhart
X
Janice Troyer
*Maureen O’Malley sat in for Marianne Johnstone-Petty from the UAA School of Nursing
**Corlis Taylor sat in for Liz Woodyard from Fairbanks Memorial Hospital
***Andrea Neuerberg sat in for Linda Boyle of the VA Healthcare system
Also in attendance for part of the morning: Mike Driscoll, UAA Provost and JoAnn GonzalezMajor of Division of Allied Health at UAA
Guest Speaker: Dr. Brian Ross, Executive Director of ISIS (Institute of Surgical and
Interventional Simulation)
I. Introductions/Scope of Work
Karen Perdue opened the meeting at 10:40am. She gave an overview of the purpose of the group.
“The purpose of this taskforce is to learn from each other’s experience with the technology, learn
what the technology can and cannot do for us, and finally develop a large-scale view the
technology’s potential for Alaska. The taskforce is not charged with making commitments or
investments regarding this technology.”
People in attendance introduced themselves.
Karen Perdue reviewed the Scope of Work and “key questions” to be answered by the Taskforce
over the course of three meetings. She noted there has been an increase in the use of simulation
technology, as well as an increase in the sophistication of the technology and part of the purpose
of today’s meeting was to find out what is going on in the state. She also noted that we have
invited Brian Ross to give us an overview of simulation and what is happening at the national
level. (Karen Perdue noted that within the Scope of the Work there is mention of a subset of
Taskforce members traveling to Simulation Centers in the Continental United States (we will not
be doing this, but we will be bringing experts up from the Continental United States to talk about
Simulation Centers.)
Clinical Simulations in Alaska
36
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
Karen Perdue says that the taskforce needs to look at what simulation can do and not do in terms
of education, continuing education and residency programs. The final outcome of the taskforce
meeting will not be recommendations about vendors or equipment endorsement, but rather to
create a picture of the potential for using simulation in our programs and to look at, for example,
whether or not we should develop some kind of system, such as a consortium, to find ways to
work together on incorporating simulation within our programs.
Karen Perdue also described some of the parallel processes that are revolving around the topic of
simulation. UA is in the mode of expanding its health education programs. We are making
investments in equipment, in buildings (including a $46M Health Science Building), etc. One
question that has arisen is whether we should have a Simulation Center in the new UAA health
building.
Karen Perdue then invited questions from the Taskforce. Harold Johnston asked who the
“decision makers” are that will be using this report. The report will advise the UA President, but
Karen Perdue also anticipates it will inform other decision-makers including hospitals and EMS
agencies.
Dr. Roy Davis explained that Providence is very interested in this technology for physician
education and physician credentialing.
Justine Muench asked about the ability, over the three meetings, to assess the value of this
technology for rural Alaska/non-road system sites. Karen Perdue agreed that this is an outcome.
Karen Perdue explained that this project is a partnership between the University of Alaska, the
Alaska Center for Rural Health-Alaska’s AHEC, and the University of Washington (Suzanne
Tryck).
Karen Perdue introduced guest speaker Dr. Brian Ross, Ph.D., M.D. (see bio below) from the
University of Washington’s ISIS center.
Dr. Ross is a member of the attending staff in the department of Anesthesiology at the University
of Washington. Since 2003, he has held the rank of full professor of Anesthesiology, and in
2005, was named by the dean of the University of Washington School of Medicine to serve as
the first Executive Director of ISIS (Institute for Surgical and Interventional Simulation).
In 1975, he received his Ph.D. in physiology/pharmacology from the University of North Dakota
and went on to complete postdoctoral research in the area of respiratory disease at the University
of Washington. He received his M.D. in 1983 from the University of Washington School of
Medicine. In 1986 he completed a fellowship in Obstetrical Anesthesia from the University of
California at San Francisco, before returning to the University of Washington to complete a
residency in anesthesiology.
Dr. Ross’s interest and involvement in medical simulation has been apparent since 1996, when
he developed the initial curriculum for the Department of Anesthesiology at the University of
Washington. Since that time, he has been responsible for the development of over 20 simulationbased courses for medical students, residents and nurses. Through community outreach and the
Clinical Simulations in Alaska
37
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
continuous development of simulation curriculum, the ISIS program, under the direction of Dr.
Ross, has become an educational cornerstone for the university, community, region (including
the five-state WWAMI area-Washington, Wyoming, Alaska, Montana, and Idaho) and the
medical simulation industry.
Dr. Ross noted that he would like to see the name of his center (ISIS) changed eventually. He
noted they have struggled to get other UW partners involved because others assume their center
is focused on surgery, which it is not. Dr. Ross advises if a group is formed, it is critical to be as
inclusive as possible and the name should reflect that. If there is someone missing from the
room, it needs to be recognized and they should be invited to subsequent meetings. People
should be included independent of the size of the organization or department they represent.
Every partner should have an equal seat at the table. This is very important.
ISIS came into being about five years ago. They recently moved into the University of
Washington Medical Center in July. Dr. Ross then played an introductory video clip generated
for their opening. (See the following website to view that clip: http://www.isis.washington.edu/ see introductory video). ISIS has approximately 15 departments involved in simulation training.
This has enabled them to standardize curriculum across those departments. Dr. Ross noted that a
recent national report (source not provided) indicated over 100,000 hospital deaths were due to
mistakes, most attributed to poor communication. ISIS can simulate an emergency and train on
communication as well as clinical responses. ISIS does the whole spectrum of clinical simulation
from low-fidelity to high-fidelity. One of Dr. Ross’ passions is “third world medicine.” He
believes simulation can be used to reach out to people beyond the road system. He plans to use
WWAMI as a model for the third world and distance education.
Dr. Ross recommended that a consortium have a mission statement or list their primary goals.
ISIS has three goals: provide leadership in use of simulation technology, improve quality of
health care education and improve patient safety and outcomes. The Dean’s mandate is to
provide simulation training (cognitive, OSCE, skills and high fidelity) throughout the WWAMI
region. He also advises that finding the capital for the technology is difficult. It is even harder to
find support for training and staff to maintain and coordinate use of the equipment.
Dr. Ross noted that medicine has for the most part used a silo approach to training and delivery
of care, such as OB, Anesthesia, Internal Medicine, and Surgery using a “see one, do one, teach
one” method. He talked about public demand for training “not on me for the first time.”
Simulation allows students to become proficient in skills before ever working on a patient. It also
allows for cross-discipline training.
Dr. Ross talked about how inefficient the earlier simulation system was for UW staff, with more
time invested in set-up and take down than in the time it took to do the actual simulation. By
having a common simulation center that serves multiple needs and shared staffing, it is a much
more efficient system. Everything is set up and ready to go for the instructor – it only needs to be
scheduled in advance. They have also developed a peer-review process for developing
curriculum. That has helped motivate clinical educators to work for them in developing
curriculum, as it can become part of their portfolio.
Clinical Simulations in Alaska
38
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
Development of curriculum has been an important piece of ISIS and one of the first people that
Dr. Ross hired for ISIS was Dr. Sarah Kim, a curriculum director. Dr. Kim has created a formal
template for their curriculum with 12 essential elements. This enables them to more easily share
curriculum with partners like Oregon Health and Sciences University and the University of B.C.
UW plans to partner with five other sites within the Seattle area and each will have a “footprint”
for simulation equipment. These sites have very different kinds of patients and needs. Because of
this Dr. Ross feels it is important to do the simulation training at the sites. He also feels it is
important for staff to use their own equipment in a simulation, as it ensures the training is as
close as possible to what will really happen.
Dr. Ross explained the new ISIS center, which they just moved into in July, sits directly below
the OR at the UW Medical Center. They had the option of having a larger space across the street,
but decided to go with a smaller space (about 2,000 sq feet), so they could be closer to the
residents and faculty that would be using the simulation center the most. It is too difficult for
residents and faculty to take the time to cross the street to use the simulation center so this was
an important consideration. They may eventually build another simulation center in another part
of campus to serve nurses and pharmacists and so on. He noted that he has seen a lot of
simulation centers that have lots of different rooms for different disciplines, but many sit empty
for large parts of the day. He believes it is more efficient and a wiser use of space to have a more
open model that can be used for multiple disciplines. Dr. Ross noted a national study noted that
Simulation Center rooms are only used 18% of the time (source not provided).
Besides the simulation center, ISIS also serves as a resource library, including curriculum.
Simulators are currently used by a myriad of industries, including health care. An important
question is whether or not simulation can substitute for real patients. There is also the need to be
trained in rare but complicated situations such as a family medicine doctor dealing with shoulder
dystocia. Dr. Ross noted that good clinical judgment comes from bad clinical decisions made
earlier. “You don’t want residents making mistakes on live patients – simulation can play a role
here.”
Dr. Ross described a study done by ISIS that compared the training time needed for eight
students using the old resident training model (see one, do one, teach one) with a group of eight
students using simulation in their training. They found that the simulation cohort was far
advanced early on, but by the end of the training both were groups were about the same level. He
said the advantage of this is that you may be able to add more skills training without increasing
the amount of time covering the curriculum to include simulation. He also noted he wanted to
repeat the experiment the following year, but none of the faculty were willing to go back to the
old training method; they all wanted to continue with the simulation training.
Dr. Ross reviewed reasons to do Simulation Training:
•
•
•
•
Patient safety
Changes in medical education
Changes in healthcare economics
Increasing necessity of sophisticated skills
Clinical Simulations in Alaska
39
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
•
•
•
Technology maturation
Change in curricula and need for validation studies
Regulatory requirements
Currently ISIS uses their simulation with nursing students, residents, visiting physicians, medical
students and with community outreach activities including tours for elementary and high school
students.
Dr. Ross reviewed different types of simulation equipment and uses. He emphasized that learners
should get exposed to the cognitive content before engaging in the simulation because it is more
resource efficient. There is an impressing diversity of equipment available. He went into some
depth on birthing simulators and laprascopic surgery simulators. “There is no reason to buy
something if someone is not taking intellectual responsibility for it and will make sure it is going
to be used.” “You need to do a formal needs assessment, and then curriculum development. The
curriculum must start with how the patient presents and the entire process for moving the patient
through the system.” Dr. Ross talked about high fidelity simulators that have all the bells and
whistles. “If you aren’t going to use all of the functions, it may not be the smartest purchase. The
purchasing decisions should be driven by curriculum needs.” “Don’t get talked into equipment
you don’t need!”
Regarding rural access and distance delivery of simulation, Dr. Ross is exploring the idea of
using Xbox technology as a way of delivering distance simulation. He says it has better video
graphics than many telehealth-specific equipment. It also has the same interface all the time. He
considers web-based education a failure because every program is different and learners have to
learn each new program. He has met with the developer at Microsoft to develop some problembased learning across WWAMI with that system using the Xbox technology. He sees value in
delivering health care with it as well someday.
Dr. Ross noted there is a Society for Simulation in Health Care (SSH) (www.ssih.org), which has
an annual meeting every year. He will be presenting on faculty development this year.
Dr. Ross advised again that the need and function should define the space and the equipment. He
gave examples of small centers which focus on only one discipline, and noted there are only five
to six centers in the country that are multi-disciplinary.
He also noted JCAHO and ACGME are strongly endorsing simulation.
The group broke for a short lunch and then Dr. Ross entertained questions for a few minutes.
Dr. Ross asked Chuck Kuhns what works best for getting simulation into rural areas. Chuck said
he is not entirely impressed with the distance education courses available. Simulation is more
hands-on and better than books. He said you need a mannequin that is easy to transport, and he
does not find the SimMan they have to be. Flying students in for training is not really an option
because of the expense. They are practicing with students now using Laerdal’s computer-based
Sim Hospital.
Clinical Simulations in Alaska
40
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
Dr. Ross’ big question is how you get this technology to remote areas, and standardize that
exposure in small areas.
Jerry Troshynski asked if there was any kind of software like Sim Public Health. Dr. Ross does
not think that exists, but did suggest some related software that may be of interest.
Paul Perry noted he had invested $1,500 in a fancy suitcase for Sim Man, but it takes over two
hours to disassemble the equipment to put in the suitcase. Now they send him on a gurney. It is
much faster and easier. He also has a checklist of things to pack with the equipment.
Dr. Ross talked about the need for a toolkit that you pack whenever taking simulation technology
away from the main facility.
Suzanne Tryck asked about how the simulation works after you get everything out there. Do
students really learn, or are they just having fun with a new toy?
Paul Perry said that students enjoy it, that it is fun, but there is a lot of learning. They have a
series of scenarios and criteria. Students must learn things on a checklist. If they do not learn,
they have to start over at the beginning of the scenario. The simulation equipment is incorporated
into their learning.
Chuck Kuhns talked about the mannequin as an instructor. “I can be behind the scenes with the
remote control. The students are focused on the mannequin, not me.” He also videotapes the
students so they can review how they performed from another angle.
Dr. Ross talked about the advantages of having a group of some sort working together on
curriculum and sharing ideas for how to use the equipment
Justine Muench spoke from a non-road system perspective. “If the simulation can’t be put on a
plane easily or packaged in a transportable manner, you cut out a 1/3 of our state using the
equipment.” Dr. Ross said we have to be able to do this. He noted “if we can put people on the
moon we should be able to do this – it’s just packing and transport. We should be able to move
the simulation equipment some way.” Janice Muench shared how a Canadian group has
converted a motor home to be ½ ER recess room and half computer control room.
Corliss talked about an ACLS class that Harborview Medical Center of Seattle provided in
Fairbanks. They sent up five hard side giant suitcases via UPS. They arrived a week before the
class. They also sent a five page list of equipment and supplies.
Dr. Ross noted there are companies that rent equipment, so you do not necessarily have to spend
$23K on a Simulation Lab when you can rent equipment two to three times a year for a lower
price.
Tom East asked about virtual reality for training. Dr. Ross gave examples of virtual simulation
equipment being considerably more expensive than simulator alternatives. The technology
Clinical Simulations in Alaska
41
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
continues to improve and the landscape will change. Right now, the extra cost is not justified in
his experience.
There was discussion about the military’s investment in simulation. Tom East referenced the
Alaska Federal Health Care Partnership (AFHCP). Andrea Neuerburg from the VA also
commented on the opportunity for partnership as well. The National Guard needs flight missions.
Chuck Kuhns talked about Bassett Hospital (Army) outside of Fairbanks having equipment that
they are not using.
Dr. Ross echoed earlier comments about the need for someone who has intellectual ownership of
the investment; who will make sure the equipment is used.
Dan Johnson talked about rural training and the need for a technical specialist that knows the
equipment and travels with it. Dan Johnson also mentioned another military facility separate
from Bassett Hospital in Fairbanks that has a significant investment in simulation.
Janice Troyer then presented her findings of what is happening across Alaska currently with
simulation technology. She contacted all the hospitals, including tribal health corporations; many
of the fire/EMS departments, air ambulances and any UA programs she had heard use the
technology or potentially could use the technology. Though a complete census of users was not
feasible, she feels she got a good representative sample and snapshot of what is happening with
simulation technology in Alaska.
Janice Troyer asked organizations that had equipment how it was being used, the advantages of
using the equipment, how it filled a need in their training, how long they had the equipment,
whether the equipment was ever used outside of the facility and if there had been any
maintenance issues. For those facilities that did not have equipment, she asked whether they
would be interested in using simulation, what some of the potential uses could be and whether
they ever envisioned using the equipment away from their main facility.
Janice Troyer reported that in general the EMS/Paramedic programs seem to be the most
numerous users; using them for ACLS training, airway management, chest tubes, surgical
criocothorotomy and ALS scenarios. A few hospitals have used simulation equipment for CE
courses for nurses and residents in airway management, ACLS and PALS training. At least one
nursing training program was using a moderate-fidelity mannequin for giving students a chance
to practice fundamentals (BP, pulse, bowel sounds and catheters), IVs and fetal heart tones.
Janice Troyer also noted the military used simulation for pre-deployment training for soldiers
headed to Iraq and Afghanistan, maintenance training and post-deployment training. She gave an
example of an OB-GYN doctor spending a year in Iraq practicing as a general physician and then
needing practice on a birthing simulator when they came back.
SimMan seemed to be the most common piece of equipment in the state.
For those she called who did not have equipment, but were interested in simulation, several
training ideas were suggested and include: day-to-day assessments and running clinical scenarios
for nursing students; procedures, exams and emergency procedures where you can’t use
Clinical Simulations in Alaska
42
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
standardized patients for NPs, PAs and medical students; and using for teamwork training across
disciplines. Hospitals were interested in using it for CE training such as ACLS, PALS and TNCC
classes; allowing staff to practice the more invasive maneuvers such as chest tube placement and
intubation and also for demonstrating new equipment on mannequins before trying on patients.
This last item was mentioned for both staff and patients or family members.
Janice Troyer then referred everyone to the table of Alaska information in the binders she
collected that contains details of the type of equipment each facility has, how long they have had
the equipment, how it is being used, any maintenance issues and whether the equipment was ever
transported out for use. See Table A for those facilities with equipment and Table B for those
without.
Janice Troyer noted she collected five pages of comments during the conversations. These were
lumped into themes and distilled into a one-page document located directly after tables A and B.
Janice Troyer reviewed these comments including the lessons learned and advice from those who
use the equipment as well as the reported advantages of using simulation technology for those
who had equipment and the perceptions of advantages for those who did not.
One of the themes that came out is that it is important to have more than one person trained to
use equipment. Dr. Ross echoed this important point. Others in the group noted that many
organizations have recently made investments in simulation technology, but do not know how to
use the equipment, or do not necessarily have someone overseeing its use.
Janice Troyer mentioned she had been told that Laerdal does provide two days of training to use
SimMan. Paul Perry noted he had a professional video team come in and tape Laerdal’s two day
training, so he can share it with new staff.
Janice Troyer noted that many of the rural facilities mentioned that students and staff do not get
the same amount of exposure to multi-traumas or invasive procedures as those in urban Alaska,
so working with mannequins can help verify skills and ensure skills are maintained.
The added step of realism and being able to rerun scenarios was also noted as a definite
advantage to using simulation equipment.
Janice Troyer noted some had a perception that simulators would free up faculty time. Dr. Ross
noted that is not necessarily true. An instructor needs to run the scenario. You do not just turn it
on and leave the room.
The logistics and expense of leaving the community for training could be avoided if the
equipment could be made available locally. Small sites cannot make an independent equipment
investment. Sharing in the purchase and use of equipment makes more sense to them.
Janice Troyer commented that it seemed the simulation equipment was being used primarily for
skills training in Alaska. Dr. Ross noted that it is also very useful for interdisciplinary training
and communication skills.
Clinical Simulations in Alaska
43
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
Dr. Ross commended Janice Troyer and others for doing such a thorough analysis of equipment
and its use in Alaska before starting the process of discussion of where do we go from here.
Justine Muench asked whether there had been any studies on using simulation equipment with
Native populations.
Cheryl Easley talked about the value of using simulation to run culturally appropriate scenarios.
She noted HRSA’s Division of Nursing might have some resources.
Brian Ross started his next Powerpoint presentation on Developing Simulation Projects
He noted that working in silos is inefficient and costly.
Seven steps to developing a successful simulation program:
•
•
•
•
•
•
•
Needs assessment
Curriculum development
Identification of curriculum components which lend themselves to simulation (and where
simulation could add value)
Identification of simulators that support the curriculum
Development of assessment tools
Allotment of dedicated non-clinical time for training-someone “owning” the simulator
intellectually
Rapid clinical assimilation
“For the Needs assessment, consider what do you need to teach? What’s the low-hanging fruit?
(for us it was patient handover in the hospitals). Ask risk managers, departments, insurance
companies, employees, faculty, regulatory agencies and so on.”
A comment that Dr. Ross reiterated throughout the day:
“Do not buy a simulator and then develop the curriculum, buy the simulator based on the
curriculum.”
Dr. Ross noted that at ISIS they have developed a standardized curriculum template that all
faculty have to follow. The following table outlines the components:
Standard Curriculum Template
Goals
Real life relevance
Anatomy
Material, media, tools, instruments, supplies
Steps of the procedure
1st, 2nd, 3rd
Cognitive
Lecture, description, error recognition
Cognitive test
Skill training
Specific criteria to meet
Test skills performance
Validation
Clinical Simulations in Alaska
44
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
Curriculum Outline
•
•
•
•
•
•
•
•
•
•
•
•
Instructor contact info
Target trainees
Description of curriculum
Goals and objectives
Instructor notes
Prerequisite knowledge and skills
Common errors and prevention strategies
Cognitive training
Simulator set-up
Skill training
Assessment methods
Appendices
Dr. Ross gave an overview of the types of validity:
Training and Testing
•
•
•
•
•
•
•
Face validity (looks like the task)
Content validity (detailed exam by content experts)
Construct validity (can identify novice versus experts)
Concurrent validity-scores on curriculum match other gold standard scores
Discriminate validity-factors that should correlate actually do –all R’s look like R’s
Clinical Outcome
Predictive validity-can curriculum predictive performance in the real world.
(All these strategies have merit; however, predictive validity is the one most likely to provide
clinically meaningful assessment.)
Jerry Troshynski talked about the cost of not doing simulation. Dr. Ross suggested the group that
has the most to gain from simulation is the insurance companies. He approached the Insurance
Commissioner in Washington State. He then spoke with an insurance company, that did not want
to contribute/make an investment when the other companies were not doing the same.
Harold Johnston talked about hospitals becoming more accountable for outcomes from their
payers, and that being a driver. There is an argument that the state should be interested in
training consistency to improve health overall.
The Taskforce took a planned break and Mia Oxley reconvened the group to facilitate a
discussion based on the following key questions:
Clinical Simulations in Alaska
45
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
SIMULATION RELATED
1. Who are the potential Alaskan users of simulation technology? (By discipline? By
geography? By organizational type – post-secondary education or provider?)
2. What Alaskan training needs could we address using simulation technology?
3. To what extent could simulation technology impact delivery of classroom education and
clinical training?
4. To what extent could simulation technology impact the delivery of continuing education and
CME?
5. To what extent will this technology enable UA to train more students?
6. What would be the anticipated training outcomes?
7. To what extent would the use of simulation technology improve patient outcomes?
DELIVERY STRUCTURE RELATED
1.
2.
3.
4.
5.
What value might a collaboration or partnership add to the use of simulation technology?
Under what circumstances?
How should our recommendations prioritize among the potential users and needs?
What is (are) the recommended delivery system structure(s)?
What structure is recommended for management and maintenance?
Mia Oxley proposed we focus on the simulation-related questions for this meeting and save the
delivery-related questions for Meeting 2 – focusing on the value of simulation to taskforce
members and their organizations.
Dennis Valenzeno pointed out that they have 8 cadavers for student training that are occasionally
used by area physicians for practicing pacemaker insertion, etc. In terms of the overall problem,
many of our issues could be resolved with lower tech solutions.
This raised a question of how to approach the topic, given the breadth of constituents in the
room. Roy Davis recommended keeping it pretty broad, but narrowing down the actual uses. He
expressed concern that health care is a team sport – health care professionals need to be able to
work as a team.
Harold recommended going back to the principle of need. Simulation equipment is only a subset
of the education universe. He also suggested that this group, or whatever succeeds it, should very
much embrace the importance of communication.
Dr. Ross agreed that we need to start with a basic list of training needs. Mia Oxley suggested
everyone do an abbreviated needs assessment for clinical simulation training opportunities in
their organization and bring it to the next meeting.
Debbie Thompson pointed out that nurses generally need six months between finishing school
and being really ready to work with patients in a hospital. She asked how much simulation will
add to or take away from that training investment.
Clinical Simulations in Alaska
46
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
Roy Davis echoed that example with his own examples of preparing physicians for working with
patients.
There was some discussion about the difference between Janice’s assessment of investments and
use compared to the next step of organizational needs assessments. As it was discussed in more
depth, the level of questioning and analysis required was daunting at the least. Karen Perdue
suggested we focus on a nucleus of partners to conduct the in-depth needs assessment, and others
could possibly branch out from there. She recommended the University, Providence, and the
Residency as a good start. Roy Davis added the State as a possibility.
Maureen O’Malley spoke about a culture that has drifted away from skill development.
Andrea Neuerburg said that if Janice Troyer called her again she would answer the question
about training needs much differently, and in greater depth. Debbie Thompson suggested that the
hospitals could ask their Risk Managers and get a wealth of useful information on training needs.
Dr. Ross described a simulation done at the ISIS center. They will run one with five residents –
usually one senior, one midlevel, and 3 junior residents. Students start with a Pre-Op form which
has missing information that they need to glean from the patient when they are taking a history.
At some point, a midlevel resident comes in and relieves a junior resident, thus practicing
handover. Then an event is triggered, with the attending physician out of the room for a donut.
After the event is completed, they do a structured debriefing. Two of the junior residents observe
the entire process with the checklist in hand. Dr. Ross noted that the observers often learn the
most.
Dr. Ross also noted when they do a “code” for team training, after the debriefing they will repeat
the scenario with blindfolds. This forces them to be more aware of verbal communication during
the event.
Harold suggested we do an inventory of communication training needs alone. There are likely to
be commonalities across facilities.
Tom East suggested that ANTHC’s training department has a laundry list of training needs. He
wonders if giving people a general list from which to choose items would be more efficient.
Dr. Ross didn’t think so. He suggested that his list may be different from Tom’s. It is more
appropriate to get site-specific ideas. He suggested asking people for their top 5-10 needs.
Harold suggested that after this taskforce completes its three meetings, one of the
recommendations may be to conduct a more thorough needs assessment in the facilities.
Mia Oxley proposed the next meeting be on January 24th, and that people send their training
ideas to Janice Troyer by the middle of January. Janice Troyer would then have time to organize
the information for sharing on the 24th.
Clinical Simulations in Alaska
47
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
Karen Perdue suggested having two reporting categories: education and clinical training. We
discussed categories and how we organize information.
There was some discussion of breadth of training needs, with a strong argument for focusing on
skill development. It is possible that Pam Jeffries could participate in our next meeting.
Meeting dates
•
Karen Perdue recommended that people tentatively hold January 24th, January 30th, or
February 5th for the second meeting.
•
Also, Karen Perdue proposed that we hold the 3rd meeting on March 5th or 18th.
Closing comments
Mia Oxley invited everyone to share what they will take away from this meeting. What follows
are the closing comments.
•
Dr. Ross wanted to follow up with rural Alaskans and their needs/opportunities.
•
Tom East said ANTHC was interested in this technology and appreciated this discussion.
•
Dan Johnson was interested to see where this goes for EMS.
•
Corliss Taylor said this was quite interesting and was surprised at how much was already
going on around the state. FMH shared some of the issues voiced by other hospitals in terms
of students and new hires. She also thought the ongoing CE/CME had applications.
•
Lynn Senette stressed that if we were going to succeed, we needed to have a common vision.
Unless we have that vision from the balcony, we won’t be as successful.
•
Jackie echoed earlier comments. She thanked Dr. Ross for coming and being the very best
presenter they could have for the first meeting. It was also daunting to think about what the
SON needs to do now.
•
Justine Muench echoed the comments about Dr. Ross. And if we have the common vision,
Lynn mentioned, we will have an easier time.
•
Cheryl Easley talked about visiting China and their simulation centers – and the Chinese
asking Cheryl Easley what she had in her country. Cheryl Easley sees collaboration as key to
going forward. The more people we have working on it, the better.
•
Harold said he has learned a tremendous amount and is impressed at the resources available.
The most important thing Harold can see is that we are approaching it methodically and
thoughtfully, and that it is a measured approach.
•
Andrea Neuerburg admitted she came in today with a stovepipe view for nursing. She now
sees value for collaborating with many other disciplines. The discussion opened her eyes
about approach, resources, and collaboration.
•
Dona Townsend also came in with tunnel vision. She has gleaned a lot of information,
including and especially the need for team development in training.
Clinical Simulations in Alaska
48
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
•
John Riley said this is another reminder of how great it is to be in Alaska and work together.
We all share the goal of having high quality providers. We learned who are the “haves” and
the “have-nots” and how to share those resources.
•
Karen Carpenter agrees with what has been said. It has been great to see so many people
together.
•
Suzanne Tryck appreciated all of the useful comments and looked forward to moving
forward.
•
Roy Davis was impressed with attendance and believed it spoke to interest and our capacity
to be successful.
•
Paul Perry uses simulation. As he looks to the next 20 years and our patient needs, and
evolving curricula, we will need innovative ways to teach those skills. Simulation is the
answer in his neck of the woods on EMS. He had no idea that it was so far-reaching.
•
Debbie Thompson came in with a narrow nursing vision. After listening to the other
comments, she saw simulation as a wide open door. The question she thought we needed to
address by the 3rd meeting was sustainability. She didn’t just mean the real estate. She meant
having the people to teach in that area, funding to support that instruction, access for
everyone – and we would be remiss if we only went part way. If we didn’t sustain it, we
would go backwards.
•
Jerry Troshynski comes from a public health background. It was gratifying to see horizons
broadened. One of the ten responsibilities of public health is assuring a competent workforce.
Also, when he talks to hiring managers, he joked he asks for a copy of their kindergarten
transcript that says “plays well with others.” He saw simulation as training us on technical
competencies, but also as a safe and reinforcing model for communication.
•
Dennis Valenzeno echoed the breadth of the discussion. His thoughts were crystallized in
two areas: one was more aligned with education, a center with higher end equipment, and the
other aspect was the technical skills training needed in the workforce. The Center would
assist with coordination. And communications training is cross-cutting.
•
Janice Troyer appreciated everyone thinking about the rural stakeholders and was glad that
was being recognized in this forum.
•
Mia Oxley talked about planning with Dr. Ross for this meeting. And his theme about
creating a prototype for the third world.
•
Karen Perdue thought it was a good meeting. She learned a lot. She agreed with Debbie’s
comments. It is important to think through how to resource this initiative for sustainability.
She also learned a lot about clinical quality and honing skills in specialized areas, especially
for hospitals in a highly regulated environment.
•
The meeting was concluded at 3:30 pm. Taskforce members were told they would be notified
by the end of the week when Meeting 2 will take place.
Clinical Simulations in Alaska
49
Appendix D: November 27, 2007 Alaska Clinical Simulation Taskforce Meeting
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
9:30 am to 4:30 pm
Attendees:
Taskforce Members:
X Karen Perdue
X Jan Harris
X Maureen O’Malley
X Dan Johnson
X Corlis Taylor*
X Lynn Senette
X Jackie Pflaum
pm John Riley
X Wilma Goodwin
X Marianne Johnstone-Petty
Staff:
X Beth Landon
X Jennifer Risse
X
X
am
X
X
X
X
X
X
Dennis Viloria**
Dona Townsend
Karen Carpenter
Suzanne Tryck
Roy Davis
Paul Perry
Debbie Thompson
Tom East
Lt. Col. Ryan Shercliffe***
X
X
X
X
X
X
X
X
Cheryl Easley
Barbara Doty****
Chuck Kuhns
Dennis Valenzeno
Justine Muench
Jerry Troshynski
Sally Mead
Megan Wilmoth
Carrie Doyle*****
Mia Oxley
X
Janice Troyer
*Corlis Taylor sat in for Liz Woodyard from Fairbanks Memorial Hospital
**Dennis Viloria sat in for Linda Boyle of the VA Healthcare system
***Lt. Col. Ryan Shercliffe sat in for Major Marlene Kerchenski from Elmendorf
****Barbara Doty sat in for Harold Johnston from Alaska Family Medicine Residency
*****Carrie Doyle sat in for Shara Sutherlin of Providence Health System
Also in attendance for part of the morning: JoAnn Gonzalez Major, UAA Instructional Designer
Guest Speakers: Shirley Anderson, Executive Director of the Oregon Simulation Alliance;
Mike Lamacchia, Director and Flight Paramedic with The STARS Centre in Alberta; and Pam
Jeffries, Author of Simulation in Nursing Education.
I. Introductions/Agenda Review
Karen Perdue provided a synopsis of progress on this project since the November meeting, gave
an overview to today’s meeting, outlined the deliverables for today’s meeting, and reviewed
what is anticipated in the final product.
After everyone introduced themselves, Janice Troyer provided an overview of the guest speakers
who would be participating via videoconference. She described the organizations they represent,
gave a snapshot of their structure, and gave an introduction of the information they were invited
to present to us.
Janice Troyer also oriented people to their packets. The majority of attendees had reviewed the
Oregon Simulation Alliance article emailed out prior to the meeting. Janice Troyer pointed out
the Simulation Delivery Models handout that provides an organized synopsis of the phone
Clinical Simulations in Alaska
50
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
interviews conducted over the past couple of months with facilities and programs outside of
Alaska.
II. Oregon Simulation Alliance (OSA)
First guest speaker: Shirley Anderson, Executive Director of OSA.
Shirley Anderson explained that, to date, OSA has secured $1.6M in funding. Most of that is
from their Workforce Investment Board, focusing on improving competence and capacity. While
OSA cannot claim all credit for improving training capacity with clinical simulation (there are
other factors), it is understood that clinical simulation facilitates a portion of it. Currently, 45
organizations use clinical simulation, and about 20 have Simulation Centers. OSA is currently
conducting surveys to collect information to guide their next steps. At this point, their grants are
done and they are now looking at sustainability more closely. Sustainability is challenging.
Because OSA has not charged their members any fees for training, members have come to
expect these services for free and are balking at having to pay the $750 membership fee. Shirley
Anderson noted that Idaho is in the process of forming a coalition of partners and has outlined a
structure for how to pay for simulation technology and training through membership fees. She
sees this as an advantage to charge for services in the very beginning.
The most successful coalitions within OSA are those that had existing partnerships on other
projects, and then expanded those partnerships to include clinical simulation. The new coalitions
that had not been functioning as a group were not as successful. One example of a coalition that
has worked well is a physician’s group that trains interns and residents in Portland on
laproscopic procedures. That is going well and they are now developing a mobile unit to train
rural physicians. Another example is a coalition that has a mobile van that travels to rural areas
and trains nurses and others in the region. In areas with bigger populations, sometimes the larger
coalitions have split into smaller coalitions because there is not enough equipment to support the
entire group. 60% of the coalitions originally formed continue to collaborate, but some of those
ways of collaborating have changed over time. Several organizations are breaking out of
coalitions and merging with organizations geographically closer to them. Networks and
partnerships have been formed through people meeting within the OSA sponsored clinical
simulation training workshops.
Team training, communication, sentinel event training, and new employee and nursing
orientation are common uses of clinical simulation. Surveys show it has decreased overall
orientation time. They can use clinical simulation to assess skills quickly. Twelve hospitals
reported that they provided over 3,000 mannequin-based trainings in the past year – a six fold
increase over the prior year. Nursing was the highest user and the first adopter of the use of
clinical simulation. They have physicians, PTAs, dental hygienists, and assistants that are
increasing their use as well. Dental folks use it to train for medical emergencies in outpatient
settings. EMS has been the most difficult group to engage. They have been using simulation
technology the longest and it is hard to get them to think past a mass casualty circumstance.
Shirley Anderson shared OSA’s lessons learned and provided the following suggestions for
Alaska:
Clinical Simulations in Alaska
51
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
• What market is ready? Conduct an assessment—the momentum is in who is ready (Shirley
Anderson noted that OSA did site visits to assess readiness and some of their need).
• Conduct a needs assessment so you know where to put your energy (Training was the biggest
need and OSA responded with a great deal of training).
• Start where you have the biggest bang for the buck; early successes will carry the project.
• Talent is what moves you forward: identify the early adopters and develop them so they can
work to develop others.
• Your motto needs to be “We can make it successful,” NOT “ I can make it successful.”
• Develop your own identity and product. Find what pieces do and do not fit with “Alaska” and
create what will work for you. (The OSA model may not be the best for Alaska.)
• Openness and transparency are important; you don’t want to give the impression it is a clique.
• Not all groups will collaborate in the same way. There are forms and each fit with different
people/groups. Some examples include:
1. Networking (little communication; all decisions made independently)
2. Cooperative (Provide information to each other; all decisions are made independently)
3. Coordination (Share information and resources; some shared decision making)
4. Coalition (Frequent and prioritized communication; members vote in decision making)
5. Collaboration (Frequent communication and mutual trust; consensus decisions)
(OSA has examples of all of these and there are no set standards. The local areas have to
decide what would work best for them.)
• Must be discipline agnostic: be inclusive and leave your specific profession and institutional
hat at the door (everyone works toward the common goal, even when sometimes it is not in
the best interests of your institution!). Make sure no one profession dominates the council.
• We found many coalitions were on paper coalitions only! Many people will buy into the idea
of simulation without realizing how difficult it is to acquire the funding. This is why we
acquired grants in order to “jump-start” the purchase of equipment and with training—what
we found is extremely important.
• Recruit a cadre of volunteers and keep them engaged; the governing board will burn out
without assistance from others.
• Be sure to manage expectations—yours and others.
• Develop partnerships with others you have not partnered with in the past (provide
opportunities for sharing and networking so you don’t reinvent the wheel).
• Be inclusive in creating your board/governing council/task force, and make sure there is
representation from all stakeholders…even if they are not currently ready to start simulation.
• Join Society for Simulation in Healthcare (SSIH)—excellent resource for information and to
learn what others are doing.
• Provide frequent opportunities for sharing and networking.
• Do not have the organization which is the “elephant in the middle of the table” be the leader
of the initiative. We found it was imperative to have the initiative brought forward by the
hospitals and academic institutions at the same time.
• Make sure the organization’s/institution’s decision makers are brought in very early into the
discussion (they control the funding and determine priorities).
• Keep your legislative and congressional delegations informed of your activities, in case an
opportunity for funding occurs.
• Don’t move too rapidly.
Clinical Simulations in Alaska
52
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
•
The mantra must be increasing competence and confidence and patient safety.
Sally Mead asked Shirley Anderson how they were able to form a governing council in equal
fashion. Many people were investing in simulation equipment in Oregon, but it was not
coordinated and there was limited communication. The Governor’s office stepped in to
encourage formation of a group. The call went out loud and clear for people to attend the
planning meeting. It was nearly a year later that they had a day-long retreat. They did not want to
call it a “board” because of the authoritative tone that conveys. They wanted an inclusive and
representative group. That day-long strategizing retreat resulted in identifying who would be
impacted by simulation, who were the key decision-makers necessary to be represented, and how
to keep this on the Governor’s radar.
Beth Landon asked if there had been any demonstrated outcomes. Shirley Anderson said she
knows that nursing education capacity has improved, but it is not entirely clear how much is due
to the use of clinical simulation. Shirley Anderson did note that clinical simulation had decreased
demand on clinical sites; some clinical time is being done by simulation. She recommended
looking at the Board of Nursing rules for didactic/clinical training requirements and figure out
how much we can move from the facilities/clinical time to simulation (some are up to 20%).
Faculty needs to be engaged–some have a philosophical issue with clinical simulation
supplanting clinical time. Rural areas are using clinical simulation for conditions/situations they
don’t see enough locally (e.g., OB, emergencies, etc.). In terms of shortening employee
orientation time, it is a gut feeling for outcomes. One OSA member says one employer has
reduced orientation time by two shifts. They are working on developing better data collection
instruments which takes time.
Marianne Johnstone-Petty asked Shirley Anderson if, in hindsight, she wished they had
developed data collection systems early. Shirley Anderson said, yes, in an ideal world, she would
have. But everything takes time and you can’t put too much on people’s plates. Many people
were overwhelmed with acquiring equipment, finding a space for it, and getting people trained to
use it.
Barbara Doty asked if there were resources for shared curriculum nationally. Shirley Anderson
said, no, they were the first “out of the box” and joked that being on the cutting edge often felt
like the “bleeding edge.”
Shirley Anderson put out an RFP for a two-day clinical simulation training course. She talked to
Mayo, Stanford, and other prestigious universities. They did not want to come to our state to do
the training and they (furthermore) did not have a curriculum in place. OSA developed their own
foundation curriculum and then worked on a clinical simulation apprenticeship, and finally a
clinical simulation technology curriculum. OSA found that the faculty members were burning
out (two exceptional faculty had quit). In response, OSA trained “clinical simulation techs” to do
a big chunk of the work previously done by faculty. The college in Springfield provided the
training and now plan to offer that curriculum to other states.
Mia Oxley asked what criteria was used for their needs assessment to determine “readiness.”
Shirley Anderson suggested contacting Dr. Michael Seropian to get his proprietary tool. Shirley
Clinical Simulations in Alaska
53
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
Anderson noted that some of the examples she might include on an assessment tool would look
at the level of buy-in and follow-through commitment, finding out if an organization had space
for the equipment, asking how they would envision using higher fidelity equipment differently
than lower fidelity equipment, and finding out if they realized how much energy it was going to
take to develop a simulation program. Shirley Anderson gave an example of someone who
would have failed a readiness assessment, and how poorly the resources were subsequently
deployed.
Beth Landon asked about the clinical simulation needs assessments. Shirley Anderson felt these
were overlooked in the race to secure and spend the money. People put together proposals before
thinking through how the suggested equipment would fill local needs. This was partly due to the
fact that OSA got their grant money too early in the assessment process. She encouraged people
to think through this process before being awarded resources. This hole in the planning
compromised efficacy for some of the coalitions.
Karen Perdue asked how the Workforce Investment Board had been involved. Shirley Anderson
noted that the Oregon WIB had been looking at workforce shortages and capacity. Healthcare
had been a target area. The other funder was the federal Department of Labor. They found two
things: it was easier to get funding for programs than for equipment or infrastructure. OWIB
funded OSA to work on marketing, sustainability, and fund development. Shirley Anderson
suggested we think about the niches this equipment will fill, and sell the concept to funders.
Justine Muench asked if the local coalitions did separate fund-raising as well. Shirley Anderson
said one coalition was successful with a foundation in their county. The bulk of the coalitions
have survived with in-kind donations from member organizations. In their recent survey, OSA
asked about in-kind donations. Respondents documented about $1M in in-kind contributions.
The equipment was primarily supported with federal funds and in-kind support from hospitals
and colleges. People were now adding different simulators and broadening what they want.
III. STARS Mobile Simulation Program
Mike Lamacchia is a paramedic and the Director of the STARS Mobile Simulation Program,
located in Alberta. Mike Lamacchia outlined the topics of his presentation: program justification,
examples and challenges of a mobile simulation program, their curriculum and audience,
program administration and costs, lessons learned, and critical success factors.
Mike Lamacchia noted a physician’s survey conducted in ’97 pointed to a need for more
community-based training. People were going to conferences separately and there were limited
opportunities for people to train with those they worked with. STARS, an air-ambulance
company, has developed a mobile simulation program. The simulation training they provide is
free and allows for “practice as you practice” training. The STARS budget is $21M for all bases
and includes their helicopters, etc. They receive 70% through private support, underlining the
importance for a public relations tool. Mike Lamacchia noted that you can’t build a centralized
simulation center and assume people will come to it for training. People want and need to be able
to be trained locally. They are able to conduct the training while people are at work, and thus
Clinical Simulations in Alaska
54
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
employees don’t have to take time away from work (reduces time away from family, coverage
issues, and travel expenditures).
Mike Lamacchia noted that there are considerations and challenges to providing mobile
simulation training. There are essentially two methods: one in which you have equipment
installed in something such as a motor home and the other in which you are packaging up
equipment and transporting it to a facility to use within the building. Set-up time needs to be
considered, especially in the latter. Both of these methods have merit depending on the audience
and location. STARS currently operates 2 motor homes with installed simulation equipment, and
uses a Suburban and transport simulation equipment for the more remote areas. (Mike
Lamacchia noted that there is a program in Ontario that uses a 28 foot trailer.)
Environmental factors (hot, cold, rain, wind, snow) need to be considered; the equipment must
be robust. Power is also an important consideration (Mike Lamacchia recommends a diesel
generator for fixed installed mobile units). If you blow a hospital’s breakers, that creates issues.
You need a dedicated AC power source and UPS units with adequate batteries. Physical space is
a consideration, as well as AV equipment (Mike Lamacchia notes that security cameras are
inexpensive compared to other systems). You also need to think about back-up equipment; if you
drive 5 hours to a community and your AV doesn’t work, that’s a problem.
Another challenge is to consider the entire clinical simulation training costs. For example,
$500,000 bought the motor home and the simulator – that’s it. You have to think beyond the
capital expenditures to set-up and delivery (and sustainability and maintenance). STARS
received its funding from philanthropic organizations. Also, mobile equipment must be used by
small groups rather than by large groups. Mike Lamacchia explained that a bare bones motor
home is over $200K alone. STARS also purchased a Suburban. Set-up on site with the Suburban
takes an hour, while setup with the mobile home is about 20 minutes. The Suburban approach is
tiring. You can burn your staff out with the set-up and take-down time (Mike Lamacchia showed
pictures of the motor home interior). STARS had to build the environment in which the crews
work within this motor home. This is a real benefit to the learners.
Mike Lamacchia shared suggestions for developing curriculum & working with your audience.
He strongly recommended having local champions to get people to sign up for trainings. He also
noted there is value in identifying cases out of past experiences in that community to help
develop the curriculum. It takes more planning, but is worth it. There is value in sending out an
orientation package beforehand as it saves time (Harvard has an excellent one that can be
adapted to any program). Rich multimedia improves buy-in. Looking at real labs, EKGs, and real
digital radiography is also beneficial. Simulators are important, but so are all other aspects of the
learning environment.
Mike Lamacchia gave an example of how simulation has been incorporated into four CME
modules created for family medicine doctors in Alberta. Four multimedia CME modules were
created that include a pre-test, the module, a human patient simulator (HPS) session, and a posttest. STARS travels to the clinics with their mobile simulation unit to provide the HPS session
and post-test. MDs love it. The session and post-test occur during clinical time, so they do not
Clinical Simulations in Alaska
55
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
have to leave their facility to complete their CME. This program was developed in conjunction
with RPAP of Alberta. (The Alberta Rural Physician Action Plan)
Mike Lamacchia noted that with a mobile simulation program you must have dedicated
administrative support. One person must have the skills and responsibility to oversee the
program. Mike Lamacchia does this for STARS. STARS has a dedicated team of individuals for
teaching with at least 4 or 5 facilitators of all types (RN, EMT-P, MD). He notes that burn-out
rate is high due to the travel requirements. STARS operates 9 months of the year. They have 3
bases, 2 motor homes and 1 suburban, 6 FTEs, 12 training mobile events per month, and a
similar number of base events. Their yearly budget is about $600K.
Mike Lamacchia suggested four critical success factors:
•
•
•
•
Develop of a rigorous, long-term business plan.
Dedicate staff members at the outset.
Establish financial autonomy through industry partnerships and aggressive pursuit of
grant/donations
Secure institutional buy-in and support from top down.
Barbara Doty asked if Mike Lamacchia did any work with training in communities that were off
the road system. Mike Lamacchia said he did not and was not familiar with any programs that
did.
Barbara Doty asked about outcomes for RPAP. Mike Lamacchia noted a study was completed
three years ago that did reflect favorably on mobile simulation training being brought. He offered
to forward that study. In terms of industry outcomes, Mike Lamacchia said little research has
been done to demonstrate the benefit of using simulation. Most of what they have is subjective
and “feel good.”
Barbara Doty asked if Australia uses simulation in non road-based systems. Jackie Pflaum
responded that she had heard at the Simulation conference she recently attended in San Diego,
that yes they were using mobile simulation training in rural, off road areas.
Dan Johnson asked if the equipment they transported via the Suburban could be easily carried in
and out of the vehicle. Mike Lamacchia responded that one case is 60 lbs, but everything else is
lighter. So yes, everything is in cases on wheels or with nice handles. The total weight is 350 lbs
dispersed over 4 bags/cases.
Justine Muench asked about competency demonstration and related paperwork, and who was in
charge of that. In the MD world, Mike Lamacchia noted they have the RPAP model. With
nurses, it is not yet that formal. STARS knows when a community has a case that has gone bad
(they get called), and their training is designed in response to that experience. National
competencies are under development.
Clinical Simulations in Alaska
56
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
IV. Simulation Technology in Nursing Education
Pam Jeffries gave about an hour long presentation titled “Simulations: Concepts, Challenges, and
Simulation Center Considerations.” See power point presentation slide handout for details.
Mia Oxley asked how clinical simulation reduces the demand for clinical training sites. Pam
Jeffries explained that data are not yet available. She knows there is demand for education
reform, and clinical simulation may fill that demand.
Pam Jeffries shared a nursing study she had conducted that evaluated three different educational
methods using simulation from low fidelity to high fidelity. They looked at learning outcomes
for each of the “roles” across educational methods. They did not find a significant difference in
learning outcomes across roles. That means those who play the role of “observer” in a simulation
are learning as much as the other participants. Pam Jeffries was surprised at this finding, but also
encouraged by the ramifications.
Mia Oxley asked if the observer’s learning improves if they are given more structure. For
example, Brian Ross had noted they give their observers a checklist to complete while observing.
Pam Jeffries responded that she was not aware of any studies that demonstrated a value in using
this type of structure, but supported the idea.
Jackie Pflaum asked a question about skills development. Pam Jeffries talked about OSCEs
(Objective Structured Clinical Examinations), and gave an example of a student that needed to
hang an IV piggyback. An actor played the role of patient. After 3-5 minutes, the student came
running out of the station in tears. The student said “the patient is talking to me.” Prior training
did not include the factor of human interaction and the need to be able to talk to the patient, or
family members, etc. It is more than the specific skills; the complexity of the real environment is
important.
There was some discussion about the use of dedicated space versus “flex space.” Both are
important considerations in a simulation center.
Pam Jeffries noted that METI and LAERDAL are cross-platform. One runs on Apple and the
other runs on a PC. Pam Jeffries suggested we think about this before making the investment.
Jackie Pflaum asked if the integrated interdisciplinary lab which is being built at the Indiana
University where Pam Jeffries works will replace other existing labs. Pam Jeffries responded that
they plan to keep their nursing lab due to issues in orchestrating use of the new center. (The
interdisciplinary simulation center will be used by many different disciplines and user groups.)
Dan Johnson asked if Pam Jeffries has any plans for community outreach with the
interdisciplinary center, working with other disciplines – for both normal training and mass
casualty training. Pam Jeffries said, yes, absolutely. You want 100% use in your center because
of the enormity of the investment. It can be used when students are not there too (weekends,
holidays, etc.)
Clinical Simulations in Alaska
57
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
Sally Mead asked about involvement of allied health students in use of the simulation center.
Pam Jeffries explained that allied health was not “at the table” much in the beginning or since for
their particular project. Pam Jeffries wants them there so it is interdisciplinary training, but that
has not happened yet.
Justine Muench asked about the “virtual technology” with outlying hospitals or schools – is it
separate or part of the Simulation Center? Pam Jeffries gave some examples. Virtual technology
is a piece of equipment. Another is the EICU that they have at the hospital. They want students
trained at the EICU. It doesn’t take much space but it is remote. Pam Jeffries says telehealth is an
area they want to enter.
V. Training Topics and other handouts
Janice Troyer gave a brief overview of the Alaska Clinical Simulation Taskforce Training Topics
handout included in the information packet. Sixteen facilities/programs completed a chart. She
noted the charts were filled out in many different ways—some topics were very specific while
others were very broad. It was not possible with over 150 topics listed to come up with a handful
of common topics. Instead, Janice Troyer did the best she could to sort the topics into some
general categories. These are listed in Appendix G and include the following: emergency airway
management and cardiac life support; disaster management-emergency scenarios (away from
hospital); codes/emergencies (in hospital); physical exams; technical skills;
deliveries/neonates/peds; communication; and health promotion/management. Examples of
topics were listed for each category. In addition to the more specific topics, some people listed
types of learners and types of training on the charts. These are listed in Appendix G.
Janice Troyer said they decided to include each individual chart in the handout since the chart
contained so many insightful comments. The Steering Committee felt it would be useful
information to all participants in the taskforce when thinking about the future of incorporating
simulation into training.
VI. Small Groups
For the next hour, the larger group was divided into three smaller groups and given a set of
questions to begin answering. These groups included: University of Alaska, Hospitals/Providers,
and Development/Delivery. All groups were asked to: 1) discuss the questions posed for the
group, 2) list key concepts for the final report, 3) identify any lingering information needs that
need to be addressed now or eventually, and 4) if relevant, pose additional related questions.
Groups were facilitated by Sally Mead, Mia Oxley, and Beth Landon.
Once the groups came back together, each group presented the highlights of their discussion to
the larger group. Below is a list of the questions posed and a summary of discussion highlights
for each group.
Clinical Simulations in Alaska
58
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
University of Alaska Group
Questions posed:
1. To what extent could use of simulation technology impact delivery of classroom education,
either positively or negatively? What are any requisite conditions to encourage desirable
impacts?
2. To what extent could use of simulation technology impact clinical training, either positively
or negatively? What are any requisite conditions to encourage desirable impacts?
3. Could simulation technology enable UA to train more students? What factors would affect
this?
4. What are realistic expectations for training outcomes?
5. What preliminary conclusions could we draw from the results of Training Topics survey of
Task Force Members?
In looking at the use of clinical simulation to impact delivery of classroom education, the UA
group asked what evidence there was for changing classroom methods towards the use of
simulation. Due to limited experiences, it is unknown if changing methods is best. They would
like to see more hybrid approaches for using simulation. There is the ideal and then there is the
real. Rebuilding coursework for simulation by older faculty is a challenge. The current
curriculum process has a set structure (chair time learning).
In looking at the use of simulation technology to impact clinical training, it was noted that in the
EMS system clinical and classroom is all intertwined. As a positive, students will demand
technology and may lead the change. Some positive benefits include interdisciplinary training,
the opportunity for competency-based training, and increased skill development in professional
communication. Simulations expose students to the reality of clinical practice.
Negative impacts include teachers not having the skills to use simulation in either the classroom
or clinical sites. Faculty development will be instrumental. Additional staff will be needed:
technology support staff and simulation specialists.
In answering the question about whether simulation technology will allow more students to be
trained, the group did not necessarily think more students could be trained, but that there would
be a significant impact on clinical competence and confidence. The larger group agreed with that
comment, though Jan Harris noted they might be able to get a few more advanced level students
trained with simulation technology. Justine Muench said you could possibly increase the number
of students trained in the distance sites.
The group thought that simulation could take a load off clinical sites which are currently
stretched to the max. Clinical sites/hospitals will benefit since students will be better prepared.
Simulation technology could improve team training which can improve patient safety. The
reality is the number of students is tied to the number of faculty even with simulation. If clinical
simulation enabled the training of more students, it would be necessary to consider adding
faculty for those students. Student expansion is most needed at the advanced professional levels.
Clinical Simulations in Alaska
59
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
The following were listed for realistic expectations for training outcomes: competency based
improvement, confidence building in critical thinking skills, communication between
professionals, quality of learning experience improved, and integration of theory and practice
placed in a practice context.
Preliminary conclusions from the training topics survey included:
•
•
•
•
•
There was too much to digest—lots of possibilities
Many topics involve high intensity events
Huge learning curve for faculty
Raises huge questions if there are simulation curricula that we can use rather than
creating them from scratch
Everyone is excited about the idea
In conclusion, the group noted we need to remember our critical focus in training outcomes.
The UA should/could be a clearinghouse of info, even if it doesn’t have equipment. The
curriculum could be housed at UA for industry to access.
Hospital/Provider Group
Questions posed:
1. To what extent could the use of simulation technology impact the delivery of continuing
education and CME, either positively or negatively? What are any requisite conditions to
encourage desirable impacts?
2. What are realistic expectations for training outcomes?
3. What are realistic expectations for improving patient outcomes?
4. What preliminary conclusions could we draw from the results of Training Topics survey of
Task Force Members?
Generally speaking, the impact on CE/CME and team development is that it can be a means for
staff to demonstrate competency. It can be used for staff cross-training, for mandated specialty
training (MD credentialing or competence for nursing staff), as a means for working with staff in
the area of patient complaints (hospitals feeling pressure for patient satisfaction), to better
standardize training, for more team-training, and to better prepare families as caregivers of
patients living with chronic conditions. (This is especially important in rural areas where the
remote clinician has limited experience with that particular condition). Simulation offers learning
and practice with rare but life threatening events. HR professionals would see simulation as a
means for advanced qualification demonstration and during orientation. The group also noted the
potential use for career exploration with the AHECs and for optimizing the use of telemedicine
infrastructure in rural Alaska.
When thinking about negative impacts, the group asked who is going to support/staff this added
function? Hospital education departments will have to develop the skills for clinical simulation.
There may be reluctant learners. Also, for those 45+ years, the concept of an annual skills
assessment via clinical simulation could be difficult. Money may have to be diverted from other
areas to be directed toward simulation. Since technology changes constantly, obsolescence of
Clinical Simulations in Alaska
60
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
equipment needs to be a consideration. There are competing space demands. The validity of
learning is not documented in the literature. Expertise is needed to run simulations.
What to conclude about positives and negatives?
We need to focus in on some needs. For example, skills training for new graduates and
orientation for new staff could be key for early focuses. Then team-based training (hand-off
communication, emergency care) would be a good start to feel success before other forays. There
must be dedicated staff to make sure it all happens; there need to be “champions” to help
spearhead the effort and keep the momentum going. There really needs to be a clearinghouse
function, someone to broker the information who knows the different models and places to get
the curricula and expertise.
In terms of thinking about outcomes, simulation is not a replacement of clinical experience. But
outcomes can include increased patient safety, improved customer satisfaction, increased learner
confidence, possibly shorter periods for staff orientation, and possibly decreased turnover
through greater satisfaction which would improve retention.
Preliminary Conclusions?
There will be revenue needs for on-going administration. It is easy to find money for equipment,
but not for programming. Mandates could be used as incentives to leverage funding. Lack of
research to document outcomes is a recurring concern. Alaska needs an investment strategy,
networks, a resource clearing house, a plan for collecting outcome date, and some super-users.
To move ahead we might ask: What can we do now so that development/use of simulation is
better for all of us?
Justine Muench added that she really likes the OSA model. She can see forming local coalitions
and looking at simulation needs in regional areas and forming partnerships based on those needs.
Jackie Pflaum noted she could see a role of AHEC to support career exploration, to support
coordination, and to support delivery of CE/CME.
Development/Delivery Group
Questions posed:
1. What preliminary conclusions could we draw from the results of Training Topics survey
of Task Force Members?
2. What thoughts do you have at this point about the overall
development/delivery/organization of simulation training in Alaska?
3. Important concepts that should be included in final report?
The majority of the topics fall neatly into developing skills according to an algorithm with clean
steps. This is often taught in a classroom structure, with straightforward memorization. The value
of clinical simulation is that it allows the learning to be enriched with communication skills
during a stressful event and helps in developing and practicing critical thinking skills. Chuck
Kuhns gave an example of teaching a student the skills for rapid sequence intubation and then
providing that student with a simulation scenario (e.g., snowmachine accident where throat is
Clinical Simulations in Alaska
61
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
hurt) so the student needed to use critical thinking skills on whether that intubation was
appropriate in that situation. Chuck Kuhns noted that while learning skills was important, it was
also very important to put those skills into contexts where critical thinking skills were used.
The following are some of the thoughts the group discussed about developing and delivering
simulation training in Alaska:
We can’t assume the same level of availability of technology across the state.
There seems to be a lack of peer-reviewed outcomes research.
Training is almost more important than equipment in terms of resources-we need to have
training to alleviate burnout. Rural community members need to be engaged in this training.
We should explore mobility of equipment and the use of distance learning technology. (There
was some discussion about the high data casting technology used by the WELLS Center in
Colorado.)
Some members liked the philanthropic aspect of STARS and the mobility aspect of that
program.
Interdisciplinary training in a team-building environment serves multiple purposes.
It was thought it would be good to have a clearinghouse of information. It was also suggested
that it would be good to develop an Alaska user group for sharing curriculum scenarios and
data. You could develop a standardized curriculum template that could be shared more easily.
One key concept the group thought would be good to include in the report included the idea
that simulation is more than just mannequins or a simulation center.
When thinking about what would happen after March 5th, the group could see a use for
continuing some sort of taskforce, but possibly morphing it and developing subcommittees to
address different areas.
VII. Large Group Continuing Discussion
After the small group facilitators finished giving their presentations, a larger group discussion
ensued, which was facilitated by Mia Oxley. She noted that one overarching theme was the idea
of people wanting to work together.
Sally Mead pointed out Oregon’s example of working together and the need for a sophisticated
structure. “If we move in that direction, we need to be careful about the words we use to develop
a structure.”
Chuck Kuhns pointed out if there was a one-time funding he would like to see a user group with
all of the disciplines represented; it could be a resource library of scenarios.
Karen Perdue pointed out that we need an investment strategy. How do we tell our funders that
we have a plan?
Clinical Simulations in Alaska
62
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
Beth Landon reiterated there are two reasons for a larger partnership/collaboration:
1. Networking (avoid redundancy, share best practices, learn from each other)
2. Investment strategy – more credibility with funders
Karen Perdue said the whole state doesn’t necessarily need an investment strategy, but UA
certainly needs one.
Barbara Doty suggests we can learn from the electronic records experience. They identified
super-users who became the “go to” people.
Dan Johnson noted that, historically, it is easy to fund equipment, but harder to find funding for
planning. Simulation technology won’t be used unless it meets a need for people; it needs to
meet existing needs. If a need can best be met by using simulation, people will find the money.
Tom East noted if we are going to have a shared governance it needs to have lots of structure.
Tom East and Karen Perdue agreed that it was nice to talk about working together, but when it
was time to put their own money on the table, the dialogue can become very different. Promising
funding and providing funding are two very different things. Distance education is a recent
example. An organization was funded to develop a clearinghouse for distance education and vet
proposals for funding. Now all the distance education funding is gone and users are not willing
to pay for clearinghouse functions. The business model to pull all this together is very tough, and
the process has to move slowly.
Tom East suggested we figure out a good business plan and sustainability model.
Beth Landon asked if their would be any use in doing a needs assessment to inform the business
plan. There was some agreement on that.
Maureen O’Malley said that today she had heard nothing about cost savings.
Karen Perdue said data did not seem to be in about outcomes.
Barbara Doty pointed out that a needs assessment must be well done and questions needed to be
asked carefully.
Dan Johnson pointed out that a needs assessment must be unbiased, and might even suggest there
was insufficient need for simulation.
Debbie Thompson suggested that we need to define simulation and include this in a needs
assessment.
Megan Wilmoth said that the needs assessment should be conducted at the administrator and
training manager level. The CEO’s perceptions are relevant, even if they are misinformed.
Beth Landon suggested the final report should not be a wet blanket, but should be cautionary.
Clinical Simulations in Alaska
63
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
Mia Oxley said we need to get more precise about what “this” is.
Lynn suggested better defining the potential for using simulation and what potential needs it
would address in Alaska. Then, if there was a windfall of resources in the future, it would be
easier to determine the type of investment to occur.
Mia Oxley asked how we can prioritize the needs. Do we identify low hanging fruit? Or do we
look for universal needs?
Tom East said if you were going to prioritize the needs, you needed to know who you were
targeting for dollars. If the investors were foundations, the approach would be different than
asking hospitals to invest in a program.
Barbara Doty pondered that if the AHEC were successful and had statewide coverage in five
years with all its centers, the AHEC could be pods of resource that broker information. She felt a
lot of this was information management, more than nuts and bolts.
Marianne Johnstone-Petty suggested focusing on the customer – the patient. That should be our
primary focus: patient safety.
Mia Oxley asked the group, if we went home today and didn’t come back, what are we still
missing?
Dennis Viloria suggested each facility needs to name its most important needs.
Megan Wilmoth said facilities weren’t necessarily willing to pay for what they needed. She
suggested taking the training topics a step further. Prioritizing training topics was not the same as
determining what someone will pay for and what they are willing to suffer with.
Corlis Taylor reminded the group that we all represent different entities. Five years from now we
will all be doing clinical simulation no matter what. We need to think about what we can do now
as we move towards simulation, so it is more organized, constructive, and collaborative the way
we do it. I wasn’t looking at this group for money. I was asking how can what we do leverage
with what others are doing in the state?
Debbie Thompson observed that Janice’s work was more comprehensive than anything done to
date. The value of the data collected, aggregated, and disseminated to date was invaluable.
Creating a clearinghouse to continue this, and possibly also doing follow-up and communication,
would be great.
Maureen O’Malley asked what a little group could do with the clearinghouse function to keep
tabs on or identify what is affordable and useful. Pam Jeffries is already a consultant to UAA. So
it would be a smaller group that took this to the next level.
Clinical Simulations in Alaska
64
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
Karen Perdue pointed out that we have considerably more information than we anticipated
having. Our report will reflect that information, and may have a few recommendations, but the
UA is not responsible for continuing the group at this time. Our purpose was to jump start the
conversations.
Karen Perdue asked if the group felt it needed to convene for a third meeting.
Justine Muench spoke to the need for a final product. Karen Perdue clarified there will be a
written report.
Barbara Doty suggested that the final report lay out scenarios for both UA and for industry. She
suggested we survey people a year later to find out what people did with the information.
Tom, despite his earlier cautionary tone, was still a believer in utopia. Given that there will be
multiple investments in clinical simulation, there is value in some level of coordination. And
then we are talking about some kind of governing body.
Chuck Kuhns agreed that we don’t need another meeting, we have accomplished a lot, but he
also did not want to see people lost out there with equipment sitting in boxes. The only way this
state will grow is if we work together.
Megan Wilmoth would like to see a concrete business plan, pick low-hanging fruit that ties back
to community benefit, perhaps a small pilot program.
Sally Mead thought the university may be in a position to try something like that on a small scale
in the form of interdisciplinary training for sake of patient safety—increasing communication
skills. Karen Perdue suggested having an employer partner. Sally Mead suggested maybe having
five interested faculty that are appropriately compensated for working on the curriculum.
VIII. Participant Closing Comments
Paul Perry said this was going to go forward. Simulation is coming. We can step up to the plate
or let it go past us.
Tom East thought this had been good and educational. He would like to see the effort move
forward.
Lynn said simulation was out there and not going away. She appreciated Corlis Taylor’s
comments and felt they helped focus their thoughts.
Marianne Johnstone-Petty thought it was a great experience and anticipated seeing us again.
Debbie Thompson thought it was a good experience and had opened her eyes to what was
happening now. She saw the need for coordination.
Clinical Simulations in Alaska
65
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
Carrie Doyle mirrored the comments. The organization and structure for long-term viability will
be important.
Chuck Kuhns commended the organizers on how informative this had been, and how exciting it
all was. He said it made you want to go further.
Sally Mead resonated with the OSA model and felt there were qualities to that structure that fit
here. Starting with some pieces, like a pilot, can be informative and help us move forward
without an expensive leap. We are not ready for that leap yet.
Janice Troyer had a lot of fun on the project, enjoyed meeting everyone, and appreciated the
learning experience.
Megan Wilmoth agrees with Sally Mead. She would like to see it progress slowly and doesn’t
want us to feel hampered because we don’t have $10M.
Dennis Valenzeno thought we were coming to a consensus on what simulation meant and what
could be done.
Jan Harris enjoyed getting a sense of the potential.
Dan Johnson appreciated hearing what was happening in other states. It was also been valuable
to get a perspective on the issues of classroom programs. We will find common ground.
Corlis Taylor appreciated the opportunity to meet with a wide variety of people on simulation
issues. This summer the FMH CEO asked her about simulation and was very excited about it.
Shortly after, Corlis Taylor got a letter about this meeting. She felt like she was finally on the
cutting edge of something.
Dennis Viloria originally thought simulation meant you plug into a mannequin and the scenario
runs. Now I’m realizing it is more than just mannequins. I like the collaboration and look
forward to more training and sharing of resources.
Karen Carpenter found this fascinating. She had no idea simulation training technology was so
organized in some places. It will be interesting to see what happens and see if people work
together and cross political barriers.
Justine Muench learned a lot, met a lot of people, and hoped this moves forward with a pilot
project. The Oregon model really resonated with her.
John Riley said the discussion had been very amorphous and was now getting somewhere. UA
has some resource and a need to develop something like a pilot project.
Barbara Doty thought it was interesting when she interviewed faculty about needs at the
Residency that they listed equipment. That was not what she got here. She spoke to the
Clinical Simulations in Alaska
66
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
possibility of clinical simulation improving retention in rural communities. She saw a role for the
AHEC.
Karen Perdue found this very “simulating.” She thanked Janice Troyer, Beth Landon, and Mia
Oxley. Karen Perdue noted, we went faster than we anticipated due to planning and organization
of this process.
The meeting was adjourned about 4:30 pm.
The next and final meeting was tentatively scheduled for 9 am to 12 pm on March 5th. (It
will likely be done via videoconference for those taskforce members outside of Anchorage.
Clinical Simulations in Alaska
67
Appendix E: January 24, 2008 Alaska Clinical Simulation Taskforce Meeting
Appendix F: A Sampling of Clinical Simulation Delivery Models
Facility Contact
Oregon Simulation
Alliance (OSA)
Formed in 2003
Contact:
Shirley Anderson
Executive Director
of OSA
Some information
from article written
in Journal
Simulation in
Healthcare (Vol 1,
Num 1, Spring
2006) and the OSA
website.
Who are the
learners?
Note OSA is
comprised of multidisciplinary regional
coalitions so learners
vary with each
coalition. The journal
article lists the
following:
1) Nursing schools
2) Allied Health
3) Hospital systems
(nursing)
4) Hospital systems
(residents)
5) Medical schools
6) Practicing
physicians
Simulation Training
Topics
Note: training topics
used with simulation
vary within each
coalition
OSA’s overall goal is to
develop & expand
simulation capacity in all
regions of the state for
multidisciplinary &
interdisciplinary use for
healthcare workforce
development, including
pre- and post-service,
career-ladder, and reentry/refresher
programs.
Some of the training
OSA has provided to
their partners include:
• 3-day Simulation
Technician Training
• Foundations for
Simulation
Education
Delivery Model
Delivery models
vary. OSA has
over 20
simulation
centers where
groups come in to
use equipment.
Some sites
transport
simulation
equipment to
sites. One
coalition is in the
process of buying
a van to travel
throughout their
region to deliver
training. Over 40
sites have
purchased their
own equipment.
Governance
Structure
OSA is a
collaborative
statewide group,
coordinated by the
Governor’s Office.
OSA is both an
advisory group and
an oversight
committee. The
Simulation Alliance
Governing Council
has representation
from states’
community
colleges,
universities,
healthcare provider
orgs, and simulation
users.
They are a corporate
non-profit.
Currently they
contract out to have
an executive
director who is
about half-time.
See website for
descriptions.
Funding Sources
Notes
Funding was obtained
from the Oregon
Workforce
Investment Board, the
Federal Dept. of
Labor, the Oregon
Dept. of Public
Health, and the
Northwest Health
Foundation (a private
granting agency).
Each org was
approached
separately with
separate proposals.
Total funding for yr
2004 was $1,050,000,
and considered seed
money for the overall
process.
The statewide simulation
process included visits to
communities to do
assessments; simulation
specialist education,
faculty development, and
a mechanism for
allocation and
distribution of funds.
They are currently in
the planning process
for finding ways to
make OSA
sustainable.
Site assessments were
designed to capture the
state of “readiness” for
simulation at different
locations in Oregon.
OSA did not prescribe
regional coalitions, but
let “local define local.”
OSA asked OHSU to
develop simulation
training curriculum &
program; OSA provided
funding for individuals
to attend training who
were selected by OSA
committee.
Used RFP process to
distribute money for
equipment and faculty
development.
Advice: In journal article, the following were things they wished they had done differently: 1) they would have disbursed their funds after the site visits rather than
concurrently (they had very little time to distribute funds), 2) they had held awardees more accountable for their use of the equipment while not being viewed as a governing
body (no clear process established to deal with an institution not meeting general expectations), and 3) hire a permanent director for the alliance (initially council members
offered services on a volunteer basis). Other words of advice from the Governing Council: a) have workforce issues define the needs, not the universities; b) develop a
plan for sustainability; c) have a succession plan for leadership; and d) coalitions may be important to a community when first starting simulation, but after maturation,
member organizations my no longer be part of the coalition, but remain viable and strong associates of the coalition.
Website: http://www.oregonsim.org/index.php
Clinical Simulations in Alaska
Appendix F: A Sampling of Clinical Simulation Delivery Models
68
Facility Contact
STARS Mobile
Simulation
Program
Based out of
Alberta, Canada
Michael Lamacchia,
HPS
Program/Outreach
Manager
Started first official
training in
September 1999.
Who are the
learners?
Healthcare providers in
rural facilities.
Simulation Training
Topics
Used to train for critical
care and emergency
medicine (e.g.,
toxicology, cardiac
emergencies, traumatic
brain emergencies). Also
used for interdisciplinary
team training.
Work with facilities to
determine their training
needs; do about 4
simulation trainings a
month.
Delivery Model
Use 2
motorhomes
equipped with a
high-fidelity
mannequin. Each
motorhome has 2
rooms--one is a
mock up ER code
room and one a
control room.
2 full-time
technicians and
18 part-time staff
work with mobile
units (physicians,
nurses, and
paramedics); part
time staff work as
air ambulance
crew when not
providing
training.
Governance
Structure
The STARS
program has 2
boards: one is a
foundation board
which oversees all
fundraising and the
other is a society
board that makes
decisions about how
the money is spent.
Both boards are
voluntary and
composed of
CEOs, CFOs, oil
and gas folks, and
community
members. The
STARS program
has a president and
CEO who have
direct control over
funds. Below them
are the VP and
directors. Mike
directs and manages
educational
activities in Alberta,
including the
mobile program.
Funding Sources
Notes
STARS is a nonprofit, charitable
organization. The
STARS Foundation is
the fundraising arm
of the organization.
Its primary purpose is
to raise the funds to
support and enhance
patient care and
transport program,
educational programs,
and research projects.
Funds are also
provided by the
health regions and
Alberta Health and
Wellness. The
majority of gifts to
the Foundation come
from individual
contributions; each
community served
also contributes with
fundraising events
(70% of funding
raised through
philanthropic
donations and 30%
raised through
government partners).
Initially did a needs
assessment of physicians
in rural Alberta. All
complained about not
being able to come in for
training because they
didn’t feel they could
leave their communities.
Originally they planned
to use a suburban to
transport simulation
equipment to facilities
for training in some of
the smaller facilities, but
found if they had a
patient in a room, there
was no place to do the
training, so that is how
they came up with the
idea of setting up a
motor home.
Note: Training does not
cost anything for
facilities as they use
foundation funds to
cover training costs.
Advice: It is important to get people together to talk about ways to collaborate. Try to discourage people from going out and buying their own equipment. The
“honeymoon” will be over quickly when people realize what it takes to maintain and program the equipment. Even now we still have people wanting to buy their own
equipment.
Website: http://www.stars.ca/bins/index.asp Go to What We do, Education & Research, Mobile Simulation Program.
Clinical Simulations in Alaska
Appendix F: A Sampling of Clinical Simulation Delivery Models
69
Facility Contact
University of
Arizona, Tucson
ASTEC (Arizona
Simulation
Technology and
Education Center)
Contact:
Alyson Knapp,
Coordinator and
Curriculum
Development
ASTEC opened in
the Summer of
2005.
Who are the
learners?
Mostly serve medical
students and residents.
EMT, paramedic,
flight nurses and fire
dept, and medical
faculty.
They work to a small
degree with College of
Nursing. And to small
degree with Allied
Health Students (rad
techs, med techs, med
assts, phlebotomists,
pharmacy).
Simulation Training
Topics
About half training is
procedures and about
half scenarios; ASTEC
staff work with faculty
to determine learning
objectives.
Teamwork training is
the focus.
To Practice their skills
(example given a
surgeon using surgical
trainer to practice for a
surgery the next day).
They have an acute care
NP program. Each class
comes to center 2X
during program to run
through scenarios--done
in between ACLS
lectures.
Delivery Model
800 sq ft
simulation center
housed in the
hospital. They
have 2 adult and
1 baby highfidelity
mannequins and
surgical trainers
and task trainers.
99% of the time
students come to
the center to
train. Training is
done either by
ASTEC staff or
by University
faculty. All
scheduling is
done by Alyson.
Governance
Structure
ASTEC is part of the
University of
Arizona Medical
School. They are
part of the Dean’s
initiative. ASTEC
staff are overseen by
the Vice Dean. The
director is a tenured
professor. A
simulation
committee is made
up of faculty,
engineers, and
telemedicine folks.
They meet every
month or two to help
with planning. The
Center has a lot of
autonomy with their
budget.
Funding Sources
Notes
Salaries &
appointments are
made by the Dean of
the College of
Medicine. An initial
budget paid for the
mannequins.
ASTEC also uses
telemedicine equipment.
They have 2 flat screen
plasmas in their center and
terminals in the lab,
control room, engineering,
and various medical
offices. One of the
surgeons is connected to
smaller hospitals in
Arizona and ambulances
through video. They use
this equipment to provide
healthcare. ASTEC is
hoping to use this
equipment in the future to
provide education in
remote sites.
EMS personnel pay to
use the Simulation
Center.
Industry partners
provide some
funding; they are a
Center of Excellence
for STORTZ. They
received a 3-year
grant of
educational/research
monies. They do
testing of new
equipment as part of
this grant.
An example of what they
have done with this
technique is: Doctors in
rural areas have used the
telemedicine equipment to
observe scenarios done in
the lab at ASTEC using
the baby mannequin. They
observe and then
participate in a debriefing.
Have had radiology
students practice low
frequency/high risk
event such as a bad
contrast reaction--run
through a scenario.
Other allied health
students have practiced
doing triage, taking
histories, doing BPs and
IVs, and so on.
Pharmacy students do
mostly team training.
Advice: Get as much space as you can. We struggle with our lack of space all the time.
What mistakes should we not make? Don’t put your blinders on. Don’t limit your imagination on how simulation can be incorporated into teaching. There are things I’m
teaching with simulation now, I never would have guessed I would be doing a year ago. Website: http://www.astec.arizona.edu/
Clinical Simulations in Alaska
Appendix F: A Sampling of Clinical Simulation Delivery Models
70
Facility Contact
Work, Education,
and Lifelong
Learning
Simulation
(WELLS) Center
Housed within the
Colorado Center
for Nursing
Excellence on the
Colorado
Bioscience
Campus.
Jana Berryman,
ND, CNS, RN
Project Director
Who are the
learners?
Nursing students,
medical students,
paramedic
students.
Continuing
education for
practicing nurses
and physicians.
High school
students.
Faculty of both
academic and
educational
settings.
They aspire to
serve more
disciplines in the
future.
Simulation Training
Topics
The WELLS Center
focuses on both
simulation training,
faculty development,
and information
dissemination.
The center develops
specific scenarios for
low occurrence/high risk
scenarios as needed by
their hospitals.
The center provides full
day workshops on how
to develop simulations,
how to facilitate
simulations, and
technical programming.
In addition, they have
developed a template for
developing a scenario.
Delivery Model
They have a 5000 sq.
foot simulation
center. They call it a
hub-and-spoke
model. They deliver
training within their
own center and travel
to other sites. Besides
partnering with 26
nursing schools
across the state, they
provide competency
training for nurses in
hospitals across the
state.
Staffing at the center
includes one fulltime
director, 2 simulation
coordinators (master
prepared RNs); 2
simulation technical
coordinators, a parttime curriculum
coordinator and grant
writer, and 1 fulltime
admin asst
Governance
Structure
The WELLS Center
is a non profit
currently housed
within the Center of
Excellence and has
an Advisory/Project
committee. This
group is composed
of statewide
members from
nursing education-both academic and
practice, medicine,
EMS, high school,
and the community.
There is also an
executive group
which oversees
policies and
procedures.
Funding Sources
Notes
Currently they are
primarily grant funded
with a grant from the
Colorado Dept. of
Labor and
Employment. They
have a building lease
in partnership with the
Colorado Hospital.
They received a 1.1
million dollar
equipment grant. They
are now beginning to
look at sustainability
and recently started a
fee for service. As the
government funds
decrease over the next
5 years, they envision
the fee for service will
provide 30-60% of the
funds with grants
making up the rest.
Recently the WELLS
Center has partnered
with their local public
broadcasting company to
deliver high-speed data
casting via satellites.
This approach allows
remote participation for
observing and debriefing.
The data casting allows
large files to be sent to
individual computers via
satellites so users can
receive images without
internet connection. Live
training events at the
simulation center can be
seen in real time. The
Center is about to begin a
pilot program to look at
potential uses for this
technology in
conjunction with
simulation technology.
The Center hosts a
listserv and bimonthly
Note: The current
meetings to cover a
The Wells Center is also
budget is about
variety of simulation
developing a library of
$400,000.
topics.
simulation scenarios.
Advice: Jana noted that they work hard to not be seen as a competitor with their partners. “We try to be transparent in what we do and look for funding sources that will
benefit our partners. Our doors are also always open to new partners.”
Website: http://www.coloradonursingcenter.org/CurrentProjects/WellsCenter.html
Clinical Simulations in Alaska
Appendix F: A Sampling of Clinical Simulation Delivery Models
71
Facility
Contact
University of
Washington
ISIS Center
(Institute for
Surgical and
Interventional
Simulation)
Contact:
Dr. Brian Ross,
Director
Who are the
learners?
Residents,
medical students,
nursing students,
visiting
physicians,
community
outreach with K12 students.
Simulation Training
Topics
Team training with
multiple disciplines.
Some of the areas in
which ISIS provides
training using simulation
technology include:
general surgery,
obstetrics,
otolaryngology, internal
medicine, and
anesthesiology
Delivery Model
Governance Structure
ISIS has a simulation
center housed within
the University
Medical Center. It is
an open space (less
than 2000 sq ft) that
can be reconfigured
as needed. It includes
a skills lab area and a
high fidelity
mannequin.
ISIS has a Governing
Board and an Executive
Committee. The
Executive Committee
runs ISIS and develops
the initiatives. Under
this committee there are
3 major committees:
Faculty/Experts Group,
an Education/
Curriculum Committee
and a Research and
Development
Committee.
Funding Sources
Notes
The ISIS mission is to
provide skills
development, serve as a
simulation resource
library, and to provide
leadership in the area of
simulation technology,
particularly in the
WWAMI region.
Note: Brian Ross was
our guest speaker for the
first taskforce meeting
on Nov 27, 2007. He
spoke about the use of
simulation technology on
the national scene,
including its historical
development, as well a
the activities of ISIS.
ISIS partners with 19
different medical
departments, nursing,
dental, and to some
degree bioengineering and
mechanical
engineering. They
also partner with
Children’s Hospital
and Madigan Army
Medical Center.
Advice: It is important to do a needs assessment before buying equipment. The curriculum should drive the training needs and these needs will determine the type of
simulation equipment/center you need. Do not buy the simulator and then develop the curriculum; buy the simulator based on the curriculum needs! Figure out the essential
elements of the curriculum and then identify those components which can have value added to them by simulation.
Simulation technology needs to be taken to where the training needs are. A “footprint” is needed in each partner facility. There needs to be a common administrative thread
and standardized curriculum. During the planning stages, it is important to be as inclusive as you can.
Website: http://www.isis.washington.edu/
ISIS also serves as a
simulation resource
library center and has
developed a standard
curriculum template for
their faculty.
Clinical Simulations in Alaska
Appendix F: A Sampling of Clinical Simulation Delivery Models
72
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
Organization
Alaska Family Medicine Residency
Alaska Native Tribal Health Consortium
Bartlett Hospital
Bassett Army Community Hospital
Central Peninsula Hospital
Cordova Community Medical Center
Elmendorf AFB-3rd Medical Group
Fairbanks Memorial Hospital
Interior Region EMS Council
Providence Alaska Medical Center (2)
State of Alaska Public Health Nursing
TVC Paramedic Academy
UAA BSHS MEDEX PA Program
UAA School of Nursing
UAA Allied Health Program
UAA WWAMI Program
VA Primary Care Clinic and Homeless Veterans Service
Page(s)
3
4-6
7
8
9
10
11
12
13
14
15
16
17
18
19-20
21
22-23
Compiled by Janice Troyer of the Alaska Center for Rural Health-Alaska’s AHEC on 1/22/08.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
73
SIMULATION TRAINING TOPICS - An overview
The categories below demonstrate the broad range of topics listed in the charts of this document with examples for each:
•
Emergency Airway Management and Cardiac Life Support (e.g. rapid sequence intubation, ventilator management, ACLS,
PALS, BLS)
•
Disaster Management-Emergency Scenarios (away from hospital) (e.g. scenarios of multiple trauma, critical care transport,
medical readiness training)
•
Codes/Emergencies (in hospital) (e.g. code and crash cart training, anesthesia crisis intervention, rapid response team, ATLS
procedures, emergency treatment of stroke patient, code response for respiratory or cardiac arrest, ED triage skills)
•
Physical Exams (e.g. exams such as thyroid and abdomen exams showing normal and abnormal finding, lung exams with normal
and pathology, diabetic foot exam)
•
Technical skills (e.g. wound care, suturing, IVs, chest tubes, blood draws, injections, catheters, complex line placement, splinting
lab, orthopedic skill, lumbar puncture, conscious sedation, virtual colonoscopy, joint aspiration, glycemic management,
administration of high-alert medication, medication reconciliation)
•
Deliveries/neonates/peds (e.g. fetal monitoring, emergency childbirth, crash C-section, neonatal resuscitation, pediatric
emergencies (not PALS))
•
Communication (e.g. team decision making/communication; communication with patients/family, physician; motivational
interviewing; interviewing skills-family assessment; patient handoff)
•
Health Promotion/Management (e.g. teaching for infectious diseases; health promotion-chronic condition)
•
Types of Learners listed in charts: ETT, EMTs, Paramedic, CHAP, RN, PA, NP, MD, Resident, Medic, new staff, faculty, new
grads
•
Types of Training listed in charts: Basic 1st responder; skills training for EMS providers; resident training; continuing education;
re-credentialing; CME; deployment training and redeployment training; skills and procedure competency screening for students, new
hires, interims, locums, travelers, emergency responders; faculty development; and training new staff for specialty areas.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
74
ORGANIZATION _Alaska Family Medicine Residency
CONTACT re this form Barbara Doty M.D.
TRAINING/EDUCATION
TOPIC
Rapid Sequence Intubation, Adult and
Pediatric
ATLS Procedures: Chest Tube, Central
Line, Cutdown, Intraosseous
Arterial Line, Paracentesis Cricothyrotomy
Thoracentesis
Demonstrate cardiac arrythmias in mock
code model
Obstetrical malposition, Gyn Procedures
including D/C, Shoulder Dystocia, Post
Partum Hemmorage, IUPC/Scalp electrode,
Perineal tear repairs
Ventilator Management including Peds and
Neonate
Virtual Colonoscopy, Flex Sig, EGD
Conscious Sedation
Neonatal resuscitation including Airway
placement, Umbilical Catheter, IV start
Suturing including tendon and complicated
laceration repair
Joint Injection, Fracture Reduction closed or
partly open
Lumbar Puncture for adults and kids
Date __Jan 15 2007
Phone 907 354-0460
e-mail [email protected]_
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or
do you aspire to improve the quantity or effectiveness of this training?
Feel free to elaborate after indicating:
SATISFIED / NOT SATISFIED
Need CALS type training with hands on tips and tricks. Airway
management is critical for bush Emergencies
ATLS courses are q4 years, hard to access. No skill review resource is
currently available in between
Rare but needed skill set for all hospital and Emergency staff
SIMULATION POTENTIAL Comment
Do you see any potential for simulation
technology in addressing this topic? Feel free
to elaborate.
YES / NO / UNSURE
Yes. See CALS Program info
Emergency Childbirth by inexperienced staff are common; OB care
requires a lot of “touch” training as assessment is usually manual
OB training models are available- see CALS
Company in Woodstock makes
Critical for bush settings when weathered in. Rare events
Could have vent machine set-up with ability
to modulate settings, etc
Many virtual colonoscopy tools available
Good one at ANMC but not enough access to
others needing training
Could do with Sim Man
Colon CA is the #1 cancer in Alaska and access to trained
professionals who can do diagnostic tests is limited
Specific training required for hospital credentials. No sim system
currently available
Available in many hospitals already
Well done with SIM Man
Many models available
Not formally available. Usually use pig feet models
Models available
Not currently available
Models available for joint injection
Not in Alaska
Many models available coupled with podcast
ipod training video clips
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
75
ORGANIZATION _______Alaska Native Tribal Health Consortium
____
CONTACT re this form __Thomas D. East, Ph.D._______________
TRAINING/EDUCATION
TOPIC
Skills and procedure competency screening
for students, new hire, interims, locums,
travelers, emergency responders
Re-accreditation and CEU: Simulators are
useful in training key courses such as PALS
and ACLS where our clinical staff require
certification
Experience acceleration… training on high
risk, low incidence situations
Phone __729-1986
STATUS Comment
Is this topic currently addressed to your organization’s
satisfaction? Or do you aspire to improve the quantity or
effectiveness of this training? Feel free to elaborate after
indicating:
SATISFIED / NOT SATISFIED
Using simulators would not subject patients to clinical staff
who do not know the basic skill or procedure. Pre-screening
would reduce negative patient experience.
Not Satisfied
Not Satisfied, limited or no experience in handling unusual
cases for clinical staff who have been recently educated, or
who are moving into different skill areas
Date __1/15/08______
e-mail [email protected]_
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology in
addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
Yes
Yes potential with existing simulators
Models that allow for physical exam skills to
be demonstrated and practiced with normal
and abnormal findings. That may not exist yet,
as it is so basic.
Models for IV/blood draw that are more
realistic than the arms we have now. But we
have been using simulated arms for years.
Models for IM/SQ injection: we have static
models for now; they practice on classmates
before real people; still works
Emergency scenarios of multiple trauma: this
is in great need. However the level of
intervention is not ACLS: no meds
Treatment skills models: eye and ear drops,
eye exams & treatments, nasal packing,
aseptic ointment on burn dressings
Orthopedic injuries for assessment & splints
Not satisfied… particularly for remote CHAP training
Yes- a simulator could be used to accelerate experience
defibrillator, management of cardiac arrest, trauma,
patients showing signs of decline ("crumping") and in
need of a Rapid Response Team (breathing, heart rate,
pulse, etc)
Yes- Physical Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Suturing, other wound care
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
76
Oxygen administration: only with use of
BVM, cannula, and nebulizer. No intubation
Emergency childbirth
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Visual pt that can go through steps in
treatment.
Small portable disposable simulation kits
would be great for wound care practice,
perhaps other exam skills like thyroid exam,
abdomen exam, maybe others I cannot think
of right now.
Models with abnormal general appearance and
simulated physical findings,
Simulated history paths and exam paths,
outcomes of any treatments. Esp. for very sick
adults and kids.
Be great if there was an online visual
simulation of how the CHAP manual is
supposed to be used.
Disaster management training
Not satisfied… particularly for remote CHAP training
Yes- Virtual Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Physical Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Virtual Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Virtual Simulation Model
Not satisfied… particularly for remote CHAP training
Yes- Virtual Simulation Model
Desktop training and disaster drills are OK but take a fair
amount of resources… would be nice if a virtual world could
be used to run the entire disaster sim using avatars for key
players
Not satisfied… some equipment failures are in the middle of
essential medical procedures and require biomedical
technician intervention
Yes- Virtual Simulation Model
Equipment failure simulation with biomed
intervention
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
77
Yes
Additional Comments: (Feel free to attach)
The distance ed students are so wide spread that it is impractical to have bulky and expensive simulation models in all possible remote
locations. From the looks of these models and associated equipment, they are not very portable on small planes! Upkeep and updating would be
a definite issue, regardless of where it is used. This would be one of our biggest concerns: day to day care and feeding of simulation equipment
to keep it healthy and ready to work!
This would be investment in big ticket items that need a workforce dedicated and training it is assembly, use, storage, and maintenance. There
would have to be a recurring budget for just those things. And we would need a clear jurisdictional path to iron out where these things would be
housed & maintained.
Comments from Herb Sivitz, Alaska Clinical Engineering Services (ACES) Director:
I would like an opportunity to provide a proposal for ACES services for equipment planning, room and facility design, implementation, and ongoing medical equipment management and support. In the Task Force SOW outline #5 under The final report will summarize findings from the
assessments and answer the following: What is the recommended Management and Maintenance Structure (sustainability)? I believe this
focuses how to have it pay for itself, but all of the medical equipment needs to be maintained. I would include the actual simulator as well, but
would expect training on any potential simulator system. I have both the Biomed techs and Medical Network Administrators that can cover the
entire system and the entire facility.
If required, I could generate a support service proposal for the final report. It would help if there was some kind of typical equipment list for
simulation rooms, but we could generate something close for budgeting purposes. Let me know if I can assist somehow in the final report,
even if it is to review an existing proposal for maintenance.
From the Task Force minutes; “Karen [Perdue] also described some of the parallel processes that are revolving around the topic of simulation.
UA is in the mode of expanding its health education programs. We are making investments in equipment, in buildings (including a $46M
Health Science Bldg), etc. One question that has arisen is whether we should have a Simulation Center in the new health building. “
I have not approached UAA about medical equipment support if there is any, but this would be a good opportunity to provide a proposal as
mentioned before to provide planning, implementation, and support services. I am sure they have Biological Safety Cabinets and hoods for
chemistry class.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
78
ORGANIZATION _______Bartlett Hospital
CONTACT re this form __Justine Muench, Staff Development Coordinator
Training/Education Topic
Date __1/15/08______
____
Phone __796-8912
e-mail [email protected]_
Status Comment
Simulation Potential
Satisfied/Not Satisfied
ACLS
Fetal Monitoring
satisfied; could be better with more
advanced simulation but adequate
not satisfied
Yes; Sim Man
yes
Difficult Birth
not satisfied
yes
Pediatric emergencies (not PALS)
not satisfied
yes
ED Triage Skills
not satisfied
yes
Emergency treatment of stroke patient
not satisfied
Coordinated and Timely DC or Transfer
Transcutaneous Pacer Insertion
Pulmonary Artery Catheter Insertion and care
not satisfied
not satisfied
not satisfied
yes
unsure; the hands-off communication piece could have
simulation potential
yes
yes
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
79
Date __15 January 2008_____________
ORGANIZATION ______Bassett Army Community Hospital
CONTACT re this form ____LTC Lisa A. Ingulli___
Phone : 907-978-6836 e-mail [email protected] or [email protected]
TRAINING/EDUCATION
TOPIC
ACLS
PALS
TNCC/ENPC
Medic Training
STATUS Comment
Is this topic currently addressed to your organization’s
satisfaction? Or do you aspire to improve the quantity
or effectiveness of this training? Feel free to elaborate
after indicating: SATISFIED / NOT SATISFIED
Yes, but would like to improve it
Yes, but would like to improve it
This is not taught at BACH, would like to have an
instructor that would do more hands on skills not just
talk through it.
Yes, but would like to enhance it with a mini sim lab
Deployment Training
No, trying to make a mini sim lab here at BACH
geared for docs and nurses as well as medics for
combat skills.
Redeployment Training
No, trying to make a mini lab here at BACH geared
for docs and nurses as well as medics
Code and crash cart training
NRP, EFM
Yes, but would like to improve it.
Yes, but would like to improve it
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
80
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology in addressing this topic?
Feel free to elaborate.
YES / NO / UNSURE
Yes, using a sim man for a mega code training
Yes, using a more advanced sim baby
Yes, use sim man for training instead of just stating what people would do
Yes, there is a MSTC (Sim Lab is a separated building on post that is not part
of the hospital) on post for medic training, but if there was something that the
hospital could do at our level then we would not have to compete with others
on post to use the lab and we could make scenarios that are for the field
medic as well as for CSHs (military tent hospital)
Yes, would like to see a lab where nurses and docs could practice skills that
they would use in combat that they normally do not do in their normal jobs
such as work with vents, art line, mascal injuries such as amputations,
massive head injuries, etc. General skills that nurses and docs normally do
not get here in Alaska are loading and unloading a stretcher, putting a person
on a backboard, KED, putting in and trouble shooting chest tubes, giving
massive infusions of blood using an infuser, using PSAG trousers, starting
largebore IVs, using nasopharyngeal and oral pharyngeal airways, practice
using critical thinking skills for actions that are taken to look for a reaction
and what to do during the reaction. Medics could learn not just hands on
skills but what is needed to be documented especially in a deployed ER
Yes, would like to see sim equip for docs and nurses to train on skills that
they may not have used in combat. Such as doc’s when they come back from
deployment they could train on using a scope sim equip to remove a
gallbladder or a nurse could practice ob deliveries and using an EFM monitor
or a ER nurse practice peds skills such as the Braslow Bag/cart/tape,
inserting peds IVs and oral airways.
Use a sim man for mega code training and Cardioversion training
Yes, would like to get a NOEL, a birthing dummy since OB is a big part of
BACH.
ORGANIZATION __________Central Peninsula Hospital___________
CONTACT re this form _____Lynn Senette______ Phone __ 262-0333
TRAINING/EDUCATION
TOPIC
National Patient Safety Goals
ACLS/BLS/TNCC etc.
Annual safety update
Clinical skills training
Infection control
____
_
Date _12/21/07______________
e-mail [email protected]__
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or do
you aspire to improve the quantity or effectiveness of this training? Feel free
to elaborate after indicating:
SATISFIED / NOT SATISFIED
We address this in our education process. However, audits indicate that
ongoing education is necessary.
This is part of educational offering.
Our process is currently cumbersome and needs some streamlining.
We provide training on selected topics for new skills, high risk/low volume
skills etc.
Need additional education.
Credentialing
Demonstrating proficiency
Have recently used a SIM man for demonstrating competency in intubations
CMEs
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology
in addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
Unsure.
Yes.
Unsure.
Yes.
Yes.
Yes, but would need to know more about logistics
and cost
Yes, but same as above
Yes, but same as above
81
ORGANIZATION ______Cordova Community Medical Center__
CONTACT re this form ___Gretchen Zolldan, RN/DON_______
TRAINING/EDUCATION
TOPIC
Date _1/9/08______
Phone __907-424-8246
e-mail [email protected]___
PALS
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or do
you aspire to improve the quantity or effectiveness of this training? Feel free
to elaborate after indicating:
SATISFIED / NOT SATISFIED
Satisfied-bring trainer from Anchorage every year to train nursing staff
unsure
ACLS
Satisfied-bring trainer from Anchorage every hear to train nursing staff
unsure
TNCC
Not Satisfied-I need to find funding/grant for the facility to be able to afford
the class for nursing staff
Not Satisfied-I need to find funding/grant for the facility to be able to afford
several nurses to attend
Not Satisfied-I need to find staff member to volunteer to become a certified
instructor
Not Satisfied-our previous trainer left the facility some time ago and the
program has “floundered” since then
unsure
Wound Care
BLS
Corporate Compliance
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology
in addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
Yes/unsure
Unsure
yes
Additional Comments: (Feel free to attach)
I have focused more on nursing/health care staff for the education/training topics. I know there is some work going on with ASHPIN to assist facilities in
obtaining video conferencing capabilities. Not sure where Cordova is on that list.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
82
ORGANIZATION : 3rd Medical Group Elmendorf AFB
CONTACT re this form: Major Marlene Kerchenski
TRAINING/EDUCATION
TOPIC
Medical Readiness Training
TeamSTEPPS (to teach junior staff to
effectively communicate to senior staff
without fear)
ACLS
PALS
TNCC
Rapid Sequence Intubation
Ventilators
Emergency Blood Admin
Precipitous Delivery
Crash C-section
Rapid Response Teams
Training related to meeting Joint
Commission standards and readiness
medical skills for each function. (IV
starts, catheter, triage, etc.)
Facial trauma/jaw fracture (from dental
point of view)
Pediatric ventilator management
Date: 14 Jan 2008
Phone: 907-580-5548
e-mail: [email protected]
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or
do you aspire to improve the quantity or effectiveness of this training?
Feel free to elaborate after indicating: SATISFIED / NOT SATISFIED
Not optimal. As relevant as this subject is to the GWOT, it would benefit
military and civilian communities to provide simulated technology to
merge thoughts, products and training to ensure training is coherent and
meets standard of care; Goal: training is consistent for providers which
leads to optimal delivery of care for patients. “Hands on” or simulated
technology is always the best teachers and motivates its learners to
participate by thinking critically.
The topic is presented to departments upon request or suggestion by the
Pt. Safety Manager if the department is having communication issues
that have been voiced. It helps just in time, but once there is staff
turnover, which occurs frequently, the teams have to regroup and new
members haven't had the benefit of the training. Simulation would help
to get everyone comfortable with the tools and techniques from
TeamSTEPPS and encourage staff to watch each other's back.
Satisfied. Could improve team effectiveness
Satisfied. Could improve team effectiveness
Satisfied. Could improve team effectiveness
Not
Not
Not
Not
Not
Not
Yes, they are being addressed currently. Readiness medical skills
training could be improved.
SIMULATION POTENTIAL Comment
Do you see any potential for simulation
technology in addressing this topic? Feel free to
elaborate. YES / NO / UNSURE
I hope that this is something that could become a
reality for our facility.
Simulation technology would be a great addition
to the TeamSTEPPS program. It is currently
being used at Travis AFB hospital to continually
promote the skills that are learned in the 4-hour
course. It would provide real-life scenarios in
which the participants would benefit from.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Ways to use simulation technology for code blue
drills, triage and nursing/tech skills. Could even
be used for military exercises with the EMEDS
to train in casualty care.
NO
Unaware of this type of simulator exists but this
is a definite war type wound as well as MVA.
NO
Could be a possibility with the hi fidelity
pediatric mannequins.
Additional Comments: In our ER setting the greatest anticipated benefit would be enhanced/improved team dynamics and effectiveness. This could be accomplished in a
simulation lab or in situ.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
83
Date __1/15/2008_____________
ORGANIZATION ____Fairbanks Memorial Hospital______________________
CONTACT re this form ___Corlis Taylor_________
Phone __ 458-5580
___ e-mail [email protected]
TRAINING/EDUCATION
TOPIC
Chest Tubes
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or do
you aspire to improve the quantity or effectiveness of this training? Feel free
to elaborate after indicating:
SATISFIED / NOT SATISFIED
We currently offer a core skills set of 6 classes for New Grad RN’s on topics
such as IV Therapy, crash cart/mock code, chest tubes, physical assessment
and lab values
We currently offer during a skills fair to staff on the surgical unit –
Cardiac catheters
Not satisfied – we just opened a cardiac cath lab
Training new staff for
specialty areas such as
Emergency Department or
ICU
Not satisfied
Core Skills for New Grad RN
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
84
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology
in addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
Yes, simulation would help tremendously and would
be a better assessment of competency
Yes, I think a simulation lab would be an
improvement on the watermelon that we currently
use
Yes, simulation offers a tremendous opportunity for
continuing education and training in this area
Computer simulation for specific areas such as ICU
or the ED would help tremendously in assessing
skills on an ongoing basis for competency and also
staff wanting to learn new skills to work in another
area
ORGANIZATION ___Interior Region EMS Council
CONTACT re this form __Dan Johnson__
TRAINING/EDUCATION
TOPIC
Basic (initial) training in “First
Responder” (AKA ETT), or EMT
in rural areas
Continuing education in skills for
first responders and EMTs (all
levels) in rural areas
Continuing education in
knowledge/content (as opposed to
skills)
Initial Training in advanced EMT
(EMT 2 and 3)
Continuing education in advanced
emergency procedures/skills for
rural RN, PA, NP, MD
Skills training for urban-based
pre-clinical EMS providers of all
levels
Advanced EMS skills training for
urban RN, PA, NP, MD
Hands on experience for urban
and rural pre-clinical EMS
providers.
____
Phone __907 456 3978
_
Date __1-15-08_______
e-mail [email protected]___
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction?
Or do you aspire to improve the quantity or effectiveness of this
training? Feel free to elaborate after indicating:
SATISFIED / NOT SATISFIED
Not satisfied. We are able to do this training, but it currently requires
face to face, traditional training and is expensive and logistically
difficult to deliver this to rural locations.
Not satisfied. This is getting done, generally using local resources.
But, the availability of actual patient experience or realistic skills
training can be scant. It is generally not practical to send out
experienced instructors for this.
Satisfied. Materials are available and easy to access.
Not satisfied. We are able to do this training, but it currently requires
face to face, traditional training and is expensive and logistically
difficult to deliver this to rural locations.
Not satisfied. We are able to do this training, but it currently requires
face to face, traditional training and is expensive and logistically
difficult to deliver this to rural locations.
Not satisfied - It is difficult to find clinical time in Fairbanks.
Not satisfied – it is often difficult to find the human (patient) and
other resources (e.g. “dog labs”, etc.) necessary to conduct this
training.
Not Satisfied - Many, if not most rural and urban pre-hospital EMS
providers get very little experience in caring for true emergency
patients.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
85
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology in
addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
Better computer-based and other distance methodologies
for delivering knowledge content. Better simulation
technologies for delivering skills training.
Better simulation technologies for delivering continuing
education in skills, especially from a distance.
Better computer-based and other distance methodologies
for delivering knowledge content, especially from a
distance.
Better computer-based and other distance methodologies
for delivering content. Better simulation technologies for
delivering skills training.
Better computer-based and other distance methodologies
for delivering knowledge content, especially from a
distance.
Lack of clinical training resources could possibly be
mitigated through the use of better “whole patient”
simulators (as opposed to specific skills simulators).
Better simulation technologies for delivering continuing
education in skills to supplement available instructor and
clinical/patient resources.
The reality is that rural and semi-rural (urban outskirts)
EMS services do not have a lot of patient volume. The
availability of better “whole patient” simulators could
improve realistic skills training as a substitute for real
experience.
ORGANIZATION: Providence Alaska Medical Center
CONTACT re this form: Dr. Roy Davis, Chief Medical Officer
TRAINING/EDUCTION
TOPIC
Code Blue Response
Physician Re-credentialing
On-going Peer Performance
Team Communication
Rapid Response Team
Patient Safety
Resident Training
Anesthesia Crisis Intervention
DATE: December 17, 2007
PHONE: 261-6020
EMAIL: [email protected]
STATUS
Training addressed by ALS & ATLS – not hands on
CME and case load – very subjective
Primarily addressed by case load outcomes
Poorly addressed
On-going education – communication skills
Variable attempts at addressing
Residency Program
CME and on-going training
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
86
SIMULATION POTENTIAL
Yes – Team Training
Yes – Hands on Training
Yes – Specific Assessment
Yes – Hand-off Simulation
Yes – Reproduce Case Presentations
Yes – SBAR Training
Yes – Supplementary
Yes – Case Specific
ORGANIZATION Providence Alaska Medical Center
CONTACT re this form Carrie Doyle
TRAINING/EDUCATION
TOPIC
Date 1/8/08
Phone (907) 261-6005
e-mail
Care of the cardiac patient
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or do you aspire
to improve the quantity or effectiveness of this training? Feel free to elaborate after
indicating: SATISFIED / NOT SATISFIED
No, this topic is not currently addressed to our organization’s satisfaction. There are
many methods of running a code smoothly and systematically but none are practiced
well. Also, many staff members have not had to deal with a code unexpectedly and
then when they are faced with a code they tend towards “panic.”
I do not believe this concept has been addressed by our organization. I have seen
this concept done in other SIM labs. Basically the student is given a patient to
include all orders, etc. They must then take off orders, complete care of patient, etc
No
Care of respiratory patient
No
Splinting lab
Not Satisfied – This has been done to a certain extent but with nothing formalized.
This would benefit techs, nurses, and residents.
Code Response – Finding
and running a patient who is
having some form of
respiratory or cardiac arrest.
Total Care of Patient
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
87
[email protected]
SIMULATION POTENTIAL Comment
Do you see any potential for simulation
technology in addressing this topic? Feel free to
elaborate. YES / NO / UNSURE
Yes
Yes
Yes – This topic could include gathering an
accurate history of all pertinent questions, doing
a focused exam of the cardiac system and then
prioritizing care according to problem.
Yes – This topic could include gathering an
accurate history of all pertinent questions, doing
a focused exam of the respiratory system and
then prioritizing care according to problem.
Unsure
ORGANIZATION ______State of Alaska Section of Public Health Nursing
CONTACT re this form __Jerry Troshynski______
Phone __ 334-2399_
TRAINING/EDUCATION
TOPIC
CPR
Certification/Recertification
Administering PPD skin tests
Administering IM and SQ
immunizations
Venipuncture
Naso-pharyngal smears
____
Date ___January 8___
e-mail [email protected]______
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or do
you aspire to improve the quantity or effectiveness of this training? Feel free
to elaborate after indicating:
SATISFIED / NOT SATISFIED
Required training for all of our PHNs. Often we depend on community
partners (usually local EMS) for training and sim models. Not satisfied with
current efforts, statewide, to maintain 100% current certification.
Currently new PHNs to our system either are already assumed to have this
skill, or practice on other staff or clients. We do require this skill to be
checked off in the orientation process, but have no real way to “practice”
other than the live “victim.” So, not satisfied with the current method
Again, currently, new PHNs or community partners (EMTs) who need to be
training as part of orientation, or as part of a mass vaccination exercise train
and practice on each other. Not satisfied with current method.
PHNs are not required, often, to perform venipuncture. However, there are
times when venipuncture is required. Currently the only training/refresher
options we have are to practice on each other. So, not satisfied.
Obtaining this type of culture, applied through the nasal passages to the very
back of the throat, is required to test for pertussis (whooping cough) and other
communicable diseases. Though we rarely need to do these, we need to have
the ability to do. Right now we have no training program for this.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
88
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology
in addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
If the sim technology is portable and available to
communities and partners, it could be useful to us.
If the sim model is portable and available, it would
be useful.
If sim model is portable and available, would be
useful.
If sim model is, again, portable and available, would
be useful.
Portable and available
ORGANIZATION __TVC Paramedic Academy________________________
CONTACT re this form _Chuck Kuhns ___________________
Phone _455-2895 ____
TRAINING/EDUCATION
TOPIC
Critical Care Transport Course
Continuing Education classes
Paramedic Training
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or do
you aspire to improve the quantity or effectiveness of this training? Feel free
to elaborate after indicating:
SATISFIED / NOT SATISFIED
Not satisfied – the course is in the planning stages to train paramedics and
nurses
Not satisfied – conflict between local courses using the simulation manikins
and taking simulation manikins to the villages by plane
Satisfied – the program relies on simulation manikins throughout the course
to create realistic scenarios for the students.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
89
____
_
Date 1/13/2008 ___________
e-mail [email protected]______
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology
in addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
Yes – if there was the ability to rent trauma manikins
for simulation during the course from within the state
Yes – if there was the ability to rent simulation
manikins from within the state
No
ORGANIZATION __UAA BSHS MEDEX PA Program________________________
CONTACT re this form _____John Riley___________________________
Phone __ 786-6570
TRAINING/EDUCATION
TOPIC
____
Date 1/15/08
e-mail AFJOR________________
STATUS Comment
Is this topic currently addressed to your organization’s
satisfaction? Or do you aspire to improve the quantity or
effectiveness of this training? Feel free to elaborate after
indicating:
SATISFIED / NOT SATISFIED
NOT SATISFIED, aspire to improve the quantity
YES ,need new clinical space and equipment for this
Basic Clinical Skills Exams:
Ear, eye, cardiac, lung, GU, GYN, with
NL and PATH
Recorded exam room activities: H&P,
OSCS
Emergency airway management and
intubation
Joint aspiration
SATISFIED, aspire to improve the quantity
YES, need new clinical space and equipment for this
SATISFIED, aspire to improve the quantity
YES, need new clinical space and equipment for this
NOT SATISFIED, aspire to improve the quantity
YES, can be difficult to get this experience with patients
NOT SATISFIED, aspire to improve the quantity
YES, can be difficult to get this experience with patients
Complex line placement
NOT SATISFIED, aspire to improve the quantity
YES, can be difficult to get this experience with patients
Skin excision and punch biopsy
NOT SATISFIED, aspire to improve the quantity
YES, can be difficult to get this experience with patients
Team decision making
NOT SATISFIED, aspire to improve the quantity
YES, with interdisciplinary simulation
Error prevention
NOT SATISFIED, aspire to improve the quantity
YES
Standardized patients
SATISFIED, aspire to improve the quantity
Need new clinical space for this
Technical skills (see below)
Technical skills:
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
Phlebotomy
IV placement
CBC interpretation
Urinalysis interpretation
EKG reading
Rhythm strip reading
Traumatic eye exam
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
Slit lamp exam
Suturing
Knot tying
Surgery gown and glove
Would irrigation, debridement
Incision and draining
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
90
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology in
addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
ORGANIZATION ___UAA School of Nursing__________
CONTACT re this form ___Maureen O’Malley______________
Phone __
786-4584
_
____ Date _______________
e-mail: [email protected]
TRAINING/EDUCATION
TOPIC
We address many topics in undergraduate nursing education. The topics below
are those we feel could be improved upon.
STATUS Comment
Is this topic currently addressed to your
organization’s satisfaction? Or do you aspire to
improve the quantity or effectiveness of this
training? Feel free to elaborate after indicating:
SATISFIED / NOT SATISFIED
Glycemic Management
We already cover all of these items. We feel
simulation would enhance all. I indicate two
items as high that come from our graduate
surveys.
High
Communication (with patients, families, physicians)
Administration of High-Alert Medications
Teaching – Health Promotion
Patient Hand-off /SBAR
Medication Reconciliation
Psychomotor skills, IVs, tube feedings, chest tubes
Skills – pediatric and newborn
Interviewing skills – family assessment
Organization and prioritization, managing a group of patients
Airway management, tracheostomy
Faculty Development
Central Line Management and medication administration
Wound Care & sterile technique
Management/Teaching for Infectious Diseases – TB
Maternal Child Health-New mom with baby
Health Promotion-Chronic Condition, Arthritis, DM, community resources
Venipuncture
High Intensity Situations-Code, hemorrhage, emergency surgery, etc.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
High
91
SIMULATION POTENTIAL
Comment
Do you see any potential for
simulation technology in
addressing this topic? Feel free to
elaborate.
YES / NO / UNSURE
Yes – could include skills with
glucometer, IV management.
Yes
Yes
Unsure
Unsure
Unsure
Yes
Yes
Unsure
Yes
Yes
Yes
Yes
Yes
Unsure
Yes
Unsure
Yes
ORGANIZATION ____________UAA Allied Health Sciences__
CONTACT re this form ___Sally Mead___________________
TRAINING/EDUCATION
TOPIC
1. Enhance Existing
Simulations in AHS
programs
2. Demonstrate
interdisciplinary simulations
____
Phone __786-6930___
STATUS Comment
Is this topic currently addressed to your organization’s
satisfaction? Or do you aspire to improve the quantity or
effectiveness of this training? Feel free to elaborate after
indicating:
SATISFIED / NOT SATISFIED
Not Satisfied: Programs like Rad Tech use a small room with
x-ray equipment for students to practice using each other. Need
trained “actors” for the doctor role or real patient who knows
the experience for feedback in session debriefing.
Not Satisfied: All AHS programs/students need to work with
other health care providers as a replication of real time
practice. It is not really occurring at this time.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
92
_
Date ____January, 2008_________
e-mail [email protected]__
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology in addressing this
topic? Feel free to elaborate.
YES / NO / UNSURE
-Need new facility/simulation space for UAA
-Need LIS software to increase simulation’s relevance to real practice
-Rad tech 2nd year students need Trauma Room simulation
-Create case-based scripts across AHS, nursing, physician training.
This would be labor intensive and have fiscal implications.
- Ideal to have Health Information system software in place, LIS, RIS,
PhIS and all HIPAA compliant
-Develop assessment process to benefit patient, student and faculty.
Did it simulate the real environment?
-Interface the telehealth network with this type of interdisciplinary for
consult/simulation for our rural students
-Could use pneumatic tube system for transporting x-rays, specimens,
paperwork between “practices” within the training facility to better
simulate the practice setting.
ORGANIZATION _UAA_CTC , Allied Health Division, Medical Laboratory Technology Department_ Date: 1-19-08
CONTACT re this form Heidi Mannion
Phone 786-6924
e-mail [email protected]
TRAINING/EDUCATION
TOPIC
Multitasking
Health care team
interactions
Shift change
Medical Informatics
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or do
you aspire to improve the quantity or effectiveness of this training? Feel free
to elaborate after indicating:
SATISFIED / NOT SATISFIED
NOT SATISFIED Due to the current design of our student lab and the need
for oversight during clinical practicums, students have little opportunity to
multitask which is an important skill for clinical laboratory professionals.
NOT SATISFIED Students do not have an opportunity to interact with other
health care professionals until they go to clinical practicum. During practicum
their interactions are limited. Graduates have said that they felt unprepared
for their interactions with the rest of the health care team.
NOT SATISFIED We provide several opportunities for students to learn the
importance of documentation and communication in microbiology and
transfusion medicine to allow a smooth transition and maintain quality of
care. Providing the same opportunity in a core lab and among other health
care professionals would enhance student learning.
NOT SATISFIED We have the software for a physician office laboratory
information system which has limited capabilities. Use of the laboratory
information systems during clinical training varies depending on hospital
policy.
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
93
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology
in addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
YES Creating a core lab within the student lab would
provide opportunities for the students to multitask
allowing them to use several analyzers and perform
multiple tests during simulations.
YES Creating simulations where medical, nursing,
radiology and clinical laboratory students interact
would provide students an opportunity to learn the
best approach for handling difficult situations.
YES Creating a core lab within the student lab would
provide additional opportunities to simulate the need
for documentation and communication within the lab
and with other health care professionals
YES Having a laboratory/hospital information
system with electronic medical records and
simulating how each health care professional uses
the system would provide students in all programs
equivalent training in medical informatics.
ORGANIZATION Alaska WWAMI Biomedical Program at UAA
CONTACT re this form Dennis Valenzeno
Phone (907) 786-4789
TRAINING/EDUCATION
TOPIC
Date 6 December 2007
e-mail [email protected]
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology
in addressing this topic? Feel free to elaborate.
YES / NO / UNSURE
Integrative Case Conferences
STATUS Comment
Is this topic currently addressed to your organization’s satisfaction? Or do
you aspire to improve the quantity or effectiveness of this training? Feel free
to elaborate after indicating:
SATISFIED / NOT SATISFIED
Under development
Physical exam
Addressed well, but briefly
Yes
Team training
Not adequate
Yes
Horizontal class integration
(bring together 1st yr, 3rd yr,
etc.)
Techniques training
Addressed, but needs improvement
Yes
Addressed as enrichment
Yes
Anatomy
Currently addressed with simulators called cadavers!
Yes
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
94
Yes
ORGANIZATION: Alaska VA Healthcare System: Primary Care Clinic
TRAINING/EDUCATION
TOPIC
Diabetic Foot Exam
STATUS Comment
Is this topic currently addressed to your
organization’s satisfaction? Or do you aspire to
improve the quantity or effectiveness of this
training? Feel free to elaborate after indicating:
SATISFIED / NOT SATISFIED
Satisfied although there are areas needing
improvement
Varied techniques
Checking in patients on initial
appointment
Satisfied although not enough time to
accomplish all clinical reminders
Electrocardiogram, 12 leads
Use of Peak Flow Meter
Room Set Up and preparation
of patient for Women’s Health
Clinic
Medication Reconciliation
Home Oxygen Evaluation
Not Satisfied. Many nursing staffs are
unfamiliar with the clinic and apprehensive
when assigned due to infrequent exposure.
The same medication with different names,
patients don’t know their medications
Need improvement
Peripherally Inserted Central
Catheter (PICC Line)
Management
Nursing Alert /code
Rare occurrence, hard to maintain proficiency
Satisfied
BLS and ACLS
ACLS not offered to non-OR nursing staff.
How to respond to Fire
Operation of Fire
Extinguishers
Parenteral injection
Satisfied
No Training
On the job training
Physical Assessment
(Providers)
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
Date 15 Jan 08
CONTACT re this form DViloria
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology in addressing this topic? Feel
free to elaborate.
YES / NO / UNSURE
Yes. Would show exact lead locations for best diagnostic result. Trouble
shooting, show readings of inaccurate placement of leads, patient movements, etc
Yes. Standardize technique, correct areas to check, what deformities, symptoms,
signs, etc. to note. Programmable patient reactions, foot conditions, nails, etc
Yes. Obtaining vital signs, standardize script in obtaining patient data.
Programmable patient personalities and characteristics such as PTSD, drug
seekers, complex health conditions, etc.
Yes. How to instruct patient on proper procedure. Effects of pulmonary conditions
on the measurement.
Yes. Standardize Lay out of room, required supplies and equipment, patient
preparation, questions to ask patient, positioning, assisting provider, etc
Yes. Explain procedure to patient, identification of medications, colors and shape,
effects, contraindications, interaction with other meds and foods
Yes. Proper technique, different phases, de-saturation, titrating flow of O2 when
at rest and ambulation. When to stop the evaluation.
Yes. Dressing change, flushing, obtain blood sample. Different types, Different
technique: Groshong, Hickmann, Port-a-Cath.
Yes. How to respond, what supplies and equipment bring, assessing patient,
different scenarios such as chest pain, dyspnea, medication reaction, syncope,
vaso-vagal
Yes. Cardiac rhythm identification, Mega Code, algorhythm for various cardiac
conditions
Yes. RACE, different types of fire
Yes. Different extinguishers for different type of fire. PASS
Yes. Proper techniques in doing intramuscular, Subcutaneous, intradermal
injections, to include administration of Goserelin (Zoladex)
Yes. Systemic Assessment of patient on Circulatory, pulmonary, neurological,
muscular, skeletal, and all the other systems. Programmable signs and symptoms,
and varying severity of ailments, and complications.
95
ORGANIZATION _Homeless Veterans Service, Alaska VA Healthcare System and Regional Office
CONTACT re this form _James M. Fitterling, Ph.D.___
Phone __273-4078 ____
TRAINING/EDUCATION
TOPIC
Motivational Interviewing
STATUS Comment
Is this topic currently addressed to your organization’s
satisfaction? Or do you aspire to improve the quantity or
effectiveness of this training? Feel free to elaborate after
indicating: SATISFIED / NOT SATISFIED
Not satisfied. Client ambivalence is a ubiquitous and
foundational problem/issue in every area of healthcare.
Motivational interviewing is an evidence-based practice that
effectively addresses this. There are a lot of training consultants
and programs that claim to be "motivational interviewing" that
aren't. Training should be provided by a certified MI trainer
(http://www.motivationalinterview.org/).
This training needs to be in-depth that focuses on developing
criterion level of knowledge and skills; simply warming a seat in
a workshop will not develop this.
(NOTE: Since the focus is on primary medical applications and
not behavioral health, I restrict my suggestions to motivational
interviewing which has broad applications in health care.)
Clinical Simulations in Alaska
Appendix G: Alaska Clinical Simulation Taskforce Training Topics
96
_
Date __Jan. 15, 2008
____
e-mail [email protected]_
SIMULATION POTENTIAL Comment
Do you see any potential for simulation technology in addressing
this topic? Feel free to elaborate.
YES / NO / UNSURE
Yes. Even though the primary focus of simulation technology is
in primary medical care, sim tech can also have potential
applications in behavioral health. Video presentation of a trained
clinician posing as a client following a scripted clinical
presentation with alternate scripted responses based on the
trainee's interactions could serve as a training tool for clinicians to
develop this clinical skill. A video of motivational Interviewing
developer, William R. Miller, Ph.D. can be found at:
http://psychotherapy.net/video/miller_motivational_interviewing?
gclid=CLTEzsHr-JACFQUgkgodrBVx3w