Healthcare Simulation Education: Evidence, Theory and Practice by Brian Jolly, Debra Nestel, and Michelle Kelly

145b1099fe9fdc4-261x361.jpg Author Brian Jolly, Debra Nestel, and Michelle Kelly
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Healthcare Simulation Education Evidence, Theory and Practice EDITED BY Debra Nestel The University of Melbourne & Monash University, Victoria, Australia Michelle Kelly Curtin University, Western Australia, Australia Brian Jolly University of Newcastle, New South Wales, Australia Marcus Watson University of Queensland, Queensland, Australia This edition first published 2018 © 2018 by John Wiley & Sons Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK. 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. 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Cover design: Wiley Cover image: © KTSDESIGN/Gettyimages Set in 8.5/12pt, MeridienLTStd by SPi Global, Chennai, India 10 9 8 7 6 5 4 3 2 1 Contents Contributors, ix Foreword, xiii Acknowledgements, xv Section I: Introduction 1 An introduction to healthcare simulation, 3 Debra Nestel & Michelle Kelly Section II: Theoretical perspectives and frameworks for healthcare simulation 2 Theories informing healthcare simulation practice, 9 Margaret Bearman, Debra Nestel & Nancy McNaughton 3 Historical practices in healthcare simulation: What we still have to learn, 16 Harry Owen 4 Exploring realism in healthcare simulations, 23 Debra Nestel, Kristian Krogh & Michaela Kolbe 5 Applying a framework to healthcare simulation: Micro, meso and macro levels, 29 Marcus Watson Section III: Contemporary issues in healthcare simulation 6 Strategies for research in healthcare simulation, 37 Debra Nestel & Michelle Kelly 7 Simulated participant methodologies: Maintaining humanism in practice, 45 Debra Nestel, Jill Sanko & Nancy McNaughton 8 Narrative dramaturgy and sense making in healthcare simulation, 54 Teresa Crea 9 Haptics-driven healthcare training simulator systems, 60 Lei Wei, Hailing Zhou, Matthew Watson, Zoran Najdovski, Mick Fielding, Richard Page & Saeid Nahavandi 10 Virtual environments and virtual patients in healthcare, 69 LeRoy Heinrichs, Parvati Dev & Dick Davies 11 Consistency in simulation: A measurement perspective, 80 Brian Jolly 12 Taking simulation beyond education in healthcare, 86 Marcus Watson v vi Contents 13 The value of professional societies to the healthcare simulation community of practice, 90 Pamela B. Andreatta, Kirsty J. Freeman & Ralph J. MacKinnon 14 Faculty development in healthcare simulation, 105 Simon Edgar, Michael Moneypenny & Alistair May 15 Programme development and sustainability in healthcare simulation, 112 Komal Bajaj, Michael Meguerdichian, Jessica Pohlman & Katie Walker Section IV: Elements of simulation practice 16 Ethics of healthcare simulation, 121 Nathan Emmerich, Gerard Gormley & Melissa McCullough 17 Teamwork and healthcare simulation, 127 Jenny Weller & Ian Civil 18 Designing simulation-based learning activities: A systematic approach, 135 Debra Nestel & Suzanne Gough 19 Facilitating healthcare simulations, 143 Michelle Kelly & Stephen Guinea 20 Strategies for managing adverse events in healthcare simulations, 152 Stuart Marshall & Cate McIntosh 21 Debriefing: The state of the art and science in healthcare simulation, 158 Adam Cheng, Walter Eppich, Taylor Sawyer & Vincent Grant Section V: Innovations in healthcare simulation practice 22 Simulation of home births: Developing safe practices, 167 Arunaz Kumar & Debra Nestel 23 Optimizing learning in simulation-based education using video-reflexivity, 171 Suzanne Gough 24 Conversations about organ and tissue donation: The role of simulation, 176 Jonathan Gatward, Leigh McKay & Michelle Kelly 25 Commencing a simulation-based curriculum in a medical school in China: Independence and integration, 181 Fei Han 26 Transport of the critically ill patient: Developing safe practices, 185 Rafidah Atan, Kristian Krogh, Nor’azim Mohd Yunos, Suneet Sood, Naganathan & Debra Nestel 27 From routine to leadership: Extending the role of simulation technicians in Southeast Asia, 190 Bee Leng Sabrina Koh & Chaoyan Dong 28 Incorporating simulation in a medical city: A case study from King Fahad Medical City, 195 Hani Lababidi 29 ‘Who‘ and ‘how‘ in simulation centre development: Buddies and ground rules, 200 Eric So, George Ng & LY Ho Contents 30 Operationalizing a new emergency department: The role of simulation, 205 Mike Eddie, Carrie Hamilton, Owen Hammett, Phil Hyde, Kate Pryde & Kim Sykes 31 Simulation modelling and analysis to test health systems, 209 Kenny Macleod & Robert Moody Section VI: Conclusions and future practice 32 Twenty years on… forecasting healthcare simulation practices, 217 Debra Nestel & Michelle Kelly Index, 221 vii Contributors Pamela B. Andreatta PhD EdD CHSE Institute for Simulation and Training, University of Central Florida College of Medicine, Orlando, FL, USA Rafidah Atan MBBS MAnaes FANZCA EDIC GradCertClinSim GradCertHigherEd Monash University Malaysia, Johor Bahru, Malaysia Komal Bajaj MD MHPEd New York City Health & Hospitals, New York, USA Margaret Bearman PhD BComp (Hons) Cert PA Centre for Research and Assessment in Digital Learning (CRADLE), Deakin University, Victoria, Australia Adam Cheng MD FRCPC Section of Emergency Medicine, Alberta Children’s Hospital, Calgary, Canada Department of Paediatrics, University of Calgary, Calgary, Canada Ian Civil CNZM MBE (Mil) KStJ ED MBChB FRACS FACS Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Teresa Crea DCA University of Canberra – Centre for Creative and Cultural Research, Canberra, Australia Asia Pacific Simulation Alliance, South Australia & Australian Capital Territory, Australia Dick Davies Ambient Performance Ltd, London Parvati Dev PhD Los Altos Hills, California, USA Chaoyan Dong PhD MS CHSE Sengkang Health, Singapore Mike Eddie BMBS BMedSci (Hons) Dorset County Hospital, Dorchester, United Kingdom Simon Edgar MBChB FRCA MScEd FAcadMEd NHS Lothian, Edinburgh, Scotland Nathan Emmerich PhD School of History, Anthropology, Politics and Philosophy Queen’s University Belfast, Northern Ireland, UK Walter Eppich MD MEd Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Illinois, USA Mick Fielding BEng PhD Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Australia Kirsty J. Freeman BNurs PGradDipMid GradDipEd CHSE WA Country Health Service, Perth, Australia Jonathan Gatward BSc MBChB FRCA DICM FCICM Cert Ed FHEA Intensive Care Unit, Royal North Shore Hospital, St Leonards, Australia University of Sydney, Sydney, Australia Gerard Gormley MD FRCGP FHEA School of Medicine, Dentistry and Biomedical Sciences, Centre for Medical Education, Queen’s University Belfast, Northern Ireland The Wilson Centre, University of Toronto, Faculty of Medicine and University Health Network, Toronto, Canada Suzanne Gough BSc (Hons) MA Ed (Research) PhD PGC-AP Physiotherapy PFHEA Department of Health Professions, Manchester Metropolitan University, Manchester, UK Vincent Grant MD FRCPC Departments of Paediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ix x Contributors Academy, Arunaz Kumar MBBS MD MRCOG FRANZCOG GCHPE Faculty of Medicine Nursing and Allied Health, Monash University, Clayton, Australia Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia Owen Hammett BN DipIMC (RCSEd) RN University Hospital Southampton NHS Foundation Trust, Southampton, UK Hani Lababidi MD FCCP Center for Research, Education & Simulation Enhanced Training (CRESENT), King Fahad Medical City, Riyadh, Saudi Arabia Stephen Guinea PhD Faculty of Health Sciences, Australian Catholic University, Victoria, Australia Carrie Hamilton RGN BSc MSc Training and Innovation, SimComm Southampton, UK Fei Han MD PhD Tianjin Medical University, Tianjin, China William L. Heinrichs MD PhD Stanford University, California, USA LY Ho MBBS MRCS FCSHK FHKAM(Surgery) FRCSEd(Urol) Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR Phil Hyde BSc BM MRCPCH FRACP FFICM FIMC RCSEd Southampton Children’s Hospital, Southampton, UK Dorset and Somerset Air Ambulance, Wellington, UK Brian Jolly BSc(Hons) MA(Ed) PhD School of Medicine & Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia Michelle Kelly PhD MN BSc RN Curtin University, Perth, Australia Bee Leng Sabrina Koh RN MHSc(Ed) PGDip(CC) BN CHSE Sengkang Health, Singapore Michaela Kolbe PhD PD University Hospital Zurich, Simulation Center, Zurich, Switzerland Kristian Krogh MD PhD Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark Ralph J. MacKinnon BSc MBChB FRCA Department of Paediatric Anaesthesia, Royal Manchester Children’s Hospital, Manchester, UK Kenny Macleod MScOR TMN Simulation, Melbourne, Australia Stuart Marshall MBChB MHumanFact MRCA FANZCA Department of Anaesthesia and Perioperative Medicine, Monash University, Victoria, Australia Alistair May BSc MBBS FRCA Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, Scotland Melissa McCullough PhD FHEA School of Medicine, Department of Clinical Medicine, Brighton & Sussex Medical School, Brighton, UK Cate McIntosh MBBS FANZCA Hunter New England Simulation Centre, John Hunter Hospital, Newcastle, Australia Leigh McKay RN BAS (Nursing) MPH Cert Intensive Care NSW Organ & Tissue Donation Service, Kogarah, Australia Nancy McNaughton MEd PhD Centre for Learning Innovation and Simulation, Michener Institute of Education, Wilson Centre for Research in Education, University Health Network, Toronto, Canada Michael Meguerdichian MD MHPEd New York City Health & Hospitals, New York, USA Contributors Michael Moneypenny BSc(Hons) MBChB(Hons) MD FRCA FHEA Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, Scotland Robert Moody St. Vincents Hospital, Melbourne, Australia Saeid Nahavandi BSc (Hons) MSc PhD Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Australia Zoran Najdovski BEng PhD Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Australia Debra Nestel PhD FAcadMEd CHSE-A Department of Surgery, Melbourne Medical School, Melbourne, Australia Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia George Ng MBBS MRCP FHKCP FHKAM(Medicine) FCICM MPH Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR Harry Owen MB BCh MD FANZCA School of Medicine, Flinders University, Adelaide, Australia Richard Page BMedSci MBBS FRACS (Orth) FAOrthA School of Medicine, Faculty of Health, Deakin University, Australia Naganathan MBBS FRCPI AM Monash University Malaysia, Johor Bahru, Johor Jessica Pohlman MPA MEd New York City Health & Hospitals, New York, USA Kate Pryde BMedSci BMBS MRCPCH Southampton Children’s Hospital, Southampton, UK xi Jill Sanko PhD MS ARNP CHSE-A University of Miami, School of Nursing and Health Studies, Coral Gables, FL, USA Taylor Sawyer DO MEd CHSE-A Seattle Children’s Hospital, Seattle, WA, USA Eric So MBBS FHKCA FHKAM(Anaesthesiology) BSc (Biomedical Science) PGDipEcho Queen Elizabeth Hospital, Hospital Authority, Hong Kong SAR Suneet Sood MBBS MS MAMS Monash University Malaysia, Johor Bahru, Malaysia Kim Sykes MBChB DCH MRCPCH FFICM Southampton Children’s Hospital, Southampton, UK Katie Walker RN MBA New York City Health & Hospitals, New York, USA Marcus Watson PhD School of Medicine and School of Psychology, University of Queensland, Queensland, Australia Matthew Watson BEng PhD Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Australia Lei Wei BEng PhD Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Australia Jenny Weller MD MClinEd MBBS FANZCA FRCA Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand Auckland City Hospital, Auckland, New Zealand Nor’azim Mohd Yunos MBBS MAnaes EDIC GradCertHigherEd Monash University Malaysia, Johor Bahru, Malaysia Hailing Zhou BEng PhD Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Australia Foreword The old English proverb ‘You can’t know where you’re going until you know where you’ve been’ rings true with many innovations and developments that have the potential to alter the way we think about how we educate and work. The use of simulation in healthcare education is not a new method, but its adoption and rate of innovation have been rapid in recent years in Australia and worldwide. This has been supported through a range of funding opportunities, training initiatives and, more importantly, through recognition by governments and the World Health Organization of the importance that simulation can have in providing safe and efficient healthcare services. As a simulation community we continue to strive for new ways to incorporate simulation, technology and innovation into our education to improve patient safety and to train clinicians to become acutely aware of the influence of human factors on performance. Simulation needs to become central to education and improvement processes in an effort to provide a more safety-conscious environment. To assist in this, work is continually being undertaken to make explicit the underpinning theory and application of simulation in the healthcare sector. Researchers, educators and clinicians alike are working together to provide evidence to support current practices in healthcare. The challenge is to build on the work already undertaken in health and broader disciplines to develop a robust programme of education and research with the central premise of improvement – that is, the safer delivery of healthcare and higher-quality education and training. This book assists the simulation community in understanding the successes and the complexities of simulation-based education in the context of healthcare. The range of chapters in this book will help readers gain a systematic understanding of the theory and application of simulation. The book offers a fantastic opportunity to make a clear connection between the underlying rationale for the use of simulation and what it looks like when applied. Although the authors offer chapters on educational theory, the elements of simulation practice and contemporary issues in simulation, they have taken a new and critical approach to these topics. The book goes beyond the healthcare sector to help inform our practices. It also contains examples of innovations from around the world that have emerged from specific challenges that each author has experienced in their simulation practice, providing us all with opportunities to learn. This text will prove an excellent resource for those at any level of experience. It is a valuable reference that can be revisited to reflect on what is known in order to know how to move forward. Robert P. O’Brien Chair, Australian Society for Simulation in Healthcare (ASSH) Clinical Education Fellow Melbourne Medical School University of Melbourne xiii Acknowledgements We acknowledge the contributions of the following colleagues: Fernando Bello, Peter Brooks, Roberta Brown, Chris Browne, Dylan Campher, Chris Christophi, John Collins, Jane Dacre, Stephen Duckett, Rosalind Elliott, Richard Fielding, Brendan Flanagan, Carol Goldstein, Carolyn Hayes, Robert Herkes, Jane Kidd, Roger Kneebone, Ellie McCann, Liz Molloy, NSW Organ and Tissue Donation Service, Stephanie O’Regan, Lin Perry, Julie Potter, Ray Raper, Adam Roshan, Peter Saul, Myra Sgorbini, Patsy Stark, Robyn Tamblyn, UTS: Health Laboratory Staff, UTS: Health Simulation Technicians, Leonie Watterson and Christopher Williams. In memory of Adelle Collins, who provided project support to form the Australian Society for Simulation in Healthcare. Debra Nestel, Michelle Kelly, Brian Jolly, Marcus Watson xv SECTION I Introduction CHAPTER 1 An introduction to healthcare simulation Debra Nestel & Michelle Kelly KEY MESSAGES • Healthcare simulation plays a critical role in patient safety. • There are benefits of integrating simulation in all phases of education and training of individuals involved in the provision of healthcare. • Although simulation modalities are diverse, there appear to be commonalities in designing for learning using simulation. • The focus of this book is on simulation as an educational method. Overview This chapter introduces essential concepts for simulation-based education (SBE) in healthcare. The role of patient safety as an endpoint for many healthcare simulation practices is highlighted. The chapter also orientates readers to the book. There are six sections, this chapter being the first, the second on theoretical perspectives and frameworks, the third on contemporary issues, the fourth on elements of simulation practice, the fifth on innovations in simulation and, finally, the sixth, crystal ball gazing 20 years from now. We invite readers to work through the book sequentially. However, it is also designed so that each section and chapter can be reviewed independently. Introduction Simulation offers an important route to safer care for patients and needs to be more fully integrated into the health service. Sir Liam Donaldson (2009) In 2009, the Chief Medical Officer in the United Kingdom, Sir Liam Donaldson, wrote that simulation was one of the top priorities of the health services for the next decade [1]. He emphasized the role of simulation in rehearsal for emergency situations, for the development of teamwork and for learning psychomotor skills in settings and at times that do not place patients at risk. He also questioned the logic of charging clinicians to undertake training to make their practice safer. Although progress has been made in some areas, much remains to be done. In this book we share some of these advances, offer guidance in others and explore new ideas and practices. Professor David Gaba, a pioneer in healthcare simulation, is widely quoted for the following definition: ‘Simulation is a technique – not a technology – to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner’ [2]. This definition sits well in the educational context for which it was developed. Like Donaldson, Gaba argues for integrated training approaches where ‘clinical personnel, teams, and systems should undergo continual systematic training, rehearsal, performance assessment and refinement in their practice’ [2]. Most healthcare simulation has patient safety as its ultimate goal. The drivers for SBE are well reported and include the expanding numbers of health professional students and clinicians balanced with constraints on work time. There is a shift to competency-based education and growing evidence supporting SBE as a strategic instructional approach [3, 4]. Healthcare simulation has a long history that includes images, layered transparencies, tactile models and simulated (standardized) patients [5–7]. Developments in computer-driven technologies such as task trainers, mannequin simulators Healthcare Simulation Education: Evidence, Theory and Practice, First Edition. Edited by Debra Nestel, Michelle Kelly, Brian Jolly and Marcus Watson. © 2018 John Wiley & Sons Ltd. Published 2018 by John Wiley & Sons Ltd. 3 4 Chapter 1 and virtual environments have increased access to SBE for all health professions. New modalities are developing and blending and refinement of existing ones are occurring. To facilitate SBE, health services and academic institutions around the world have invested in infrastructure in the form of skills labs, simulated clinical settings and mobile training spaces [4]. Faculty development programmes have emerged to support the quality of simulation educational practices [8, 9]. There is a vibrant research community, witnessed by the proliferation of healthcare simulation–oriented scholarly journals and publications. Since the visions of Donaldson and Gaba, professional and regulatory organizations have begun to accept time spent in SBE as a proxy for some clinical placements [10, 11] and to provide credentialing for simulation-based operative skills [12]. SBE has also emerged as a valuable approach for preparing students across the health disciplines for upcoming clinical placements and for supporting the development of effective interprofessional practice and respectful team-based cultures. Healthcare simulation also has limitations and information on these is shared across the book. Assumptions are often made about learning in simulation being safe. Although it is patient safe, it is not necessarily safe for participants. High levels of stress, anxiety, different power relationships and the same sorts of physical risks of working in a clinical setting may all be present during SBE. Clinician safety is essential and in this educational context largely refers to the creation of a safe learning environment in which clinicians (and students) can learn and/or improve their practice without psychological and/or physical harm. for simulation educators, technicians, simulated participants and administrators. However, it is likely to have a wider reach in two directions: to those interested in patient safety, policy and governance of healthcare professionals; and to those interested in educational and training methods. Origins of this book Theoretical perspectives in healthcare simulation When in the role of Chair of the Australian Society for Simulation in Healthcare (ASSH), one of the editors (DN), in conversation with the Chair Elect (MK), reflected on the extraordinary contribution of the Society’s members to the Australian and international healthcare simulation communities, especially offerings showcased annually at the SimHealth conference [13]. Acknowledging this contribution, we proposed a book that would be jointly edited by four consecutive Chairs of the ASSH. This book is the product of that conversation. It is intended to be a valuable resource The second section addresses theoretical perspectives in healthcare simulation. Bearman et al. write: ‘Theories can be considered coherent frameworks of ideas, which inform learning and other simulation practices’ (Chapter 2). Frameworks or structures help organize, situate and make meaning, so are an obvious way to start a book. We then look to the past to make sense of current healthcare simulation practices. In Chapter 3, Owen is clear that we have not leveraged the learning of pioneers in healthcare simulation. If so, ‘we would not have had to reinvent the tools and rediscover the Editors and authors The editors all hold academic appointments and work to varying degrees in healthcare simulation education and research. Although many of the authors are very experienced researchers, the common thread is that they all use simulation in their practices. Contributions are truly international, with authors’ current workplaces located in Australia, Canada, China, Denmark, Hong Kong, Ireland, Malaysia, New Zealand, Saudi Arabia, Singapore, Switzerland, the United Kingdom and the United States. Structure of the book The book is divided into six sections. The first consists of this introduction. The remaining sections lightly hold an exciting and thoughtful range of topics. We use the term lightly because inevitably there is overlap between sections. For example, Emmerich et al.’s contribution on the ethics of simulation practice (Chapter 16) would sit well within the sections on contemporary issues and elements of simulation practice, but we have located it in the latter as we envisage it will increasingly become core to any SBE. An introduction to healthcare simulation value of it in education and training’. Centuries-old simulation-based curricula have gone unnoticed. We then shift to a discussion of the contested notion of realism in simulation by Nestel et al. (Chapter 4). Synonyms of realism are presented and the concept considered outside of healthcare. The authors then place realism against meaningfulness, focusing on educational goals rather than aspiring to heightened realism. The section closes with an alternative structure from a social science framework of micro, meso and macro levels, first applied to healthcare simulation by Arora and Sevdalis [14]. This framework shifts the focus of much educational work at the micro level to opportunities at meso and macro levels. In Chapter 5, Watson shares several examples from his practice to illustrate this framework. Contemporary issues in healthcare simulation The third section explores contemporary issues in healthcare simulation. Nestel and Kelly describe research agendas and programmes of research in healthcare simulation (Chapter 6). They draw on work from several simulation or discipline-specific communities where agendas provide strategic direction. In Chapter 7, Nestel et al. use the overarching term simulated participants to refer to various roles that individuals may be asked to portray in scenarios (e.g. patients, relatives, healthcare professionals etc.). They describe ways in which simulated participants contribute to healthcare simulations and the importance of caring for them. From Crea et al. we are given insights into ways in which narrative arts offer insights to the complexity of clinical practice (Chapter 8). Wei et al. direct attention to the role of haptics in simulation training, and particularly the benefits of visual-haptic systems in training healthcare professionals (Chapter 9). Heinrichs et al. orientate readers to the expanding role of virtual environments and virtual patients (Chapter 10). Jolly offers guidance on issues of consistency in simulation from a measurement perspective (Chapter 11). Watson looks beyond simulation in healthcare to its application in other industries in an effort to inform our practice (Chapter 12). From Andreatta et al. we learn about the critical role of professional communities in developing simulation practices (Chapter 13) and the related topic of faculty development is addressed by Edgar et al. (Chapter 14). The section closes with a chapter from Bajaj et al. 5 on the role of the simulation centre in programme development and its positioning within the landscape of education and the health service (Chapter 15). Elements of simulation practice The fourth section focuses on elements of simulation practice. Ethical practices in education are increasingly being made explicit. Such practices deserve particular attention in healthcare simulation, as we have the ability to manipulate elements, which is in stark contrast to teaching and learning opportunities in the clinical practice setting. Ethical issues relate to learners, faculty and simulators too – especially in the form of simulated patients (and as Nestel et al. in Chapter 7 discuss, are relevant to the broader roles of simulated participants). Emmerich et al. apply four principles of bioethics to SBE and extend considerations to include virtue ethics and the role of building character through simulation (Chapter 16). From Weller and Civil we learn how simulation can support the development of effective teamwork (Chapter 17). Nestel and Gough share basic structures for healthcare simulation practice and draw on those used in a national simulation educator programme, NHET-Sim. Phases of simulation include preparing, briefing, simulation activity, debriefing, reflecting and evaluating (Chapter 18). The next two chapters explore in greater detail elements of these phases. Kelly and Guinea focus on the role of facilitation across each simulation phase and also consider the characteristics of facilitators (Chapter 19). Marshall and McIntosh offer guidance on dealing with unexpected events in simulations (Chapter 20). Finally, Cheng et al. review approaches to debriefing – a cornerstone of effective SBE (Chapter 21). Using evidence and theory, they suggest frameworks that provide structure to this important conversation. We are reminded that debriefing approaches are characterized by particular methods of questioning, flow of discussion, overarching goals and contextualizing learning to clinical practice. Simulation applied to practice The fifth section contains ten innovations of simulation practices. Each innovation is drawn from challenges that the authors have faced when introducing or trying to sustain healthcare simulation. The micro, meso and macro framework from Chapter 5 has been used to order the case studies. For example, at a micro level, that of individual behaviours and actions, Kumar and Nestel 6 Chapter 1 share experiences of using simulation to enhance safe practices of home birthing in Australia (Chapter 22); Gough describes her experiences of video-reflexivity to amplify learning through simulations (Chapter 23); and Gatward et al. document the outcomes of SBE to augment the national organ and tissue donation requestor training programme (Chapter 24). At the meso level, from a curriculum perspective, Han writes about his journey in reconfiguring and integrating SBE into a medical degree in China (Chapter 25). Next, Atan et al. provide their collective experience of using simulation to help junior doctors identify critical elements of transporting critically ill patients in Malaysia (Chapter 26). Koh and Dong share their success in creating a programme to extend the role of simulation technicians (Chapter 27). This initiative in Singapore and Malaysia has led to increased job satisfaction and retention and continuity of simulation centre operations. Finally, we feature four macro-level initiatives that focus on the organizational or systems level of healthcare practice and delivery. Labibidi offers insights into the challenges of planning simulation for a unique healthcare facility in Saudi Arabia – the King Fahad Medical City – comprising four hospitals, four specialized medical centres and a Faculty of Medicine (Chapter 28). An integrated approach to simulation was adopted through central governance and funding, which still allows a level of independence in educational content and delivery in separate facilities. So and Ng write about the importance and benefits of establishing partnerships early in the process of developing a new simulation centre (Chapter 29). The example, from Hong Kong, highlights a tripartite relationship with leaders from the simulation centre, the hospital and the broader health authority. The impact of simulation on groups and their interactions is illustrated by Eddie et al., who report on the benefits of testing workflow and patient care processes in a new paediatric emergency department (Chapter 30). And finally, from Macleod and Moody comes a case study from simulation modelling showing how the configuration of space design features can be manipulated to maximize work efficiencies and patient flow (Chapter 31). In summary, these innovations illustrate the diversity of the application of simulation in healthcare contexts. In the final section we look to the future of healthcare simulation. Crystal ball gazing, we consider directions for practice drawing on the contents of this book and our own experiences. We are enormously grateful to our colleagues for sharing their expertise in healthcare simulation to advance our practices. References 1 Donaldson, L. (2009) 150 years of the Chief Medical Officer’s Annual Report 2008, Department of Health, London. 2 Gaba, D. (2007) The future vision of simulation in healthcare. Simul Healthc., 2, 126–35. 3 Bearman, M., Nestel, D. and Andreatta, P. (2013) Simulation-based medical education, in The Oxford book of medical education (ed. K. Walsh), Oxford University Press, Oxford, pp. 186–97. 4 Nestel, D., Watson, M., Bearman, M. et al. (2013) Strategic approaches to simulation-based education: a case study from Australia. J Health Spec, 1 (1), 4–12. 5 Owen, H. (2012) Early use of simulation in medical education. Simul Healthc, 7 (2), 102–16. 6 Bradley, P. (2006) The history of simulation in medical education and possible future directions. Med Educ, 40 (3), 254–62. doi: 10.1111/j.1365-2929.2006.02394.x 7 Howley L, Gliva-McConvey G, Thornton J. Standardized patient practices: initial report on the survey of US and Canadian medical schools. Med Educ Online. 2009;14(7), 127. doi: 10.3885/meo.2009.F0000208 8 Nestel, D., Bearman, M., Brooks, P. et al. (2016) A national training program for simulation educators and technicians: evaluation strategy and outcomes. BMC Med Educ., 16, 25. doi: 10.1186/s12909-016-0548-x 9 Navedo, D. and Simon, R. (2013) Specialized courses in simulation, in The comprehensive textbook of healthcare simulation (eds A. Levine, S. DeMaria, A. Schwartz and A. Sim), Springer, New York, pp. 593–7. 10 Watson, K., Wright, A., Morris, N. et al. (2012) Can simulation replace part of clinical time? Two parallel randomised controlled trials. Med Educ, 46 (7), 657–67. doi: 10.1111/j.1365-2923.2012.04295.x 11 Hayden, J., Smily, R., Alexander, M. et al. (2014) The NCSBN National Simulation Study: a longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. 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SECTION II Theoretical perspectives and frameworks for healthcare simulation CHAPTER 2 Theories informing healthcare simulation practice Margaret Bearman, Debra Nestel & Nancy McNaughton KEY MESSAGES • Learning theories are guides rather than prescriptions. • Learning theories align with different ways of understanding the nature of knowledge. • Behaviourism emphasizes the achievement of an external standard through demonstrated behaviours; elements of ‘deliberate practice’ reflect behaviourist principles. • Constructivism is a broad umbrella term for theories concerned with individual and social constructions of knowledge, many with great relevance to simulation-based education. • Critical theory approaches focus outward on society and its effect on simulation practices. Overview Theories can be considered coherent frameworks of ideas, which inform learning and other simulation practices. This chapter provides a brief overview of different types of theories, illustrated by selected theorists and examples of application to practice. The first section provides a short overview of behaviourism and some of the key debates, as well as expanding on an additional theory, deliberate practice, which draws from behaviourist principles. The next section starts by describing constructivist approaches associated with theories such as reflective practice, before going on to explore a social learning theory, situated learning. The final section articulates the broad premise of critical theories, before focusing on one theorist, Michel Foucault, and providing an exploration of simulated patient (SP) practice through a critical theory lens. The development of patient-focused simulation is presented as an example of how theory can be applied to develop simulation practice. Introduction Ideas about how people learn underpin simulation-based education (SBE) in the health professions. When these ideas are formalized into coherent frameworks, they are referred to as learning theories. Learning theories permit educators to identify teaching approaches that can optimize the opportunity afforded by the simulation encounter, and thereby assist learners to acquire new knowledge or skills. They can be purely conceptual or derived from the rigorous collection of qualitative and quantitative data. Learning theories are not absolute; they guide rather than prescribe. Educators draw on them for different reasons. For example, theories can support the initial educational design such as making decisions about what simulation method to choose and why; they can assist with resolving specific dilemmas such as how to manage underperforming learners; or they can challenge accepted practices such as a longstanding approach to debriefing. This overview of theories that inform healthcare simulation practice can assist in guiding simulation design, development, implementation and facilitation. It is by no means comprehensive, but gives an indication of both the value and the diversity of theories informing SBE. We provide our perspectives as SBE practitioners, researchers and scholars, noting that this is an area in which there is no definite expert consensus. Healthcare Simulation Education: Evidence, Theory and Practice, First Edition. Edited by Debra Nestel, Michelle Kelly, Brian Jolly and Marcus Watson. © 2018 John Wiley & Sons Ltd. Published 2018 by John Wiley & Sons Ltd. 9 10 Chapter 2 Learning theories are often very abstract. Educators may find theory most helpful by considering its value within local professional and environmental contexts. For example, the legacy of Western political domination may seem irrelevant to SBE, but thinking about this in theoretical terms can prompt educators to review whether their simulators and SP represent the skin colour and physical appearance of the local community. We suggest that learning theories can be aligned with ways of understanding knowledge (epistemology) and reality (ontology). This chapter presents three overlapping categories of learning theories, which align with particular notions of knowledge and reality. Behaviourist learning theories align most easily with worldviews that are concerned with objective truths and measurement. These theories are less concerned with the internal mechanisms of learners, and more with their behaviours, which can be observed. Constructivist theories are focused on the learner’s role in learning, while social learning theories extend this to consider the role of the learning environment. Both of these approaches are concordant with a worldview that is concerned with individual and social constructions of knowledge. Finally, critical theories consider the broader questions of society and social behaviours. These are not learning theories per se, but provide valuable lessons on understanding how the broader sociocultural context may influence learning. It is worth noting that there is little consensus on the categorization of learning theories and that educators draw from multiple theories for diverse reasons. We will present some of this complexity in our discussion while maintaining the focus on the practical value of learning theories to SBE. Behaviourism Behaviourism, unlike the other categories in this chapter, can be considered a coherent theory as well as a pedagogy. Behaviourism’s dominance of the educational literature has waxed and waned over the last 80 years. Its current place in the learning theory landscape is controversial. Some people consider it to be primarily a notion of learning as response to a stimulus, and certainly Ivan Pavlov, a notable historical influence, studied stimulus and response in animals [1]. Rote learning, such as memorizing the sum ‘7 × 8 = 56’, is a simple example of this. In this instance, ‘7 × 8’ is the stimulus and ‘56’ is the learnt response. Behaviourism was once seen as being superseded by a cognitive view of learning [2], but over time discourses about behaviourism have continued to develop. Those who draw on it today distinguish a range of more nuanced features, although they still hold to the basic premise of stimulus and response [1]. We broadly define contemporary behaviourism as those approaches to learning that focus on achieving an external standard that must be achieved through demonstrated behaviours. This aligns with Woollard’s view [1] that ‘behaviourism, in terms of learning, considers that it is through modifying behaviour and ensuring learners’ preparedness for learning that the best outcomes will be achieved. Behaviourism embraces a pedagogy built upon precision, rigour, analysis, measurement and outcomes’ (p. 22). These notions provide the foundation for many of our historical educational practices. For example, the writing of learning objectives focuses on demonstrable change in behaviours, as proposed by Ralph Tyler in 1949 [3]. Equally, accreditation of learning with its concerns about valid and reliable assessment also aligns with behaviourist principles. There are some areas where we think behaviourism is most valuable in SBE. In particular, health professional practice is full of simple and complex practices, which should occur automatically without the practitioner thinking deeply about how to complete the tasks as they do them. These activities can be psychomotor skills such as suturing, cognitive tasks such as pattern recognition, or even communication skills, such as always introducing oneself to the patient or healthcare consumer by name. These activities are also often well taught in simulation, due to the emphasis on repetitive practice to ensure automaticity. McGaghie et al. [4], in their 2011 critical review, noted a number of ‘best practices’ in SBE that draw from behaviourist principles. One of these is deliberate practice, which is presented as an example of a theory with particular relevance to SBE. Deliberate practice was conceptualized by Anders Ericsson, a cognitive psychologist, who sought to understand how elite performers achieved excellence [5]. From this empirical basis, he concluded that a necessary part of excellence was the notion of focused, repetitive practice. He described essential elements: a highly motivated individual can develop expertise through repetitive practice that also Theories informing healthcare simulation practice involves receiving feedback on performance, goal setting that continuously seeks to extend performance, individual coaching and practice occurring under different conditions. Like many approaches, this is not purely behaviourist in its approach, but there are key elements – ‘well-defined learning objectives’ and ‘rigorous precise measurements’ of demonstrated behaviours [4] – that align with behaviourism. See Box 2.1 for an example of how deliberate practice can be integrated into simulation educational design. Box 2.1 Theory in Action: Patient-Focused Simulation Deliberate practice, reflective practice and situated learning were developed in real rather than simulated settings and are appropriated with caution to the world of healthcare simulation. Drawing on these three theories, Roger Kneebone, a surgeon educator, and Debra Nestel, a communications educator, developed the concept of patient-focused simulation for learning procedural skills [11]. Patient-focused simulation involves a learner performing a procedural skill while working with a simulated (standardized) patient (SP) aligned with a task trainer (bench-top simulator). Kneebone and Nestel had noticed that teaching basic procedural skills on a task trainer was effective inasmuch as correct sequencing of psychomotor skills could be observed, but the experience was out of context. When the learner was required to perform the procedure on a patient in a clinical setting, the bench-top simulator experience alone was insufficient because it was not situated. That is, there was little resemblance to the setting in which the learner would be required to practise. Notably, there was no patient, no human interaction. Nestel and Kneebone argued that safe training approaches need to include ways in which learners can integrate complex sets of skills (psychomotor and professional) as they will be required in clinical settings. At a minimum, patient-focused simulation comprised a SP trained to respond as if undergoing the procedure in a simulated clinical setting. The learner in patient-focused simulation was offered the opportunity to perform the whole procedure in simulation and to receive feedback on their performance – from the SP and experienced clinicians and further individual reflection, to make sense of the experience from the learner’s perspective. Elements of deliberate practice included motivating individuals, encouraging goal setting, multiple repetitions in different contexts and feedback. From situated learning, patient-focused simulation located the procedural skill in a clinical context with a SP; and from reflective practice, reflection-on-action was adopted, most commonly as facilitated dialogue between the learner, SP and observers after the simulation. 11 Constructivism and associated social learning theories Constructivist theories of learning argue that individuals construct knowledge and meaning based on their experiences and ideas. Fosnot [6] claims that educators adopting constructivist theories enable learners to use ‘concrete, contextually meaningful experience through which they can search for patterns, raise their own questions, and construct their own models, concepts, and strategies’ (p. ix). Adopting this stance, educators may be seen to be orienting their role to that of facilitator rather than teacher. Using Sfard’s metaphors [7], constructivists sit more comfortably within the metaphor of learning as participation than within that of learning as acquisition. Education is seen as what the learner can learn rather than what the teacher can teach. Constructivism is an umbrella term for many theories that acknowledge the role of the learner in constructing their own meaning from experiences. Cognitive constructivism respects traditions of cognitivist theories, of acknowledging individuals’ characteristics such as their stage of development, motivation, engagement and preferences for learning. Social constructivism emphasizes how understanding and meaning emerge from social encounters. Imagine a simulation educator who has been asked to design an activity for medical students to safely put in a drip (that is, establish a peripheral intravenous infusion, IVI). Adopting a constructivist stance, the educator is likely to use some of the following techniques: • Finding out what other similar procedures students have been learning and how. • Asking students about their relevant knowledge, prior experiences and practices relevant to IVI. • Demonstrating, talking through and inviting questions from students on IVI performed on a task trainer. • Encouraging students to set goals related to performing the IVI. • Providing opportunities for students to perform the IVI on a task trainer. • Providing opportunities for students to observe others performing the IVI on a task trainer and then share their observations. • Providing opportunities for students to receive feedback on their performance on the task trainer from experts and peers.

Author Brian Jolly, Debra Nestel, and Michelle Kelly Isbn 9781119061595 File size 4MB Year 2017 Pages 248 Language English File format PDF Category Medicine Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare Written by a leading team from the Australian Society for Simulation in Healthcare (ASSH), Simulation Australasia, Healthcare Simulation Education is a new resource for a rapidly expanding professional healthcare simulation community. Designed as a core reference for educators who use simulation as an educational method, it outlines theory, evidence and research relevant to healthcare simulation. Containing examples of innovations from around the world, the book offers opportunities to make clear connections between the underlying rationale for the use of simulation, and what this looks like in practice. Healthcare Simulation Education: Helps readers gain a systematic understanding of theory and application of simulation Facilitates access to high quality resources to support healthcare simulation education and research Edited by a leading team from the Australian Society for Simulation in Healthcare (ASSH), the leading body for healthcare simulation in Australia Contains information on educational theory, the elements of simulation practice and contemporary issues in simulation An important text in healthcare literature and practice, Healthcare Simulation Education provides a unique cross-disciplinary overview of an innovative subject area, and is ideal for medical, nursing and allied health educators, policy makers and researchers.     Download (4MB) Breastfeeding Handbook For Physicians, 2nd Edition Foundations of Professional Nursing : Care of Self and Others Initial Management of Acute Medical Patients Patient Safety Scholarly Inquiry And The Dnp Capstone Load more posts

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