High-fidelity simulation in EMT/Medic schools

[KELRAG]

How often is the use of high-fidelity simulators used or were used in your paramedic programs i.e. Simman 3g? How has the response been? If not and the resources did ya'll have, what were the barriers?

I am faculty at a local CC and we have a great simlab shared with the nursing program. The nursing instructors use these simualtors frequently but our skills instructors never use them. I used them for ACLS scenarios this past week and the students were awstruck. I saw on their faces, what my face must have been like on my first critical call, "deer in the headlights."

I am just wondering what current, recent and educators opinions are

 

[usalsfyre]

They're great...when they work. Mine is a couple of generations old and takes a godawful amount of tweaking to keep running.

 

[NomadicMedic]

We had one in paramedic school, never worked. We have a SimMan at my current service and we use it frequently. He makes some people really sweat, but it helps build skills.

 

[DesertMedic66]

We have a 5 month old, 5 year old, and 2 adult ones. We use them all the time for both the medic and EMT and respiratory programs. They have all the functions from BP to capno and 12-leads on any monitor. They have ups and downs

FWIW we use http://www.gaumard.com

 

[Medic Tim]

They are required equipment (or soon will be) for medic programs up here.

 

[nwhitney]

I'm in medic school right now and the program is heavy on sims. I like them a lot. Our sim manikins are pretty dang cool. In addition to BP, pulse, and lung sounds they also have abdominal sounds, scream (which is weird) can swap out genitals, add a amputated leg, start IV's, 12 leads, push meds, and get feedback to interventions including CPR.

 

[KELRAG]

Thank you all for your responses. This is one thing that really aggrivates me. We have outstanding resources that the instructors are too stuck in their ways to realize the advantage of or too lazy to learn and as a result we are doing a serious disadvantage to our students.

Has anyone started a program like this and any tips to getting instructors on-board? I did a big educational module and walk-through on their use but nothing has changed.

 

[OnceAnEMT]

add a amputated leg, .

Is that an oxymoron?

 

[nwhitney]

I was thinking that as I typed it.

 

[nwhitney]

KELRAG, shot me a PM and I can get you in touch with our program director who oversees our sims. We also have a pretty cool mobile training unit ambulance that is set up so instructors can stand outside and watch a life feed of a student running a call.

 

[Handsome Robb]

We have 5-6 HiFi mannequins along with a nice sim lab with all the goodies and they're used every day between our medic program, FTO clearing scenarios and crew trainings or other classes we host beyond the standard alphabet soup.

I think they're an awesome tool when they're working. We have a position in our education department dedicated to the mannequins and the sim lab.

 

[mycrofft]

reply redacted

 

[xrsm002]

I loved using ours in medic school. We could do a lot of things with them. Had adults, children's and babies and even had one they was an Ob/GYN one that simulated "delivery" via motors etc. the instructors were also good "actors" as they did the voices for them. We used it for ACLS megacode practice and different scenario practice. Our instructors said they'd rather us mess up in there than on an actual call.

 

[ThadeusJ]

I opened a sim lab in Canada that was supposed to be an off shoot from an aviation training model. In aviation, there are several levels of fidelity, any of which can be applied to the skill being assessed. Very low fidelity models are used for the most basic tasks and you work your way up from there. It makes no sense to use a high fidelity device for very basic skills (like basic chest auscultation or landmarking skills).

The highest fidelity scenarios are with standardized patients and can involve sounds, smells and emotions. Truly scary stuff (we ran one assessment for physicians where they had to tell a "family member" that their loved one had died-there were a lot of tears).

The aviation industry has used simulation methods for many years and it's very advanced in human learning methodology. Healthcare instructors should not be expected to be given a room full of tools and told to use them or else you will end up with a variety of applications which may or may not actually assess or teach what you think you are. Simulation has truly changed the face of education.

 

[mycrofft]

http://www.emtlife.com/showthread.php?p=344223

 

[KELRAG]

I opened a sim lab in Canada that was supposed to be an off shoot from an aviation training model. In aviation, there are several levels of fidelity, any of which can be applied to the skill being assessed. Very low fidelity models are used for the most basic tasks and you work your way up from there. It makes no sense to use a high fidelity device for very basic skills (like basic chest auscultation or landmarking skills).

The highest fidelity scenarios are with standardized patients and can involve sounds, smells and emotions. Truly scary stuff (we ran one assessment for physicians where they had to tell a "family member" that their loved one had died-there were a lot of tears).

The aviation industry has used simulation methods for many years and it's very advanced in human learning methodology. Healthcare instructors should not be expected to be given a room full of tools and told to use them or else you will end up with a variety of applications which may or may not actually assess or teach what you think you are. Simulation has truly changed the face of education.

I'm finding this out. I'm gonna have to try and figure out another way for the students to experience these using "correct" simulation practice. Thanks for your reply!

 

[ThadeusJ]

To understand their training methods, you have to look at their safety culture and acceptance of failing during training. In healthcare, we are nervous about failing (human nature) and loath having those errors discussed in public, especially in front of classmates. HOWEVER, most medical errors are based on human factors and several contributing factors are often found to be the cause (even errors caused by the most experienced practitioners).

To get a great glimpse of the culture and how it should be applied to healthcare, I suggested my sim lab staff to read "Why Hospitals Should Fly" by John Nance. Its a short but powerful book.

 

[Carlos Danger]

How often is the use of high-fidelity simulators used or were used in your paramedic programs i.e. Simman 3g? How has the response been? If not and the resources did ya'll have, what were the barriers?

I am faculty at a local CC and we have a great simlab shared with the nursing program. The nursing instructors use these simualtors frequently but our skills instructors never use them. I used them for ACLS scenarios this past week and the students were awstruck. I saw on their faces, what my face must have been like on my first critical call, "deer in the headlights."

I am just wondering what current, recent and educators opinions are

I went to paramedic school before simulators were common, so didn't use them there.

The most recent HEMS programs that I worked for used them for the interview process, orientation, and a fair amount for continuing skills practice. We also used one a fair amount during the first few semesters of my CRNA program.

I'm not a big fan of using them with experienced personnel. Why? Because even the "high-fidelity" ones just aren't nearly realistic enough to be worth the expense, IMO. The "low-fidelity" ones that you use for skills practice can be handy for learning new skills, though. I found the arterial and central line trainers much better than nothing, for instance; not that they are at all "realistic" but at least you can practice finding landmarks and handling the equipment and doing the process. Same thing with dual-lumen ETT's.

For new people, I can see how the "high-fidelity" trainers would be much more useful, but I still feel like the whole simulation thing is a little over-hyped.

 

[mycrofft]

I went to paramedic school before simulators were common, so didn't use them there.

The most recent HEMS programs that I worked for used them for the interview process, orientation, and a fair amount for continuing skills practice. We also used one a fair amount during the first few semesters of my CRNA program.

I'm not a big fan of using them with experienced personnel. Why? Because even the "high-fidelity" ones just aren't nearly realistic enough to be worth the expense, IMO. The "low-fidelity" ones that you use for skills practice can be handy for learning new skills, though. I found the arterial and central line trainers much better than nothing, for instance; not that they are at all "realistic" but at least you can practice finding landmarks and handling the equipment and doing the process. Same thing with dual-lumen ETT's.

For new people, I can see how the "high-fidelity" trainers would be much more useful, but I still feel like the whole simulation thing is a little over-hyped.

Yes. See studies in the link I listed. Diminishing returns early in the dollar spent versus test score rise-curve.

 

[ThadeusJ]

Sorry guys I have to disagree to some degree. The point of high fidelity scenarios comes to light when you take 10, 30, 50, 100 experienced practitioners and place them in a true life scenario and note if EVERYONE performed exactly the same way to the standards. The exact same scenario (that's why we use simulation, for its reproducibility. If we assume that no one is perfect and that everyone makes mistakes, simulation tries to identify what mistakes were made and why they were made. Then you feed that back into the loop, use those years of experience and compress them into a learning moment for the others.

There are over 120,000 preventable deaths in US healthcare annually and it would be disingenuous to say that none of them occurred in the prehospital setting. Many of them were performed by experienced personnel. High fidelity scenarios are not tasks like starting lines, etc., but are expected to take those intangible moments that we are expected to learn on the job and teaches the profession by compressing years of experience into that lesson.

I managed a simulation for heart/lung perfusionists at one of their international conferences and we set up four operating rooms and gave 28 experienced perfusionists the exact same scenario (lasting about 25 minutes each. Some issues were technical, some with distractions, some stock issues during a critical moment...but everyone got the same scenario. All were recorded and viewers could observe from behind a mirror. It was quite eye opening, especially when you collated the data and presented it to those who challenged it. People will deny that they acted like they did. as long as its treated as a teaching moment fro all to learn, it was great.