Simulation and Education

[Melclin]

I'm putting together a few ideas for some lecturers (and looking to guide my own development for a future in education) on ways in which to improve simulation and training for our course.

For those who aren't aware the entry level qualification here is a 3 year bachelor degree and I'm speaking in regards to improving simulation techniques and tutorials in a university environment.

Predominantly I'm looking for information or guidance on realistic simulation for paramedics. What parts need to be hyper realistic and what parts don't and why? How do I do it? Any literature, resources on paramedic education or personal experience would be appreciated.
-I'm currently looking at increased use of standardized patients. We have started using them recently for selected purposes - they are very expensive. But I like to hear opinion on increased use (I wonder what JP think on this matter )
-Recruiting arts and drama students to be patients.
-Exercises with the police and fire students.
-Treating patients in actual ambulances to increase familiarity with the environment.

Also I'm looking for creative ways to prepare very young high school grads better for some of the difficult parts of the job. People always say nothing can prepare you, but I think that's rubbish, its a cop out. The idea being how can we actually affect the kinds of things mentioned in Mycrofft's What every EMT should be required to experience before they graduate" thread. The idea being to reduce the 'greenness' of grads without turning the degree into a technical college course full of skills sheets and robotic practical activities.

Ideas: clinical rotations in morgues and the coroner, placements with the netcoms (BLS IFT), more relevant team work and problem solving activities instead of just learning abstract theory about interpersonal communication, clinical placements on med/surg wards. I also like the idea of "paramedic camps" - taking people out of their comfort zone..getting them involved in teamwork when they're tired, wet, cranky etc. But I'm quite sure the students wouldn't fancy that idea and it would be very difficult to swing in the uni setting.


Thoughts, resources, papers, experience?

 

[busmonkey]

I really like your idea - It seems excellent and I agree with a lot of it. In my EMR course a large portion of it was done in a 'fake ambulance' which was actually a real one with the cab stripped and turned into a simulation HQ (instructor could sit and activate different errors on machines, give different responses, listen to my questions like "I take a BP." and he would respond through the mic with "BP is 120P" etc.) and it really helped me when I actually took my licensing and got on an ambulance simply because it helped me with learning how the ambulance works.

Regarding high school students - for me my instructor always taught me remember to always be doing something on the patient. Now I don't think he meant that we need to be going overkill but what I think he means is that if you are busy with something, rechecking vitals, performing CPR, bagging etc. it will keep you from focusing on the, what might be, very obvious "He's going to die."

That's my piece.

 

[LucidResq]

The first scenario I ever did in EMT class was an "elderly gentleman" who experienced vasovagal syncope on the potty and bonked his head on the bathtub on the way down. The cool thing that my class did was convert some supply closet in to a simulated residential bathroom - toilet, bathtub and everything.

My patient had wedged himself in the small space between the toilet and bathtub. He was c/o head & neck pain and tingling. I had to backboard him... which wasn't easy. Being the smart *** I am I tried to just move the toilet out of the way since it wasn't actually connected to plumbing, but my instructor wouldn't let me. I thought it was very neat of them to create a situation like that where I actually had to think and figure out a good way to get him on the board. My training facility had fake bedrooms, bars, restaurants, a well-modeled fake back-of-the-rig and an ambulance. Rarely do we find our patients lying perfectly prone on the floor of a wide-open classroom, and I liked that my training reflected that.

 

[Melclin]

The cut away style ambulance is outside my scope of suggestion but it would be nice. We do own a number of ambulances..we just never use them. Actually using the simulation facilities we have is first on my list.

We have:
- a number of fully kitted out ambulances.
- buckets of ALS mannequins that do everything and can have everything done to them.
- toilet, living room, bedroom and kitchen simulation areas with glass walls for facilitators and observers to stand behind + microphones to talk through the mannequins.
- all the gear and consumables we could need.

I'm really interested to hear from any instructors about resources or theories they have on simulation...I have many of my own but I'm hoping to take suggestions with some weight back to my lecturers.

 

[JPINFV]

-I'm currently looking at increased use of standardized patients. We have started using them recently for selected purposes - they are very expensive. But I like to hear opinion on increased use (I wonder what JP think on this matter )

Hehe... I love the SP program at my school, but yea, I can't imagine how expensive it is considering that we have SPs on campus 2-3 days a week with 2 full time administrators running the program. However, if you want to practice assessments, I can't think of a better method.

From my experience, what needs to be hyper-realistic is the interpersonal communications and, to an extent, environment. There's only so much moulage can do for medical patients before you might as well say, "f this, here's a card with what's abnormal from this part of your assessment" (don't do that part of the assessment, don't get the card) and what's important is interacting with a patient that isn't a classmate pretending to be a patient. Similarly (and this is where it can get real cost prohibitive), an important thing is to cut out the abnormal distractions. Want to have family or friends present to cause a distraction? Sure. That's different from having a student having to split attention between their patient, the class mates watching, and looking up at the instructor when they get lost.

Thinking back over the past year, I wonder how beneficial it would be to form a partnership with a clinic in the area and allow students to volunteer following the assessment module. For example, one of the clinics run by a faculty member has the first and second year med students do the assessments, present to the resident (and now the students learn how to do a hand off report), and write up the SOAP note, which both the student and the resident (and later the attending who reviews the case) signs.

 

[MrBrown]

Our simulation systems are not too different from what it appears you have in Australia, We have a number of SimMans and set up cut away ambulances, model bedrooms and other places which are used for simulated jobs.

ASNSW used to put people into a vehicle and drive them around the streets of Sydney for some OCSEs ... brilliant idea.

Most US schools I know of have days where they do scenarios with the Fire Service (almost always cutting people out a car). One or two programs my friends have gone through take you into model scenarios at 1 or 2am after you have been up all night to simulate what its like to work on the street. I got 20 minutes sleep on my last night shift of about 13.5 hours.

Hospital rotations are good to a degree but I think far too much emphasis is placed upoin putting people into a hospital vs out on the street. Our degree program (like yours I suspect) gives you 1,000 hours of practical learning in the three years you are a student Paramedic. In first year most of that time is spent in hospital (predominatly in ED or at private ED clinics) while some time is spent in theatre and CCU/ICU during year 2 and 3 for specific skills eg intubation and 12 lead ECG interpretation.

The new Degree model is to do one year full-time at school and two years on the road as a Technician on-road gaining experience and completing the Degree part-time until you are a Paramedic.

 

[Melclin]

One or two programs my friends have gone through take you into model scenarios at 1 or 2am after you have been up all night to simulate what its like to work on the street.
...
Hospital rotations are good to a degree but I think far too much emphasis is placed upoin putting people into a hospital vs out on the street. Our degree program (like yours I suspect) gives you 1,000 hours of practical learning in the three years you are a student Paramedic
...
The new Degree model is to do one year full-time at school and two years on the road as a Technician on-road gaining experience and completing the Degree part-time until you are a Paramedic.

We actually have the opposite problem. One of the unis do zero hospital placements. We have started doing some, but its very few. Seems like it would be a good idea to have more simply to spend more time around sick people and get plenty of experience doing the basics. The problem with only having ambulance placements is that its a learning lottery. I've been lucky. But most people see and do very little.

I like the idea of practical work early in the morning, problem is that you can't really do that sort of a thing at a uni. Its not a boot camp after all. But I always thought it would be interesting to hold an OSCE at 3am. B)

Hehe... I love the SP program at my school, but yea, I can't imagine how expensive it is considering that we have SPs on campus 2-3 days a week with 2 full time administrators running the program. However, if you want to practice assessments, I can't think of a better method.

From my experience, what needs to be hyper-realistic is the interpersonal communications and, to an extent, environment. There's only so much moulage can do for medical patients before you might as well say, "f this, here's a card with what's abnormal from this part of your assessment" (don't do that part of the assessment, don't get the card) and what's important is interacting with a patient that isn't a classmate pretending to be a patient. Similarly (and this is where it can get real cost prohibitive), an important thing is to cut out the abnormal distractions. Want to have family or friends present to cause a distraction? Sure. That's different from having a student having to split attention between their patient, the class mates watching, and looking up at the instructor when they get lost.

Thinking back over the past year, I wonder how beneficial it would be to form a partnership with a clinic in the area and allow students to volunteer following the assessment module. For example, one of the clinics run by a faculty member has the first and second year med students do the assessments, present to the resident (and now the students learn how to do a hand off report), and write up the SOAP note, which both the student and the resident (and later the attending who reviews the case) signs.

I agree very much about having people who aren't peers pretending to be patients. Everything is too casual, too stress free. In the absence of SPs, I like the idea of drama students. It could be especially helpful to act out a whole scenario complete with psychosocial components that need to be dealt with, a lot of work though, I don't know how it would fit into the uni schedule. I think we can learn more from medical education.

The clinic idea is difficult because clinics and primary care works significantly differently here..there isn't any other person but the doctor doing any assessments. But I love the idea of paramedic students getting out into community health. I like the idea of placement with the Royal District Nursing Service. They do dressing changes, geriatrics and paliative care type things. I think that'd be great.

 

[LucidResq]

Another thing that worked well, I believe, was having instructors and classmates bring in their kids for a peds day. Wow - imagine that, actually trying to taking a BP on an upset 11 mo. old that wants nothing to do with you! It worked much better with classmate's children than the instructor's though, because the instructor's kids had clearly done this about 800 times and would probably happily backboard themselves given the chance.