Simulation Key to training tomorrows rural healthcare providers

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Simulation Key to training tomorrows rural
healthcare providers

• Hicham Rahmouni, MBA
• Richard G. Lugar Center for Rural Health

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Richard G. Lugar Center for Rural Health

• formerly Midwest Center for Rural Health
• Established in 1992
• Mission advancing rural health through
  education, innovation, and collaboration.
• March 20, 2006

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The Environment

• Severe Healthcare worker shortages
• Particularly in Rural Underserved Area
• Demographic Pressures
• Increasing Demand
• Limited Pool of Available Workers
• Rural Health Innovation Collaborative

• Time is of the essence
• Studies suggest that current enrollment
  projections will not be sufficient to meet
  anticipated physician demand.
• 7-10 years post-baccalaureate to educate a
  doctor, todays decisions impact patient care
  well into the next decade.

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Rural Terre Haute, Indiana

• Indiana State University
• College of Nursing, Health, and Human Services
• Health Programs expansion
• Richard G. Lugar Center for Rural Health

• Union Hospital Family Medicine Residency
• Rural Training Track
• Indiana University School of Medicine Expansion
• Terre Haute Regional Campus (Rural Curriculum)
• Teach science from the perspective of clinical
  medicine during the basic science years

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The RHIC

• To respond to the current and worsening health
  care worker shortages
• Unique Partnership
• Address workforce needs
• Neighborhood revitalization and Economic
  development
• Increase of rural health care services, training
  and research.
• Simulation to Play a Key Role

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Integrating medical education

• Todays Approach
• Compartmentalized, teaching activities and
  accreditation
• 2 years basic health sciences
• 2 years clinical skills
• M.D. degree
• Typically 1-3 years (or more)
• Practicing physician
• Continuing education
• Reaccreditation
• Coordinated approach that integrates medical
  education across all levels and across multiple
  healthcare professions.

A New Approach
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Constraints

• Historically, See one, do one, teach one
• Unwritten motto at teaching hospitals
• Today, Different situation
• Restrictions on residents working hours
• Financial pressures make faculty less available
  for supervision
• Wariness from malpractice litigation
• RESULT Less and Less such teaching cases

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Challenges

• Feeding the Pipeline to address the shortages
• Effectively Bringing down the Silos
• How can physicians, nurses (etc.) in training
  acquire the skills they will need in practice?
• How can experienced clinicians breathe life back
  into critical skills that they use infrequently?

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looking for creative Solutions Simulation
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Tailor Made to fit your Needs

• Human Patients
• Objective Structured Clinical Examinations
• 2D, 3D Models
• High Fidelity Human Patient Simulators

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What is it? Why?

• Modernize medical education
• Accelerate residency training
• Extend the careers of practicing physicians
• Improve patient care while minimizing cost
  increases

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History of Simulation

• Prehistoric Roots
• Hunting skills
• Tribal games or warfare
• Greeks
• To illustrate philosophical concepts, help
  students understand them ah ha
• Today, used in various industries and
  disciplines, when real-world training is
• Too dangerous,
• Too expensive, or
• Impossible

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Modern Simulation

• Orville Wright
• 1908 first fatal airplane crash
• 1910 1st airplane simulator
• Required Training for All Pilots
• Periodic skills and behavioral assessments to
  maintain Licensure

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Simulation in Medicine

• Clay and Stone Models
• Representations
• diagnostic instruments
• Silicon Models
• CPR Mannequins
• Active models
• Harvey mannikin (cardiology)
• 2 D Computer Simulations acted more like a
  textbook than a patient.
• Interactive 3D Models
• Advances In Technology

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An Education Technique

• Provides learners with opportunities to
• Practice
• Gain Experience
• Refresh
• Credible way to augment educational curriculum
• Improve patient safety and reduce the likelihood
  of adverse outcomes
• Malpractice insurers sim training part of
  safety and risk reduction initiatives

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Suspension of disbelief
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Characteristics of Adult Learning

• Need to know how, what and why?
• Autonomous, self-directed, and goal oriented
• Bring a foundation of knowledge and life
  Experiences
• Active learners
• Internalize more with opportunity to critically
  reflect on new learning
• Thrive on contextual problem-solving

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Example of activities
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How do we do it?

• Moulage-Kits
• Make-up/Fake Wounds
• Food Items
• Oatmeal
• Canned fruits/vegetables
• Food coloring
• Wigs

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Its all in the makeup!
3rd Degree Burns

• Deep bruising
• Deep cuts with debris

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Recipes

• Blood Recipe
• For each liter of sterile water, add3 mL of red
  food coloring
• 1 ml of blue food coloring
• 1 ml of black food coloring
• Purulence
• Mash an over-ripe banana
• Mix with water for desired thickness
• Add clam juice for odor (optional)

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The art of debriefing
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Why be Real?

• Definition of Simulation imitation of some real
  thing, state of affairs, or process
• Wikipedia
• Simulation creates fantasywe are talking about
  the ability to immerse oneself in fantasy.
• SSIH List-serv

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Importance of Debriefing

• Objective?
• To improve performance in similar situations
• Led by Facilitator, teammates discuss
• Assumptions, Actions, and feelings
• Matters of teamwork and communication
• Availability of needed equipment or other
  resources

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Debriefing Framework

• Matching teaching objectives with trainee
  concerns
• Identify deficiencies in practice and
  documentation
• Promote best practices for teamwork among
  physicians, nurses, and support staff.
• Expose Vulnerabilities

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How can you join the fun?
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Around the State

• Established Centers
• Medical Schools
• Nursing Schools
• Hospitals
• Military/DHS
• Several in the planning
• Mobile Units

As per my own research
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Landsbaum Center for Health Education
2008
Main Users

• Union Hospital - Family Medicine Residency
• Indiana University School of Medicine-Terre Haute
  Center
• Indiana State University CONHHS
• West Central Indiana Area Health Education
  Center

• Medical students basic science classes
• Clinical nursing skills
• Family Medicine Resident Training
• Resp./ACLS Review
• OSCEs
• Recruit students into health careers
• Continuing education of critical care and OB
  nurses from Critical Access Hospitals
• Community Outreach

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• Costs vary from a few thousands to hundreds of
  thousands of dollars

I dont endorse any particular vendor over
another and recommend you do your due diligence
in researching the simulators that best fit your
needs!
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What the future holds
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The Classroom of the Future"

• The simulator will be a "living" textbook
• Part of the practice of medicine.
• Standard platform for curriculum development.
• Several kinds of simulators along with textual
  and visual learning tools.
• Better Prepared Students Postgraduates
• Credentialing Process for regulatory bodies and
  medical institutions

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Segue from the Bench to the Bedside

• Likely to become part of medical accreditation
  standards.
• Basis of a clinical skills unit for continuing
  education of medical personnel
• Similar to periodic flight training for airline
  pilots,
• Assist practitioners throughout their careers.

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To Improve Patient Safety

• By reducing errors during technically challenging
  procedures (surgery, interventions, etc)
• Technical errors are reduced by improved training
  with a focus on error identification
• Simulation technologies have a proven record in
  improving safety through decreased errors

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The Message

• Simulators are only a tool, and must be
  integrated into a comprehensive curriculum which
  is criterion (proficiency) based
• Only through stringent validation of simulators
  and their curricula will it be possible to have
  acceptance by the training and regulation bodies
• It is not Build it and they will come
• but validate it and they will come.

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Parting Words

• When Stan D. Ardman goes into anaphylactic shock
  and his heart begins its frantic palpitations,
  the medical learners nearby launch into real
  life-saving action.
• You would be amazed at how the nurses and
  medical students react when Stan is in crisis,
• Almost all of them Id say 95 react as if
  he is a real patient. I see him as a real
  patient. The other 5 dont see him as a patient,
  dont care and dont learn.

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Questions