Pre-conference spotlight – Mode of delivery: How to build a program of in-situ simulation
We sat down with Michelle Morais, MD, to discuss in-depth the details of this pre-conference course scheduled for Wednesday, October 26 at ICRE 2022.
Q: What is the most important lesson(s) that you want participants to learn?
A: I want participants to see how in-situ simulation is a fun, engaging educational modality for residents, that it can target resident education across a variety of CanMEDS roles, and it can also be valuable as a tool to explore patient safety.
Q: Why should participants register for your pre-conference?
A: It will be a one-stop shop for everything they need to know about in– situ simulation! Participants will leave this session with practical tools and confidence that will enable them to develop in-situ simulation in their respective contexts. We will review all the steps to identify and engage stakeholders, create a needs assessment to identify learning objectives, review frameworks for building simulations and debriefing conversations, and mitigating barriers.
Q: In terms of in-situ simulation, can you give an example of how it would be used to promote learning? Are there any trends in in-situ simulation you are witnessing in health care practice today? And what should participants know and how can they apply any lessons to their practice?
A: As educators, we have a duty to ensure that we train and assess residents across the spectrum of CanMEDS competencies. In-situ simulation provides a unique opportunity to do so that is not solely reliant on chance clinical encounters. For example, you can develop in– situ simulations that target rare but critical emergencies that may be difficult to ensure consistent exposure during training in order to provide a standard means of training and assessment for all learners. You can observe a resident’s Medical Expert, Communicator, Collaborator and Leadership abilities while working within their authentic team and clinical environment to feel confident you are training safe physicians who are ready for independent practice.
Many areas of medical education rely on curricula where individuals or groups training in silos. The interprofessional and interdisciplinary nature of in-situ simulation that takes place in the real clinical environment provides an additional opportunity to address patient safety in a way that may be more challenging in simulation-centre based learning. You can identify and address latent safety threats that have the potential to impact safe patient care in real-time. As well, it’s remarkable how wonderful it can be as a team-building learning modality, not just for residents, but for physicians and allied health care professionals across disciplines.
I would say the debrief is the critical timepoint at which learning goals and objectives are highlighted and a shared mental model is crystallized. Everyone has an opportunity to share what took place, and to highlight what was done well and where the areas for improvement are. Approaching the debrief with good judgement and curiosity is key to understanding how your team thinks and works, which can be invaluable when you are working together to provide patient care in what can be high stakes, high stress situations.
Q: What are some potential barriers and mitigation strategies for in-situ simulation?
A: Some barriers will include a perceived lack of time and space. There will always be patient care that needs to take place and there may not always be physical space to run an in-situ simulation at a given moment in time. Strategies that our group has found helpful and critical to our success included engaging key stakeholders for support and informing our needs assessment so that we could be sure the program we developed was meeting the needs of the end users. As well, we liaised with risk-management regarding considerations to actual patient care that would be taking place concurrent to any in-situ simulations that were planned.
Flexibility has also been key to our success. We look to the clinical activity in order to identify when and where during a given day our in-situ simulations should take place. With this approach, we have nearly 100 per cent success with our planned simulation sessions.
Q: Can you elaborate on frameworks to assist with debriefing simulation and evaluating a simulation program?
A: The first thing I would suggest about debriefing is that you need to set the intention at the beginning to create a safe learning environment. I like to remind everyone that I know everyone came to work with the mindset of planning to do their best, and that we are all here to learn with, and from, each other.
I find the PEARLS (Promoting Excellence and Reflective Learning in Simulation) debriefing structure, along with an advocacy-inquiry approach to questions be very useful to maintain a clear outline to the debriefing conversation and to ensure people can share their thoughts in an open and safe manner. By using an advocacy inquiry approach to gathering information, it can provide an opportunity to highlight observations that were made during the simulation, and to understand what the participants were thinking in those moments that led them to taking the actions that they did. Truly coming from a place of curiosity can shift the narrative from “You did something wrong” to “I observed this, and I want to understand more about what was going on in that moment.”