Dr. Dan’s Plenary Presentation Creatively Addressed Sticky Issues in Simulation

By Kris Slawinski

 The topic of Monday morning’s plenary at the ASPE 2012 Annual Meeting was Hybrid Simulation. While not a new concept to most SP educators at this point, the topic discussion was delivered in a different and refreshing format. Presented as a TV talk show titled “Good Morning ASPE Show,” and hosted by “Dr. Dan” Raemer, the conceit was complete with theme music, commercials, and even a ‘live’ caller.

Daniel Raemer, PhD, is Associate Professor of Anesthesia at Harvard Medical School and Bioengineer,

Dr. Dan’s first ‘guest’ was Dawn Schocken, MPH, PhDc, Director of the Center for Advanced Clinical Learning at USF Health Morani College of Medicine in Tampa, Florida. Schocken’s focus was faculty development, which Raemer set up by stating it is harder to teach teaching skills than previously thought, and certainly harder to teach people to teach than to manage disease.

Schocken described her institution’s faculty training to include participation in the simulation and debrief process as a trainee so that they understand the process; observing themselves on video; and requiring faculty to take an instructor course. Schocken drew on content she has contributed to a book, written for the SSH, to be published by LLW in December 2012, titled “Defining Excellence in Simulation Programs”. Her chapter is titled “Faculty Development for Debrief of Hybrid Simulation,” which gives the 10 Best Practices as:

  1. Write clear objectives
  2. Set ground rules
  3. learner orientation is essential
  4. theory base for debriefing: construction theory
  5. length of debrief for simulation—variable but generally is twice the length of the simulation
  6. where should you debrief—separate space is preferred
  7. start with “how did it go,” be comfortable with silence
  8. different learners may require different debrief techniques
  9. general debriefing techniques: reflection, Socratic method, video debrief
  10. be prepared for learner challenges

Raemer, true to his talk show host persona, introduced his next guest with such enthusiasm it suggested he was harboring a teen crush. Jill Sanko’s past history includes Assoc Director of the NIH Simulation Service, protocol manager at the National Institute of Heart Lung and Blood, and Research and Simulation Education Specialist at the U of Miami-Jackson Memorial Hospital Center for Patient Safety. Sanko, BSN, MS, is currently embarking on a PhD in nursing at U of Miami with a concentration in patient safety. She has been involved in training “Standardized Healthcare Practitioners Acting as Confederates” (SHPACS), as reflected in her chapter “Acting in Healthcare Simulation,” whose 10 Best Practices are defined as:

  1. Preserve the student’s learning opportunities
  2. Adapt when necessary
  3. Know your learners
  4. Ad-lib when needed
  5. Voice communication devices: pros & cons
  6. Props & costumes tell a story—use them
  7. Commit to the character
  8. Learn & remember the role’s emotional contribution
  9. Debrief/evaluate the actor’s performance
  10. Always rehearse first

Sanko largely focused on terminology for the planted “confederate” who controls or facilitates the direction of events that guide the flow of the unfolding simulation. Responses to a query she posted on the SSH Listserv revealed great variation in terms and reasons for their use. “Confederate,” “Simulated,” “Standardized,” “Actor,” “Actor-SP”–none satisfied everybody using simulation in healthcare. This led to a lively exchange in the Q & A afterward, during which audience members proposed use of the term “ESP,” for Embedded Simulated Person, or “EP” for Embedded Participant—both of which seemed to attract general approval.

 “Good Morning ASPE”’s next guest was Janice Palaganos, PhDc, RN, MSN, CRNP, CEN, prior Director of Accreditation and Certification for the Society for Simulation in Healthcare, and current member of the Board of Review for the Council for Accreditation of Healthcare Programs. Palaganos’ focus was interprofessional simulation and she advised the audience to avoid profession-centric simulation, to draw in all specialties, understand ‘change theory’ and then “get busy.” Her chapter on “IPE & SP Strategies for Action,” identifies those 10 Best Practices as:

  1. Use evidence
  2. Identify your sphere of influence
  3. Disseminate IPE competencies/domains
  4. Align scenarios with IPE competencies
  5. Utilize evaluation tools
  6. Use existing resources
  7. Contribute to and use a repository
  8. Recognize the need to use change theory
  9. Examine your own assumptions
  10. Look for partners

The conceit of the talk show format allowed Raemer to play devil’s advocate by addressing or teasing out touchy realities and exploring tensions within our rapidly expanding field. One was the need to exchange theatrical language for terms that convey the educational purpose to simulation. Another is that, while your institution’s leadership may say “’great idea, we should do [simulation],’ they want someone else to do it.  A ‘caller,’ “Jim” from “Last Hope of Mary’s Simulation Center,” said that his nursing students did not have the same experience as medical students in simulations, allowing Palaganos to underscore that profession-centric  simulations can be “very dangerous,” and can create “adverse learning.” Finally, Raemer addressed the age-old bugaboo of “participants in simulations [being] confused about whether what they’re seeing is part of the experience” or just flaws in the scenario.

As we move forward into more complicated simulations with more diverse participants and partners, we must question what we’ve been doing, be ready to change, and look to new players for fresh ideas while we contribute our own decades’ worth of experience to the mix. As “SP Educators,” we may have to be ready to compromise with new language that satisfies all new, more diverse users. Brian Hodges spoke to us in Toronto in 2007 about the future need for a new term for SPs—now is the time!

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