Clinical simulation for teaching in health

Abstract

Today’s healthcare professionals face many challenges. Preparing the next generation for these challenges requires innovative and daring new ways of thinking. Globally, healthcare faculty are aging and find themselves in an increasingly complex healthcare system compared to when they were educated. The patient population includes frail elderly, physical comorbidities, and mental health issues to name a few. An explosion of information provides new research and best practice standards, including new pharmaceutical options, complex technological medical treatments, and nursing care must evolve and include a multiprofessional approach. Healthcare professionals recognize the need to collaborate interprofessionally with the multiple allied health professionals emerging, and yet they face challenges daily trying to make this practice a reality. What options exist for education of healthcare students and how can we manage professional development of healthcare faculty to accommodate these changes? Over the past thirty years, I have been educating nurses and healthcare faculty for the future. As a practitioner myself, I recognize the value of case studies, concrete examples, and or practicing skills, whether role-playing in the clinical lab(1) in a clinical experience with live patients. I began my journey using simulation to teach approximately 15 years ago, and as technology has evolved, faculty have gained increasing skills and best practice standards have been created to make the use of simulation a valuable strategy for teaching healthcare professionals. Let me explain my perception of the what, why, how, and next steps…. What: Simulation is the use of virtual, high-, medium-, or low-fidelity, or simulated/standardized patients to create a fictional but credible situation (scenario) with as much realism as possible to mimic clinical events healthcare . students may encounter(2) Why: With expanding needs for health professionals, the increase in numbers of students results in clinical placement sites unable to keep up with the demands. Also, the increased complexity of patients, shortened hospital stays, and complex health system environments require skill sets beyond a novice healthcare students’ capabilities. Thus, practicing the technical and non-technical skills in a safe environment such as a clinical lab with simulation, allows for risk free, hands on learning without patient harm. This also means that students come to the clinical practice site more prepared increasing the safety of the care provided. How: Students take roles during a scenario, interact with the ‘patient’ and sometimes their family, and gather information to create a plan of care. For example, the clinical simulation lab with a high-fidelity robotic mannequin can allow for the student to assess heart rate, breathing, pulses, bowel and lung sounds, and talk with the patient about what is going on (faculty respond via microphones that project the voice responding from the mannequin’s mouth). The student has access to a chart, physicians’ orders, and interprofessional colleagues to manage the situation. The scenarios can range from nausea and vomiting after surgery or critical events such as an asthmatic attack in a teenager, a postpartum hemorrhage, or a cardiac event, varying according to the learning objectives. Next steps: In order for faculty to integrate simulation into their program, faculty champions who understand the application of theory and have some education around the development, facilitation, debriefing, and evaluation of simulated learning are needed. Choose a theory, create or find a scenario, set up the lab, prepare students, run the scenario, provide feedback and cues during the scenario, debrief with students/faculty/volunteers at the end, and evaluate the scenario for effectiveness, needed changes, and modify – repeat! Decades of nurse educators’ research has identified the importance of experiential learning. Classic models of healthcare education include two key theories: Carper’s Ways of Knowing(3) and Benner’s novice-to-expert(4) both reflecting the importance of how healthcare practitioners learn and grow as experts over time. Many healthcare educators apply Kolb’s Experiential Learning theory(5) , while nurse educators /simulationists have developed their own frameworks to incorporate learning with simulation for healthcare student education. Jefferies / National League for Nursing (NLN) Simulation(6) and Daley & Campbell’s Framework for Simulation Learning(7) are examples of models that have been designed to guide the development, facilitation, and evaluation of simulation for educating the next generation. Present research is beginning to test these methods compared to more traditional models (e.g. apprentice learning in clinical) to determine the translation of knowledge to behavior change, . and overall effects on patient safety(8) Recently, the International Nursing Association for Clinical and Simulation Learning (INACSL) developed best . practice standards for the integration of simulation learning(9) The importance of psychological safety for students in the clinical lab environment(10) allows students to practice skills, build confidence, and gain valuable experience critically thinking, therapeutically intervening, and practicing effective communication – both with patients and teams. Positive aspects of the use of simulation are reflected by students enjoyment and learning during the experience, and faculty’s growth and positive response to the opportunity to make their teaching come alive!