1. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Hybrid Task Training Simulation with Objective-based Outcomes for Mastery-based Learning Presented by John J. Schaefer, III, MD Frances W. Lee, DBA Heidi H. Schmoll, RN, MSN-Ed

2. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Session Learning Objectives 1.Describe "hybrid simulation" and how it can be applied to task trainers 2.Define the mastery-deliberate practice educational teaching model 3.Design a program in which hybrid simulation with preprogrammed grading scenarios could be used to create a mastery-deliberate practice educational teaching experience with documented objective-based outcomes. 4.Incorporate hybrid simulation into a new or existing program to support a mastery-deliberate practice educational teaching model.

3. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Session Outline 1.Introduction (10 minutes) 2.Creating a Hybrid Simulation Course (30 minutes) 3.Interactive, Hands-on Exercises with eight interactive stations (30 minutes) 4.Incorporating Hybrid Simulation into new or existing programs (20 minutes) 5.More Hands-on with Questions/Answers (30 minutes)

4. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Charleston, SC Medical University of South Carolina

5. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com

7. Conflicts of Interest Disclosure: John Schaefer, MD: –Patent royalties from Laerdal Medical Corp. (SimMan/Baby/3G) –Non majority owner of SimTunes (outlet for MUSC simulation copyrightable material) –Publishing contract with Lippincott through MUSC –Simulation Copyright royalties through MUSC –Grant support from Duke Endowment, Fullerton Foundation, SC Nursing Deans & Directors

8. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Conflicts of Interest Disclosure: Frances W. Lee, DBA –Publishing contract with Lippincott through MUSC –Simulation Copyright royalties through MUSC Heidi H. Schmoll, RN, MSN-Ed –Publishing contract with Lippincott through MUSC –Simulation Copyright royalties through MUSC

9. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Hybrid Simulation Definition Hybrid simulation is a blend of two or more different forms of simulation.

10. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Hybrid Simulation Definition in this case take: High fidelity simulator Operating System Any task trainer + =

11. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Hybrid Task Training Simulation In this session we are specifically combining the software that runs a high fidelity simulator with non-computerized task trainers (e.g. an IV arm) to create a simulation system that supports: running objective based scenarios, providing feedback, accessing educational support materials and reviewing recorded video during debriefing.

12. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Mastery-Deliberate Practice Educational Model Definition Its not practice that makes perfect---- its perfect practice that makes perfect Coach Vincent Lombardi

13. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Mastery-Deliberate Practice Educational Model Definition The mastery-deliberate practice education model is a training model incorporating formal, repeated exercises with feedback until the learner displays proficiency in a skill, technique or assessment. In this application we are using structured, dynamic hybrid simulations to support deliberate practice to a specified level of mastery.

14. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Hybrid Simulation Skills Lab Concept Trainee A Performs task After practice both review performance Then switches roles with Trainee B Trainee B Runs simulation practice scenario Logs steps from list in menu Pulls up debriefing Accessible to Trainees: Task curricula (multimedia) Immediate feedbackObjective evaluation Video feedback

15. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com NG Tube Insertion

16. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Key features of the Hybrid Simulation Model Simulation scenarios provide deliberate practice with feedback (e.g. video, sound, documents, pictures, vital signs) displayed on the simulated patient monitor to the student learner.

17. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Key features of the Hybrid Simulation Model Another student (the student operator) runs the easy-to-run, menu- based scenario from a laptop computer. The scenario software provides feedback to the learner based on the training objectives. Note: Running the scenario and seeing feedback provides a benefit to student operator as well as the student learner.

18. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Key features of the Hybrid Simulation Model The students alternate roles as learner and operator until both master the learning objectives. This set up may also foster healthy competition and helpful interaction.

19. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Key features of the Hybrid Simulation Model The students may also use the laptop computer to access web-based, or other curricula, built around objectives when appropriate.

20. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Key features of the Hybrid Simulation Model One facilitator (e.g. upper level student, teaching assistant, or teacher) can supervise multiple stations, providing individual help as needed.

21. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Key features of the Hybrid Simulation Model If documentation of student mastery is desired, the facilitator can run a summative evaluation using the same or similar station set up.

22. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Interactive, Hands-on Exercises with eight interactive stations (30 minutes) 1.NG Tube Insertion (2 stations) 2.Urinary Catheter Insertion (Male) 3.Urinary Catheter Insertion (Female) 4.IV Therapy (2 stations) 5.Lumbar Puncture (2 stations)

23. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com NG Tube Insertion

24. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com

25. Diagnostic Lumbar Puncture

26. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com

30. Interactive, Hands-on Exercises with eight interactive stations (goal) 1.Look at the curricula 2.Run the scenario 3.Stop and go to debrief 4.Note objective formative feedback and grade 5.Try from perspective of operator then task performer 6.We will rotate stations

31. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Variations of method B-Line EMS METI vision Power Point

32. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com IV.Incorporating Hybrid Simulation into new or existing programs (20 minutes) Station requirements (see Fig. 1) 1.Moveable table and chairs, with minimum dimensions: 48" W * 60" L, alternatively 72" L for extra space if room size accommodates. Serves two students per table. Tables may be grouped as rows or combinations of four tables. 2.Laptop computer with a connected monitor, speakers, and a wireless or USB mouse. USB camera is optional for recording. 3.The appropriate task trainer. 4.Laerdal simulator operating software loaded on the computer (or B-Line/EMS/METIvision)

33. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Room Requirements for a 32-student Hybrid Simulation Skills Lab 1.Seats 32 students at 16 workstations. 2.Front of classroom supports one or two projectors and screens or white boards to review assignments (generally web-based) before starting and to review how to run scenarios. Table area in the front of the classroom should contain elements of two workstations to support summative grading by teaching assistants for other evaluators. Facilitators can also use this table in front of classroom with a central, well-laced pan-tilt-zoom camera to demonstrate techniques to students. 3.Podium with wireless microphone to allow demonstration or speaking from podium. 4.Ceiling speakers. 5.Appropriate computer technology to support audiovisual integration systems such as B- Line SimCapture. 6.Controllable lighting to dim lighting at front of classroom where projector screens are located (controlled from front of classroom near podium). 7.Floor has recessed tracks in a grid representing rows and columns of table layout to support power and data needs to stations. 8.Room supports wireless environment with high bandwidth and traffic (up to twenty computers per room.) 9.Space (closets) for task trainer storage and support located on two sides of room. 10.Four sinks are located in storage area around four corners of the room to allow hand washing related to task training. Soap and paper towel dispensers are needed to support 32 students. Glove boxes are also located on counter top near sinks. Note: May want to consider six sinks with three per side to avoid traffic jam at sinks. 11.Room (with task trainers removed) can be used as classroom or testing room as needed. 12.Estimated room dimensions: approx. 40' * 50'.

34. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com

36. Greenville Technical College Project Faculty were trained in May of 2011 Pilot was performed in June, 2011 Faculty debriefed to discuss feedback from students survey and improvements to the hybrid simulation After IRB approval, the study began in September, 2011 September, October, and November 2011 was performed with ease

37. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com GTC Project (Continued) December retention was performed on the September group Over 100 students have participated in the study with another 100 students anticipated to complete this January, March, and April Faculty use a laptop with the high-fidelity Nasogastric Tube Insertion Scenario All faculty evaluate any student since the scenario is standardized

38. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Logistics Students are divided into two groups and staggered for time Students are randomly paired for practice Students are allowed to practice until they feel they are comfortable They are randomly chosen for evaluation Faculty evaluate the students

39. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Results Thus Far Only the group with retention data collected thus far is presented (N = 37) No critical steps were missed during evaluation AveragesScores Practice 190.7% Practice 297.5% Practice 398.9% Evaluation99.5% Retention82.9%

40. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Feedback Over 80% of students enjoyed the experience Faculty feedback described student as …more confident to perform the skill in the clinical setting and …better prepared for the skill and not apprehensive to performing the skill…

41. © 2010 Healthcare Simulation South Carolina healthcaresimulationsc.com Is this magically easy to do? Success is like anything worthwhile. It has a price. You have to pay the price to win and you have to pay the price to get to the point where success is possible. Most important, you must pay the price to stay there. Vince Lombardi