Pro Con - A Discussion Dr Agnes Ng KK Women’s and Children’s Hospital Medical Simulation Pro Con - A Discussion Dr Agnes Ng KK Women’s and Children’s Hospital Thank Prof Dinker and AIMST U and Cybron METI 2 tasks , one running the paed station and second entertain you whilst the field casualty exercise is being set up

First Impressions “Actors” Debriefing Set-up Manniquin A patient with HI for emergency craniectomy, the problem was equipment malfunction after intubation One of the trainee was in the hot seat and we were team members He was so devastated that during the debriefing the trainer was so gentle

The following year I moved to KKH to form the first and only paed AN in singapore and it was not until After 10 years,stepping down as HOD to turn my attention to children’s tower, improve acute management of care and sedation enhancing patient safety especially in children’s tower

KKH PSTC What motivated me was patient safety in children’s tower pushing for this centre and training anaes’ trainees was not my priority

Jackie pedisim and Baby Sam, simbaby

Pro Con - A Discussion (Debate) Medical Simulation Pro Con - A Discussion (Debate)

Medical Simulation Doctors Trained On Patient Simulators exhibit Superior Skills Beth Israel Medical Centre New Virtual Reality Surgery Simulator hones Surgeons' Skills, Improves Patient Safety Oregon Health & Science University School of Medicine Naturally one turns to the internet and I found this american website with screaming tiles as above Clinical Simulation Technology Used To Improve Communication Of Medical Teams Washington University School of Medicine Science Daily

Pro Con - A Discussion (perhaps a debate) Medical Simulation Pro Con - A Discussion (perhaps a debate) And after further trawling of the internet, wondered if I had made a wise decision after all How to approach? It’s true when prof wang said that there’s really no outcome studies

Medical Stimulation Simulation is a technique, not technology, to replace or amplify real experiences with guided experiences……. in an interactive fashion Obviously I must to some extent be a believer or I will not be invited here or spent my effort in pushing for it in kkh Gaba Qual Saf Health Care 2004; 13

Role Playing Task trainers Computer patient Manniquin simulators Medical Simulation Role Playing Task trainers Computer patient Manniquin simulators Imitate real patients, anatomic regions or clinical tasks or mirror real life circumstances in which medical services are rendered

Limitations Over-expectations Medical Simulation Limitations Over-expectations Cons are the result of limitations and over-expectations, relatively rich experience in children’s tower In one stroke medical simulation is a panacea of all ills in health care Enable clinical competency without putting real patient at risk Improve patient safety Reduce medical errors

When one first decides to set up a med sim centre one desires a setup similar to ones above In fact it is now so desirable to own a sex new toy Individuals or Teams

Medical Simulation Hardware & Infrastructure Money can be easy to come by or difficult and both can bring certain problems, need forward thinking and honest evaluation of what you actually need

Medical Simulation Manpower and Training “Chicken and egg” Funds allocation e.g. high end computer to find that we only 10% of function

Manpower Singapore has at least 7 on last count $610,000 $568,000 METI PediaSim and Laerdal babysim

Teacher……. Trainer, Medical Educator Guided experiences

Medical Educator “SODOTO” See One Do One Teach One

Standards & Commitment Medical Stimulation Standards & Commitment Tired to ensure trainers undergo course, have a common philosophy of teaching, maintain a required number of hours Before they are allowed to use the medical simulator To a large extent most due

“In the Hot-Seat” Medical simulation Communications Medical Educator “In the Hot-Seat” Medical simulation Communications What about time spent in doing medical simulation education?

Clinical skills Psychological skills (Situation awareness) Medical Educators Clinical skills Psychological skills (Situation awareness) Situation awareness; perception of elements, comprehension of current situation and projection of future status Sensitive, Draw out from trainees learning points, don’t out-talk the trainees Seniority does not take a priority

Simulation Based Medical Education: an opportunity to learn from errors Provide professionals with the correct attitude and skills to cope competently with those mistakes that could not be prevented Reduce occurrences of errors in real life As your participants getter more senior Medical Teacher Vol 27, Issue 3 May 2005

Medical Simulation in professionals Balance between the emotional load associated with the experience and the professional lessons that can be learned.

Medical Simulation “Sharing the Load”

Trainees “Suspension of Disbelief” Medical Simulation Trainees “Suspension of Disbelief”

Blurring the boundaries: scenario-based simulation in a clinical setting quasi-clinical scenarios, where inanimate models attached to simulated patients Med Education Vol 39:6, 2005

Not a problem for generation weaned on computer games

Looking at the monitors to prompt next move Monitor focused That’s what worries me as the patient becomes an after sight ! Looking at the monitor to prompt the next move!

Medical simulation Crises Driven Crises after Crises Preventing a Crises Does conquering a crises becomes a game, point scoring game The participants come expecting a crises

Resource Intensive and Time consuming Trainers & Trainees Medical Simulation Resource Intensive and Time consuming Trainers & Trainees How much training does a trainer need? How much should he spend on medical simulation How much time is needed to make not only an impact but a clinical difference UG vs PG vs professionals Skills training e.g. laparoscopy

Medical Simulation Initial exposure raises awareness Repeated exposure to simulation improves performance It has been shown that trainees get better with repeated exposure

High Impact But does it translate into improved clinical outcomes? Medical Simulation High Impact But does it translate into improved clinical outcomes? If I am not supported by studies for and against because I cannot find convincing data either way

Assessment of Medical Competency Medical Simulation Assessment of Medical Competency Awareness Improve with time

Medical Simulation Competency Assessment Reliability Validity Predictive validity Reliability, yes the manikin is able to reproduce the same signs Validity, no the range of signs may not always be the only signs Will performance on a given assessment predict future performance in actual practice?

Defining Systems Expertise: Effective Simulation at the Organisational Level- Implications for Patient Safety, Disaster Surge Capacity, and Facilitating the Systems Interface 2008 Academic Emergency Medicine Consensus Conference on the Science of Simulation

2008 Academic Emergency Medicine Consensus Conference on the Science of Simulation Objective methods and measures to demonstrate simulator training actually improves patient safety Effective feedback of information from error reporting systems into simulation training to improve patient safety Methods and outcome measures to demonstrate teamwork improves disaster response ……………..

No official instruction manual with the human body Medical simulation cannot replace the primacy for training and apprenticeship system on real patients No official instruction manual with the human body

The Patient is complex organism Physical Psyche Behavioural Environs Right mix of traditional, simulation based learning and actual patient care

The Health Care Professional Physical Psyche Behavioural Environs Right mix of traditional, simulation based learning and actual patient care

Reduction of Human errors Patient safety Medical Competence 1999 IOM, USA report on medical errors Panacea to all that’ wrong with our health care problems

Medical Simulation A tool, powerful teaching tool We should wield this tool and not the industry !