©2009 Louis P. Halamek, M.D.
How to Build a Successful
Cost Effective Simulation
Program
Louis P. Halamek, M.D.
Associate Professor
Division of Neonatal and Developmental Medicine
Department of Pediatrics
Stanford University
Director, Center for Advanced Pediatric and Perinatal Education
Lucile Salter Packard Children’s Hospital
©2009 Louis P. Halamek, M.D.
Disclosure: In the past 12 months the speaker
listed below has had the following financial
relationships with manufacturers of commercial
products and/or providers of commercial services:
Louis Halamek: Consultant, Laerdal Medical and
Advanced Medical Simulation; Grant Recipient,
Laerdal Foundation
©2009 Louis P. Halamek, M.D.
Learning Objectives
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Understand what simulation is…
or should be.
Appreciate the fact that building a
simulation center and building a simulation
program are distinct activities.
Know the steps in building a successful
simulation program.
Know the potential sources of revenue that
can support a simulation program.
©2009 Louis P. Halamek, M.D.
Part I
©2009 Louis P. Halamek, M.D.
What is the difference between
teaching and learning?
©2009 Louis P. Halamek, M.D.
Teaching


something that is done by an
instructor to trainees
 active endeavor for the instructor
 passive activity for the trainees
trainees accept little responsibility
for learning
©2009 Louis P. Halamek, M.D.
Learning


something that is done by trainees
 active exercise for instructor and
trainee
trainees bear most of the
responsibility for their own learning
©2009 Louis P. Halamek, M.D.
Teaching vs. Learning
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Whom do we teach? --->
 Who are the learners?
What do we teach? --->
 What can be learned?
How do we teach? --->
 How is learning best facilitated?
Halamek LP. J Pediatr 2007;151:329-330
©2009 Louis P. Halamek, M.D.
The Learners

adults
 independent
 self-directed
 internally motivated
 seek immediate applications for
their knowledge
©2009 Louis P. Halamek, M.D.
Today’s Learners are
Different from Yesterday’s

first year medical students
in 2009
 were born 17 years after
man first walked on the moon
 have no visual memory of vinyl
records or rotary dial phones
 have never been without laptop
computers or the internet
©2009 Louis P. Halamek, M.D.
What Can Be Learned

acquisition, recall, and application of
content knowledge
 serves as an essential foundation
 yet is inadequate preparation for the
complexity of real-life
Bloom BS, et al. Taxonomy of Educational Objectives. 1956.
©2009 Louis P. Halamek, M.D.
What Can Be Learned

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cognitive skills
 what we know: drug dosing
technical skills
 what we do with our hands: intubation
behavioral skills
 how we use our cognitive and technical
skills in working with patients and
colleagues: communication
©2009 Louis P. Halamek, M.D.
Behavioral Skills
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know your
environment
anticipate and
plan
assume the
leadership role
communicate
effectively
distribute work
load optimally

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

allocate attention
wisely
utilize all available
information
utilize all available
resources
call for help early
enough
maintain professional
behavior
©2009 Louis P. Halamek, M.D.
Facilitating Learning
©2009 Louis P. Halamek, M.D.
Facilitating Learning


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tailor the training to meet the needs of
trainees as adult learners
emphasize active rather than passive
learning methodologies
 require trainees to do more than write
and answer questions
integrate cognitive, technical and
behavioral skills into comprehensive
learning opportunities
©2009 Louis P. Halamek, M.D.
Facilitating Learning



provide relevant, challenging, immersive
learning experiences
 develop and stay focused on learning
objectives
conduct in an environment with high
fidelity to the real domain
utilize technology to optimize not
overshadow the learning experience
©2009 Louis P. Halamek, M.D.
Facilitating Learning

don’t dominate the learning process
 ask questions rather than make
statements
 listen rather than talk
 be comfortable with silence
 allow time for reflection
 debrief rather than lecture
©2009 Louis P. Halamek, M.D.
Part II
©2009 Louis P. Halamek, M.D.
What is simulation-based
learning?
©2009 Louis P. Halamek, M.D.
Simulation-based Learning
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re-creates key visual, auditory and
tactile cues
engenders authentic responses in
trainees
allows practice of cognitive, technical
and behavioral skills under realistic
conditions (e.g. time pressure)
provides opportunity for self-reflection
©2009 Louis P. Halamek, M.D.
Key Points for Instructors

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Set clear expectations for your trainees.
Tailor the training to meet the needs of
your trainees.
Facilitate, don’t dominate.
Debrief, don’t lecture.
©2009 Louis P. Halamek, M.D.
Key Points for Instructors

Remember:
 It’s about the methodology,
not the technology.
 It’s not about you as instructor,
it’s about your trainees and
ultimately their patients.
©2009 Louis P. Halamek, M.D.
Key Points for Trainees

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
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Take responsibility for your learning.
Behave during scenarios as you do in
real life.
Be willing to makes mistakes and learn
from them.
Maintain confidentiality.
©2009 Louis P. Halamek, M.D.
Key Points for Trainees

Remember:
 It’s not about you,
it’s about your patients…
©2009 Louis P. Halamek, M.D.
Part III
©2009 Louis P. Halamek, M.D.
How do you build a successful
simulation program?
©2009 Louis P. Halamek, M.D.
Steps in Building a Successful
Simulation Program

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identify the learners
establish learning objectives
identify the skills to be taught
 cognitive, technical, behavioral
WHO needs to learn WHAT?
©2009 Louis P. Halamek, M.D.
Steps in Building a Successful
Simulation Program

determine the optimal learning
methodology for achieving those
objectives
 cognitive: self-study
 technical: task trainers
 behavioral: simulation
©2009 Louis P. Halamek, M.D.
Steps in Building a Successful
Simulation Program

determine the curriculum
 scenarios based on
learning objectives
 record scenarios for
playback during debriefing
 debriefings to follow
each scenario
 debriefing points follow
from learning objectives
©2009 Louis P. Halamek, M.D.
Steps in Building a Successful
Simulation Program

develop instructors
 content expertise
 debriefing expertise
 technical expertise
©2009 Louis P. Halamek, M.D.
The Ideal Instructor

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facilitates rather than dominates the
learning process
utilizes technology to optimize the
educational experience
provides relevant, challenging, scaleable immersive experiences
focuses on the learning, rather than
the teaching, environment
©2009 Louis P. Halamek, M.D.
Instructor Roles
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advocates
scenario design
confederates
assistant instructors
lead instructors
employees
investigators
©2009 Louis P. Halamek, M.D.
How do you identify “the best”?

look for those who
 are “early adopters”
 they “get it”
 are willing to let the learners assume
responsibility for their own education
 bring enthusiasm and passion
©2009 Louis P. Halamek, M.D.
Steps in Building a Successful
Simulation Program

secure the necessary physical resources
©2009 Louis P. Halamek, M.D.
Steps in Building a Successful
Simulation Program



“find*” space
 * = trade your firstborn
“borrow**” working medical equipment
 ** = steal
“secure***” a budget
 *** = lie about what it will be used for
 audiovisual equipment
 human patient simulators
©2009 Louis P. Halamek, M.D.
Borrowing Medical Equipment

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working medical
devices
monitors coupled with
patient simulators
drivers for real
monitors
 bedside
 fetal
©2009 Louis P. Halamek, M.D.
Securing AV Gear

videotape is a tremendously powerful
but vastly underutilized tool
 creates an objective record of events
 allows trainees to see what they do
and hear what they say
 essential for debriefing
©2009 Louis P. Halamek, M.D.
Securing AV Gear

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pan-tilt remote-control cameras
 hidden under acrylic domes
multiple microphones
 adjustable gain
a small camera
on a tripod works,
too!
©2009 Louis P. Halamek, M.D.
Buying Patient Simulators

lower vs higher complexity simulators
 higher fidelity typically comes with a price
 more hardware
 computers, wires, tubes
 more software
 someone must “run” the simulator
 more training, more people
 Sometimes simpler is better…
©2009 Louis P. Halamek, M.D.
Buying Patient Simulators


lower fidelity “off the shelf” manikins
used for
 routine scenarios
 routine interventions
“modified” manikins
 external and internal
alterations
 richer training
experiences
©2009 Louis P. Halamek, M.D.
It’s the methodology,
not the technology,
that is at the heart of
simulation-based learning.