Global Perspective for
Integrating Simulation
Across the Curriculum
Dr. Teresa Gore
SIM-One
2015 SIM EXPO
Simulation and Integration
Toronto, Canada
December 14, 2015
Presenter
• Teresa Gore, PhD, DNP, FNP-BC, NP-C, CHSE-A
– Associate Professor
– University of South Florida College of Nursing
– INACSL President 2015-2017
– Disclosure: Elsevier Simulation Learning System
(SLS) scenario development
Overview
• The body of evidence supporting the use of standards in
Simulation education is growing.
•
This presentation will introduce the standards and provide
concrete examples for faculty to integrate the standards across
nursing curriculum globally.
What is Simulation
• “A pedagogy using one or more typologies to promote,
improve, or validate a participant’s progression from
novice to expert”
• “Technique not technology to replace or amplify real
experiences”
• “An educational technique that allows interactive and at
times immersive activity by recreating all or part of a
clinical experience without exposing patients to the
associated risks”
• A pedagogy using one or more typologies to promote,
improve, or validate a participant’s progression from
novice to expert - CASN
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Australia
Canada
China
Egypt
Europe
France
India
Mexico
Middle East
South America
Spain
Turkey
USA
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GNSH
• Brazilian Association for
Simulation in Healthcare
• Association for Simulated Practice
in Healthcare (ASPE)
• Association for Standardized
Patient Educators (ASPE)
• Australian Society for Simulation
in Healthcare (ASSH)
• Canadian Network of Simulation
in Healthcare (CNSH)
• Nine Industry Providers
• International Nursing Association
for Clinical Simulation and
Learning (INACSL)
• International Pediatric Simulation
Symposia (IPSS)
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• Japanese Society for Instructional
Systems in Healthcare (JSISH)
• London Deanery
• Polish Society for Simulation in
Healthcare (PSSH)
• Royal College of Physicians and
Surgeons of Canada (RCPSC)
• Spanish Society for Simulation in
Healthcare
• Swiss Standardized Patient and
Simulation Group
• Society for Simulation in
Healthcare (SSH)
• Society in Europe for Simulation
Applied to Medicine (SESAM)
Global
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INACSL
• Vision: INACSL is the global leader in
transforming practice to impact patient safety
through excellence in healthcare simulation.
• Mission: Advancing the science of healthcare
simulation
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Canadian Representation
• Nicole Harder
– University of Manitoba
– VP of Finance
– Assistant Editor Clinical
Simulation in Nursing
• Colette Foisy-Doll
– Grant MacEwan University
– Awards and Nominations
Chairperson
• Leslie Graham
– Durham College
– Standards Committee
– Running for VP of
International Collaborative
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INACSL Standards
• INACSL Standards of Best Practice:
SimulationSM
• 2011
• 2013
• 2015
• 2016
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External Review
• American Academy of Pediatric
Dentistry
• American Nursing Association
• Association for Simulated Practice
in Healthcare
• Australian College of Nursing
• Australian Society for Simulation
in Healthcare
• British Columbia Institute of
Technology School of Health
Sciences
• International Council of Nurses
• International Federation of
Dental Anesthesiology Societies
• International Simulation and
Gaming Association
• National League for Nursing
• Royal College of Physicians and
Surgeons of Canada
• Sigma Theta Tau International
• Simulation Task Force of QTAR
• Scottish Centre for Simulation
and Clinical Health Factors
• Society for Simulation in
Healthcare
Standards
1. Terminology
2. Professional Integrity
3. Participant Objectives
4. Facilitation Methods
5. Facilitator
6. Debriefing
7. Evaluation
8. Sim-IPE
9. Simulation Design
INACSL Standards of Best
SM
Practice: Simulation
TERMINOLOGY
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Consistent terminology provides guidance and
clear communication and reflects shared values
in simulation experiences, research, and
publications. Knowledge and ideas are clearly
communicated with consistent terminology to
advance the science of simulation.
• Consistency
INACSL Standards of Best
SM
Practice: Simulation
PROFESSIONAL INTEGRITY
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It is essential to provide clear expectations for the
attitudes and behaviors of simulation
participants. Professional integrity related to
confidentiality of the performances, scenario
content, and participant experience is required
during and after any simulation. Confidentiality is
expected in live, recorded, or virtual simulation
experiences.
• Criterion 1. Protecting content of scenario and
simulation
• Criterion 2. Demonstrating professional and
ethical behavior
• Criterion 3. Receiving and providing
constructive feedback
INACSL Standards of Best
SM
Practice: Simulation
PARTICIPANT OBJECTIVES
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All simulation-based learning experiences begin with development
of clearly written participant objectives, which are available
prior to the experience.
• Criterion 1. Address domains of learning
• Criterion 2. Correspond to participant’s knowledge level and
experience
• Criterion 3. Remain congruent with overall program outcomes
• Criterion 4. Incorporate evidence-based practice
• Criterion 5. Include viewing of client holistically
• Criterion 6. Be achievable within an appropriate
timeframe
Curriculum
Overview
• Typical
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• Innovative
INACSL Standards of Best
SM
Practice: Simulation
FACILITATION
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Multiple methods of facilitation are available, and
use of a specific method is dependent on the
learning needs of the participant(s) and the
expected outcomes.
• Criterion 1. Using facilitation methods
congruent with simulation objectives
• Criterion 2. Using facilitation methods
congruent with expected outcomes
• Pre-briefing
• During Simulation
• Debriefing
INACSL Standards of Best
SM
Practice: Simulation
FACILITATOR
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A proficient facilitator is required to manage the complexity
of all aspects of simulation. The facilitator has specific
simulation education provided by formal coursework,
continuing education offerings, and targeted work with
an experienced mentor.
• Criterion 1. Clearly communicates objectives and
expected outcomes to participant(s)
• Criterion 2. Creates a safe learning environment that
supports and encourages active learning, repetitive
practice, and reflection
• Criterion 3. Promotes and maintains fidelity
• Criterion 4. Uses facilitation methods appropriate
to participants’ level of learning and experience
• Criterion 5. Assesses and evaluates the acquisition
of knowledge, skills, attitudes, and behaviors
• Criterion 6. Models professional integrity
• Criterion 7. Fosters participant learning by providing
appropriate support throughout the simulation
activity, from preparation through reflection
• Criterion 8: Establishes and obtains evaluation data
regarding the effectiveness of the facilitator and the
simulation experience
• Criterion 9. Provides constructive feedback and
facilitates debriefing with participants
INACSL Standards of Best
SM
Practice: Simulation
DEBRIEFING
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All simulation-based learning experiences should
include a planned debriefing session aimed
toward promoting reflective thinking.
• Criterion 1. Facilitated by a person(s) competent
in the process of debriefing
• Criterion 2. Conducted in an environment that
supports confidentiality, trust, open
communication, self-analysis, and reflection
• Criterion 3. Facilitated by a person(s) Who
observes the simulated experience
• Criterion 4. Based on a structured framework for
debriefing
• Criterion 5. Congruent with the participants’
objectives and outcomes of the simulation-based
learning experience
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Debriefing Methods
How and why do you debrief?
• Plus – delta (can use delta sign)
• Structured and Supported Debriefing Module using
Gather, Analyze, and Summarize (GAS)
• Debriefing for Meaningful Learning
• Debriefing Assessment for Simulation in Healthcare
• Debriefing Using Good Judgment
• PEARLS
INACSL Standards of Best
SM
Practice: Simulation
EVALUATION
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In a simulation-based experience,
formative assessment or summative
evaluation can be used
• Criterion 1. Formative assessment
• Criterion 2. Summative evaluation
• Criterion 3. High-stakes evaluation
• Adamson, K. A., Kardong-Edgren, S., & Willhaus, J.
(2012). An updated review of published simulation
evaluation instruments. Clinical Simulation in
Nursing, 9(9), 393-400.
http://dx.doi.org/10.1016/j.ecns.2012.09.004
• Kardong-Edgren, S., Adamson, K. A., & Fitzgerald, C.
(2010). A review of currently published evaluation
instruments for human patient simulation. Clinical
Simulation in Nursing, 6(1), e25-e35.
doi:10.1016/j.ecns.2009.08.004
Sample Evaluations
• CLECS
• CCSI
INACSL Standards of Best
SM
Practice: Simulation
SIMULATION-ENHANCED INTERPROFESSIONAL
EDUCATION (SIM-IPE)
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Sim-IPE occurs when participants and facilitators from two or
more professions are engaged in a simulation health care
experience to achieve shared or linked objectives and
outcomes. The Sim-IPE is designed for the individuals
involved to “learn about, from and with each other to enable
effective collaboration and improve health outcomes” (WHO,
2010, p.31)
• Criterion 1. Based on Theory
• Criterion 2. Follow Best Practices in Simulation-Based and IPE
• Criterion 3. Address Institutional and Local Issues
• Criterion 4. Include an Evaluation Plan
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INACSL Standards of Best
SM
Practice: Simulation
SIMULATION DESIGN
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Simulation-based experiences (SBEs) should be
purposefully designed to meet identified objectives
• Criterion 1. Needs Assessment
• Criterion 2. Measurable Objectives
• Criterion 3. Format of Simulation Based Experiences
• Criterion 4. Clinical Scenario or Case
• Criterion 5: Fidelity
• Criterion 6: Facilitator/Facilitative Approach
• Criterion 7: Briefing
• Criterion 8: Debriefing and/or Feedback
• Criterion 9: Evaluation
• Criterion 10: Participant Preparation
• Criterion 11: Pilot Testing of the SBE
Simulation Design
Needs
Assessment
Format of
Simulation
Fidelity
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Measurable
Objectives
Clinical
Scenario or
Case
Facilitator /
Facilitative
Approach
Debriefing
and / or
Feedback
Briefing
Evaluation
Simulation Design
Effective Simulation-based
Learning Design
Aldridge, M (2012) Developing Healthcare Skills through Simulation. London, SAGE.
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Application
• Arizona State Board of Nursing Advisory Opinion:
Use of Simulation in Approved RN/LPN Programs
• Incorporates a policy, general guidelines,
requirements for simulation
• Training requirements for facilitators
• Canadian Association of Schools of Nursing
(CASN)
Simulation Guidelines
• The NCSBN Simulation Guidelines are
available at
http://www.journalofnursingregulation.com/a
rticle/S2155-8256(15)30783-3/pdf
• Commitment from the institution
• Appropriate facilities
• Educational and technological resources and
equipment
• Qualified faculty and personnel
Resistance
• Buy-in
• Roger’s Diffusion of Innovation Theory
– Diffusion of innovations is a theory that seeks to
explain how, why, and at what rate new ideas and
technology spread through cultures
• Cost
• Mindset
– Skills lab versus simulation
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Simulation Fellowship
• INACSL and CAE Healthcare
• Fellowship based on the INACSL Standards of Best
Practice: Simulation SM and the Essential of
Simulation
• Timeline
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Webinar
Two-day immersive workshop
Webinar
Two-day immersive workshop
Mentorship online
INACSL-CAE Healthcare
Simulation Fellowship
• Formal education program for simulation-immersive kinesthetic
learning
– Educational theories
– Development, practice, and validation of scenario development for
high quality simulations
– Facilitation methods and facilitator skills
– Effective debriefing techniques
– Evaluation methods
• The INACSL Standards of Best Practice: Simulation SM and the
Essentials of Simulation
• Timeline
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Webinar
Two-day immersive workshop
Webinar
Two-day immersive workshop
Mentorship online
Sim-ONE
• SIM-one enables and supports research,
development and innovation in the field of
simulation for health professions education and
health system improvement.
–
–
–
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–
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Keystones Certificate Course
MASCS Certificate Program
Meta-Leadership Program
Summer Simulation Institute
Grants
Scenario Repository
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INACSL 2016
Please join us next
year at the Gaylord
Texan Resort!
June 15-18, 2016
Grapevine, Texas
Contact Information
Teresa Gore
• tgore@health.usf.edu
• University of South Florida College of Nursing
• INACSL President 2015-2017
USF College of Nursing
12901 Bruce B. Downs Blvd, MDC 22
Tampa, Florida 33612-4766
www.health.usf.edu/nursing
Transforming Healthcare, Transforming Lives:
Creating the Nursing Leaders of Tomorrow and the Research
that Improves Health
54
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