Innovation and Policies

Innovation Workshop Experiment

This is the MHI workshop we gave today and live broadcast. It was an Experiment and got cut out around first hour, but non-the-less I am excited about the possibilities. Looking forward to your comments. You also may need to fast forward a bit!

Monsters Inc and Simulation: Email from the Wizard

Below is the post of an email I received from the Society for Simulation In Healthcare (SSIH). I was originally written by Richard Kyle, the Wizard of Simulation since 1997. He has authored a book on simulation in healthcare here.

Here is the email! Would love to hear your comments!

So, just why is the training scene from Monsters, Inc., the best for training the trainers in using simulation?

Because of the massive error in the use of simulation as depicted within this movie: the key, the most essential teaching point "letting a real child through the door" IS NOT IN THIS TRAINING SIMULATION. It is in the movie, but makes zero contribution to the simulation depicted within the movie.

This essential point IS brought out in the TALKING that the boss gives AT the students (it was not a discussion, not a debrief, but a car-wash spray of words). Note that this talking at the students could take place anywhere: a public parking lot, an elevator, in a box with a fox, .... there was little need for a sim facility and no use of sim tools or methods made by the boss. His talk was a classic example of argument by authority, which was rejected in the Renaissance as a defective basis for learning the rules about how our world really works.

If this key point for would-be monsters was actually integrated into the sim, if the student does leave the door open, then a child would come through it, a mock disaster would occur, and the student would directly experience the consequences of "leaving the door open". This direct ingestion of a purposeful experience followed by digestion/integration through focused debriefing is sim-based learning. Presenting monologs within every expensive teaching spaces is not sim.





How does this observation about the sim depicted in this movie relate to you and your use of sim?

Generally
Anytime any authority figure is talking at the students while standing anywhere in a sim facility, then no one is doing sim, then little learning is happening as well, and no one else can use that sim facility for actual sim-based learning. Ever find yourself standing between your students and their synthetic patient (just like to do with real patients) while you talk about those actions that, in fact, could be done by your students on/to a synthetic patient? Is this the best use you can make of everyones' time and this very expensive teaching space? Whenever you observe this kind of low value activity, ask how you could be quiet and let consequences convey the lesson for the day.

Until you observe your students taking action, you really don't know what they can do, and their learning to do is the reason for their being students.

Until you observe your students taking an action, behaving in a certain way, the most you can say is "that topic was scheduled for a class at date/time".




Specifically
The number one teaching point "letting a real child through the door" and having the consequences happen to the student within the sim is a lot like the issue about patient death when the students do/don't prevent something lethal. Perhaps with a student's very first experience within your sim facility, the massive full consequences of the worst outcome (a patient's death, a child coming through the door) just might not be the most effective teaching. Perhaps for newcomers, a better teaching would be to hint those consequences, provide cues that death is oncoming but can be avoided but only if/then X, Y, Z, are done. Leave the patient suspended in air off the cliff for as long as it takes the new student to comprehend the seriousness of the situation, then let the student work out at and perform least one way to pull the patient back to safety. O2 Saturation values well below 90% for long durations of are excellent cues. During the debrief, the instructor must direct the students' attention to the damage to brain tissue from long periods of hypoxia by asking them to .




Curiously
Why do we ever resort to talking at students after they fail to learn what we said at them previously? Seriously, is not this form of repetitive action seeking an alternate outcome the very definition of insanity? Sure, talking at others does allow us to send out a lot of info very quickly, but is anyone ingesting, let alone digesting and integrating the meanings within our words? If lecture was a valuable teaching method, then why would any school have to take attendance?






Sim can be an excellent method for the students to learn through their errors in those ways that no one should allow in real life. Learning from the errors of others is the basis of all knowledge used in formal teaching. Now if only learning from those errors of others was as easy as being made aware of them ;)

Richard

________________________________
Richard Kyle
CIV USUHS
Wizard of Patient Simulation since 1997

USU Patient Simulation Laboratory

Thoughts on Patient Simulation

There is little research about it that is actually useful. In fact, I did an EBP project on simulation for increasing clinical competency. There are many research studies out there related to if people like simulation. Yeah, for the most part, people like simulation. Does it make a difference, beyond skills, but to make more competent practitioners? The initial research is coming out now. At Banner Healthcare Dr. Mark Smith showed a 50% increase in surgical skill rate using haptic based simulation and even just using the Marble Madness on the Nintendo Wii.
In the area of Human Patient Simulation (Simman, Meti) we are still wondering and researching. A review of the literature states that it is at least equal to problem based learning or the status quo in nursing and medicine now. So if it doesn’t hurt, why not use it, the research may show it is better.
I am currently working on a project with the Arizona Board of Nursing, Arizona State University, and Scottsdale Community College to assess competency of nurses whose license is on censure.
Working for Elsevier Publishing I was one of 3 authors on the Simulation Learning System, http://sls.elsevier.com Here we are trying to bridge the gap between nursing lecture and practice all while preparing you for the NCLEX.

There is no doubt, that if nothing else, simulation allows the faculty to identify knowledge gaps, put the nurse in the driver seat, and test new teaching techniques. And if you don’t believe any of it, you have to admit its better then sitting through a 5 hour lecture!

Please contact me with any questions!!!! dan(at)Simovativesolutions.com

Does this remind your of healthcare Administration?

What similarities do you see??? Is this totally off base??? Does it feel like things continue to be taken away from you??? Thoughts and Comments welcome!!!

Can It Be Done?

A colleague and I are starting a business related to bringing clinical answers to the bedside faster and easier. We are creating a robust, community driven database that, in time, contain evidence synthesis papers from all diseases and more!

I am posting this blog to ask if the following can be done.

If our company, or any company for that matter, could index enough evidence based practice synthesis papers would it be possible to combine specific data sets to create a picture of a complex patient?

Now that is slightly confusing so let me give a little background. While schmoozing on Twitter i asked what the problems were with services like Up To Date and Epocrates. Several uses spoke about how UTD was great for textbook cases but was difficult to use for complexly ill ones. Epocrates was said to be too slow and not enough detail for some users.

So, if UTD is textbook and a limited number of patients are textbook are we really treating patients as individuals and in the best way?

Of course this is a tough question to answer, but there has to be a better way. If it was possible to index EBP data by population, co-morbidity, treatment, & outcome, would it be possible to cross-connect data to create a clinical picture of an individual patient? I think back to this TED Talk here. When watching this, substitute the pictures with data about patients. Imagine if we could link the data together to create virtual data pictures of complexly ill patient.

No longer would we be treating patients diseases individually, but rather, the best treatments for the whole patient would be discovered and interconnected. The ICU patient with multiple system diseases could have a clinical picture just for them, specified down to the age, co-morbidity's, and outcomes desired. It moves beyond the linear medical model and begins to cross into a holistic approach to care. With enough data, and the addition of genomics, individualized treatment patterns based on gene data as well as clinical diagnosis would be available creating personalized treatment plans for all the individuals on earth.

This idea is VERY exciting for me and if you are interested in helping, or learning more about EBPico LLC please let me know.

But we must remember the initial question. Is a quest like this possible... please twitter me (@nursedan, email me dan(at)simovativesolutions.com, or comment with your thoughts.

Out Growing Blackboard and Angel Course Managers

The time has come to evolve! The Masters in Healthcare Innovation program at Arizona State University has officially become too robust and innovative for the traditional and proprietary course management system known as BlackBoard.

We are getting to a point now that we need to change too fast, the structure and limited bandwidth for uploads is hindering our ability to share ideas easily and quickly. We are now exploring utilizing free web tools to create our own, makeshift CMS system.

Although still under investigation and refinement, we are looking at FriendFeed as our central hub. Each student will create an account and share that account with the other students and faculty. For sharing up to date information on the students implementation of Innovative Leadership skills we will use Twitter. For presentation sharing, SlideShare. For group meetings and faculty office hours, Skype, and for papers Blogging.

Utilizing these tools we can begin to not only link all the assignments, courses, content, and successes together, but we can also share faster, better, and with the world.

This new direction will be under development in the coming semester starting in January. As we learn and grow this could be a new way to run courses, saving universities millions of dollars. The downside then becomes getting older faculty to adopt a new way of teaching, something that is not always easy.

We intend to share our successes and learning moments in blog form. If you have suggestions about tools that may be of use to us, please email me.

Hopefully, this will be creating a new way to conduct class and share information. Transparently.