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

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Richard Kyle
CIV USUHS
Wizard of Patient Simulation since 1997

USU Patient Simulation Laboratory