Simulation Labs Making Us Better One Student at a Time

Report
SIMULATION LAB
Making Us Better One Student at a Time
Alexandra C. Snyder, B.S.
Division of Cardiovascular Perfusion
Medical University of South Carolina
November 9, 2011
Disclosures
 I have nothing to disclose
 I have no relationship with commercial
supporters
Objectives
 To examine the use of simulation in other industries
 To examine the current role of simulation in perfusion
 To discuss the advantages of training students using
simulation
 To consider what the future possibilities of perfusion
simulation may be
 To present students’ perspectives of simulation in their
perfusion education
Simulation in Other Professions
 Routinely used in aviation, the nuclear industry, NASA & in many
medical specialties
 Initial qualifications and beginning training
 Ongoing training and assessment/certification process
 Remedial training
 Add-on training for new techniques and skills
Simulation in Perfusion
 No high-stakes assessment of competency using
simulation is required by the ABCP for certification, recertification, or professional development
 Used primarily by perfusion schools and for research
 Investigation of human factors
 Few high-fidelity Orpheus perfusion simulators
available worldwide*
*ULCO Technologies, Sydney, NSW, Australia
Traditional Perfusion Training
 Basic science background
 Academic instruction with some lab sessions and
hands-on experience
 Clinical training as an apprenticeship process under
supervision of an instructor

“see one, do one, teach one”
Perfusion SimulatorA New Paradigm in Student Learning
Learn by Doing
Orpheus Perfusion Simulator
(Sim- Central Pty Ltd, Earlwood, New South Wales, Australia)
Orpheus Perfusion Simulator
“The easy to use, intuitive software
allows the Perfusionist Trainer to
control the simulator and execute
the training session manually, or use
a set of predefined scripts”
http://www.ulcotechnologies.com/products/orpheus
/orpheus.pdf
“The fidelity of the physiologic
monitoring is so realistic that our
students will not be simulating bypass,
they will be doing bypass on a
simulated patient”
-Bruce Searles
Simulation-Based Curriculum
 Initial skill development
 Skill Refinement
 Performance Assessment
 Emergency Procedures
SUNY Upstate’s Simulation Lab
Routine Bypass
Patient Emergencies
Equipment Malfunctions
Initiation of bypass
Blood loss
Aortic cannula
obstruction
Weaning from bypass
LV dysfunction
Oxygen supply failure
Cooling/Rewarming
Cardiac Arrhythmias
Pump power supply
failure
Use of centrifugal pumps
Failure of anticoagulation
Heat exchanger failure
Variations in patient
resistance
Air embolism
Monitor failure
Variations in patient
coagulability
Anaphylaxis
Aortic cannula
displacement
Use of
vasodilators/constrictors
Protamine reaction
Oxygenator failure
Use of vasoconstrictors
Transfusion reaction
Venous air entrainment
O2 consumption changes
Blood gas abnormalities
Circuit leaks
Benefits of Simulation Training
 Improved performance of individuals
 Long-term maintenance of proficiency
 Provides a real-time, safe setting without harming patients
 Instructors can devise training scenarios that will test certain
skills (“trigger events”)
 Coaching and Debriefing
 Improved patient safety
Sim Lab vs. Operating Room
Sim Lab
Operating Room
*Student-focused
*Patient-focused
-No room for mistakes
*Reinforces lectures
*Determined by random
case for the day
*Exposure to low volume, highrisk events frequently
*Experience determined
by cases
*Can demonstrate corrective
action
*No re-dos
*Unlimited experience
*Limited case load
*Clinical variety
*Experience based on
rotation and surgeon
Future Applications
 Human factors training
 Interprofessional education
 CPB for MDs
 Continuing medical education
 Simulation-based competency test
 Recertification (Re-CCP)
 Rehearse new procedures & devices
 Product development
 Patient Safety Research
Barriers to Simulation in Perfusion
 Limited number of high fidelity perfusion simulation centers
 Lack of validated & standardized evaluation instruments
 Lack of trained simulation facilitators
 Lack of agreed standards for simulation-based education
 Lack of simulators used for training in pediatric perfusion
The Student Perspective
Fernandez A. Simulation in perfusion: where do we go from here?. Perfusion. 2010;25(1):17-20.
The Student Perspective
 Thought simulation was beneficial prior to doing clinical
work
 Thought that the simulator was a good alternative to
doing a clinical case
 Thought that simulation should be used from the first
day of class through graduation
 Want more simulation!
Conclusions
 Simulation is commonly used to train professionals in
equally risky industries to improve critical skills and patient
safety
 Implementation of simulation into perfusion training is
currently in its infancy, but is proving worthwhile
 This modality has been used in the academic setting to
develop basic perfusion skills, gain experience, and
practice emergency procedures
 There is a role for simulation in the future of perfusion
beyond academics
 Student opinion supports full integration of simulation
training into their perfusion education
Acknowledgements
 Ashley Hodge, MBA, BS, FPP, CPP
 Joseph J. Sistino, CCP, MS, MPA
 Adam Fernandez, MPS, CCP
 Nicole Michaud, MSP, CCP
 Medical University of South Carolina
 Division of Cardiovascular Perfusion
 The American Society of Extracorporeal Technology
References
 Fernandez A. Simulation in perfusion: where do we go from here?. Perfusion.
2010;25(1):17-20.
 Issenberg SB, McGaghie WC, Hart IR, et al. Simulation technology for health care
professional skills training and assessment. JAMA. 1999;282(9):861-866.
 Ray RN. Simulation: its application in the nuclear power industry. Proc Indian
Acad Sci C1(4):345-59.
 Gaba DM. The future vision of simulation in health care. Qual Saf Health Care.
2004;13(Suppl 1):i2-i10.
 Sorensen B, Crane P. Cardiopulmonary bypass simulation training adapted from
air force flight simulation.
 Sistino JJ, Michaud NM, Sievert AN, Shackelford AG. Incorporating high fidelity
simulation into perfusion education. Perfusion. 2011;26(5):390-394.
 SUNY Upstate Medical University. "Upstate Leads Internationally in Perfusion
Simulation Training." SUNY Upstate Medical University. Web. 01 Nov. 2011.
<http://www.upstate.edu/chpalumni/>.
References
 Darling E, Searles B. Oxygenator change-out times: the value of a written protocol
and simulation exercises. Perfusion. 2010;25(3):141-143.
 Palanzo DA. Perfusion safety: defining the problem. Perfusion. 2005;20(4):195-203.
 Morris RW, Pybus DA. “Orpheus” cardiopulmonary bypass simulation system. J
Extra Corpor Technol. 2007;39(4):228-233.
 Ninomiya S, Tokaji M, Tokumine A, Kurosaki T. Virtual patient simulator for the
perfusion resource management drill. J Extra Corpor Technol. 2009;41(4):206-212.
 Ninomiya S, Tokumine A, Yasuda T, Tomizawa Y. Development of an educational
simulator system, ECCSIM-Lite, for the acquisition of basic perfusion techniques
and evaluation. J Artif Organs. 2007;10(4):201-205.
 Merry A. Human factors and the cardiac surgical team: a role for simulation. J
Extra Corpor Technol. 2007;39:264-266.
 Turkman A, Rosinki D, Noyes N. A simulator for perfusion training. Perfusion.
2007;22:397-400
Thank you for your time

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