Running the SIM exeperience

Image 1: Simulation set up for medical students with human
simulator. 

So as a simulation fellow, with hopes of soon becoming a simulation director, I am responsible for running simulation lab for my residents every month.  In order to do this, you have to develop cases and ensure that they are written and executed in a realistic way.  This insures that you get what is called learner "buy-in." one of the most challenging things to accomplish in simulation in my book.   I find that for those who have never been in simulation lab, the buy-in component comes a little easier.  But for the residents, who do simulation monthly, getting them to buy into the feigned realism can be a little bit tricky.

Image 2: Simulation set up for the OR.

What helps in this situation is the way that you write the case.  Give them something they haven't seen before or that will challenge them while caring for the simulated patient.  This takes the feeling of familiarity away from the situation, even though they are there monthly.  This challenge is what will keep them on their toes.

In addition, keep in mind that it becomes difficult to replicate the actual findings of what occurred with a patient, such as becoming lethargic and unresponsive.  One can mimic wounds, scars and physical findings with moulage, the sounds of fainting, or becoming very sick with vomiting through the human simulator, provide an emesis basin of blood or vomit, or even get the simulator to seize....  But often times because the simulator has limitations with real-time movement, you may want to consider the use of a standardized patient instead.  At times, I have played the role of the patients as a standardized patient.  Although I think this worked a little better as far as realism is concerned for the residents, I wasn't quite sure it was as effective as I had hoped because they are familiar with who I am and my role as an educator.

To solve this problem, I decided to start a standardized patient volunteer program with the medical students who are part of our simulation interest group.  In this way, having an unfamiliar body playing the role of the patient would contribute to the realism of the case.  Not only this, but it gives the students more of a sense of ownership to the simulation interest group as well, and helps to build their curriculum vitae with volunteer and educational opportunities.  

Image 3: The debriefing room 

Aside from case development, the biggest part of simulation is the debriefing portion at the end.  Its very important that there be a type of evaluation system for the learner.  Dive into the emotional component of the case.  Be sure to ask the learners to summarize the case, to ensure understanding.  Ask about their feelings regarding the case... did they feel that they did well?  What did they not do well?  Would they have done anything differently?

Image 4: Real time image of a simulation
session during UC Irvine Simulation
Instructor course. 

Once this evaluation portion is complete, ask the learners about what they know about the topic.  Do they know the presenting signs and symptoms?  Are they familiar with the management of that particular disease?  Do they know who appropriate consult services are that should become involved in the patients care, and the to which part of the hospital the patient should be admitted, ie the telemetry floor vs the ICU?

Some instructors use this discussion component of debriefing as the only method of learning.  Others, such as myself, like to supplement the debriefing session with a brief lecture outline the signs and symptoms, diagnosis, treatment and management of the particular illness, pitfalls, complications, etc, to reinforce the learning experience.  However you chose to conduct your debriefing, always remember that the most important component is asking the students how they felt, and challenging them to discuss what they already know and how they would alter their care in the future.

When all is said and done, your outcome will be successful!

Are you a simulation fellow, director or instructor?  How do you conduct your simulation sessions?  What works for you?   Please share your comments below!