pelc 021725

Transcript

• 00:00Started?
• 00:02Absolutely.
• 00:03I'm going to introduce you
• 00:04very officially.
• 00:06Panina is away on vacation,
• 00:08so I am I'm put
• 00:09in charge with Carina
• 00:11of doing your intro. So
• 00:12I'm gonna hopefully do you
• 00:13justice.
• 00:14So welcome to PELC friends,
• 00:16and happy Presidents' Day. We
• 00:18were we were just commenting
• 00:19on the fact that even
• 00:20though it's not a university
• 00:22holiday, I think, many faculty
• 00:24might have taken time off
• 00:25today to be with their,
• 00:27friends and family members who
• 00:29may also be off and
• 00:30not working. So I expect
• 00:32that in addition to our
• 00:33fabulous group who's,
• 00:35here presently on Zoom today,
• 00:37other people will have the
• 00:38opportunity to watch this virtually.
• 00:40So welcome to all.
• 00:42Doctor Isabelle Teresia Gross is
• 00:45an associate professor of pediatric
• 00:47emergency medicine.
• 00:48She serves as the director
• 00:49of the pediatric simulations
• 00:51teaching,
• 00:52all learner levels across the
• 00:54university and the hospital system.
• 00:56She is the incoming chief
• 00:57of the International Network for
• 00:59Simulation based Pediatric Innovation Research
• 01:01and Education, otherwise known as
• 01:03INSPIRE.
• 01:04And she cofounded the health
• 01:05care distance simulation collaborative, which
• 01:07is called HDFC,
• 01:09as well as the AI
• 01:10simulation health care collaborative.
• 01:12Doctor Grossen is is an
• 01:13amazing established simulation based researcher
• 01:16and research mentor for her
• 01:18international colleagues as well as
• 01:19those here at Yale.
• 01:21Her simulation based research focus
• 01:23is on distance simulation, international
• 01:25outreach simulation,
• 01:26and exploring new approaches in
• 01:27simulation based education, including using
• 01:30artificial intelligence.
• 01:32Isabelle is a wonderful friend,
• 01:34collaborator, and colleague, and I'm
• 01:36so delighted to welcome her
• 01:37to share her expertise with
• 01:38our group today. So take
• 01:40it away, Isabelle.
• 01:43Wonderful. Can everybody see the
• 01:45slide okay?
• 01:47We see it in presenter
• 01:48view, so I can see
• 01:49the Let me unshare again.
• 01:53K.
• 01:59How does that look?
• 02:01Perfect.
• 02:02Great.
• 02:03So welcome, everybody, and, also,
• 02:05welcome to the audience that
• 02:07might be, seeing this remotely
• 02:09or afterwards.
• 02:10I didn't realize this was
• 02:12president's day until
• 02:14I realized it this morning.
• 02:16So thank you so much
• 02:17for being here during this
• 02:18cold winter day in Connecticut.
• 02:20I'm very honored and excited
• 02:22to be here. Thank you
• 02:23so much, Lindsay, for your
• 02:25generous introduction. Lindsay Lindsay has
• 02:27been my mentor for many
• 02:28years. I always call her
• 02:29my female mentor.
• 02:31So thank you so much
• 02:32for that.
• 02:33Today, we will be talking
• 02:35about,
• 02:36pediatric simulation based medical education,
• 02:39basics, resources, and opportunities.
• 02:42I know that many here
• 02:43have extensive
• 02:45medical education background, so I'm
• 02:46hoping that we still have
• 02:47some nuggets for you,
• 02:49but there's also some basic
• 02:50information if this is a
• 02:51bit more new to you.
• 02:54I always have a bit
• 02:55hesitation
• 02:56giving a talk about a
• 02:57topic that
• 02:58questioning questions if talks are
• 03:00the way to teach adult
• 03:01learners.
• 03:03But I hope I mean,
• 03:04here we are. So I
• 03:05hope that,
• 03:06I will get to do
• 03:07simulations with all of you
• 03:08at some point.
• 03:10Please place any questions in
• 03:11the chat if you would
• 03:12like.
• 03:13And the moderator at the
• 03:14end, either Lindsay or Karina,
• 03:16you can facilitate the discussion.
• 03:17I will probably do all
• 03:18the questions at the end
• 03:19if that's okay.
• 03:21And at this time,
• 03:23if you could just put
• 03:24your role
• 03:25in medical education as well
• 03:26as your involvement in simulation
• 03:28training in the chat so
• 03:30we can get an idea
• 03:31of who
• 03:32of what because we know
• 03:33who each other is. Right?
• 03:34But we not know might
• 03:35not know exactly what we
• 03:37are all doing in in
• 03:38MedEd.
• 03:51Great. So Melissa is teaching
• 03:53PEM fellows. That's wonderful.
• 04:01Lindsey is teaching everyone.
• 04:07Excellent. Heather,
• 04:10pediatric hospitalist fellowship.
• 04:11Awesome.
• 04:14Clara, I really can't wait
• 04:15to work with you more.
• 04:16So that's gonna be great
• 04:17as well. Students, residents, APPs.
• 04:20So as this keeps going,
• 04:21you you all can keep,
• 04:23keep seeing what what everybody
• 04:24is doing. So I think
• 04:25this is a good audience
• 04:26actually for this talk. I
• 04:27was hoping to see these
• 04:28answers here. So that's wonderful.
• 04:33So I have nothing to
• 04:34disclose today. So let's get
• 04:36to our learning objectives. You
• 04:37probably saw them already on
• 04:38the flyer. We'll talk about
• 04:40very basic definition of simulation
• 04:42based medical education and debriefing
• 04:44to get everybody on the
• 04:45same page. We'll talk about
• 04:47how to apply simulation based
• 04:49medical education in diverse clinical
• 04:51settings. There will be some
• 04:53theoretical background here, so I
• 04:55hope you'll stay with me.
• 04:56But I try to make
• 04:57it fun, so hopefully, you'll
• 04:59you'll you'll take something away
• 05:00from it. And lastly, probably
• 05:02my favorite and the most
• 05:03exciting part is how to
• 05:04integrate simulation based methods into
• 05:06your
• 05:07medical education activities. So this
• 05:09will be concrete examples of
• 05:10what we have done, what
• 05:11I have done, what others
• 05:13have done at Yale to
• 05:14actually apply it.
• 05:17So let's talk about
• 05:19simulation first. What do we
• 05:20mean by simulation independent of
• 05:22health care? Right. So,
• 05:25simulations or environments are designed
• 05:27to closely approximate the real
• 05:29world situations to achieve a
• 05:31stated goal. Right. So what
• 05:32that means is you're simulating
• 05:34something.
• 05:35In our case, in our
• 05:36setting, we're simulating a situation
• 05:38that is designed mostly for
• 05:40education, assessment and quality improvement.
• 05:42I would say most of
• 05:43us use it for that.
• 05:44I mostly use it for
• 05:46education.
• 05:46Some of our colleagues actually
• 05:48use it more for systems
• 05:49testing and assessment.
• 05:53So
• 05:54I can't do a talk
• 05:54without a picture of the
• 05:56Simpsons.
• 05:58So why why are we
• 05:59doing simulations?
• 06:01So if you
• 06:02think about it, usually simulations
• 06:05in general are done in
• 06:06areas where
• 06:08real world training
• 06:10would maybe be either too
• 06:11costly or too dangerous. Like
• 06:13Homer is just reading the
• 06:14safety manual for the nuclear
• 06:16reactor, which might not be
• 06:17the way to train. A
• 06:18simulation would have served him
• 06:19better, I suppose.
• 06:21It is very widely used
• 06:23in the airline industry with
• 06:25NASA, the military, and nuclear
• 06:27powers, actually, for decades already.
• 06:29And I will tell you
• 06:30something that,
• 06:31became clear to me recently
• 06:33doing a keynote, doing one
• 06:34of our simulation presentations
• 06:36is that one of the
• 06:37big differences is really that
• 06:39in those
• 06:40areas,
• 06:41it's your own safety is
• 06:43on the line. Right? So
• 06:44in medicine, it's a little
• 06:45bit different
• 06:46because you are treating patients
• 06:47and their safety is on
• 06:48the line.
• 06:49At the same time, you
• 06:50will relate to it, but
• 06:51it's not you in the
• 06:52bed, it's the patient in
• 06:53the bed. So maybe that
• 06:54has really sparked things a
• 06:56little earlier in those other
• 06:57industries.
• 07:00Here you can see some
• 07:01very early simulators, which I
• 07:02love. I love that picture.
• 07:03So,
• 07:05Edwin Link, this is just
• 07:06a little history, had a
• 07:07passion for flying, but he
• 07:08couldn't afford the lessons because
• 07:10it was really expensive to
• 07:12get flying lessons in the
• 07:13early twenties of, of the
• 07:15twentieth century.
• 07:16So he developed his own
• 07:17flight simulator. It took him
• 07:19eighteen months to make it.
• 07:21It was a toy plane
• 07:22as you can see with,
• 07:23like, short wooden wings. Those
• 07:24wings are made from wood
• 07:25that you can see there.
• 07:27It had an electric pump
• 07:28to simulate the movements of
• 07:30the plane.
• 07:31And actually, companies started liking
• 07:33it and it got rapidly
• 07:35adopted by the military and
• 07:37it really revolutionized
• 07:38pilot training. You you can
• 07:39already see how it looks
• 07:41a bit like a flight
• 07:42simulator, doesn't it? So you
• 07:43crawl in there and,
• 07:46and you feel like you
• 07:47are flying, and you can
• 07:48maybe produce the hours
• 07:50needed to actually
• 07:52you know, that you're actually
• 07:53gonna need in the air
• 07:54that are gonna be so
• 07:55much more expensive, costly, right,
• 07:57and also risking your life
• 07:58up there.
• 08:01Here you can see a
• 08:03probably familiar face to most
• 08:05of you if you have
• 08:06done CPR training in your
• 08:07career.
• 08:08So,
• 08:09now we're in the sixties
• 08:10in our history lesson. So,
• 08:12Asmund Laerdal. Laerdal is probably
• 08:15a name that sounds familiar
• 08:17to most of you,
• 08:19because of the Laerdal company
• 08:20that makes simulation equipment. Right?
• 08:23So actually, Asmund Laerdal is
• 08:25a person in Norway, and
• 08:26he saved the life of
• 08:28his young son, Tora.
• 08:30Tora was drowning in some
• 08:32body of water. Actually, I'm
• 08:33not sure what where exactly
• 08:34he was drowning. And his
• 08:36father, Asmund, grabbed the boy
• 08:37out of the water just
• 08:39in time, cleared his airway,
• 08:40and Torre is still with
• 08:42us now,
• 08:43which is wonderful.
• 08:45At that time,
• 08:46Asmund Lardell was a toy,
• 08:49factory.
• 08:50Worked in a toy factory.
• 08:51He was a manufacturer for
• 08:53toys in in Norway, and
• 08:55his specialty was a very
• 08:56specific new soft plastic.
• 08:59So a few years later,
• 09:01I think, like, about five
• 09:02years later, he was approached
• 09:04to help make,
• 09:05a trainer to
• 09:07train that newly invented technique
• 09:09called CPR that all of
• 09:10us are familiar with, I
• 09:11hope. And he remembered his
• 09:13own experience with the sun
• 09:14drowning. So he became really
• 09:16passionate about this and moved
• 09:17away from making toys
• 09:19to making those simulators.
• 09:22So first, he developed a
• 09:23torso.
• 09:24It simulated
• 09:25an unconscious patient that needs
• 09:27CPR that you can give
• 09:29CPR to.
• 09:31It was really important to
• 09:32him though that the mannequin
• 09:34looks very natural. He didn't
• 09:36want something that looks like
• 09:37a toy or looks like
• 09:38a robot. He also felt
• 09:40that maybe a female
• 09:42doll might look a little
• 09:43bit less threatening to the
• 09:45trainees
• 09:46at the time. And then
• 09:47he remembered a mask at
• 09:48his grandparents' house, and he
• 09:49thought that
• 09:51the
• 09:52which
• 09:53is it's basically a person
• 09:55that was found in the
• 09:56Seine, which is a river
• 09:57in Paris.
• 09:59She she was dead at
• 10:00the time, but as you
• 10:01can as you can see
• 10:02in the picture in the
• 10:03lower right,
• 10:04she looks so peaceful and
• 10:05she looks so neutral.
• 10:07So he used her as
• 10:09a face for Versace Annie,
• 10:11which maybe you've heard that
• 10:13term before. Versace Annie is
• 10:14actually that first Laerdal simulator
• 10:17that you can see on
• 10:18these pictures as well.
• 10:20So, yeah, since then, since
• 10:22he is Tora is actually
• 10:23a really nice guy. He
• 10:25comes to all of our
• 10:26simulation conferences. He's always very
• 10:28interested and is totally down
• 10:29to earth. You can just
• 10:30come up to him, talk
• 10:31to him. You can just
• 10:33see that
• 10:34because of this early life
• 10:35experience, his life was saved.
• 10:37He's very passionate, and
• 10:40he his foundation invests a
• 10:42lot in,
• 10:43or funds a lot of
• 10:44low resource,
• 10:45setting
• 10:46research, so it's pretty impressive.
• 10:48There's a paper that's gonna
• 10:49come out soon in the
• 10:49New England Journal of Medicine
• 10:51improving
• 10:52maternal health in,
• 10:54low resourced countries. Pretty impressive
• 10:56work.
• 10:58And now marching through, you
• 10:59can see more and more
• 11:00computers here. You can listen
• 11:02to the heart. There's some
• 11:03sounds to this one in
• 11:04the sixties.
• 11:05You can see the first
• 11:06commute computer simulator. It was
• 11:09called sim one.
• 11:10I'm putting this one in
• 11:11there because I I thought
• 11:12it was kind of interesting
• 11:13that, it was developed in
• 11:15South in South California
• 11:17to train anesthesiology
• 11:18residents in endotracheal intubation and
• 11:20then maintaining their anesthesia. So
• 11:23So it has a computer,
• 11:25a console and also an
• 11:26anesthesia machine as well as
• 11:28the mannequin that you can
• 11:29see.
• 11:30You could feel a heartbeat,
• 11:31temporal carotid, pulses, blood pressure.
• 11:34So it was pretty realistic.
• 11:35If you look at it,
• 11:36it looks like a person,
• 11:37doesn't it?
• 11:38But the problem was it
• 11:39was so expensive, a hundred
• 11:41thousand dollars. So, that was
• 11:43not sustainable. So they only
• 11:44ever made one, didn't maintain
• 11:46it, no idea where it's
• 11:47now.
• 11:49This is the then they
• 11:50in the eighties,
• 11:51we started having the first
• 11:53computerized mannequins. That's also when
• 11:55we start seeing our first
• 11:57medical simulation based literature coming
• 11:59out. Like,
• 12:00I would say most of
• 12:01the relevant articles started coming
• 12:03out around then. And here,
• 12:05this guy looks familiar to
• 12:06you, doesn't it? This is
• 12:07Laertal's SimMan. It's a portable
• 12:10simulator really making things so
• 12:12much easier because now you
• 12:13can take simulation into your
• 12:15clinical setting, do something that's
• 12:17called in situ simulations as
• 12:18well.
• 12:22See one, do one, teach
• 12:23one. Doesn't that sound familiar?
• 12:26It used to be in
• 12:27medicine, and to a certain
• 12:28degree, it probably still is
• 12:30that we use this approach
• 12:31of see one, do one,
• 12:32teach one. It's probably fine
• 12:34in some situations, and it
• 12:36works too. But it does
• 12:38put the patients at risk
• 12:39that the trainees
• 12:41learn on in their early
• 12:42so it it's really risky
• 12:44for the patients if the
• 12:45trainee is still in their
• 12:46early stages of learning. Right?
• 12:47Would you like to be
• 12:48this patient?
• 12:50Maybe not. Right. If the
• 12:51trainee hasn't really done this
• 12:52before and he just saw
• 12:54one and then did one
• 12:55and then taught one, maybe
• 12:57not the right approach.
• 12:58Because if that was the
• 12:59case with pilots,
• 13:01what if your pilot was
• 13:02trained this way? Would you
• 13:03how would you feel about
• 13:04getting on this plane? Right?
• 13:06There are reasons why the
• 13:07airline industry fortunately is considered
• 13:09pretty safe. And one of
• 13:10those reasons is probably their
• 13:12solid simulation program before a
• 13:14pilot
• 13:16even ever enters a cockpit,
• 13:18of a of a real
• 13:19plane. I must say, I
• 13:20don't know too many pilots.
• 13:21I don't know exactly how
• 13:22their training works, but I
• 13:24sure hope that they do
• 13:24a lot of simulation training
• 13:26as we as we all
• 13:27think.
• 13:30So now how do we
• 13:31apply simulation based medical education
• 13:34in diverse
• 13:36clinical settings? So here we're
• 13:38going to dive into a
• 13:39little bit of background,
• 13:41of simulation training. So
• 13:44simulation and medical education.
• 13:46What types of educational methods
• 13:48could we think of? So
• 13:49let's see.
• 13:51We can do what I
• 13:52would call here traditional medical
• 13:55education. Let's just call it
• 13:56that for now. That would
• 13:58include
• 13:59lectures, workshops,
• 14:01bedside teaching,
• 14:02also the see one, do
• 14:03one, teach one approach as
• 14:05we mentioned above.
• 14:06Then we can
• 14:08start integrating simulation into our
• 14:10medical education strategy.
• 14:12That way, competency can be
• 14:14achieved before
• 14:15the learner reaches the patient.
• 14:18At that at the same
• 14:19time, simulations can still match
• 14:22real life scenarios
• 14:24as well. Right? So this
• 14:25would make me feel a
• 14:26little bit better as a
• 14:27patient or also if one
• 14:28of my loved ones is
• 14:30a patient. Right? So lectures
• 14:31and workshops are great. We're
• 14:32doing lecture today, which is
• 14:34fine.
• 14:36But, of course, if you
• 14:37integrate simulations
• 14:39into your training, that might
• 14:40actually be beneficial, and we'll
• 14:42talk about some logistics supporting
• 14:44that later on.
• 14:45And then within our simulation
• 14:48experience, we can create an
• 14:49environment for experiential learning
• 14:52that will allow hopefully for
• 14:53concrete experiences for participants potentially
• 14:56with active feedback,
• 14:58reflections, and debriefings.
• 15:00I would suggest actually more
• 15:01debriefings than feedback. We'll talk
• 15:03about that later. And there's
• 15:04also an option for being
• 15:06videotaped
• 15:07but you
• 15:08can sort of
• 15:10see yourself acting in the
• 15:12real scenario
• 15:14and give yourself feedback. Right?
• 15:15Because you could see what
• 15:16you did or didn't do.
• 15:18I personally rarely use it
• 15:19in my debriefings,
• 15:21but of course, it depends
• 15:22on your learning objectives.
• 15:24Most of my
• 15:25debriefings are actually done in
• 15:26situ, so I don't usually
• 15:28use video debriefings,
• 15:30but maybe some others have
• 15:31and we can discuss it
• 15:32later if you'd like. It's
• 15:33a whole body of literature
• 15:34on video debriefings as well.
• 15:38Let's talk about some uniquenessness
• 15:40in medical education
• 15:42and training, which is what
• 15:44all of us do. Right?
• 15:45So first,
• 15:47most of the times you
• 15:47will be interacting with adult
• 15:49learners,
• 15:50and they will require very
• 15:52different teaching approaches than children
• 15:54and adolescents might need.
• 15:57I say that not teaching
• 15:59children and adolescents. It might
• 16:01be that there is more
• 16:02overlap than we know, so
• 16:03let's get out of our
• 16:04silos more in the future.
• 16:06As an educator,
• 16:07for an adult learner,
• 16:09you should aim for being
• 16:10a facilitator,
• 16:11not necessarily a didactic
• 16:14teacher, although there is a
• 16:15place and time for that
• 16:16as well. Of course, It's
• 16:18really important to spend some
• 16:19time. So basically, the learners
• 16:21here to learn. They're self
• 16:22determined most of the time.
• 16:25They want to develop as
• 16:26individuals. Right? And I can
• 16:28relate to that as a
• 16:29as an adult learner myself.
• 16:30Right? You don't want to
• 16:31just learn a skill. You
• 16:32want to become better at
• 16:34what you're doing.
• 16:38If you are
• 16:39an educator for adult learners,
• 16:41as I just mentioned, you're
• 16:43a facilitator more than just
• 16:44a teacher that is just
• 16:45telling people what to do.
• 16:46It's sometimes tempting to do.
• 16:47Right? Especially if we're in
• 16:49a rush at the bedside,
• 16:50I just wanna say what
• 16:51what needs to be done,
• 16:52which is fine too. In
• 16:53simulation, we try to facilitate
• 16:55instead of just tell what
• 16:57needs to happen.
• 16:59I will say for curriculum
• 17:01development, I actually just met
• 17:02with, Daniella,
• 17:04last week and we were
• 17:05talking about curriculum development for
• 17:07a moment. It is really
• 17:08important to spend some time
• 17:10developing your curriculum. And if
• 17:12you don't have financial
• 17:14knowledge in curriculum development,
• 17:16phone a friend like Lindsey
• 17:17Johnson and
• 17:19Melissa Langham or others, on
• 17:21this call, actually, who have
• 17:23extensive experience in curriculum development.
• 17:25It's really worth the extra
• 17:27mile to make sure it's
• 17:28done well
• 17:29based on known frameworks.
• 17:31You don't need to reinvent
• 17:32the wheel, and you really
• 17:33shouldn't reinvent the wheel because
• 17:35you might not be inventing
• 17:36it the way they should
• 17:37be invented.
• 17:38Lastly, feedback and debriefing, really
• 17:40important skills,
• 17:42to also dedicate some time
• 17:43to exploring and
• 17:45actually getting more education about.
• 17:47I would say, for me,
• 17:48debriefing is the is the
• 17:49most important thing about my
• 17:51simulation experiences.
• 17:53But, of course, everybody,
• 17:55does it differently.
• 17:56There's so much literature out
• 17:58there. There are people dedicating
• 17:59their whole careers to specific
• 18:01debriefing styles, so
• 18:03look into it. It's fun.
• 18:09Alright. So then there it
• 18:10is important specifically for your
• 18:12adult learners
• 18:13that you repeat skills and
• 18:15practice them over on over
• 18:18again. Right? So because repetition
• 18:20enhances your skill set acquisition.
• 18:22For example, with an intubation.
• 18:24Right? Your Your technical skill
• 18:26is how to intubate.
• 18:28Your cognitive skill
• 18:30is
• 18:31when to intubate, for example.
• 18:33Right? And the behavioral skill
• 18:35would be the coordination of
• 18:36your team doing the respiratory
• 18:38arrest. So now you're not
• 18:39you're going away from just
• 18:41your,
• 18:42plain task of the intubation
• 18:44technique. How do you do
• 18:45it? You're going away from
• 18:46that and you're moving towards
• 18:48integrating that into your scenario.
• 18:52The safe learning environment. This
• 18:54is particularly important for the
• 18:56more experienced
• 18:57learner. There might be a
• 18:59fear of failure being watched
• 19:00while mistakes happen. And
• 19:03we have actually, for example,
• 19:04just had a faculty procedure
• 19:06day for our pediatric emergency
• 19:07medicine attendings,
• 19:09and we really carefully considered
• 19:11psychological and emotional safety in
• 19:13the planning process. For example,
• 19:15we invited specialists to teach
• 19:18the procedure to our learners.
• 19:20So the attendings, in our
• 19:21case,
• 19:22could feel comfortable
• 19:24not knowing something or doing
• 19:25something maybe not correctly.
• 19:27We also did not invite
• 19:29any trainees to these sessions
• 19:30even though there was a
• 19:32lot of interest on the
• 19:33trainee side, actually, of course,
• 19:35to see their attendings exploring
• 19:37the edges of their skills
• 19:38and knowledge.
• 19:40But this really lacked allowed
• 19:41for a very relaxed approach,
• 19:44and I would say it
• 19:44went really well. I know
• 19:46that, miss Melissa was there
• 19:47as well and and others.
• 19:51Of course, ultimately, that will
• 19:53improve, hopefully, patient safety
• 19:55and the quality of our
• 19:57care.
• 19:59So does simulation education actually
• 20:01work? Yes. It does.
• 20:04And I don't just say
• 20:05that.
• 20:05This article is actually an
• 20:07article that I, that I
• 20:08recommended reading.
• 20:10It is something that I
• 20:11usually recommend reading when I'm
• 20:13doing
• 20:14review my review activities for
• 20:16the flagship
• 20:17chip journal of the Society
• 20:18for Simulation Health Care.
• 20:20This was done by Cook
• 20:22et al. They looked
• 20:25at, does simulation work? They
• 20:26looked at all those articles
• 20:28where we did simulation versus
• 20:30nothing
• 20:31and wanted to see, does
• 20:32simulation training make your training
• 20:34better? They looked at almost
• 20:36eleven thousand articles,
• 20:38a hundred and thirty seven
• 20:39randomized studies,
• 20:43enrolling
• 20:44thirty about thirty five thousand
• 20:45trainees. So huge. And as
• 20:47you can see, don't look
• 20:48at this in detail, but
• 20:49you can see that, the
• 20:50left side would favor the
• 20:52intervention.
• 20:53The other one favors the
• 20:54simulation. You can see that
• 20:55pretty much all the studies
• 20:57were favoring the simulation. The
• 20:59effect of that was actually
• 21:00the stronger, the higher quality,
• 21:02and the larger the study
• 21:03was. So, it's really,
• 21:06very impressive.
• 21:08So the essence of the
• 21:09conclusion of this article is
• 21:10first, don't do more studies
• 21:12just looking at,
• 21:14at no intervention. So simulation
• 21:16does something. And,
• 21:18and we need to really
• 21:19elevate the sophistication
• 21:20of of looking into our
• 21:21simulation based research.
• 21:24The largest effect outcomes were
• 21:25seen in knowledge, skills, behaviors,
• 21:28and moderate inpatient outcomes.
• 21:31As many of the simulation
• 21:33researchers on this call know,
• 21:34it's the holy grail to
• 21:35get to the patient outcomes.
• 21:37So first, we need to
• 21:38focus on,
• 21:39Kirkpatrick
• 21:40level one and two, which
• 21:42would be knowledge, skills, behaviors
• 21:43to see,
• 21:45you know, that we improve
• 21:46those first.
• 21:50Alright.
• 21:51Stay with me here. We're
• 21:52going to dive more into
• 21:54theory learning theory. It'll get
• 21:56lighter later on. I promise.
• 21:57But this is actually really
• 21:58cool and interesting. So,
• 22:00let's do this together. Okay?
• 22:01Let's talk about some learning
• 22:03theories that you can apply
• 22:04in your simulation based education.
• 22:08So we have the behaviorism
• 22:10approach, cognitivism, and constructivism.
• 22:13The initial work in simulation
• 22:15based education focused
• 22:16mostly on the behaviorist approach.
• 22:19So you place people in
• 22:20a simulated environment and when
• 22:22they make mistakes, you give
• 22:23them feedback and then they
• 22:25correct
• 22:26their actions. Right? So that
• 22:27would be that first box
• 22:28that you can see here.
• 22:31With the cognitive revolution in
• 22:32the sixties, there was more
• 22:33and more focus placed on,
• 22:36the cognition behind your behaviors
• 22:38and decisions. Like, why did
• 22:39you do it?
• 22:40We'll talk about this actually
• 22:42more when we move into
• 22:43the feedback debriefing,
• 22:46the part of this talk
• 22:47later on. So this is
• 22:49really more exploring why did
• 22:51you do certain things.
• 22:52The constructivism
• 22:53refers to learning to your
• 22:56individual experience and interacting in
• 22:58the clinical environment. So this
• 22:59is very learner centric.
• 23:01And so the learners here
• 23:02built their built on their
• 23:04own previous experiences.
• 23:08Often the problem is making
• 23:09sure that your learners are
• 23:11getting to see what they
• 23:12need to see in their
• 23:13clinical environment. Right? We struggle
• 23:15with that. Do they see
• 23:16enough of a certain diagnosis?
• 23:18Do they do enough procedures?
• 23:19Certain scenarios they might not
• 23:21see very often. Right?
• 23:24So there is a theory
• 23:25in cognition
• 23:27cognitive reasoning that students need
• 23:29to see several
• 23:30representative
• 23:31examples of a condition or
• 23:34scenario that would allow them
• 23:35to create their mental model.
• 23:36So it doesn't help to
• 23:38just
• 23:39see one scenario
• 23:41of,
• 23:42let's say,
• 23:44a
• 23:45an NAT case.
• 23:46If you just see one
• 23:48one that might not fully
• 23:50train you, you need to
• 23:51actually see it from different
• 23:53angles. And if you can
• 23:54do that if you can't
• 23:55do that in the clinical
• 23:56environment, but you have enough
• 23:57patient volume where patients where
• 23:59your learners are exposed over
• 24:01and over again to the
• 24:02same concept,
• 24:03it is actually a great
• 24:04tool to use simulation for
• 24:06this.
• 24:07Of course, it gives you
• 24:08a safe environment, right, where
• 24:09you can experiment. You can
• 24:10use novel
• 24:12try out novel conditions. Remember
• 24:13when COVID came out and
• 24:14we did all those COVID
• 24:16scenarios so you can play
• 24:17out how would it be
• 24:18if we had a case
• 24:19here? What if we need
• 24:19to decontaminate?
• 24:22So it's a nice little
• 24:23sandbox.
• 24:24That's what I like about
• 24:25participating in SIMS that you
• 24:27can try things that might
• 24:28be out of your comfort
• 24:29zone.
• 24:32This circle, I think most
• 24:34of you probably have seen.
• 24:35This is the experiential
• 24:37learning model after
• 24:38Kolb. So first,
• 24:40you have a concrete experience
• 24:42right up top. The concrete
• 24:43experience,
• 24:44that could be a simulation
• 24:46scenario.
• 24:47Then you can reflect on
• 24:48the scenario,
• 24:49your reflection observation phase
• 24:51reflective observation phase. You reflect
• 24:54on it, and then you
• 24:54test it again, either in
• 24:56a new simulation or in
• 24:57a clinical environment.
• 24:59And then it's this repeat
• 25:01scenario that is interesting because
• 25:03it allows for deliberate practice.
• 25:06Okay? So and then you
• 25:07go back to the your
• 25:08concrete experience and then you
• 25:09reflect again, and that's how
• 25:11you build your experience.
• 25:14And I just mentioned the
• 25:15word deliberate practice. Deliberate practice
• 25:17is something you all know.
• 25:18It's just the question if
• 25:19you know that term. Right?
• 25:20So let's talk about deliberate
• 25:22practice for a moment. On
• 25:23the upper left, you can
• 25:24see
• 25:25a gymnast, I would say,
• 25:27flying
• 25:28gracefully through the air. Then
• 25:29you see on the right
• 25:30side a concert pianist that
• 25:32is just putting the audience
• 25:33out.
• 25:34You see on the left
• 25:36lower side a trial attorney
• 25:37that's breaking down the defendant's
• 25:39argument. Very impressive.
• 25:42Then you can see a
• 25:43clinical expert doing surgery, and
• 25:45it looks so effortless when
• 25:46he does it. But if
• 25:47you were to try, you
• 25:47probably couldn't do it. So
• 25:49despite the fact that these
• 25:50professionals are all performing in
• 25:52very different fields,
• 25:54they actually probably followed a
• 25:56similar path in
• 25:57their expertise, which is deliberate
• 25:59practice. So if you want
• 26:00to be a world class
• 26:01soccer player,
• 26:03it's more than just playing
• 26:04soccer games over and over
• 26:05again. Right? So they need
• 26:06to work on specific skills
• 26:08such as running, strength training,
• 26:10coordination.
• 26:12And they need a coach
• 26:13that's gonna provide them specific
• 26:15feedback immediately. And there need
• 26:16to be performance standards. That
• 26:18all sounds familiar, doesn't it,
• 26:20to our medical practice where
• 26:22if you want to run
• 26:23a successful resuscitation,
• 26:25you have to have a
• 26:26lot
• 26:27of different skills that you
• 26:29must have. You need to
• 26:30work on teamwork and communication
• 26:31skills and leadership skills. So,
• 26:35yeah,
• 26:37it does apply in many
• 26:38different areas. I got this
• 26:39from a journal from the
• 26:40New York Indian Journal of
• 26:41Medicine two thousand twenty two.
• 26:43I kind of like this
• 26:44picture actually for to to
• 26:46get an idea about deliberate
• 26:47practice in medicine.
• 26:49So,
• 26:49in medicine, learners can
• 26:52also practice
• 26:53specific skills and receive precise
• 26:55feedback
• 26:56to improve their performance.
• 26:58And what was really interesting
• 26:59to me that came out
• 27:00of this article is, as
• 27:01you can see, right, so
• 27:02as you do a deliberate
• 27:03practice, you get better and
• 27:04better and better. If you
• 27:05don't do it, you
• 27:07also get better, but maybe
• 27:08not as fast. What was
• 27:09interesting to me is that
• 27:10the average US residency graduate
• 27:13is likely to complete only
• 27:14two thousand five hundred to
• 27:16three thousand hours of deliberate
• 27:18practice and clinical reasoning
• 27:20during their clinical years in
• 27:21med school and residency.
• 27:23So
• 27:25I think most of you
• 27:26have probably heard that number
• 27:27of ten thousand hours to
• 27:28reach mastery. Right? Right? So
• 27:30two and a half thousand
• 27:31or three thousand doesn't cut
• 27:33it. Right?
• 27:34And
• 27:35simulation can help in that
• 27:36case.
• 27:37And we do hear this
• 27:39subjectively also from our trainees.
• 27:41Right? Right now the ACGME
• 27:42survey is out. Everybody's going
• 27:44to rank the programs.
• 27:45And they might comment on
• 27:47concerns about decreased procedural exposure
• 27:50overall because that's just how
• 27:51medicine is right now. There
• 27:52are fortunately
• 27:54less, let's say, less lumbar
• 27:55punctures in infants because they
• 27:57the guidelines have changed. And,
• 28:00so simulation can help here.
• 28:02We did this recently with
• 28:04our medic med peds residents,
• 28:06specifically doing a procedural academic
• 28:08half day where we incorporate
• 28:10more and we're also incorporating
• 28:12more procedures intentionally, which with
• 28:14our Tuesday pediatric simulations, allowing
• 28:16for more
• 28:17IO placements, even intubations no
• 28:20matter if the resident will
• 28:21use them later on or
• 28:22not.
• 28:23I'm actually really passionate about
• 28:25this.
• 28:28When teaching our learners,
• 28:30we really should aim to
• 28:32provide experiences
• 28:34that are tailored to
• 28:36the student's
• 28:37ability level. Easier said than
• 28:39done. Right? If it's too
• 28:41easy, they get bored. If
• 28:42it's too difficult, they're overwhelmed.
• 28:44Right? So this is why
• 28:45I like this picture actually
• 28:46from I'm probably saying this
• 28:48wrong. Vygotsky.
• 28:49Those are the zone. It's
• 28:51called the zone of proximal
• 28:52development. But if you have
• 28:53this in your head when
• 28:54you're doing your sims, you
• 28:55can tie trade your sims
• 28:57to the learner's stress level
• 28:59and the learner's experience level.
• 29:01It's quite fun, actually. So
• 29:02here you can see what
• 29:03people can do in the
• 29:04middle, that green little,
• 29:07round, bubble.
• 29:08So this is what people
• 29:09represents what people can already
• 29:10do. Right?
• 29:12So that will be too
• 29:13easy. If you do these
• 29:14things, they're gonna be bored.
• 29:15Then there is the area
• 29:17on the outside, the blue
• 29:19things that they can't do
• 29:20that's outside. That will be
• 29:21too difficult. So the sweet
• 29:22spot is we're really in
• 29:23that zone here in purple
• 29:26where
• 29:27which says what I can
• 29:29do with help.
• 29:30And that's what we call
• 29:31the zone of proximal development.
• 29:33Fancy term for something that
• 29:34is probably actually pretty easy
• 29:37to understand.
• 29:40Let's talk about fidelity for
• 29:41a moment. I'm sure you've
• 29:42used the word fidelity
• 29:44a lot in your career
• 29:45and you've maybe heard it
• 29:46a lot. But what it
• 29:47actually stands for, we need
• 29:48to really talk about that
• 29:50because
• 29:51we need to match our
• 29:52learning objectives
• 29:53to the realism. How much
• 29:55realism is actually needed? And
• 29:57that depends on your learning
• 29:58objectives.
• 30:00There are many different components
• 30:02that go into determining
• 30:03fidelity of a clinical simulation
• 30:05experience.
• 30:06As you can see, some
• 30:08components just simplified up here.
• 30:10So you can have you
• 30:11can we can talk about
• 30:12the equipment fidelity on the
• 30:14upper right. That's the degree
• 30:15to which the simulator
• 30:17replicates
• 30:18or duplicates the appearance
• 30:21and feel of the real
• 30:23system. So an example would
• 30:24be a flight simulator with
• 30:26an appropriate cockpit layout. Right?
• 30:28So does it match the
• 30:29real cockpit? That's the question
• 30:30for the equipment.
• 30:33Talking about environmental
• 30:34fidelity,
• 30:36this the question is, does
• 30:38the simulation environment duplicate
• 30:40your sensory information? For example,
• 30:43visual cues, maybe the monitor
• 30:45alarming. A good example for
• 30:46this would actually be our
• 30:47insight to simulation in the
• 30:49pediatric trauma bay, right, or
• 30:50on the pediatric floors where
• 30:52you're in your environment and
• 30:53you're hearing the sounds you
• 30:54would be hearing, you're seeing
• 30:56the things you would be
• 30:56seeing. So that's really representing
• 30:58the, environment.
• 31:00Psychological fidelity is the degree
• 31:03to which the learner perceives
• 31:04the simulation to be believable
• 31:06and to be a believable
• 31:08surrogate
• 31:09for the train task or
• 31:11experience. I find psychological,
• 31:14fidelity actually the most interesting.
• 31:16Do we need a lot
• 31:17of high technology in order
• 31:18to maintain a lot level
• 31:20of psychological fidelity? And
• 31:22what factors go into that
• 31:24to make that happen? Right?
• 31:26For example, if you look
• 31:28at at least two. Right?
• 31:29So you can see a
• 31:30high fidelity mannequin, so called
• 31:32high fidelity, I would say
• 31:33high technology probably, on the
• 31:35left upper side,
• 31:36offers moderate physical
• 31:38realism, allows for some conceptual
• 31:40realism. Right? And assists with
• 31:42emotional realism too. But it
• 31:44does not provide a high
• 31:45level,
• 31:47for any any of those.
• 31:48Then look at the IV
• 31:49pole to the right. It's
• 31:50extremely high in physical realism
• 31:52and fidelity. Right? It looks
• 31:54much more than an IV
• 31:55pole then,
• 31:56the mannequin that's lying in
• 31:57the bed would look like
• 31:59a like a man, right,
• 32:00or a person.
• 32:03But by its nature, the
• 32:04IV pole offers no emotional
• 32:06realism and depending on the
• 32:07objectives, little conceptual realism.
• 32:10So what do we need
• 32:11for high fidelity? Again, it
• 32:13depends on your objectives. First,
• 32:14you need to determine your
• 32:16objectives,
• 32:17which is probably something, Lindsay
• 32:19would preach.
• 32:20Then you can choose the
• 32:21appropriate fidelity and technology level,
• 32:24and sometimes you can balance
• 32:26your resources. So technology can
• 32:28be very expensive. Right? So
• 32:29it is really okay to
• 32:30use lower technology
• 32:32solutions,
• 32:34as long as you can
• 32:35achieve appropriate
• 32:36fidelity.
• 32:40Suspension of disbelief. If you
• 32:42increase your fidelity, it allows
• 32:44your learners to suspend disbelief.
• 32:45They will buy into your
• 32:47fiction contract. Right? Having said
• 32:49that, high realism doesn't always
• 32:51mean better learning.
• 32:53It may actually have more
• 32:55to do with presence, and
• 32:57I've experienced that certainly with
• 32:58my learners. So how much
• 32:59your learners truly believe they're
• 33:01in an artificial environment.
• 33:02Just like here, the child
• 33:03is getting such a great
• 33:04experience at Disney right now
• 33:06because he believes that he's
• 33:07talking to Cinderella.
• 33:09So I I actually love
• 33:11that, comparison for suspension of
• 33:13belief. And sometimes I use
• 33:14that example in my sense.
• 33:16Just a little recommendation.
• 33:18I cannot do a talk
• 33:19about simulation without talking about
• 33:21your briefing for just a
• 33:22moment.
• 33:23David Gaba is one of
• 33:24the early,
• 33:25simulationists
• 33:26in,
• 33:28in our simulation world,
• 33:31who said that his his
• 33:32definition early on was already
• 33:34it's a that debriefing is
• 33:36a facilitated or guided reflection
• 33:37in the cycle of learning
• 33:39experience. So the goal is
• 33:41you have learners and you
• 33:42have the facilitators.
• 33:43The learners need to bring
• 33:44to the table the active
• 33:46participation,
• 33:47and then the facilitators
• 33:49guide the discussion,
• 33:50identify gaps, and help close
• 33:52those gaps.
• 33:57So if there if there
• 33:58was such a thing as
• 33:59a as a as an
• 34:01exam, like a a site
• 34:02exam on simulation practice, people
• 34:04would get the question, please
• 34:06define the difference between debriefing
• 34:08and feedback. Really important because,
• 34:11in most,
• 34:14yeah, I mean, in most
• 34:15cases, feedback is just different
• 34:16to debriefing. Right? So feedback
• 34:18is you give get information
• 34:20about your behavior to improve
• 34:22your performance in the future.
• 34:24Debriefing is an interaction. As
• 34:25you can see, the arrows
• 34:27go back and forth. It's
• 34:28not just from the teacher
• 34:29to the learner. It's going
• 34:30from a facilitator to a
• 34:31learner back and forth through
• 34:33a conversation,
• 34:35through,
• 34:36reflection.
• 34:39And simulation
• 34:40literature identified feedback in the
• 34:42form of debriefing as the
• 34:43most important feature of the
• 34:44simulation based education. So
• 34:47despite there being pretty few
• 34:49papers telling you how to
• 34:51best debrief,
• 34:52most will say you should
• 34:54debrief. We actually recently completed
• 34:56a systematic review on this
• 34:57topic as part of the
• 34:58Society of Simulation Healthcare Research
• 35:00Summit.
• 35:01Also found lots of literature.
• 35:03We still we still don't
• 35:04have clear guidance of what
• 35:06debriefing style works best, so
• 35:08pick which one you
• 35:10like. This is what I
• 35:11would consider more like a
• 35:13yeah okay not that. So
• 35:14in the debriefing you start
• 35:16with having
• 35:18your own frame on the
• 35:19left. You can see that
• 35:20right. Then you're in the
• 35:22sim. You do an action
• 35:23and there are certain results.
• 35:25Then you talk about it
• 35:26in the debrief
• 35:27and that might later change
• 35:29your actions. Right? And the
• 35:30debrief might also change your
• 35:32frame. And then you do
• 35:33your next scenario or clinical
• 35:34experience.
• 35:35You might have different results.
• 35:36Now reflect again. Go back
• 35:38to your frame that might
• 35:39have changed or your actions
• 35:40might change.
• 35:44There are different debriefing methods.
• 35:46And just in honor of
• 35:47the efforts at Bridgeport Hospital
• 35:49with a new simulation,
• 35:51debriefing technique, I would like
• 35:52to just point this out.
• 35:54This is a post scenario
• 35:55debrief, which is what most
• 35:56of you guys would probably
• 35:58consider a debrief.
• 35:59You start at the beginning
• 36:00of the scenario. You go
• 36:02all the way to the
• 36:02end and talk about it.
• 36:04There's something that's called rapid
• 36:06cycle deliberate practice
• 36:08where actually you start in
• 36:09the beginning, you go to
• 36:10a certain milestone,
• 36:12you get very direct feedback.
• 36:13You go to the next
• 36:14milestone, you get direct feedback.
• 36:16You either go all the
• 36:16way to the back again
• 36:17or you just go back
• 36:18to the previous milestone. I'm
• 36:20going to show you on
• 36:20an example. It's going to
• 36:21be easier. For example, you
• 36:23have an eight month old
• 36:24bronchiolitic patient. Right? So your
• 36:26first milestone might
• 36:27be recognize that there is
• 36:29respiratory distress. If the patient
• 36:31if the learners didn't do
• 36:32it, you go back to
• 36:34the beginning and do it
• 36:35again. Now they've recognized it
• 36:37so they can go further
• 36:38right up to backmask ventilation.
• 36:39They get feedback, they go
• 36:41back and then calling for
• 36:42help using the braslo tape
• 36:44intubating. So that way you
• 36:45work your way through the
• 36:46scenario.
• 36:47If you're interested in learning
• 36:48more about different debriefing styles,
• 36:50I would actually recommend
• 36:52this resource, which is the
• 36:53Yale Center for Healthcare Simulation.
• 36:56They have different debriefing courses,
• 36:59for you available for you
• 37:00to take. I think all
• 37:01of us should, should take
• 37:03them. I think most of
• 37:03the people on the call
• 37:04actually have taken a course
• 37:06at the simulation center. I
• 37:07highly, highly recommend that.
• 37:13So we're doing so good
• 37:14with time. I'm so happy.
• 37:16So in the last part
• 37:17of this talk, I would
• 37:17like to just talk about
• 37:18a few applications of,
• 37:20of simulations here, integrating simulation
• 37:22based methods into your medical
• 37:25education activities. Now now that
• 37:26you have gone through all
• 37:27that background and theory that
• 37:29I just made you go
• 37:30through,
• 37:32let's talk about some practical,
• 37:35practical applications. So here you
• 37:37can see that you don't
• 37:39always have to have it
• 37:40like the person on the
• 37:40left where it looks
• 37:42very realistic like on a
• 37:43person, you can also just
• 37:44have a partial task trainer
• 37:46where you can learn suturing
• 37:48for example in this case.
• 37:50Here you can see also
• 37:53doing the ear exam,
• 37:54ear exam task trainer, We
• 37:56have a lumbar puncture trans
• 37:58task trainer. And you can
• 37:59see actually myself when I
• 38:00was still a fellow doing
• 38:02a pericardial sentesis very excitedly.
• 38:05You can have the high
• 38:06technology simulators
• 38:08on the upper
• 38:09lower left. We see a
• 38:10simulation down in the PTCD
• 38:12and the equipment that we
• 38:13used on the upper right.
• 38:14Very sophisticated.
• 38:16You can have standardized patients,
• 38:17which are extremely helpful as
• 38:18well for our simulation practice.
• 38:21There are screen based simulations.
• 38:23This one is from the
• 38:23PALS course that maybe a
• 38:25lot of you have seen.
• 38:26I certainly saw it recently
• 38:27when I recertified.
• 38:29This is another example of
• 38:30a screen based disaster,
• 38:33medicine simulation.
• 38:35This one
• 38:36here was when I took
• 38:37my boot camp as a
• 38:38fellow. You can see me
• 38:39in the right in the
• 38:40middle lower as I'm trying
• 38:42to manage those two patients,
• 38:43which is a mass casualty.
• 38:45So you can see that
• 38:45here many simulation
• 38:47scenarios were not only happening
• 38:48at the same time, but
• 38:49actually one participant had to
• 38:51handle different patients at the
• 38:52same time.
• 38:54Here's another example of a
• 38:55life mass casualty simulation.
• 38:57So you don't have to
• 38:59all go out and do
• 39:00these,
• 39:01these big simulations, That is
• 39:02a fun thing to think
• 39:05about. Now a few nuggets
• 39:06of things that we have
• 39:07done at Yale. This one
• 39:08is a corporation that I
• 39:09did as a fellow with
• 39:10Latvia. So this is already
• 39:12a few years ago, but
• 39:13it is still nice to
• 39:14mention
• 39:15where I was in at
• 39:16Yale and I was co
• 39:17facilitating with a team
• 39:19in Latvia
• 39:20via
• 39:22Zoom, basically. Well, we used
• 39:24all different kind of platforms,
• 39:25but I think that's where
• 39:26we settled.
• 39:27So I was at Yale.
• 39:28The team was in Latvia.
• 39:30This is what it looked
• 39:31like. Basically, I had my
• 39:32computer.
• 39:33I could see the vital
• 39:34signs. I could actually run
• 39:36the simulator and,
• 39:38do all of these things.
• 39:38And then for the debrief,
• 39:39we had a a camera,
• 39:41like a three sixty camera,
• 39:42and I could
• 39:43talk to my participants in
• 39:45English. And they were also
• 39:46speaking Latvian, which I didn't
• 39:47understand. It was a great
• 39:49experience.
• 39:50You can see my screen.
• 39:53Then just a cool little
• 39:55tool that I wanted to
• 39:55mention is the eye tracking.
• 39:58You can see here, those
• 39:59are the Tobii two glasses,
• 40:01that we used in our
• 40:01research using eye tracking.
• 40:04You have four sensors in
• 40:06there, an integrated microphone and
• 40:08a screen
• 40:09camera,
• 40:10that can help you both
• 40:12so that you're able to
• 40:13see the environment, like, that's
• 40:14being recorded, and your eyeballs
• 40:16are being recorded.
• 40:18Maybe some people have actually
• 40:19already seen these guys, which
• 40:21are,
• 40:23which are glasses that
• 40:25some some people wear. I've
• 40:26I've seen it in the
• 40:27hospital even. You can ask
• 40:28it questions and it can
• 40:30scan QR codes, take pictures
• 40:32for you that you're looking
• 40:33at. We can listen to
• 40:34musics.
• 40:35You can,
• 40:36there's a voice command command
• 40:38component.
• 40:40So, basically, what did we
• 40:41use it for in simulation?
• 40:43I wanna show you a
• 40:43video about that. Alright. So
• 40:46yeah. Do you mind Absolutely.
• 40:47That. Alright. There you go.
• 40:49Perfect.
• 40:50See, that's the airway. Alright.
• 40:51There you go. Perfect.
• 40:55So you got the airway.
• 40:56Alright, mom. Any problems during
• 40:56your pregnancy? No? No? Okay.
• 40:56And what's baby's name?
• 40:58Jack. Jack. Jack. Okay.
• 41:01And bring it to Carta.
• 41:38Yeah. Sorry. Dodgerly after an
• 41:40abruption.
• 41:43No.
• 41:47Okay. So
• 41:49as you saw in this
• 41:49scenario, we were recording what
• 41:51the person that was back
• 41:52mass ventilating was looking at.
• 41:53And on this heat map,
• 41:55you can see the summary
• 41:56of what the person was
• 41:57looking at that was in
• 41:58charge of back mass ventilation.
• 42:00You can see how they
• 42:01focus quite a bit on
• 42:02the umbilical vein catheter insertion
• 42:04because it just looks so
• 42:05cool, but it does distract.
• 42:07Right? So after this, we
• 42:08did two more studies with
• 42:10our team in Vienna.
• 42:12One was just accepted for
• 42:14publication. The other one is
• 42:15under review looking at distractibility.
• 42:17So kind of fun if
• 42:18you're ever interested in collaborating
• 42:20with these type of studies.
• 42:24As the next, exciting thing
• 42:25we're doing at Yale, I
• 42:26would like to mention artificial
• 42:28intelligence
• 42:29and simulation.
• 42:30I'm sure you've all been
• 42:31exposed to it by now,
• 42:32and I'm pretty sure many
• 42:33of you have already seen
• 42:34a few presentations about it.
• 42:36So I would like to
• 42:37focus
• 42:39specifically on,
• 42:40a study that we did
• 42:42here at Yale.
• 42:46So we actually used
• 42:49a large language model to
• 42:50make it easier for debriefers
• 42:51to conduct the debriefs. So
• 42:53our custom gbt, meaning a
• 42:55large language model, almost like
• 42:57you know how you I'm
• 42:58not sure how much you
• 42:58guys know about it. Okay
• 43:00so if you have chat
• 43:01gbt right you can ask
• 43:02it questions
• 43:03chat gbt is based on
• 43:04all the knowledge but you
• 43:05can customize your GBT to
• 43:07a custom GBT where you
• 43:09just feed it,
• 43:11the information that we wanted
• 43:12to know. So I I
• 43:13gave it the information about
• 43:14the pearls debriefing framework, about
• 43:16non non excellent dental trauma,
• 43:18and
• 43:21that basically trains your the
• 43:23GPT that was then listening
• 43:25to our debrief.
• 43:27You can see all the
• 43:28roles on here. Right? We
• 43:29have the laptop with a
• 43:30custom GPT,
• 43:31a large screen that would
• 43:32later display the debrief, and,
• 43:35actually a printer for more
• 43:36old school people that might
• 43:38want it in paper.
• 43:41And yeah, that work is
• 43:42is just under consideration right
• 43:44now at a journal. And
• 43:45we have another study
• 43:47that's going out in in
• 43:48that round.
• 43:51I know that Lindsay quickly
• 43:52mentioned the AI collaborative. I'm
• 43:55going to post a little
• 43:56link in the chat if
• 43:57you're interested. This is just,
• 43:59a white paper that we
• 44:00wrote that that, the Society
• 44:02for Simulation Healthcare asked us
• 44:04for about the future of
• 44:05AI and in simulation education.
• 44:08It was edited by Omar
• 44:10Patel, Maria Bajwa and myself,
• 44:12and we had a huge
• 44:13group of diverse educators working
• 44:15on this piece. So
• 44:16we are quite excited that
• 44:18this got published and out.
• 44:21Lastly, I would like to
• 44:22talk about our simulation team
• 44:24here at Yale, which is
• 44:25myself, Lindsay,
• 44:26and Mark, as well as
• 44:28Rabia and Lisa D'Alessignor.
• 44:31Shout out to the team
• 44:32doing a lot of simulations.
• 44:34We do medical simulations.
• 44:36They are usually doing the
• 44:38pediatric OB block. We use
• 44:39four sims in two sessions
• 44:40with two facilitators per sessions.
• 44:44The cases are,
• 44:47usually epilepsy, asthma, DKA, and
• 44:49coarctation of the aorta. This
• 44:51is after a lot of
• 44:52iterations over many years to
• 44:53see what works best best
• 44:55for our learners.
• 44:56We also have a lot
• 44:57of pediatric simulations going on
• 44:59with a lot of support
• 45:00from other faculty in other
• 45:02areas.
• 45:02There are Yale and Bridgeport
• 45:04simulations.
• 45:05We have floor simulations, PNCD,
• 45:07NICU, PICU, intern retreat, senior
• 45:09retreat, half days, procedural training,
• 45:11behavioral since trauma since
• 45:13you name it, we're doing
• 45:14it. And of course, with
• 45:16the support of all this
• 45:17amazing faculty that is helping
• 45:19facilitate
• 45:20them, the learner groups are
• 45:22pretty much reflected also in
• 45:24what you had put in
• 45:24the chat who you are
• 45:25teaching. So a lot of,
• 45:27PEM fellows, NICU fellows, PICU
• 45:30fellows, med peds, ED residents,
• 45:32OBPs,
• 45:33EMS transport, and nurses.
• 45:36In terms of systems simulations,
• 45:38our trauma simulations, which I
• 45:40actually really love doing. We
• 45:41do those every other month,
• 45:43multidisciplinary,
• 45:44where everybody responds from massive
• 45:46transfusion
• 45:47protocol,
• 45:48heme lab, x-ray techs,
• 45:50leadership comes. It's amazing.
• 45:52ECMO simulations are happening with
• 45:55PICU and NICU. We have
• 45:56office based simulations under the
• 45:58leadership of Rabia and also
• 46:00community
• 46:01outreach simulations at Greenwich Hospital.
• 46:04Something that's really dear to
• 46:05me is that we are
• 46:07doing a lot of scholarship
• 46:08with trainees with our trainees,
• 46:10with students, residents, fellows, and
• 46:12junior faculty.
• 46:13Currently, I'm working on a
• 46:14study with Billy, you can
• 46:16see on the lower left
• 46:17side, and Ariel,
• 46:18looking into peer,
• 46:21peer teaching and simulation training.
• 46:23Mateo is actually,
• 46:25has a master's in AI,
• 46:26so he's helping me with
• 46:27all my AI stuff. So
• 46:29just brilliant. Brilliant.
• 46:31Shout out to Gunjan for
• 46:33implementing our DEI objectives in
• 46:35our simulations.
• 46:36So the simulations that you
• 46:37saw before we're doing with
• 46:38students, we're actually integrating a
• 46:40DEI curriculum for homelessness, undocumented
• 46:43status, language barrier, microaggression, which
• 46:45has been extremely
• 46:48successful.
• 46:49And we're gonna gonna close
• 46:50with some works in progress
• 46:52here, and then I'm gonna
• 46:52have some a little bit
• 46:54of time for questions. We
• 46:55do faculty simulations.
• 46:57We just
• 46:58did our procedure simulations with
• 47:00our PEM faculty, which was
• 47:01awesome.
• 47:03In fellow education, we are
• 47:05hoping to more integrate PICU
• 47:06simulations into the pediatric
• 47:09curriculum under the leadership of
• 47:10Lisa Del Signore. Then we
• 47:12have trauma simulations for pediatric
• 47:14residents, and that is under
• 47:15the leadership of Sofia Athanasopolo
• 47:17who's also on this call
• 47:18today.
• 47:19So shout out, to Lisa
• 47:21and Sofia in the leadership.
• 47:25We are increasing academic half
• 47:27days with procedures
• 47:28as as that's something that's
• 47:30really needed. Allison Bradley is,
• 47:32helping us formalize the pediatric
• 47:34resident simulation curriculum to make
• 47:35it more,
• 47:37standardized over over the academic
• 47:39year, And doctor Tamila Hochreiter
• 47:41and her team are doing
• 47:43off our floor simulations, which
• 47:44are just a fantastic idea
• 47:46to do
• 47:47more simulations,
• 47:48interdisciplinary,
• 47:50with a focus on team
• 47:51training. And there are many
• 47:52more activities, and this is
• 47:53it. Thank you so much
• 47:54for your attention, and I
• 47:55am
• 47:56ready for
• 47:58your questions.
• 48:01Thank you so much, Isabel.
• 48:03This was so impressive.
• 48:04I I think,
• 48:06you've created so much. Isabelle,
• 48:08starting when I met her
• 48:09as a fellow has been
• 48:10one of the most amazingly
• 48:12productive humans that I have
• 48:13ever encountered
• 48:15in life.
• 48:16So, Isabelle, I would love,
• 48:18if you could give some
• 48:19suggestions to our team. There
• 48:20are some people who have
• 48:21been doing this for a
• 48:22really long time. There are
• 48:23some, looking at the chat
• 48:24that are a little bit
• 48:25newer either to simulation or
• 48:27to Yale.
• 48:28How would you suggest that
• 48:30people,
• 48:30most effectively get involved if
• 48:32they're looking to either
• 48:34develop a new,
• 48:36educational program
• 48:37involving simulation or they they
• 48:39are really
• 48:40wanting to dabble in what
• 48:42are the opportunities in simulation
• 48:43based research?
• 48:45Where would be the places
• 48:47to stop? This is a
• 48:48really question that is really
• 48:49dear to me. Thank you
• 48:50so much, Lindsay, for asking
• 48:51that.
• 48:53Reach out to me.
• 48:55Reach out to any of
• 48:56us. We actually love doing
• 48:57consultations. And depending on what
• 49:00area you're interested in, if
• 49:01it's more curriculum development, you
• 49:03might be talking to Lindsay.
• 49:04If it's more about,
• 49:06specific in situ simulations, you
• 49:07might be talking to Mark
• 49:08Auerbach. If it's more for,
• 49:10distance simulation technology enhanced simulations,
• 49:13you might be talking to
• 49:14me. All of us are
• 49:15able to give you resources
• 49:17in where to start, such
• 49:18as your first starting point
• 49:20should probably be a debriefing
• 49:21course. So I would highly
• 49:23recommend that if you are
• 49:24doing medical education and you
• 49:26are considering doing some sims
• 49:28at some point, that you
• 49:29take that class that, the
• 49:31center for simulation health care
• 49:32is offering.
• 49:33And after that, we can
• 49:34really tailor everything to your
• 49:36needs. The simulation center has
• 49:37amazing technicians and support personnel
• 49:40that can do a lot
• 49:41of things for you.
• 49:43So that's, where I would
• 49:44start.
• 49:47That's a great opportunity to
• 49:49be able to utilize this,
• 49:51educational methodology,
• 49:53not only for
• 49:54education as Isabelle had, reviewed
• 49:57all of the really helpful
• 49:58things in adult learning theory
• 50:00why this is supported,
• 50:01but to be able to
• 50:02get,
• 50:04your
• 50:05your work out there. And
• 50:06Isabel had noted a couple
• 50:08of the different organizations
• 50:10that exist.
• 50:11The International Pediatric Simulation Society
• 50:14is a very welcoming and
• 50:15friendly international group of education,
• 50:19providers and simulation based researchers.
• 50:21So if you're looking to
• 50:23get yourself a reputation like
• 50:25most of us are when
• 50:27we're going up the promotional
• 50:28ladder at Yale, that's a
• 50:29really nice group to engage
• 50:31with because you're getting international
• 50:33connections and reputation.
• 50:35The Society for Simulation and
• 50:37Health Care is one that
• 50:38is inclusive
• 50:40of all people who do
• 50:41simulation, not just in pediatrics.
• 50:43INSPIRE,
• 50:44Isabelle is really one of
• 50:46the one of the leaders
• 50:47of INSPIRE,
• 50:49which is an international network
• 50:50also really focused on research.
• 50:52So for all of us
• 50:54as we're thinking about,
• 50:55our our professional development and
• 50:57our promotional pathway thank you,
• 50:59Isabelle. She's putting all these
• 51:00things right in the chat.
• 51:02These are really great opportunities
• 51:03for you to get your
• 51:04name out there. And when
• 51:06you're trying to figure out
• 51:07people to collaborate with, projects
• 51:09to get involved with, people
• 51:10to potentially write you letters
• 51:11for promotion,
• 51:12these have really opened up
• 51:14doors for a lot of
• 51:14the members of our community.
• 51:17You can also, of course,
• 51:18get involved with doing, with
• 51:19getting on the board, getting
• 51:21involved in comedy work, and
• 51:23that's also really helpful for
• 51:24promotion. I think Sofia is
• 51:25raising her hand.
• 51:29Thank you, Isabelle, for the
• 51:30wonderful presentation.
• 51:31Along those lines,
• 51:33any advice on
• 51:35presenting your simulation work on
• 51:37your CV and how to
• 51:39kind of organize those things
• 51:41for
• 51:42when you're applying for a
• 51:43job or when you're asking
• 51:44for promotion?
• 51:45Presentation of the scholarly work,
• 51:47I would say, in general
• 51:48for your CV. Sorry.
• 51:50I'm happy to look at
• 51:51everybody's CV that are educational.
• 51:54It is very important that
• 51:55you really keep track of
• 51:56it, Sofia. So I'm very
• 51:57glad that you're pointing this
• 51:58out. A lot of our
• 52:00activities go in the CV
• 52:01part two, which is equally
• 52:02important,
• 52:04where you can really have
• 52:05more of a narrative of
• 52:06what you're doing.
• 52:07It is crucial, especially with
• 52:10simulation activities, that you are
• 52:11very, very,
• 52:13very good about keeping track
• 52:14of things. I know that
• 52:15actually Melissa has a good
• 52:16system in keeping track of
• 52:17things as well, and so
• 52:19do I. As soon as
• 52:20you do it, make sure
• 52:21it gets on your CV
• 52:22because as if you're a
• 52:23bench researcher, you might be
• 52:24publishing in nature every five
• 52:26years, and that's good enough.
• 52:28I publish probably ten times
• 52:29a year, and it's really
• 52:30easy to
• 52:32completely keep track of all
• 52:33the posters you're doing, the
• 52:34talks you're giving, the scenario
• 52:36designs you're doing, just all
• 52:37the work you're doing. I
• 52:39personally have a running document
• 52:40where I just write things
• 52:41down, especially now doing my
• 52:43sabbatical time. I write down
• 52:45every month just little notes
• 52:47so you don't have to
• 52:47feel the pressure of updating
• 52:49your actual CV.
• 52:51Lindsey, do you have any
• 52:52recommendations from your standpoint for
• 52:54your simulation work, how you
• 52:55presented on your CV?
• 52:57Well, I'm similar. For any
• 52:59of my conferences,
• 53:00I make a reminder to
• 53:02myself
• 53:03in my notes. So when
• 53:04I'm on the plane going
• 53:05home, I put the presentations
• 53:07or the abstracts in in
• 53:09the CV because Isabelle's absolutely
• 53:11correct. You will just forget.
• 53:13I think keeping track in
• 53:15your CV part two about
• 53:17what sort of educational activities
• 53:18you're you're giving, how many
• 53:20learners, what types of learners,
• 53:22if you're helping to mentor
• 53:24somebody who's developing, these are
• 53:26all really important,
• 53:28and then getting some sort
• 53:29of feedback.
• 53:30So if you're going through
• 53:32our department or you're going
• 53:33through the sim center, they're
• 53:34giving surveys. You may have
• 53:36to give your own surveys
• 53:38if you're presenting somewhere else,
• 53:39but having these these other
• 53:41pieces of supporting evidence that
• 53:42you've had an impact, that
• 53:44can be really helpful. And
• 53:45I wanna hear about Melissa's
• 53:47system.
• 53:48Tell us, Melissa, what is
• 53:49your system?
• 53:51Generally, when something comes through,
• 53:52I just immediately put it
• 53:53on my CV site over
• 53:55again. But I do use,
• 53:56like, a Trello board just
• 53:57to keep track of everything,
• 53:59and that also helps me,
• 54:01just, gosh, remember
• 54:03all the little pieces. And
• 54:04then I can backtrack to
• 54:05it too to make sure
• 54:06things are getting updated.
• 54:08Yeah.
• 54:09Does anybody else have suggestions
• 54:11for how to keep yourselves
• 54:13organized? Because it's so easy.
• 54:15We do so many things
• 54:16every day that if you
• 54:17don't have some sort of
• 54:19method to
• 54:20put these into your queue
• 54:21so they get added, it's
• 54:23really easy to forget.
• 54:31No other brilliant ideas. If
• 54:33anybody thinks of anything after
• 54:34the fact and wants to
• 54:35share, let us know. We
• 54:37can certainly push it out.
• 54:39But that's a really important
• 54:40part of our professional development
• 54:42that is really good to
• 54:43consider. Sofia, thank you so
• 54:45much for that awesome question.
• 54:47Any other questions for Isabel?
• 54:50Probably have time for one
• 54:51more if
• 54:52if there's anything that's on
• 54:54somebody's mind.
• 55:02Or we're gonna give everybody
• 55:03two minutes back in their
• 55:05afternoons.
• 55:06Thank you so much. It
• 55:07was so great to see
• 55:08everybody here. Appreciate,
• 55:10your engagement and especially appreciate
• 55:13Isabelle sharing all this wonderful
• 55:14information and her knowledge and
• 55:16expertise with us. What a
• 55:18great way to spend my
• 55:19Monday.
• 55:20Thank you so much for
• 55:21coming. Bye bye.
• 55:23Sure.