Peter Dieckmann

Deepening the Theoretical Foundations of Patient Simulation as Social Practice

Simulation is a complex social endeavor, in which human beings interact with each other, a simulator, and other technical devices. The goal-oriented use for education, training, and research depends on an improved conceptual clarity about simulation realism and related terms. The article introduces concepts into medical simulation that help to clarify potential problems during simulation and foster its goal-oriented use. The three modes of thinking about reality by Uwe Laucken help in differentiating different aspects of simulation realism (physical, semantical, phenomenal). Erving Goffmans concepts of primary frames and modulations allow for analyzing relationships between clinical cases and simulation scenarios. The as-if concept by Hans Vaihinger further qualifies the differences between both clinical and simulators settings and what is important when helping participants engage in simulation. These concepts help to take the social character of simulation into account when designing and conducting scenarios. The concepts allow for improved matching of simulation realism with desired outcomes. It is not uniformly the case that more (physical) realism means better attainment of educational goals. Although the article concentrates on mannequin-based simulations that try to recreate clinical cases to address issues of crisis resource management, the concepts also apply or can be adapted to other forms of immersive or simulation techniques.

The art and science of debriefing in simulation: Ideal and practice

Objectives: Describing what simulation centre leaders see as the ideal debriefing for different simulator courses (medical vs. crisis resource management (CRM)-oriented). Describing the practice of debriefing based on interactions between instructors and training participants. Methods: Study 1 – Electronic questionnaire on the relevance of different roles of the medical teacher for debriefing (facilitator, role model, information provider, assessor, planner, resource developer) sent to simulation centre leaders. Study 2 – Observation study using a paper-and-pencil tool to code interactions during debriefings in simulation courses for CRM for content (medical vs. CRM-oriented) and type (question vs. utterance). Results: Study 1 – The different roles were seen as equally important for both course types with the exception of ‘information provider’ which was seen as more relevant for medical courses. Study 2 – There were different interaction patterns during debriefings: line – involving mostly the instructor and one course participant, triangle – instructor and two participants, fan – instructor and all participants in a dyadic form and net – all participants and the instructor with cross references. Conclusion: What simulation centre heads think is important for the role mix of simulation instructors is (at least partly) not reflected in debriefing practice.

Setting a research agenda for simulation-based healthcare education: a synthesis of the outcome from an Utstein style meeting.

Although the use of simulation as a methodology for learning continues to grow at a rapid pace throughout all of the healthcare professions and disciplines, research in this field is still at an early stage. Increasingly, decision makers and stakeholders must see evidence that the use of such a meth

Simulation and CRM.

Patients are harmed as a result of incidents. Both poor interdisciplinary communication and teamwork are contributing factors to such events. The principles of crisis resource management are meant to help prevent and manage difficulties and reflect both, the social-team-oriented and cognitive-individual-oriented aspects of human factors. This article explores the importance of human factors training for safe care of patients and the role of simulation. Based on the available literature, the need to integrate this type of training to increase awareness of the importance of human factors and to change attitudes appears obvious. A combination of different training methods appears to be useful. Simulation-based training appears to be favourable, although the number of studies demonstrating the impact of training is limited. It is important to develop training programmes for individual teams, based on the knowledge of challenges and deficiencies, and to monitor behavioural change. Several methods, including patient safety data, interviews, observational studies and simulations, can be used to specify learning objectives. The training should be established for the real team(s). Furthermore, leaders need to implement training in the organisation and establish databases to monitor the impact on patient outcome.

Goals, Success Factors, and Barriers for Simulation-Based Learning: A Qualitative Interview Study in Health Care

Introduction: This study describes (a) process goals, (b) success factors, and (c) barriers for optimizing simulation-based learning environments within the simulation setting model developed by Dieckmann. Methods: Seven simulation educators of different experience levels were interviewed using the Critical Incident Technique. Results: (a) The main process goals were to enhance learning, engage participants, and aid the application of what was learned during the course. (b) As success factors, educators stated their own competencies and attitudes, motivation and openness of participants, and a functional environment. (c) As barriers, educators stated a lack of willingness to actively engage in simulation by the participants and time pressure. The results emphasize the need to consider jointly the interrelated elements of simulation-based learning environments to optimize the use of educational simulation. Discussion: The results support the applicability of Dieckmann’s setting model to describe simulation-based courses and emphasize the diversity of factors that need to be considered in optimizing simulation practice. This article can serve as a practical aid for educators within health care simulation settings and in other domains.

The first research consensus summit of the society for simulation in healthcare: Conduction and a synthesis of the results

Introduction: In this article, we describe the preparation and execution of the first Research Consensus Summit (Summit) of the Society for Simulation in Healthcare (SSH) held in January 2011 in New Orleans, Louisiana. The goals of the Summit were to provide guidance for better simulation-related research, to broaden the scope of topics investigated, and to highlight the importance of simulation-related research. Method: An international Core Group (the authors of this article) worked with the SSH Research Committee to identify 10 topic areas relevant for future research that would be examined by the 10 Topic Groups composed of Topic Chairs and Topic Group Members. Each Topic Group prepared a monograph and slide presentation on their topic which was presented at the 2-day Summit. The audience provided feedback on each presentation. Based on this feedback, the Topic Groups revised their presentations and monographs for publication in this supplement to Simulation in Healthcare. The Core Group has synthesized an overview of the key Summit themes in this article. Results: In some groups, the agreement was that there is currently no consensus about the state of the science in certain topic aspects. Some key themes emerged from the Topic Groups. The conceptual and theoretical bases of simulation-related research, as well as the methods used and their methodological foundations, need to be more explicitly described in future publications. Although no single method is inherently better, the mix of research methods chosen should match the goal of each study. The impact of simulation, whether direct or indirect, needs to be assessed across different levels of training, and larger, more complex contexts need to be taken into account. When interpreting simulation-related research, the ecological validity of the results needs to be taken into consideration. The scope of simulation-related research can be widened from having simulation as the focus of research (research about simulation), to using simulation to investigate other research questions (research with simulation). Simulation-related research can benefit from an improved understanding of structural differences and similarities with other domains. The development of simulation equipment and concepts will benefit from applying known and available science-based design frameworks. Overall, the context of simulation-related research needs to be better understood. The progress of research depends on building overarching and sustainable research programs that relate individual studies with each other. Discussion: The Summit was successful in taking a snapshot of the state of the science. Future summits might explore these topics further, monitor progress, and address new topics.

Faculty development for simulation programs: Five issues for the future of debriefing training

STATEMENT Debriefing is widely recognized as a critically important element of simulation-based education. Simulation educators obtain and/or seek debriefing training from various sources, including workshops at conferences, simulation educator courses, formal fellowships in debriefings, or through advanced degrees. Although there are many options available for debriefing training, little is known about how faculty development opportunities should be structured to maintain and enhance the quality of debriefing within simulation programs. In this article, we discuss 5 key issues to help shape the future of debriefing training for simulation educators, specifically the following: (1) Are we teaching the appropriate debriefing methods? (2) Are we using the appropriate methods to teach debriefing skills? (3) How can we best assess debriefing effectiveness? (4) How can peer feedback of debriefing be used to improve debriefing quality within programs? (5) How can we individualize debriefing training opportunities to the learning needs of our educators?

The Relationship Between Facilitators' Questions and the Level of Reflection in Postsimulation Debriefing

Introduction Simulation-based education is a learner-active method that may enhance teamwork skills such as leadership and communication. The importance of postsimulation debriefing to promote reflection is well accepted, but many questions concerning whether and how faculty promote reflection remain largely unanswered in the research literature. The aim of this study was therefore to explore the depth of reflection expressed in questions by facilitators and responses from nursing students during postsimulation debriefings. Methods Eighty-one nursing students and 4 facilitators participated. The data were collected in February and March 2008, the analysis being conducted on 24 video-recorded debriefings from simulated resuscitation teamwork involving nursing students only. Using Gibbs’ reflective cycle, we graded the facilitators’ questions and nursing students’ responses into stages of reflection and then correlated these. Results Facilitators asked most evaluative and fewest emotional questions, whereas nursing students answered most evaluative and analytic responses and fewest emotional responses. The greatest difference between facilitators and nursing students was in the analytic stage. Only 23 (20%) of 117 questions asked by the facilitators were analytic, whereas 45 (35%) of 130 students’ responses were rated as analytic. Nevertheless, the facilitators’ descriptive questions also elicited student responses in other stages such as evaluative and analytic responses. Conclusion We found that postsimulation debriefings provide students with the opportunity to reflect on their simulation experience. Still, if the debriefing is going to pave the way for student reflection, it is necessary to work further on structuring the debriefing to facilitate deeper reflection. Furthermore, it is important that facilitators consider what kind of questions they ask to promote reflection. We think future research on debriefing should focus on developing an analytical framework for grading reflective questions. Such research will inform and support facilitators in devising strategies for the promotion of learning through reflection in postsimulation debriefings.

It is time to consider cultural differences in debriefing

Summary Statement Debriefing plays a critical role in facilitated reflection of simulation after the experiential component of simulation-based learning. The concept of framing and reflective learning in a debriefing session has emanated primarily from Western cultures. However, non-Western cultures have significant characteristics that manifest themselves in teaching and learning practices substantially different from Western cultures. We need to consider how to balance standardization in debriefing with a culture-sensitive interpretation of simulation-based learning so that learners receive the maximum benefit from debriefing sessions. Our goal was to raise awareness of cultural differences and stimulate work to make progress in this regard.

Long-term intended and unintended experiences after Advanced Life Support training

AIM Highly structured simulation-based training (SBT) on managing emergency situations can have a significant effect on immediate satisfaction and learning. However, there are some indications of problems when applying learned skills to practice. The aim of this study was to identify long-term intended and unintended learner reactions, experiences and reflections after attending a simulation based Advanced Life Support (ALS) course. METHOD Semi-structured interviews were conducted by telephone with a purposive sample of prior ALS-course participants. A constructivist grounded theory approach was used to analyze the data. RESULTS Seventeen former participants were interviewed. The main themes related to context adaptation, communities of practice and to transfer of skills. Interviewees described challenges in adapting to the structured simulation setting and going back to the uncertain and unstructured clinical world. In part, a result of the several conflicting communities of practice - one being the ALS-community and the others relating to professional roles. Despite reporting transferring a more systematic approach to managing patients in emergency situations and during ward rounds, surgery, and in their teaching, participants also reported poor transfer in emergency situations where not all team members had the same ALS-structured approach. CONCLUSION The result from this study indicates that the efficiency dimension of ALS competence is taught well in ALS courses, but that the form and content of these highly structured/model courses are insufficient in training the innovative dimension of competence that is needed for transfer of skills in unstructured, emergency situations.