ESS Collaborative leads Special Edition of Clinical Simulation in Nursing
Prof Tracy Levett-Jones and the ESS Collaborative edited a Special Edition of Clinical Simulation in Nursing with a focus on Patient Safety. https://www.nursingsimulation.org/issue/S1876-1399(20)X0006-5
On July 10th the ESS Collaborative hosted an invitation only forum in Sydney. Can simulation be used to replace clinical placement? Lessons learned from global and national perspectives to inform future research and practice.
38 participants attended the forum and the evaluation of the event was extremely positive.
“A great day, well organised. Felt inspired hearing the speakers to continue moving forward in relation to my own research and curriculum design”.
Many participants requested that the ESS Collaborative hold annual events to bring together thought leaders in the intersection between education, simulation and safety.
So it seems that there is a real appetite to move this agenda forward and participants identified the following priorities for future activity.
The ESS Collaborative is currently working on, and seeking funding for, a number of projects which will inform these priorities. We are meeting in Wellington NZ in October to continue developing an undergraduate curriculum approach and principles which will guide future work. We are also looking for ways to widen participation in the ESS Collaborative – so watch this space!
Recently, the area of cultural considerations in relation to learners – and faculty – has been featuring in writings, conference presentations, and discussions. All of us are aware of the diversity of cultures within student cohorts across Australian universities. This requires all of us to become more attuned to the differing expectations of learners, from both academic and student perspectives. We love students to engage in Socratic dialogue, that is, to discuss, explore differing opinions and sometimes challenge what is written or said. This can be quite an adjustment for some students to participate in small group work within tutorials, and group assignments – popular approaches to broaden thinking and understanding.
So what about in simulation? How might we best foster exploring new knowledge and understanding about practice? For students with differing cultural backgrounds, should we assign simulation roles differently? I’m sure this is already done implicitly, but it’s worth thinking about how best to approach this and whether we should have more dialogue about such considerations in our simulation practices. One way to inform if our ‘natural tendencies’ are on point, is to gain student feedback about what they gained from participating in simulations, and how. For instance, in my own research, students who were deemed ‘international’ preferred to be an observer of the simulation first off rather than participating in an active role. This way they could build their own schema of professional behaviours – what to say, where to stand, how to respond – so their upcoming portrayal of the nurse role was ‘as expected’.
Let’s now fast track to the simulation debriefing session where the expectation of contributing to feedback in the spoken word can be daunting, for many students actually. Explicit directions (stated verbally by the instructor or through using a rubric) of what learners should focus on while observing simulations provides more structure when facilitating the debrief. Grouping observers into pairs or 3’s allows for more intimate time to talk as they watch the unfolding action. One person can be nominated to provide verbal feedback, which may on one hand take the pressure off others to ‘speak up’ while also allowing group members’ opinions to be added to the mix.
Why am I raising these points that some of you have realised already? If you incorporate some of these strategies already in your simulation delivery, tell us how they work for you. If you haven’t given much thought to the points I raise, take a look at the emerging literature on the topic, and talk with your colleagues – and students – about some strategies. And of course I’d be happy to take this line of conversation further. Post a response …
Thank you to all the speakers and participants at the very successful Sydney Forum – Can simulation be used to replace clinical placement? Lessons learned from global and national perspectives to inform future research and practice.
A summary of the Forum is available here.
The Education, Simulation and Safety Collaborative is delighted to host an invitation only one day forum: Can simulation be used to replace clinical placement? Lessons from global and national perspectives to inform future research and practice.
This forum and will be held at the Mercure George St Sydney on 10th July 930am – 430pm to coincide with the visit of Prof Pam Jeffries https://nursing.gwu.edu/pamela-jeffries to Australia and New Zealand.
The primary purpose of the forum is to share best practice in research on simulation integration in health education from international and national perspectives. In addition to Professor Jeffries, a range of high profile, invited speakers will address current evidence and share experiences. Our thanks to Laerdal Australia for their generous sponsorship of this event.
In March the Nursing and Midwifery Council in the United Kingdom announced changes to standards for pre-registration nursing programmes, which were reported in the nursing press as ‘historic”. The term historic can have all manner of meanings ranging from important (momentous, remarkable, significant) to old (ancient, past, bygone) or simply full of history.
Amongst the raft of changes was the decision not to raise the cap on simulation hours from 300 hours from a total number of 2,300 clinical practice hours to the anticipated 1,150 hours i.e. a maximum of 50% of clinical practice hours being undertaken by simulation. Instead, the NMC decided to completely remove the cap on the hours that can be spent in simulation activities. Not surprisingly there has been some disquiet expressed about this decision and the NMC response is reportedly that they will monitor universities’ use of simulation. But if we look at the situation from an evidence based perspective, the decision by the NMC is difficult to challenge.
Historically simulation has been used for a long time in nursing programmes, with little evidence to support the type or amount of simulation learning and, it could be argued, with little or no control over the quality of simulation learning experiences. Early findings from a systematic review we are currently undertaking suggests that the evidence for an accreditation standard ratio, or proportion, of simulation hours to clinical placement hours is scant. While we are still synthesising international RCTs of the substitution of clinical placement hours with simulation hours across health disciplines, trial interventions favour replacement of 25-50% simulation to clinical placement, but determining the proportion for replacement seems arbitrary.
Application of these replacement proportions is made even more tenuous by the lack of evidence to support the mandated number of clinical placement hours in the first place, and that evidence gap is also the subject work by the ESS Collaborative. Perhaps our efforts will provide solid ground to inform standards for clinical placement hours and the use of simulation and, in doing so, we can stop history repeating itself.
So why am I passionate about simulation and why is it important? As a young bloke I used to work in the field of resuscitation – running around a massive UK hospital attending resuscitation attempts and teaching the life support courses. Over the years I probably attended around 1,600 emergencies – which was great for my skill development. The problem of course is that most of us don’t get that level of experience as emergencies are rare and often confusing and worrying events. Now-a-days we also have a much bigger focus on the management of deteriorating patients which makes a lot of sense, as the earlier we catch people the less likely they are to arrest – with subsequent poor survival rates. Where though are mandatory and essential updates on patient deterioration – not just resuscitation?
How also do we develop clinical skills in a safe and secure environment – the days of see one, do one, teach one should be gone – but are they? Of course, centres around the world teach skills in labs with fantastic and often very realistic kit – but do they really simulate the real world or is it just – here’s is a head – have a practice intubating. Interestingly, there is also evidence that teachers don’t know how to use the advanced manikins, so they get left in the cupboard.
We also know that failures of patient safety are frequently due to communication and teamwork problems, but how often and how well do we actually practice these non-technical skills? Not a lot in my opinion and probably not helped by the fact that we call them ‘non-technical’ – not technical – not important!
The solution to these issues are of course high quality simulation – that matches the real world and is believable. We call this high fidelity. Note though that high fidelity does not need to be high technology and high cost. Patient actors, for example are able to mimic the real world, provide fantastic feedback and when recruited locally enhance community engagement. Interactive screen based e-simulations are also available that are low cost and enable repetitive practice.
So my advice for educators is to plan enjoyable and holistic scenarios that encompass the relevant aspects of the real world. Teach a skill first – say IV cannulation – but then encompass this into a medical emergency team call – lots of people, time limited, noisy and stressful. Ideally video it as well – use your phone or an iPad then use this record for review and feedback. Don’t get bogged down with all the educational theory on how to run a simulation – it’s just another teaching method and if you’re a good clinician you will know how the real work works and how to mimic it. Try also to run things ‘in-situ’, in your ward or department, and don’t drag people away from their work for hours on end – just do a quick update during a shift overlap or a lunch break. The important thing is to repeat frequently and have a good chat about performances.
In summary get siming and make healthcare safer.
In 2016, I fortunate enough to be invited by Fiona Bogossian to join the ESS Collaborative Group as an associate collaborator. I was excited and very nervous at the thought of carrying out some research with a group of very experienced researchers.
I teach into the Graduate Entry Masters (GEM) program which is a truncated pathway of four semesters leading to nurse registration. Coming from the clinical environment, I realise the value of ensuring nursing students move beyond competency to reflect on their practice and so develop the capability to effectively manage unfamiliar situations in the clinical environment. With the GEM students, the acquisition of these skills and the development of self-confidence, competence and applied knowledge must be achieved more rapidly.
I wanted to extend my research skills beyond the topic and focus of my PhD and it was challenging to scope a research project that could improve the application of theory to the development of practical skills in real-world situations for the GEM students. Scoping was an issue for myself as I had to determine what exactly I wanted to investigate in my project and what was feasible within the timeframe. My conversations with Fiona helped to frame my project and gave me a ‘reality check’ about what was feasible. These discussions led to meeting Amal Al-Ghareeb whose PhD research (supervised by Simon Cooper and Lisa McKenna) included a survey instrument which she consented for me to use in my project.
As a novice researcher, I was challenged and stimulated by the actual process of setting up and conducting my own research project. The meetings we have had as ESS Collaborative group provided the opportunity to gain insights into how the other group members were conducting their research. The ESS Collaborative provides me with the opportunity to discuss ideas and gain valuable advice and network with experienced researchers from all over Australia.
The truth is that academics are always busy; and the Principal Collaborators of the ESS Collaborative are no exception. We have been meeting and working together for several years and yet, the last item on our meeting agendas always seemed to be carried over for the next meeting. The item in question was ‘how we should name our group?’
In desperation last year I offered a gift voucher to whoever could capture the nature of the work we do, and the way that we do it, in a succinct name. This focussed everyone’s attention and finally we all agreed that Simon Cooper should win the prize for his offering The Education, Simulation and Safety Collaborative.
Last week we gathered in Sydney for a two-day meeting. I arrived in a post- summer holiday fugue state, hoping that the energy of the group would carry me along and that the meeting would be reenergising and productive. By the end of the first day we had achieved so much and on the second day of the meeting I paused for a moment to look around the room. It was buzzing…
Everyone was focused, engaged, enthusiastic, contributing, offering ideas freely and sharing the responsibilities for tasks required in order to develop our next project. And then it occurred to me that, as a group, we embody what it means to be a true collaborative. So whether by accident or design the name The ESS Collaborative suits us to a tee. By the way Simon immediately bought a lovely bottle of gin with his prize – which he has yet to share with his collaborators!
