Transcript
Melanie Barlow: Hi, welcome to another episode of Simulation Happy Hour. It is just Kerry and I today. How are you, Kerry?
Kerry Anne ReidSearl: Yes, good morning, Mel, and how are you?
Melanie Barlow: I'm good. Summer is here in full force already.
Kerry Anne ReidSearl: I don't know if it's good or bad.
Melanie Barlow: It's not already. So it's you and I, and we're going to talk about QSAFe today because we're both involved in the development of something called QSAFe we're gonna have a chat about it.
Melanie Barlow: oh
Kerry Anne ReidSearl: Okay.
Melanie Barlow: But I guess, first of all, Kerry, what is QSAFe
Kerry Anne ReidSearl: and Great question. Q-SAFE actually stands for Quality Simulation Assurance Framework. And in essence, it's a supportive framework that we've designed with a lot of support and consideration of other standards that individuals can follow to develop and design robust simulations.
Kerry Anne ReidSearl: But it's not just about the design. It's also a framework that individuals can use to benchmark their existing simulation activities to both simulation standards and professional standards of practice.
Kerry Anne ReidSearl: So it's a great document also for auditing processes, for curriculum. So there's lots to it. Yeah. So I'm going to ask you then, Mel, how is this different to other simulation practices?
Melanie Barlow: Brilliant.
Melanie Barlow: oh
Kerry Anne ReidSearl: frameworks or, you know, quality simulation standards that exist. How is this different?
Melanie Barlow: Thanks, Kerry So what we did with this is we fully recognise... existing simulation standards. So their healthcare simulations are best practice out of an INACSL North America and also the ASPiH out of the UK. So there are evidence-based standards, simulation standards that exist and they're really good.
Melanie Barlow: What we were finding though was, I guess, particularly, well, we're both in higher education and so often people get tapped on the shoulder to say you're teaching in the simulation lab or you're now in charge of a simulation-based unit and they haven't had the training or they've had in the past but not a lot of support in designing robust simulations.
Melanie Barlow: what we thought was, well, when we also put the standards down in front of people, like there are 10 standards and the standards thorough, but they all intertwine and interconnect.
Melanie Barlow: And it can take a lot of work and knowledge to unpack those and really make them tangible to operationalize.
Melanie Barlow: So we just wanted to take that great work and simplify it. And also things that are developed in the Northern Hemisphere don't always translate for us in the Southern Hemisphere.
Melanie Barlow: It's different contexts, different, I guess, sociocultural backgrounds. And so we just wanted to simplify and to make it contextualised for our kind of simulation environment.
Melanie Barlow: So we did a lot of literature reviews and some of those published. We did ones on the application of the INACSL standards. Lots and lots of people reference these standards, but what we found was very few people tangibly explain how used the standards to design and develop their simulation.
Melanie Barlow: So we thought we would help that process and develop this. And you were there, we did a nominal group technique, which is get experts together, which we did across Australia and New Zealand, and just go round and around and nut out and distill down, you know, the evidence and people's expertise down to key things.
Melanie Barlow: We had a day to go through the 10 and INACSL standards. We got to hour six and we were still on the design standard and we just had to pause and go,
Kerry Anne ReidSearl: Thank you.
Melanie Barlow: why we after six hours still on the design standard? And it was a bit of an aha moment and we were like, oh my gosh, because absolutely everything in all the standards is relevant when you're designing.
Melanie Barlow: Like when you're designing, you've got to think about evaluation. When you're designing, you've got to think about how, well, you should be thinking about how I'm going to prepare my learners for this. How am I going to prepare my teaching staff for this? What do I need in place?
Melanie Barlow: So fundamentally, we thought we would then design a framework that supported simulation design.
Kerry Anne ReidSearl: Fantastic.
Melanie Barlow: Yeah.
Kerry Anne ReidSearl: And it has been a fantastic process. And it was also identified, you know, for us in in this process of really evaluating other standards and and documentation that we needed something that would be very much aligned to the Australian context and something that would be fairly easy to follow.
Kerry Anne ReidSearl: If I'm somebody coming into simulation as a fairly new academic or new in the healthcare for so sector and I've just taken on simulation, then this is a really great resource.
Melanie Barlow: huh
Kerry Anne ReidSearl: So, yeah, Mel, I might actually tell our learn our audience then what the elements are of those five basic elements.
Melanie Barlow: Do, please.
Kerry Anne ReidSearl: So, The first one we talk about is simulation modalities and methodologies. I'll speak about that in a moment. Then there's consultation and co-design.
Kerry Anne ReidSearl: where we talk with all the key players who might be really relevant to the the content of that simulation. So for example, if I've got simulation portfolio in a healthcare facility and I'm doing some simulation for cardiac nurses, then of course, I'm going to be talking with the cardiac educator. I might be talking with the The NUM, I'm going to be talking with people who see why do we need to develop this particular topic for this particular audience. So it is about thinking who we need to talk to.
Kerry Anne ReidSearl: it is also number three. So number one, simulation modalities and methodologies. Number two, consultation and co-design. Number three is curriculum alignment.
Kerry Anne ReidSearl: and where simulation fits according to our levels of learners and the type of best type of modality or method to use. Four is faculty preparation for the delivery and five is learner preparation for delivery.
Kerry Anne ReidSearl: So let's just go through one of them and simulation modality and methodology now. So if we looked at
Melanie Barlow: Mm-hmm.
Kerry Anne ReidSearl: What is the actual difference with that? And, you know, if I was to perhaps go and randomly ask some new players into simulation, what's the difference? They may not necessarily understand, but this resource helps put all of that into context. So in essence, a mode of simulation is that is that type of simulation you're delivering, whether we're doing a mannequin, whether we're doing hot task trainers.
Kerry Anne ReidSearl: So it it is the actual mode. whereas the method refers to how that mode will be delivered. for You know, for example, a pause and discuss, a rapid cycle, whether it be tag team, whether it be... So there's different but there's different ones. So let's look at some of them. We'll break down some of them.
Kerry Anne ReidSearl: Modalities that we can brainstorm. Desktop simulation. Case-based learning. mannequin-based, task trainers, hybrids, mix simulation, role play, online computer-based simulation, telesimulation, virtual reality, augmented reality, mixed reality, holograms, immersive rooms, caves, commercially produced.
Kerry Anne ReidSearl: So there are a variety there. And this resource, the people who are using this can click onto some of those areas and it gives them a great definition or an explanation or even a link of what examples might be.
Kerry Anne ReidSearl: The methods are really important in terms of, as we just said, the level of learner that we're dealing with. So they could be immersive. They could be a pause, dust discuss and reflect.
Kerry Anne ReidSearl: It could be a procedural training, a rapid cycle deliberate practice, a tag team, a skill rehearsal, an in situ, a process simulation, a team rehearsal, a distance simulation, et cetera. And let's let's give an example. So I'm an educator who is about to teach, I'll use the university six sector for the moment. and I've got first year students and I'm teaching them vital signs.
Kerry Anne ReidSearl: I want them be able to manually understand use the equipment. I want them to understand what they're doing and what they're listening for with the blood pressure, et cetera, et cetera.
Kerry Anne ReidSearl: So in that type of simulation, I might do a basic standard, might be a role play where we've got one person who is in the bed and I'm going to undertake their vital signs.
Kerry Anne ReidSearl: I might get that person to I'm going to use the introduction. I'm going to do the hand hygiene. I'm going to do all of that as I go through. But the method that I'm going to use as I deliver it is basically a skill rehearsal on or even a standard demonstration where then we might pause, we might then discuss, we then might reflect.
Kerry Anne ReidSearl: So, for example, as I take the blood pressure, I might get the learners to think about, I've got this cup. How do I decide what is the best size for this particular patient?
Kerry Anne ReidSearl: We then give the dis demonstration. Then we're going to discuss, well, what would happen if we use the smaller one? So it's it's very much that first year level as opposed to, I'm going to use the same topic, vital signs, recognising and responding to deterioration and the context might be the sepsis patients.
Kerry Anne ReidSearl: Here it might be, the modality might be a case-based situation. We could be using role play, we could be using a combination, but then when we are going into that, it might be a tag team type simulation where, you know, the learners have to pause, they also have to get into it, they they have to think about what what the consequences are if they didn't pick up on those types of things.
Kerry Anne ReidSearl: So I guess what what this does is even with and I'm just going on here about the modalities and the methods it just allows us to really break up and think about what's elements of simulation that we really need to stop and think about in order to make sure that we are addressing our learners so for example that first year scenario I just gave you if I was not to give any rehearsal, not to give any demonstration. And I said to a group of first-year students, you are going to do your vital signs and here I'm going to give you really quite a complex scenario and you've got to work your way through it.
Kerry Anne ReidSearl: What we're going to see is really dissatisfied learners at the end of it. There'll be a lot of how do they do that, how do I do this, we waste time in the simulation and we've got a level of, as I said, dyfaty dissatisfaction as well as potential Trauma or concerns that those learners are going to leave behind after the sin.
Kerry Anne ReidSearl: So, yeah, that that's just exactly one example of the modalities and methodology section of this framework.
Melanie Barlow: Yeah.
Melanie Barlow: But it's like even at the start, so modalities and methodologies are at the start. The rest of the tool is also about getting people to think as they go through it, is that the right method and modality? So, you know, we tend to tick mannequin-based and immersive But if that was just say then we want to do a look after an Indigenous patient, well, then we get to the consultation and co-design.
Kerry Anne ReidSearl: Yeah.
Melanie Barlow: And so there's a whole resource there of considerations.
Kerry Anne ReidSearl: and so
Melanie Barlow: And in the handbook, associated handbook, it explains what not only what consultation and co-design is, but why it's important. And so you might go through that process and discover that's a completely inappropriate mode and method and go back and change it.
Melanie Barlow: So the whole, I guess, the elements are to get you thinking about, and it's a bit of a needs analysis really, isn't it?
Kerry Anne ReidSearl: and
Kerry Anne ReidSearl: Absolutely. And what this also does is makes us think about if we're using simulation and then we need to actually review what we've done for the next cohort. You know, it might be our responsibility as nursing academics to review our content at the end of each semester and get look at the feedback. Well, actually, have a look at this framework. Have I actually addressed each of these modes?
Melanie Barlow: who
Kerry Anne ReidSearl: And, you know, that consultation includes just, you know, your industry representation.
Melanie Barlow: Yeah.
Kerry Anne ReidSearl: It's like,
Melanie Barlow: Yes.
Kerry Anne ReidSearl: hey, guys, what do you think you really want of first-year students when they're out on practice? Where should they be at? It's that content designers. It's the curriculum experts.
Kerry Anne ReidSearl: It's also the logistics and resources that are available in terms of doing your methodology or your modality. Have I actually got the resources to be able to do it?
Kerry Anne ReidSearl: and And also the evaluation and research. So don't forget the importance of looking to what the research is saying about is this the best mode or modality for a method or modality for this particular type of simulation.
Kerry Anne ReidSearl: So, again, this resource tells us, this this great framework goes allows us to go through all of that.
Melanie Barlow: Yeah.
Kerry Anne ReidSearl: So... so Yeah, and then I guess the other side of things is the risk assessments.
Kerry Anne ReidSearl: And you might you might ask me the next question you had in mind if I know what this one is, Mel.
Melanie Barlow: yeah
Melanie Barlow: So I guess, you know, whenever we talk to you, Kerry, about simulation, you're very focused and rightly so on the psychological safety of our learners.
Kerry Anne ReidSearl: Yeah.
Melanie Barlow: So how does this framework support that?
Kerry Anne ReidSearl: So...
Kerry Anne ReidSearl: Look, it it makes us think about when we're, again, designing any simulation, the number one thing is that have we prepared our learners sufficiently and have we prepared the people who are delivering those simulations?
Kerry Anne ReidSearl: And so quite often we know, and again, I don't want to harp on about the tertiary sector, but often in the clinical laboratory context, We find ourselves where clinicians come in and do the teaching and often or not often, I'm going to generalise there, there may be times where they're not actually prepared or have had the education for the delivery of the simulation. Here's the simulation, this is what you have to do. One of the other things that we want to remove in the ideas of simulation is that fear factor for students. You know, you've got to really test them, you've got to
Kerry Anne ReidSearl: If we upload our learners with preparation before they go into a simulation, A, that level of confidence, B, the level of knowledge that they know they need to be prepared for, B, that they've got a bit of an idea of what this simulation is going to be about.
Kerry Anne ReidSearl: We see the positiveness of learning then. We don't see the fear and the anxiety because of I don't know or I'm going to potentially be stood up in front of my peers.
Kerry Anne ReidSearl: And that's also where the cycle or the preparation of the educator who is delivering those simulations. What is it that they need to know? How do we gauge those learners? How do we bring the learners in and out?
Kerry Anne ReidSearl: What is the content level that I need to give? How do I run this simulation? Is it a pause and discuss as opposed to I'm just delivering all of this information? So I guess what I'm saying is that the the physical risks need to be considered, the cultural safety risks, the psychological risk, and also that negative learning risk.
Kerry Anne ReidSearl: This framework goes through those elements of what we need to consider because at the end of the day, we want learners to be coming to simulation with a level of, I love simulation in that I gained so much from it.
Kerry Anne ReidSearl: if we see individuals are fearing simulation because of previous experience that have been so negative, it's like that caveman that sees the lion or the the dinosaur coming towards them, they're going to run, you know, as opposed to, no, this, I've dealt with this before, I know how to navigate through it and this is going to be a really positive experience. So Negativity breeds fear and a blockage of what I can't learn from this as opposed to this is going to be a positive experience. I've learnt from it before. I've got a great facilitator that can help me move through this. I know the information I need to know.
Kerry Anne ReidSearl: i trust and another the facilitator will work with my learners and we go from there.
Jenny: I need to see.
Melanie Barlow: Great. Yeah, and I think that was the difference. So I'm going to talk a little bit about because we had, I guess, you know, a bunch of experts across Australia and New Zealand, but we didn't really want to take just our word for it. So we we after we drafted the tool and the handbook, we sent it out to nursing and schools across Australia and New Zealand to get feedback. And so we achieved some awesome feedback. So they used the tool to benchmark existing activities.
Melanie Barlow: And we're going to publish these results, but fundamentally the feedback was, the tool was really supportive. It helped them particularly, there was a lot of feedback around modalities and methodologies and the terminologies. And often a lot of different terms are used for the same thing. And there was a lot of confusion and, you know, often things that are termed a particular way in other countries are not the terminologies we use here.
Melanie Barlow: So they found that really beneficial to have terminologies and to understand definitions. And in the handbook, we link out to key resources too, to simulation dictionary and and things like that. But we kind of contextualize it to our out context.
Melanie Barlow: The other thing too was around like the risk factors. So not just the physical risk factors because everyone knows how to assess those, but it was around the psychological safety and the cultural risk and the consultation and co-design.
Melanie Barlow: So the strongest theme that came through in the feedback was around how the tool was like a really good educator.
Melanie Barlow: that it allowed them to reflect on their activity and it really highlighted their own learning needs. And the commentary was, I realised what I needed to learn in a really non-judgmental, safe way.
Melanie Barlow: And a lot of it was around gaps in knowledge around cultural safety and how to develop cultural safe simulations and psychological safety. And a lot of people said, oh, I hadn't even really thought about where my simulation activities fit in the bigger picture and how it connects to other units or other programs. or so that curricular alignment and understanding you know, is my activity helping the learners scaffold their learning? Where does it sit?
Melanie Barlow: So it was actually some really great feedback, not only in supporting robust SIM design, but it was a really good way to understand individuals' own learning needs. So that was really good.
Melanie Barlow: The negatives were, was quite long.
Kerry Anne ReidSearl: Thank you.
Melanie Barlow: The tool was quite long. which we completely agree because we were using Qualtrics to sample data and there wasn't any kind of logic. So people could see the whole tool all at once, which could look a bit overwhelming. So we'll talk a little bit soon about next phases and what that would look like, but certainly we have a way forward to address that, which will be amazing. So the feedback feedback,
Melanie Barlow: Yeah, we were really happy with the feedback. If we can help educators not only create great, robust, safe simulation, but also address that gap of enhancing their own knowledge, then and what a win.
Kerry Anne ReidSearl: Absolutely. And so can ask just another question of you? I'm going fire them at you now, Mel, but yeah what think, how do you think QSAFE actually promotes equity and inclusivity in simulation-based learning?
Melanie Barlow: yeah
Melanie Barlow: So I'd have to say there's, you know, in existing standards, they they talk about this and they support it really well.
Melanie Barlow: It is really generic, though. So important but generic. And other people's or countries' cultural contexts are quite different to Australian and New Zealand countries.
Melanie Barlow: And even Australia and New Zealand are very, very different in regards to cultural context. So, for example, New new Zealand has, you know, a treaty and so they have a lot of cultural support and and structure.
Melanie Barlow: In Australia, we have over like, what, 250 different cultural nations, all who have different connections to their country, different customs.
Melanie Barlow: And so you can't just have one person's perspective. You've got to get broader perspective. And so this is the importance of consultation and co-design. It's really about understanding your context and making simulations to support that.
Kerry Anne ReidSearl: And I guess that way simulations are meaningful to individuals. You know, when you're designing any simulation, if it's applicable and meaningful and you've got learners that are going to be engaged in it because they're get something out of it that applies to their real-world practice.
Melanie Barlow: And it's super important because when you look at accreditation standards across the board, no matter what discipline, it calls out, you know, cultural elements and the inclusion of First Nations perspectives in what we do.
Kerry Anne ReidSearl: Yeah.
Melanie Barlow: It calls simulation is a person a great learning tool to prepare our learners for practice, yet there is no tangible explanation of what that should look like and how it could be done. And that was a gap that we identified in the standards, not only from a general simulation perspective but from a cultural perspective.
Melanie Barlow: Everyone was asking, well, how do we do this? We know we need to, but how do we do this? And so that's the goal of QSAFE as well, is this is a roadmap to help you do that, whether you're designing it or whether you want evidence for accreditation if you use the tool to benchmark.
Kerry Anne ReidSearl: and So that that was something in terms of if I'm being audited, my program's being audited, I'm putting things up for accreditation, then I've got this framework that says, look, these are the elements that we're including inside our simulation.
Kerry Anne ReidSearl: I think this is, you know, the transparency as well is is really great when a framework like this exists.
Kerry Anne ReidSearl: So in terms Mel, I know the answer, but I'm going to ask you because you speak so well. Where to from here?
Kerry Anne ReidSearl: You know, like, well, before I go back, you you mentioned there, like, we've we've seen the end users.
Melanie Barlow: anna
Kerry Anne ReidSearl: have We've had people that have actually used this and given us some feedback. And based on that, if you could just sort of summarise that and then where to from here?
Melanie Barlow: Yeah, so one thing haven't said is to help to help people make this as simple as possible. What we have done in the back of the handbook is actually against each element in QSAFE, we have matrixed key standards relevant to context. So we've got one for Australia and one for New Zealand.
Melanie Barlow: And so the generic handbook matrix Q-Safe to INACSL standards, to the ASPiH standards, to the Australian Aboriginal and Torres Strait Islander health curricular framework, and to national safe safety and quality standards, which is the accrediting standards within healthcare.
Melanie Barlow: Then what we've done is created a nursing and midwifery version of that, which we created for the pilot and end user feedback. So we've gone a step further and then against each element Q-Safe, we have matrixed.
Melanie Barlow: So ANMAC, the Australian Nursing and Midwifery Accrediting Council Standards Act, the Nursing Midwifery Board of Australia Standards and for both nursing and midwifery.
Melanie Barlow: And then that was replicated in New Zealand for their particular standards. And so you are benchmarking or designing simulation and you can clearly see if you've addressed that point, then you've also aligned that work.
Melanie Barlow: with all these different standards. That's like immediate evidence for your accreditation. Like we can't, you know, our goal was to help people and make it simple. And I think for me, that's one thing I'm i'm super excited about.
Melanie Barlow: And our goal is, is this is not just for nursing and midwifery. So we want to work with other disciplines to create handbooks and matrices that are relevant to support their work as well.
Melanie Barlow: So that's one thing going forward. The other thing is we want to go web. So we're going to have our own website. The Qsafe will be, our goal is that it's freely available and it'll be in a digital format. So a lot of logic built in.
Melanie Barlow: And our goal is, is you can download the handbook in its entirety or You can use it. Our goal is to have each element and link each element out to the relevant sections within the handbook to, again, make it as simple as possible.
Melanie Barlow: And each discipline-specific handbook and matrices would be on the site for different resources. So, so yeah, we want to go digital, Kerry. Yeah.
Kerry Anne ReidSearl: Fantastic, fantastic. So, Mel, just in closing this today, Q-safe were a metaphor, what would it be and why?
Melanie Barlow: I think it would be like having a best friend, Kerry because it's going to give you honest feedback about your activity.
Melanie Barlow: and you might not like to hear it, but it's in your best interest.
Kerry Anne ReidSearl: So is it talk to me when you say it's going give me feedback or is it a reflection?
Melanie Barlow: Uh,
Melanie Barlow: No, that's just scary.
Kerry Anne ReidSearl: Is it like a reflection I go through and i think, oh, wow, I actually haven't addressed this or I haven't addressed that.
Melanie Barlow: Yeah.
Kerry Anne ReidSearl: In essence, it's something that I can overlay on existing simulations or what I've been doing and it's almost like, oh, my gosh, I now know why.
Melanie Barlow: Yeah.
Kerry Anne ReidSearl: I was missing out on this or I hadn't included that. No wonder the learners were experiencing this and this.
Melanie Barlow: Yeah.
Kerry Anne ReidSearl: Or, wow, I just used Copilot. They were great. They developed up this simulation for me. But, oops, Copilot didn't necessarily understand my learner needs or et cetera.
Melanie Barlow: Yeah, context, yeah.
Kerry Anne ReidSearl: So, yeah, we're not saying we don't like Copilot or AI, but,
Melanie Barlow: I love a bit of co-pilot.
Kerry Anne ReidSearl: we We, yeah, in fact, you told me earlier that you'd divorce your husband. and told me
Melanie Barlow: i may I may be in love with Copilot.
Melanie Barlow: Anyway.
Kerry Anne ReidSearl: So I guess what I'm saying, there is so much risk now in that AI world where we can simplify and use that sort of those programs to develop up our simulations.
Melanie Barlow: Yeah.
Kerry Anne ReidSearl: But without necessarily having a framework like this to go through each element, there is a risk. So I love, this has been such an exciting project to be involved in and the fact of having things that are simplistic and easy to apply and easy to use is is the answer for for me as a someone someone experienced in simulation to hand over the reins to others.
Kerry Anne ReidSearl: So I think it's great and I'm excited to hear what our audience have to say once they see get access to this and start using it.
Melanie Barlow: Yeah, thanks, Kerry. And, yeah, anyone interested, we're looking, i guess, for, you know, having little sub-projects for different disciplines or different cultural contexts. So I guess, yeah, reach out.
Kerry Anne ReidSearl: So how do I reach out, Mel?
Melanie Barlow: Oh, well, you could go to Simulation Happy Hour website and send us a message or, yeah, you can contact me or go to LinkedIn.com.
Kerry Anne ReidSearl: yeah.
Melanie Barlow: and and leave a message for us there.
Kerry Anne ReidSearl: fantastic all right and uh jenny bassett isn't here today to ask us but if you were anywhere in the world having your little cocktail now what where might it be and what would you be drinking
Melanie Barlow: Oh, Kerry, so many choices. I think I'd be like to be, yeah well, I was going to say lying on a beach, but I'd really like to be sitting in a nice piazza in Italy drinking an espresso.
Melanie Barlow: What about you?
Kerry Anne ReidSearl: Oh, look, I'm just excited. I'm going to Antarctica soon, so I'd like to be in in Antarctica drinking a hot chocolatelk hot chocolate with marshmallows and cream.
Melanie Barlow: you?
Melanie Barlow: You kept that one to yourself.
Kerry Anne ReidSearl: Okay, so over and out from us and thank you so much.
Melanie Barlow: Thank you. See you next time.
Kerry Anne ReidSearl: Okay, bye.
