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The Embedded Coach with Dr Jennifer Keast
34 Plays3 months ago
Dr Keast is a Registered Nurse, Rural Health Researcher and Medical Simulationist at the University of Melbourne
Dr Jennifer Keast : Find an Expert : The University of Melbourne
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Transcript
Intro
00:00:40
Speaker
Hi, I'm Jenny Bassett. I'm Jane Frost. I'm Mel Barlow. And welcome to today's session. We've got Dr Jennifer Keast with us. Welcome, Jen.
00:00:51
Speaker
Thanks so much for having me. So, Jen, I'll just give a little bit of a background in your bio and then we'll jump into some questions with you. So your background is you're an ICU perioperative nurse and you've been a simulationist at the Melbourne University Clinical School.
00:01:07
Speaker
and the Rural Health Researcher with the University of Melbourne Department of Rural Health. Your career in simulation began in 1997, and that's when you established Australia's first high-technology medical simulation at the Monash Medical Centre.
00:01:23
Speaker
From there, you moved to lovely Shepparton, where I'm located, and you set up the Melbourne University Simulation Skills Lab's. And then from there, Jen, you went to currently based at the Melbourne University Clinical School, where you completed your doctoral thesis on learning to practice medicine, developing medical students' acute patient management skills using a longitudinal program of mannequin-based simulation.
00:01:51
Speaker
So welcome. Thank you very much. So we've invited you on today because you've been doing some wonderful work and I heard you talk to the Hume-Lodden Mallee Regional Simulation Alliance about your embedded coach research that you've been doing.
00:02:10
Speaker
And I thought, you know, our our podcast audience might like to have an understanding. So could you give us what is the Embedded Coach Program? Sure, Jen, and thank you for the opportunity to talk about it.
00:02:23
Speaker
Yeah, it's something that came out of my doctoral thesis. at the Royal Melbourne Clinical School when we were looking for optimal conditions for learning for novice learners. so I think you'd all agree that facilitation and debriefing are the most important components of simulation where the learning really happens.
00:02:42
Speaker
And also that the quality of the debriefing and facilitation is really important to ah achieve those objectives. And that also that novice learners struggle to complete a whole simulation without some sort of inaction support.
00:02:58
Speaker
And we were using pause and discuss as a as so as a facilitation technique at the Royal Melbourne. And there were a few things that were disturbing us about it.
00:03:10
Speaker
And I think when can become really experienced at a certain skill like facilitation, you start to reflect on how you might do it differently or do it better. And that's what we started to do. And out of that came embedded coaching.
00:03:24
Speaker
Excellent. Thanks, Jennifer. Can you explain to me, because it's not a term I'm familiar with in Sim, what is an embedded coach? Yeah. So the coach is in the room, in the simulation room the whole time with the learners.
00:03:38
Speaker
And I liken it to a little league footy coach. So let's say the footy coach has got two ah teams of kids they're having a practice match. And the coach is actually on the field with the kids. So not in the coach's box, not waiting for quarter time or half time to do the teaching,
00:03:54
Speaker
but identifying learning needs in the moment. So the coach might be kind of running up and down the sidelines or on the field and explaining to one kid why it's important to stay down in the back pocket and to another kid why we need to kick it directly up the centre and not out to the wings.
00:04:10
Speaker
So as the coach is identifying kind of learning needs, they're addressing them, but just as a one-on-one interaction between that that kid and the coach, so not pausing all of the actions.
00:04:22
Speaker
So that's very similar to what an embedded coach does. You're in the sim room with the group of learners and as you identify something that they might need support with, you approach that learner and discuss whatever it is with them, but you don't address the whole group and you don't stop the flow of the simulation.
00:04:41
Speaker
Great. And so often people will have different names for it, associate in the room, confederate, simulated participant.
00:04:52
Speaker
How are those roles like different? Like how is it different from a simulated participant going up and whispering to someone versus an embedded coach?
00:05:03
Speaker
Yeah. So the whole role of the embedded coach is based on Brown and Collins cognitive apprenticeship model where you're using scaffolding, articulation, feedback, et cetera. And the whole purpose of it is to explore thinking.
00:05:17
Speaker
So for example, if if the patient has low blood pressure, You might say to one student, what do you think about that low blood pressure or what are your thoughts on that low blood pressure?
00:05:27
Speaker
So you're exploring their understanding of the low blood pressure in the clinical context, whereas an embedded participant, embedded nurse, whatever you like to call it, does more of a hint and hope. And they might say something like, oh, gee, that blood pressure is a bit low. I'll just check it with a manual cuff or something like that.
00:05:46
Speaker
And the purpose of that is not to explore thinking, but to prompt an action. You know, it might be that the participants have overlooked the low blood pressure. They're focused on something else and you're wanting to push them along the kind of trajectory of the simulation by prompting an action.
00:06:01
Speaker
So, yeah, one's exploring thinking and one's prompting an action. So they're there the purpose is very different. And I kind of have a bit of ah an issue with the embedded participant. Like I see their role as twofold. One is a very helpful role where they're finding equipment or setting up equipment for the the learners in the simulation who might not know where things are stored or how to set them up.
00:06:24
Speaker
But the other way they often prompt these actions is through hinting and hoping by saying something like, oh, just check that blood pressure with a manual cuff. And we know that hinting and hoping in the real world contributes to patient harm.
00:06:38
Speaker
So why are we doing something in simulation when we're trying to role model expert clinical practice and clinical thinking in simulation? Why would we do something like hinting and hoping that we're trying to eradicate in the real world by teaching greater assertiveness and patient safety codes and things like that? So think you've got to be very careful with how you use an embedded participant, embedded nurse, whatever you want to call it, in the room.
00:07:04
Speaker
It's so interesting because I've written and I've talked about hinting and hoping and the impact on speaking up and the clarity of the messages. and I've never connected it to you've just said it to what we do as simulated participants.
00:07:20
Speaker
Right. 100%. You've just blow my mind Just before Jane asked her question, can I just ask, so when you're actually talking to the students in the simulation, it's different to a pause and discuss design, isn't it? Can you maybe give our listeners a bit of an idea how it differs?
00:07:40
Speaker
Because you don't actually pause the simulation to ask the learner the question, do you? That's correct. So we can just go back a step to what kind of prompted all of this in the first place.
00:07:52
Speaker
The three things we were concerned about with pause and discuss was the student's stress and cognitive load in the lead up to the pause. The fact that they're probably outside of their zones of proximal development because if they knew how to do something, we wouldn't be poop pausing in the first place.
00:08:09
Speaker
And then the interruption to flow. And we know that this this immersive state of flow is conducive to learning. So the cognitive load theory, the flow theory and the zone of proximal development were the things that we wanted to manage within the action.
00:08:24
Speaker
And we wanted to be that expert other in the room that could identify a learning need in the moment, catch the learner in right there, advise them or explore their thinking or whatever, so that they could achieve that proximal goal and move through the simulation.
00:08:40
Speaker
So let's say the simulation starts, there might be a team leader at the foot of the bed who allocates roles. I just pay attention to all the conversations, I watch what they're doing. And let's say they do have, the patient does have some hypotension and they decide to start fluids.
00:08:55
Speaker
The student thats that's been tasked with that job, I'll say, you know, tell me what your thoughts are on this blood pressure, what what fluid are you thinking about, how much fluid, et cetera, et cetera. So I'm checking just with that one participant while all of the action around this continues that they haven't just made a lucky guess when they've said a litre of saline that they actually understand, you know, how much fluid the patient needs.
00:09:18
Speaker
And once they explain that to me, I think, you know, I say, great, I agree with that. And I always give them feedback on their choices. Like I agree with how much oxygen you're giving or good decision on the fluid.
00:09:30
Speaker
Because if you don't do that and they have made a lucky guess and they put up a litre of fluid, they'll be stuck in what's called cognitive drag. And that's when they've put up a litre of fluid. I haven't commented. So they think, oh, well, it must be kind of okay if she hasn't said anything.
00:09:45
Speaker
But they can't move on to the next task a bit that they're assigned because in their head they're still thinking, is a litre enough? Is a litre too much? Am I going to make the situation worse? So if each time they do something, you say something like great decision on the fluid or i agree with that.
00:10:00
Speaker
They can move out of that state of cognitive drag, achieve that proximal goal and move on to their next task. So then I might be listening in on the history taking and making suggestions about exploring something around history taking.
00:10:12
Speaker
I listen in to the, or I might go up to the person who's been assigned to take the bloods and ask them what investigations they're taking, get them to justify those investigations. And so I'm very much part of a team, but just one-on-one conversations. And as I said, the flow is happening or the action is continuing around me.
00:10:31
Speaker
Lovely. Thank you
00:10:35
Speaker
Before I go to the official question, can I just ask, how many people do you have in these simulations? So there's normally a group of four to five medical students in the sims working as a team.
00:10:50
Speaker
They're all case-based presentations and there's always an ah some element of clinical deterioration. So they have to kind of sort identify and manage that and sort that out first before they can get into kind of their clinical reasoning cycle of what's caused the problem in the first place. So me, the ideal group size is four or five.
00:11:13
Speaker
And that's with one coach? Correct, yeah. And I'll point out that this is just medical students. This is not interprofessional simulations, but I think there's certainly cognitive space in the room for two coaches if you wanted to have a say a medical and a nursing or a physio and a nursing coach.
00:11:32
Speaker
Great, thank you. So can you share a story or a moment where you saw the embedded coach make a difference in a learner's development? Yeah, well, I've had a good think about this and I would say that it happens in small moments in every simulation when you're challenging a learner's thinking,
00:11:52
Speaker
They might not be understanding something properly. And in that moment, you're explaining something to them and you can see the light bulb moment for them. And they can, as I said, achieve these proximal goals and move forward.
00:12:05
Speaker
So I can't think of kind of one significant moment for a learner, but I can talk about how I think embedded coaching is applicable to all level of learners. When I was doing my doctorate, I was really focusing on novice learners who need support within the action.
00:12:22
Speaker
But if you like, I could share my thoughts around how it supports other learners as well. And that might illustrate a moment of learning for someone. That would be great. please Okay.
00:12:34
Speaker
So let's say that we have an interprofessional team that come along to do team training, let's say from an operating theatre. So it's interprofessional. And what we would normally do is put them into an immersive simulation and we'd be in the control room watching.
00:12:48
Speaker
And you normally know in advance what the stumbling blocks are going to be within a case because you've run it so many times. you usually know the things that you'll typically debrief. And let's say you're observing that and the the issue for the team that are managing the patient is that there's no clear leader. No one's actually stepped up and said, i'll lead this, and the room's a bit chaotic.
00:13:09
Speaker
If you were the coach in the room at that time, you could go up to someone and say, why don't you team lead this and I'll help you do it? And the two of you together could then go to the foot of the bed and team lead.
00:13:20
Speaker
And the room would go from the chaos to the control of having a designated leader. So in the moment, everyone has experienced the difference. You could still go back then at the end and debrief that, but your question, your advocacy inquiry question might be something like, I noticed there was no team leader.
00:13:38
Speaker
I was concerned it was quite quite chaotic in the room. How did that change when a team leader stepped up? You can still have that great discussion around how chaotic it is without a team leader, but everyone got to experience the difference. So I think the conversation in the debriefing is much richer.
00:13:55
Speaker
They're saying things like, oh, I suddenly knew had who to report back to or the role allocation was was much clearer. Because what normally happens with the group in a in a post-action debriefing is they don't get another chance to go back into the room and apply the learning.
00:14:11
Speaker
The next group goes in because it's their turn. Whereas if you've coached them through it, they've they have experienced the difference. And not only that, you've enabled someone who might not have ever stood up as team leader to stand up and do it with your support.
00:14:25
Speaker
And the next time something happens in the real world, they might say, actually, I know how to do this, I'll lead. So I can see it working for a whole level a whole range of learners, not just novices.
00:14:38
Speaker
And it's quite a flexible model. As I said, you can still do a post-action debrief and just incorporate coaching into the facilitation. Yeah, i like that, Jen, because I think we talk about in simulation about learning from mistakes.
00:14:54
Speaker
And so then we go into the debrief and we unpack that. And a lot of powerful learning happens in that. But what you're effectively doing doing is august sometimes for or often for our novice learners, they haven't seen the I guess, the performance they need to achieve for themselves.
00:15:15
Speaker
So you can talk about it, but they haven't kind of visualized it or participated in it. So effectively, what you've done is kind of let them, obviously, they're making some errors because no one stepped up to a team leader.
00:15:30
Speaker
But then you've brought in that element of success and then the debrief then is focusing on that difference rather than the deficit, which I think is lovely.
00:15:42
Speaker
Yeah, exactly right. And as i said, i I would do that for, you know, experienced clinicians because it still happens with an experienced team, but people don't team lead.
00:15:55
Speaker
So is there any times when you would not use an embedded coach, Jen? We've talked about where you are. Are there other examples where you might use it? Yeah, I think the only thing I can think of for that is, say, if you're doing it a communication station, so you might be doing simulations to break bad news or get consent or something like that. I wouldn't interrupt the flow of that conversation, say, with a simulated patient and a participant.
00:16:19
Speaker
I'd wait until the end and talk about maybe sticking points or roadblocks they might have encountered. But I think for any immersive simulate simulation, where it's a clinical basis rather than a communication basis, I can't see any time when you wouldn't use coaching.
00:16:35
Speaker
And the beauty of it is you might be standing there as the coach and never have to step in and coach, but you're kind of there to do that. With our medical students, we have them for 15 simulations across second year.
00:16:48
Speaker
And, you know, by the second half of the year, I'm not coaching anywhere near as much as I am in the first half. And by the end of the year, they're saying to me, Jen, go for a coffee. You know, come back in 20 minutes, we'll we'll have this nail. So you're but certainly withdrawing that scaffolding over time. So the beauty is that you can just stand there and not coach at all if it's not needed.
00:17:08
Speaker
Yeah. um yeah So if I'm new to simulation, Jen, how do you choose which bits to coach? That was my other question. I think sometimes when you're new to simulation, you want to over-coach it.
00:17:22
Speaker
So can you you know where what's your advice there? Yeah, that's a great question. the i think that, first of all, the coaching role, I think, does align nicely with how clinicians work in the real world. You know, let's say you've got a registrar doing their first trauma call. You might have a consultant standing next to them and almost coaching them through it or you might have a nurse preceptor, you know, coaching someone through taking a nursing history or whatever. So I think it aligns pretty much with what we do in the in the real world.
00:17:59
Speaker
And the things that I coach, I think that generally speaking, you can coach more things than you would debrief. Often, you know, you might have three learning objectives in an immersive simulation and they're the things that you generally debrief and you can't debrief all the other little things that might have happened.
00:18:16
Speaker
But with coaching, as they're happening, it might just be one or two words you need to say to someone that you can give feedback or correct. So I kind of can coach a lot of stuff simultaneously because I've been doing this for a long time and I have a well-developed sense of situation awareness as the coach.
00:18:34
Speaker
I can listen to a history while I'm talking to someone about something else and, you know, doing kind of three things. And that's a challenge for a novice, of course. But I still think that's easier than coaching ah trying to develop tricky advocacy inquiry questions, trying to remember all the action that you have to debrief then in a pause or at the end of the action in a post-action debrief.
00:18:58
Speaker
So because it's happening in the moment, you're kind of knocking things over as they happen. So my cognitive load is much less doing that. And I think you can correct a whole lot of other things. So, for example, you know, at the start of the year, the medical students are aren't confident to use medicalised language. They don't think that they're, you know, professional health professionals yet and they'll say say things like, oh, let's chuck on some air if they want to, you know, apply oxygen. And I say, oh, do you mean administer oxygen?
00:19:28
Speaker
So all the time I'm kind of correcting little things like that that you would never really debrief. But getting back to overlooking things, if you're situation awareness is not quite that well developed.
00:19:42
Speaker
The advantage of having students for 15 simulations is that the one student that you're talking to about fluid management, let's say, and the other three then miss out on that, the other three will end end up picking all of that up over the course of the year, like because you're reteaching it all the time.
00:19:59
Speaker
But let's say you've only got a group for one or two simulations and you're coaching everyone individually. At the end of the sim, you could do a ah clinical wrap-up And you could just go around the room and say, right, Mel, what did you learn from an interaction with the coach? And Mel might explain about volume management. And then, Jen, what did you learn around about investigation? So they could all share their learning in kind of a peer teaching session at the end of the simulation to share whatever whatever it is that they've learned.
00:20:27
Speaker
Yeah, nice. That's a great idea. How does this embedded coach support anxious students during simulation? Because I think, you know, you talked about cognitive load, but think a lot of students are coming, are very anxious when they're going into simulation. So can you share with us what you've seen about the embedded coach and student stress?
00:20:49
Speaker
Yeah, for sure. so when we started to think about pause and discuss and its effect on the students, I asked them about it. That was part of my research.
00:21:00
Speaker
And I was really flabbergasted at their responses about how stressful it is for them, how they hate a timeout because it interferes with their thinking, or they love a timeout because they're really stressed and frustrated at that point.
00:21:15
Speaker
And there were even comments like, very hurtful ones, haha, Like I can see her in the corner waiting to pounce on us and stuff like that. And, you know, when you really think about all the things that are going on in the simulation room for them, especially when they are novices about conflicting data sources, you know, the patient's telling them one thing and the monitor's telling them something else. And you might use the overhead paging system to give them information and then the team leader's giving them instructions.
00:21:43
Speaker
They don't know how to find equipment. They're not sure whether, like they might identify that the patient needs oxygen, but then they're not sure whether that's their job to start it and how much to give. So they found it really stressful during a pause and discuss. we're very much about reinforcing with them that the coach is on their team.
00:22:05
Speaker
So right from the start of the year, we we embed that into every simulation I'm here as your coach, I'm philip ah metaphorically rather holding your hand through all of this, I'll help you with any help that you need.
00:22:19
Speaker
We also take them into the control room and say to them that the the person on the console is also on their team, setting them up for success every time. So, you know, if they give oxygen in the setting of hypotension, they're the blood pressure will improve.
00:22:35
Speaker
So we would never be dropping the blood pressure to make them notice it, you know, in the room. It would be the coach saying, hey, have you noticed that blood pressure? What are your thoughts about it? So they know that we're all on their side.
00:22:47
Speaker
So the kind of post-traumatic intervention interviews with those those same students were that the coach was fantastic the the the thread running through the whole experience the one supporting us they catch us before we fall all of those sorts of comments so the students had much less aous anxiety much less extraneous cognitive load they were in flow yeah so they they found it hugely beneficial and much less stressful so my my
00:23:20
Speaker
belief about it is that it's the ultimate in creating psychological safety. You know, we often talk the talk about psychological safety and simulation. But if we put people into immersive simulations, knowing what the same three stumbling blocks will be,
00:23:38
Speaker
then we're setting them up to fail. We know that they're going to stumble at three points because we've run this simulation a lot and they're the typical things that learners stumble on.
00:23:50
Speaker
And when they do stumble, we think, great, now I've got something juicy to debrief at the end. Now, why are we doing that? Why aren't we catching them before they fall? and saying to them, okay, noticed you've started a litre of fluid there, just talk them through that decision because let's say litre is too much for that particular patient in heart failure.
00:24:07
Speaker
So you're getting them to explain why they chose a litre, maybe reframe their thinking in the moment, they reduce it down to 250 mils, they've had success and they move on to the next thing.
00:24:20
Speaker
So we really think it creates optimal conditions for learning and, as I said, is the ultimate in psychological safety. That's really interesting. You answered it bit there, but I was really super keen on how do you, from a logistics perspective, how do you pre-brief it? And you explained a bit of that.
00:24:39
Speaker
But also in the room, like we talk a lot about for simulated participants, you know, you don a particular role and doff at certain things to get in and out of character. And so as the coach in the room, how do you present yourself and how do you not get in the way? Yeah.
00:24:55
Speaker
Yeah. Yeah. We call ourselves coaches all the way through. We explain the role. We can talk a bit about the Little League footy coach to students as well. And they know that we're part of the team.
00:25:08
Speaker
Often, you know, they might get blood results back and then they look to us. They want to have the discussion with us as the coaches about those results. And I'll just say, we'll just discuss those within the team. Like I deflect back to them if they're becoming over-reliant on the coach.
00:25:23
Speaker
Yeah. And I'm just kind of on the periphery all the time, just not prowling, but just in a position where I can visualise everything that's happening.
00:25:33
Speaker
So I've just... Are you in particular? Do you have a badge on? Are you in scrum? No, it's like... They just know that whoever's in the room with them for that whole year and and for fourth year as well is their coach.
00:25:45
Speaker
So the other thing you can do here Alter the element to interactivity if they are overloaded. So I'll give you an example which might help answer that question as well. So let's say at the beginning of the year they're doing a STEMI, we know it's a STEMI, but they're getting to the point of thinking it might be a STEMI, and they're just as concerned about the nausea as they are about, like, getting a 12-liter or troponin, and they're very much focused on the nausea.
00:26:11
Speaker
To kind of reduce the element interactivity and reduce their cognitive response load and role model expert thinking around that, I'll say something like, let's get the nurse to deliver an antiemetic.
00:26:24
Speaker
And what I would focus on right now is a 12 lead and the troponin. So I've told them what my focus as an experienced clinician would be. And we've got this imaginary nurse that doesn't exist. And and then I just say to them, the nurse has given, you know, four milligrams of ondansetron and they that doesn't actually happen.
00:26:44
Speaker
Yeah, so we're never... And if theyre they're not usually looking for any equipment or things like that because we don't ever do any skills teaching within the simulation either. um So we're not they're not cannulating or... they They put up fluid because that's pretty simple to do and it's a bit of fun. But if you've got them cannulating, then that's going to, you know...
00:27:08
Speaker
often detract from the simulation, it's 20 minutes because they haven't done it for ages and stuff like that. But we don't have skills ever as a learning objective within the simulation. It's all about their thinking.
00:27:19
Speaker
Yeah. So there's not a lot of equipment to be sorting out or finding for them apart from blood results. Yeah. Yeah. So we we're not we're never out of the coaching role. Okay.
00:27:32
Speaker
Right. And are you the debriefer then at the end? Yeah, we don't do a debrief because all the teachings happened in the action. So when we've got them for so many simulations, like I explained, at the end we'll just whip around and see if they've got any questions.
00:27:50
Speaker
They might have missed something on management of AF, for example, so we clarify that. But we might get another student to explain that that we know we've had that conversation with. And then we ask them one thing that they'll take away from the simulations.
00:28:03
Speaker
And that might be management of AF, but it might also be something like the importance of clear role allocation. So, you know, they' they'll come up with something they've learnt. We never say to them, how do you think you went? Because as you said earlier, Mel, they haven't got a reference point.
00:28:20
Speaker
You know, what what are they comparing themselves against? Are the second years at the same level or a MET team? Or, you know, so we don't ask them how they think they went. and And we don't ever kind of say things like, oh, yeah, I think you did really well.
00:28:35
Speaker
we we just leave that and give them specific feedback. We might ask them how the phone calls went if they've called the registrar. And then we have that person, the console operator, come into the room and give feedback on the on the phone call, for example.
00:28:49
Speaker
But everything else has been picked up and corrected or explored or given feedback on within the action. Okay. So if I was a participant,
00:29:02
Speaker
And you didn't have the conversation with me, but I saw something happen and I didn't understand why it happened. Do I have an opportunity to get that clarification? Yeah, that's one thing we do say in the pre-brief.
00:29:15
Speaker
Like there can be a constant dialogue between the learner and the coach. So ask anything you need to ask. Now, sometimes they might say things like, do you think I should make a Met call? And I'll say, well, ask your team what they think.
00:29:28
Speaker
And then at the end I might say, look, indications for a met call and if you're having trouble deciding on whether to make one or not ask the team if the majority vote for a call then you probably need to make one but if but if they're saying no no we're fine and you probably don't so often if it's a ah question that I think that it's not up to the coach to answer then I'll put it back on them but if they don't know the dose of a drug then I'll just tell them what it is how can they find that out otherwise sort of thing yeah Thanks, Jen. Is there anything that we haven't asked you about the embedded coach that you think it's important for the listeners to to know about think the embedded coach?
00:30:06
Speaker
Oh, just I can't emphasise enough catching the teaching moment and really optimising that for the learner and correcting things in the action rather than waiting half an hour for the debriefing when you've missed that moment to correct it.
00:30:25
Speaker
Yeah. So that's probably the only thing. Yeah. Thank you. That's fantastic. Now, a bit more of a general question. What you think the future of simulation looks like for healthcare education?
00:30:37
Speaker
Yeah, that's a great question as well. I think it's a really exciting time when you think about AI, virtual reality. So, technology that hasn't even been developed yet.
00:30:50
Speaker
So I think from a technological perspective, it's really exciting. But I think the pain points haven't changed about how to embed simulation, you know, into healthcare culture, how to embed it into hospital-based curricula. you know, it's quite easy to embed it into a university curriculum because the students have dedicated teaching time.
00:31:12
Speaker
How, pardon me, how do you get executive buy-in, how do you identify champions? I don't think any of those things have changed for about 20 years. So I think we've got to start thinking differently about how we measure metrics and measure outputs and just keep persisting with all of that. But that still is really disappointing that there's not that buy-in across the board.
00:31:37
Speaker
Yeah. but I think from other perspectives, it's really exciting. I mean, the reason we do all these simulations at Royal Mel, clinical school, which which aren't necessarily done at other Melbourne University clinical schools because they're not part of the set curriculum, is because our clinical dean, Professor Peter Morley, is a champion.
00:31:57
Speaker
who loves simulation, who thinks we do create optimal conditions for learners, who delivers a particular curriculum in a particular way. So if the students are learning about AF, they have their lectures, their tutorials, their cardiac ah outpatient clinics, et cetera, et cetera.
00:32:15
Speaker
But one slice of that AF pie for him is simulation to learn about AF. so We have a champion that enables us to do all of this teaching and be inventive in the way that we do it. But, you know, there are others that other clinical schools that don't have that.
00:32:31
Speaker
And so, you know, it's not embedded into the into the curriculum. So you need that champion for sure. And you need someone who's got the checkbook as well to invest the money. Yeah.
00:32:43
Speaker
But I think it's amazing what you can ah create. with very low technology mannequins and half an hour in double staffing time. You know, there are still opportunities there to optimise exposure to simulation.
00:32:59
Speaker
But I think the other thing too is that we're still struggling a bit to embed a feedback culture in healthcare organisations from a clinical perspective. So not in simulation, but in the real world.
00:33:14
Speaker
And until that's a more accepted culture where giving feedback is normalised and expected and done really well, you know you can't expect then students to, or learners rather, to be open to the feedback that we we give them in simulation.
00:33:31
Speaker
so So we didn't put this question on the list to ask you, but do you think the feedback that you give as an embedded coach is received differently than feedback we give in a debrief? Jen, did that come out in your research?
00:33:46
Speaker
I think so, because i think because it's in the moment. As I said, they because of the feedback, they achieve that proximal goal and can move on. You know, it always concerned me, the short distance between a simulation room and the debriefing room where participants would be walking back to into the debriefing and they'd be saying oh god I really stuffed that up or we didn't have a leader or no one noticed the blood pressure they're owning that before they get into the debrief because they want everyone to know that they've recognized that they missed that before the debriefer picks them up on it so I think that the feedback given in the moment as I said it catches them before they fall they're not feeling foolish walking back to the debriefing room because they missed something
00:34:31
Speaker
They were coached through it. And it's interesting, especially with the fourth years, because we coach them less and we do do a... full kind of debriefing with them at the end.
00:34:45
Speaker
And when they say things like, oh, well, we focused on X because of Y, they've forgotten that it was the coach that refocused them to that. They just think of the coach as part of the team and that they achieved that. So sometimes they can't even remember what the coach has told them as opposed to what their colleagues in the team might have told them.
00:35:06
Speaker
And I love that because it's just, organically come up within the action and not necessarily identified as a coaching moment even. So that's how accepting they are of this coaching role, that you really are in the team and setting them up for success.
00:35:22
Speaker
Yeah, lovely. And when I asked you to do this podcast, Jen, is there a paper where, if I wanted more information about the embedded coach, um ah where are we up to with that?
00:35:33
Speaker
So we're that far off submitting the paper And we're more than happy we're developing workshops. um So lots of people are interested in it. we've just We've signed a Memorandum of Understanding with Victoria Police. They have a simulation lab where they address domestic violence issues and their trainees all go through simulations.
00:35:56
Speaker
It's a full house and it might you know i have lots of alcohol spread around the house and unmade beds and dirty washing everywhere. They have actors role-playing the victim and the perpetrator.
00:36:08
Speaker
They have a sim baby that doesn't stop crying throughout the whole thing that's wearing a wet nappy. You know, like they really make it realistic. They put their trainees through sessions and they now want to use coaching as the facilitation model.
00:36:22
Speaker
So we're running workshops for Victoria Police. So we're more than happy to run workshops and and speak at conferences and stuff like that. But the paper, I'm hoping, is only that far off.
00:36:34
Speaker
Perfect. Thanks, Jen. And then the question, the last question we like to ask everybody because we are at simulation happy hour is you could be anywhere in the world having a drink, where would you be and what would your drink be, please?
00:36:49
Speaker
Now, I didn't have to think about this for a very long. So I'd be in Paris. I'd be on Avenue Montagne at the Dior Salon and I'd be drinking Krug.
00:37:01
Speaker
Oh, sounds great. Oh, my goodness. That's amazing. Amazing. but So thank you, Jen, very much for coming along this afternoon and sharing ah your embedded coach information.
00:37:15
Speaker
And people can contact you at Melbourne University. That's correct, yeah. EastJay at unimelb.edu.au. Great.
00:37:26
Speaker
Thanks, Jen. Thanks for coming this afternoon. Thank you so much for having It was so much fun and lovely to catch up again and always great to talk all things simulations. Perfect. Thank you. Okay.
00:37:40
Speaker
Thanks, Dawgs.