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00:00:01
Dear Maddie
21 Plays6 months ago
Questions the listeners have shared with Maddie
Recommended
Transcript
Intro
Introduction and Overview
00:00:40
Melanie Barlow
Welcome to Simulation Happy Hour, I'm Mel Barlow.
00:00:44
Jane Frost
I'm Jane Frost.
00:00:45
Jenny
And I'm Jenny Bessett.
Listener Questions with Maddie
00:00:47
Melanie Barlow
Welcome to today's session is the questions that came in to our resident mixologist, Maddie. And you can find her and you can see her on our website or you can send her questions via our social media.
00:01:04
Melanie Barlow
And so a few questions came in this week.
Psychological Safety in Education
00:01:07
Melanie Barlow
One from LinkedIn, which was a really interesting question. So much so we have an upcoming podcast dedicated to it around psychological safety And are we being too safe now, particularly in undergraduate training? And is that in itself impeding learning? Are we doing our learners a disservice around not building resilience?
00:01:33
Melanie Barlow
So super interesting question. We could debate that all day long, which we will soon. ah But we're going to jump into a few questions today. the first one being...
Understanding Simulation: Definitions and Contexts
00:01:45
Melanie Barlow
What is the big fuss with simulation? What is actually simulation? So I thought that was a good place to start on our first Maddie questions who couldn't be with us today, but I caught up with her at happy hour last night and she mixes a good cocktail, our Maddie.
00:02:03
Melanie Barlow
And so she gave me this question. So I thought I'd start with the SSH dictionary definition of sim and then I'm going to throw it out to you guys to see.
00:02:14
Melanie Barlow
if you agree or not.
00:02:14
Jane Frost
Yeah, great.
00:02:16
Melanie Barlow
So there are two. So it says it's a technique that creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions.
00:02:36
Melanie Barlow
Or it's a a pedagogy using one or more typologies to promote, improve,
00:02:37
Jenny
Bye.
00:02:42
Melanie Barlow
or validate a participant's progression from novice to expert. What's your definition? Do you agree with those?
Simulation in Healthcare: Emphasizing Safety
00:02:52
Jane Frost
Look, I'm going to go I prefer the second one rather than the first. I think simulation is is pretty broad and that you'll often hear of simulations being run to see where the traffic will go around Sydney, for example.
00:03:10
Jane Frost
We're not talking about that kind of simulation. We're really looking at the simulation that prepares people our student nurses or health professionals be better prepared when they go into the workforce, I think.
00:03:26
Jane Frost
And I guess that brings us back to that psychological safety and how prepared we can actually make them.
00:03:29
Melanie Barlow
Thank you.
00:03:31
Jane Frost
But them a safe space to make mistakes is is what I really value about SIM. Jenny, what do you think?
00:03:39
Jenny
Yeah, look, I agree, Jane. I'm a huge believer in simulation can be anywhere. I think sometimes when we think about simulation, lots of people default to mannequins in labs, whereas for me simulation can be in a classroom, it can be in a workshop.
00:03:58
Jenny
You know, it doesn't have to be with a manikin So I think it's any opportunity for learners to practice, consider, give professional thought to situations that that they may face in their clinical experience. So for me, it's an education, teaching experience tool.
00:04:19
Jenny
I know sometimes we use simulation for assessment. And I think that's, again, back in that psychological safety space. So for me, it has a really broad range meaning you know like lots of institutions don't haven't yet implemented virtual simulations.
00:04:38
Jenny
lots of opportunities there to still come.
Impact of Funding on Simulation Practices
00:04:41
Jenny
the other thing, the HWA funding has left the simulation sector, so we got HWA funding in about 2010, 2012, but since we that national funding is no longer available,
00:04:57
Jenny
I've seen huge changes in simulation and the roles that we all play in simulation. So, yeah, I think simulation can be very broad in its definition and I think it comes with experience about how you apply that.
00:05:16
Melanie Barlow
Hmm, interesting.
00:05:17
Jane Frost
Jenny, do you think it's almost a way of thinking or ah from what you were saying, I kind of thought that's what you were alluding to, that simulation is almost the mindset of how you're going into the classroom and doing things?
00:05:31
Jenny
yeah As an educator, I think it's about thinking which simulation do I use for what I want to teach today. Like we've we've spoken to Alistair and if you haven't listened to Alistair's podcast, please go and listen to Alistair's podcast because if you think about improv, well, then, you know, it's absolutely completely limitless about what we do around simulation.
00:05:48
Jane Frost
Yeah.
00:05:53
Jenny
So I think it comes down to the knowledge and experience of educators and And I think this could be quite controversial, but I think one of the other things is we are sometimes constrained by how we can replicate simulation across facilities inside of of accredited courses.
Flexibility in Simulation Modalities
00:06:14
Jenny
You know, we we need to replicate to make sure that every student gets the same experience on every campus.
00:06:20
Jenny
But, you know, I think provided the principles of the lesson are taught, and the experience of the of the educator.
00:06:32
Jenny
So for me, Jane, I'd like to see it have a bit more freedom in the you know the the no the modality, to use one of the big words, the modality or the type of simulation that we can use because I can see areas where when you're talking about a case study in a workshop, I'd love to give improv a go.
00:06:57
Jenny
But I've been doing simulation for a while, so maybe, you know, that's my own personal choice.
00:07:04
Jane Frost
So Mel, do you mind if I ask Jenny another question about that? that okay?
00:07:08
Melanie Barlow
yeah
00:07:10
Jane Frost
If you're saying that we can do things differently, how do we have that
Challenges in Simulation Consistency and Scalability
00:07:15
Jane Frost
consistency? And I know that there are a lot of maybe less experienced educators than yourself and casual staff that may not be as comfortable with using these techniques. So How do we make it scalable and unique and keep those learning objectives? I think that there's a probably another podcast on that itself in how to maintain that consistency. It it concerns me that we won't get that if if we do improv, for example.
00:07:53
Jenny
So I think it's about investing in the staff that we employ, Jane, and I agree that there's a lot of casual staff that are doing simulations. Maybe that's in the tertiary sector, but I work in a GP practice as well as working in an institution.
00:08:10
Jenny
And so for me, simulation, you know, I've got a lot of, um um you know, huge avenue around which simulation I choose to use for which situations.
00:08:22
Jenny
so I agree with you. I think there does need to be a safety net about the scalability of simulation. But where you've got experienced clinicians, you know, for me, I'm happy to share my experience. I'm happy to teach other clinicians.
00:08:37
Jenny
So it's about having time to do that, to have those discussions.
Educator Preparation and Time Constraints
00:08:42
Jenny
But I think sometimes we're on such tight timelines. And the other thing is it's cognitive load for educators.
00:08:49
Jenny
If I've got to come in and teach a session around vital signs and somebody's given me ah ah script and this is how to do it, you know, how much time have I had to prep as the casual academic to do that?
00:09:02
Jenny
And, vice you know, the same thing I think applies to in situ simulations, whether it's in a GP clinic or a hospital setting. How much time has the clinical educator got to prepare for that simulation? Because really when you're doing it it's in in situ, it's in that handover time and it depends what's happened on the shift.
00:09:22
Jenny
So sometimes you've got to make an in-the-moment decision to change it because if the because the other thing is sometimes the manikin's voice doesn't work or you know the battery's flat.
00:09:36
Jenny
So then what do you do? Then really you go to improv, which is not the – you know the exact thing around what Alistair was talking about, but I think it comes down to the experience of the simulation educator to be able to adapt that to still work in the timeframe or cancel it and reschedule it.
00:09:57
Melanie Barlow
So before I jump to kind of my thoughts on the definition, ah ah think I just want to touch on a point like that scalability, and we're talking about improv, but improv is really a way of also enhancing our role play, which we do all the time.
00:09:58
Jenny
Great.
Case Studies vs. Simulations
00:10:14
Melanie Barlow
And role play isn't traditionally by a lot of people, like an academics. seen as simulation for some reason. And these are ah ah conversations I have a lot. And I think we need to look at putting structure more structure around our role play. Like how do we prepare our academics?
00:10:41
Melanie Barlow
You know, how pre-brief? How do we debrief or give feedback? How do we build a background for that character, all those things. I think if there's structure in place, we can replicate it and scale it. So that's my thought.
00:11:01
Melanie Barlow
But in regards to the definitions, I think it's really about the environment you work in. So I looked at the first one, which is around representation of a real event for, you know, not only learning, but for testing and understanding systems. So Prior to higher education, I was in a hospital-based sim centre. And so that definition was really relevant because we did a lot of usability process and system testing where we'd replicate elements of a process or of a room and we'd test that.
00:11:37
Melanie Barlow
But now I'm in higher education, it's definitely more the second with the pedagogy. But I just want to call out that bit about representation of a real event.
00:11:50
Melanie Barlow
So when we look at that in itself, we do that in paper-based case studies, we do that in tabletop exercises. So is that, is a case study sim?
00:12:04
Jenny
Yeah, I think it is, Mel. I think that students giving cognitive thinking to situation that they may be exposed to in a healthcare setting. And so, you know, Jane, what do you think? Because, I you know, I think it is.
00:12:25
Jenny
But what do you think, Jane?
00:12:27
Jane Frost
I think that it depends on the case study because you can have a case
VR in Simulation: Structure and Debriefing
00:12:34
Jane Frost
study that says Mr. Smith attends the ED department with chest pain. That can be your case study and I don't think that's simulation.
00:12:45
Jane Frost
If you augment that with all the details and and really try and have a realistic representation of what that that person is experiencing, then I think that becomes more of a simulation with all the background and the information around it.
00:13:03
Jane Frost
So i'm kind of on the fence really about case studies because I have seen case studies really thin in the detail. Here you go, go off. and And it's much more about the just the presentation rather than the person. And for it to be a realistic representation, my thoughts are it it needs to have the person, it needs to have the information about what they're experiencing and then how you react to it, not just...
00:13:37
Jane Frost
the they physical signs
00:13:41
Melanie Barlow
Yeah.
00:13:42
Jenny
And can I just add something there, Jane? I think that's a really valid point because sometimes I think we forget that the students don't have the clinical context or the clinical experience that we have. So when you set a case study and you set it in ED, if a student has never been or a learner has never been to an ED department, you know, that they have no clinical context. And so I think we forget how stressful that is for the learner.
00:14:11
Jenny
So, and I think that's, I agree with you, I think it's very much in the design and how much information you give to the learner prior and then what has been their experience in their learning journey.
00:14:12
Melanie Barlow
yeah
00:14:25
Jenny
So, you know, it's no use giving really complex, in-depth disease, chronic care, multi, you know, disease patient to a first year student.
00:14:37
Jenny
And I think that's the art and craft that experienced um clinical educators bring to the space.
00:14:45
Melanie Barlow
And yes, around that case study, like how is it structured? Are we pre-briefing? Are we getting them together afterward and debriefing it? Or is it just go to your tables, work through the case study and then off you go?
00:14:58
Melanie Barlow
So is there pedagogy around that? Yeah. Interesting.
00:15:04
Jenny
Because the other thing I think the in there is that we ask ask the students to do the pre-learning. Well, you know in most teaching situations there are some students who have done the pre-learning and there are some students who haven't.
00:15:19
Jenny
So then as an educator I've got this other... complexity to my setting in that I'm not just teaching simulation to, you know, learners inside the box.
00:15:30
Jenny
You know, you've got to teach across a ah breadth of students who did do the work and the students who didn't do the work. And I think that's another conundrum that educators face, whereas if, you know, if you're going to a simulation centre, most people have done the learning because they're paying money or they're excited and motivated to be attending there.
00:15:54
Jenny
They want to do well, so they may have done the pre-learning. So, yeah, I think there's a couple of other topics in there we can do a few more, you know, quick chats around.
00:16:01
Melanie Barlow
Yeah.
00:16:03
Jenny
So I may have made a complex situation of just a quick chat. These things go around in my brain and I think, wow, this is a great opportunity to be able to discuss them.
00:16:15
Jane Frost
think that's why we're doing this podcast, Jenny, so that you can get it out there.
00:16:15
Melanie Barlow
Excellent. like Yeah, we're probably all thinking it.
00:16:19
Jenny
Oh, good. Thank you.
00:16:22
Melanie Barlow
So another question came in and I'm going to direct this towards Jane because I know you've got experience in this. Is virtual reality VR ah simulation?
00:16:32
Melanie Barlow
and often they talk about in the same context, this concept of micro simulations. So what is a micro simulation and is VR simulation?
00:16:44
Jane Frost
So I think there are lots of products out there that are called VR ah simulation. And I think when you're in an immersive environment, it is simulating the real environment can be very realistic.
00:17:00
Jane Frost
I'm not sure that we always apply the same principles. So I think sometimes we... forget to do the pre-brief or and it's well I guess more importantly we forget to do the debrief because and they come out of the experience and they're all high on the experience and all that was really cool but we actually don't have the same structure as we might do if we were doing it in a simulated ward environment where where we debrief the situation so I think
00:17:33
Jane Frost
are a lot of things that are now called simulation that we just have to be aware that you still need to to close the loop in the learning cycle really by coming back and doing that debriefing at the end to see what people got out of it because think as we're going to talk about in another podcast, the psychological safety is is an issue when you're putting people into very realistic situations and VR can really make that immersion.
00:18:06
Jane Frost
there's also mixed reality which can which can help I think that can augment simulation and actually show you and signs and symptoms and actually display a patient so that you're seeing a patient.
00:18:21
Jane Frost
term micro sim is something that's come out recently and it's more about those short bites of almost interactive like training that you can do on a a computer.
00:18:36
Melanie Barlow
Bye.
00:18:36
Jane Frost
Whether Whether we think of that as
00:18:39
Jane Frost
Simulation, mean, I think it is a simulation, but again, we're just often putting those into an LMS, sorry, Learning Management System, just for anybody who's not not um from a university.
00:18:55
Jane Frost
And we just leave it for the students to have a look at and go, you know, tell us what you thought of that rather than actually wrapping around and and embedding it and or using it in a classroom or a workshop where you can actually debate or talk about and debrief the concepts that came out of that.
00:19:17
Jane Frost
So I think it can be considered, but I think it's a bit like, case study. It depends on the content and it depends on that wrap around would be.
00:19:27
Melanie Barlow
Yeah.
00:19:28
Jane Frost
But those are only my thoughts.
00:19:30
Melanie Barlow
Yeah.
00:19:30
Jane Frost
You may totally disagree.
00:19:32
Jenny
So, Jane, can I ask you something?
00:19:32
Melanie Barlow
I think they are. Oh, yeah.
00:19:35
Jenny
So, and I don really enjoyed, you know, your line around VR. What role then do you think reflective practice plays? Because, you know, we talk about the debrief, but sometimes I wonder, you know, what happens around reflective practice, whether that's, because to me, debrief can sometimes be guided reflective practice.
00:19:59
Jenny
But do do you think our learners go away and go, oh that happened and this happened, and then they go and look it up, or do you think they just dump it and move on to the next experience?
00:19:59
Melanie Barlow
Oh.
00:20:11
Jane Frost
um Well, I guess it's it's what the simulation is.
00:20:14
Jenny
Yeah.
00:20:16
Jane Frost
So there are some very... maybe not traumatic, but realistic simulations that put you in the position of being the patient and things.
00:20:29
Jane Frost
For example, there's a cultural one where you're in ah overseas hospital you are the patient, but you can't understand what's going on.
00:20:38
Jane Frost
And after that, you probably do need the debrief. I mean, you can write a reflection, sure, but...
00:20:42
Jenny
you
00:20:44
Jane Frost
The safety around that, so I'm conscious that we might be going into that psychological safety that we're going to talk about another day, but I think you do need to protect the students because you don't know what their background is.
00:21:02
Jane Frost
you don't know what they've experienced before and what's actually going to trigger them in ah a virtual environment. So think there needs to be that safety net.
00:21:12
Jane Frost
And I think you could use guided reflection. You could actually have them watch it and then do that. But I guess you're still not going to get that interactive debrief of actually being able to talk through what's just happened and how that might work in practice, which I think is what what we actually want to close the loop on is, yes, we can show you this, but in reality, what's going to happen?
00:21:37
Jane Frost
And in reality, what would you do differently? those kind of things to give them the chance to go, oh no, I went into VR and I killed the patient.
00:21:49
Jane Frost
Okay, that's that's quite traumatic.
00:21:49
Jenny
Thank you.
00:21:52
Jane Frost
Afterwards, you go, okay, so what have you learned from that? Well, I've learned that I'm never going to do this again. Okay, so you can close that loop and and reassure them that actually what you've done is learn in a safe environment rather than leaving them with the fact that, oh, my goodness, they killed the patient.
00:22:11
Melanie Barlow
And I think in an upcoming episode, like, yeah, that's a super important
Feedback and Debriefing in Simulations
00:22:16
Melanie Barlow
point. And it also brings up like debrief versus feedback. And when do you use either of those?
00:22:22
Jane Frost
Mm-hmm.
00:22:24
Melanie Barlow
And so I know upcoming we've got Kate Morse and Mary Fey that's going to be a topic of discussion like in Sim, when is feedback okay action-based feedback, which is more in VR. ah And And when you get scores or you go to the next level in gamification, that's a form of feedback.
00:22:44
Melanie Barlow
And when do you need a debrief, a facilitated, reflective discussion? So, yeah, that's a session in itself too. These are good questions.
Adapting Simulation Standards for Australia and New Zealand
00:22:54
Melanie Barlow
And our last question for today's session was around that there are... Well, it's really around should we be following in Australia the American-based INACSL or standards?
00:23:09
Melanie Barlow
So I have a strong opinion about that. But anyway.
00:23:11
Jenny
was going to you answer that one, Mel.
00:23:13
Jane Frost
Yeah, I think we'll we'll let you answer that one.
00:23:18
Melanie Barlow
Well, I guess fundamentally, yes. I mean, these standards exist. They're good. They're evidence-based, I think. We need them to guide practice. There are also standards out of ASPE, the UK-based society.
00:23:34
Melanie Barlow
They're great. We need you know guidelines to guide our practice so we can be consistent and safe. They are good standards, but they are North American-centric, and some of the terminology and translations don't really translate to the Australian or New Zealand context, really. We have different socio-cultural, socio-historical,
00:24:04
Melanie Barlow
i guess, impacts. And so in recognition of that, like Kerry, who couldn't be here today, but and I and a a number of others across Australia and New Zealand recognise this. And so we've actually done some work to contextualise these international standards to the Australian and New Zealand context initially to say, well, how can we do that and focus on simulation
Introducing Q-Safe Framework
00:24:33
Melanie Barlow
design? Because we kind of thought when we went through all the standards, if you get the design right, it kind of has input and cross-contamination, if you like, across all the standards in the design. You've got to think about the pre-brief. You've got to think about the debrief. You've got to think about evaluation.
00:24:52
Melanie Barlow
Who's facilitating this? what is their capacity and capabilities and and all those things. So we've created a framework called the Quality Simulation Assurance Framework.
00:25:04
Melanie Barlow
So we call it Q-Safe.
00:25:05
Jenny
Excellent.
00:25:07
Melanie Barlow
we've had end user input into that. And so that we're about to publish, but in recognition of that, we've like, well, it doesn't quite...
00:25:22
Melanie Barlow
tick the box of ensuring culturally safe simulation relevant to our context. So that's our next phase of research is we're getting broader perspectives and First Nations input across Australia and New Zealand to say, how do we create culturally safe simulation relevant for our context?
00:25:46
Melanie Barlow
So, yes, I agree standards exist. We should be using them all. We actually did a scoping review to to see how these standards have been implemented, not just referenced, but how they've been explained, they've been applied and there were
00:26:03
Jenny
In Australia or in America, Mel?
00:26:03
Melanie Barlow
but
00:26:06
Melanie Barlow
globally, but virtually no one is referencing these in the Australian and New Zealand-like.
00:26:07
Jenny
Right.
00:26:14
Melanie Barlow
based research and literature. So I think raising awareness that these standards exist to support educators, but in acknowledgement that they might find it overwhelming at first, because there are many standards that all intertwined.
00:26:31
Melanie Barlow
And so hopefully our work in can help simplify that for people.
00:26:36
Jane Frost
That sounds like really amazing work, Mel.
00:26:36
Jenny
Thank you.
00:26:38
Jane Frost
So I hope you'll give us a link when you do publish so that we can put it it on the on the site. I think from my perspective, in the absence of other things, I think that they're a good start, the the ones that are published, the INACSL Standards. And until we have your fantastic work, um do think that they're a reference point, and ah but I don't think enough people know about them.
00:27:03
Melanie Barlow
Agree.
Challenges in Quality Simulation Practices
00:27:04
Jenny
Yeah, and can I agree totally with what you've both said. And I think sometimes trying, you know, when you go to your manager and say, I need this personnel to be able to do this, we have nothing to base that in. You know, there's nothing in ah in any accredited or registration within Australia or New Zealand that says, you know, you need this personnel to be able to do this simulation. And I think that's creating some stress points.
00:27:31
Jenny
for educators in and in in trying to implement quality simulation. So I'm looking forward to hearing. Are we doing a podcast about the Q-safe, Mel and Kerry?
00:27:41
Melanie Barlow
We can, we can.
00:27:41
Jenny
Is that what we'll be doing? All right, I'm looking forward to that.
00:27:44
Melanie Barlow
And I think it all stemmed from, yeah, it really stemmed from when you look, I'm going to use the ANMAC standards because we're nurses. but So they're the accrediting standard for nurses and midwives.
00:27:58
Melanie Barlow
It recommends quality simulation. ah recommends the integration of First Nations perspectives. When you ask frontline educators and academics,
00:28:11
Melanie Barlow
what does that mean? How do you do it? That's the point that's lacking. That's the gap. And so that was our sole purpose really initially of creating Q-safe was around, well, this could be what quality simulation looks
Conclusion and Next Steps
00:28:29
Melanie Barlow
like.
00:28:30
Melanie Barlow
This could help considerations of First Nations perspectives and doing it safely because Ultimately, people are too scared to go there because they don't want to offend. They come from a really good place.
00:28:42
Melanie Barlow
But we need to go there. We need to have these conversations improve health care. So, yeah.
00:28:50
Jenny
Looking forward to that one.
00:28:51
Jane Frost
Yeah, that'd be great.
00:28:54
Melanie Barlow
Excellent. Well, thank you, Maddie, our mixologist, for gathering those questions for us. And we'll see you next time. So thanks.
00:29:05
Jenny
Thanks, girls.
00:29:06
Jane Frost
ae
00:29:06
Melanie Barlow
Bye. See you next happy hour.