"The level of student engagement and real-world clinical pressure during my simulation courses provide lots of extraordinary teaching moments. I find it an educationally powerful approach to learning."
Brian S. Kaufman, MD
Director, VA NY, Harbor Healthcare System Simulation Learning Center
Teaching simulation courses at NYSIM is a dynamic interactive experience in which faculty use the tools of new technology combined with experiential teaching techniques to bridge the gap between standard medical/healthcare curricula and actual treatment of patients.
For clinicians, advanced NYSIM programs provide opportunities for professional development.
At NYSIM we specialize in three main types of simulation-based healthcare education activities: Mannequin Simulation; Standardized Patient (SP) Programs; and Partial Task Trainers. Each offers its own educational focus and teaching opportunities.
NYSIM, which opened in September, 2011, is one of the newest, largest, and most sophisticated urban simulation facilities in the country. NYSIM has over 17 high tech mannequins, a large variety of partial task trainers, standardized patients and wall to wall audio/video recording capabilities.
The simulation instructor does not prepare traditional lectures but instead teaches through debriefing, facilitation, assessment and mentoring. Nonetheless, preparation is critical for success.
For example: Before the class (scenario) itself begins, the instructor briefs learners on the situation they will face. This introduction usually includes setting the context for learning, and a discussion of confidentiality, videotaping, assessment, and logistics.
During the scenario itself, the faculty member serves as a facilitator and occasional guide. The teacher usually controls vital signs and physical exam findings on the patient as well as direct the scenario. Video cameras record each simulated exercise, and can be played back for the learners immediately afterwards for class review, discussion and debriefing led by the instructor.
New NYSIM instructors are trained by NYSIM faculty in this methodology well ahead of their first day of teaching. NYSIM directors and simulation facilitators and coordinators can also help you design these sessions.
Very little. The faculty focus stays on teaching. Programming of the mannequins, and other technical support for each scenario, are provided by NYSIM support specialists. You do not even need to know how to properly turn on and off the computerized mannequins.
The day of each session, NYSIM technical staff will launch the recording software, and provide faculty observation stations and technical assistance from start to finish. When your session is complete, they will assist you in accessing and viewing the recording and data.
Immersive simulation draws on a spectrum of technologies and related educational approaches that literally immerse healthcare learners in an experience that allows them to practice skills repeatedly in a safe realistic setting.
The most wholistic of these technologies, high fidelity (computerized) mannequin are frequently used by teachers in tandem with classes based on partial task trainers and standardized patients. Together, these techniques provide a 360-degree learning experience that bridges the gap between the traditional classroom and the actual patient encounter.
No matter what technology is used, at its core, simulation is active, experiential learning. The learning process for each individual is based on concrete experience, followed by observation and reflection, followed by identifying how to improve performance next time. Each learning cycle builds on the previous experience, which research has shown leads to more active experimentation by the learner the next time around.
A program with mannequins may consist of several simulation sessions (called a scenario), either on the same day or during the semester. Some of the participants may be involved in patient care activities while others observe (either in the room or through a one-way mirror). The session is focused around specific objectives.
Each participant takes the role he or she would take on a real-world healthcare team. Sometimes learners are asked to work one level above their usual role so they can work more independently. For example, a nursing student may be asked to take the role of a newly graduated nurse; a medical student the role of an intern; a resident the role of an attending physician.
The debriefing that follows the scenario can be done at the bedside or in a separate debriefing room. Each has its own advantages. At the bedside, the teacher can demonstrate skills, have the learners retry or role-play through key moments, and save time and “stay in the moment” by not traveling to another room. A separate debriefing room gives learners time to decompress, a change of scene, more privacy, and access to video playback.
During the simulation scenario there are several roles for the faculty and instructors to play:
As Scenario Director Behind One-Way Mirror
At the Console
As an Actor Embedded in the Scenario
Practice Makes Perfect
Skills instruction and the educational concept of “deliberate practice” are essential and powerful tools in healthcare education. Teaching with partial task trainers is shown to decrease hospital-acquired infections, length of hospital stays, and cost. It also has the obvious advantage of improving a health care student’s procedure skills and comfort level before working with an actual patient.
NYSIM has a variety of partial task trainers available to help you teach your learners in a safe simulation environment many of the skills they will use in their practice. At NYSIM, instructors can also design courses that integrate task trainer learning with computerized patient simulators and standardized patients.
From difficult airway management and central venous catheterization to pelvic exams and ostomy care, NYSIM can help you design a high fidelity simulation program suited for your learners.
The effectiveness of deliberative practice teaching is based on research on how to improve performance among the masters of other complex, task-focused fields such as chess and violin. When a teacher provides motivation, a concrete goal, feedback and adequate time to practice, learners can attain higher levels of expertise, according to K. Anders Ericsson, professor of psychology at Florida State University and a pioneer in research the deliberate practice teaching method.
Based on this and related theories, the ideal procedure for a partial task trainer course might include the following:
Use of standardized patients (SPs) is a powerful teaching methodology in simulation education, either as a stand-alone learning experience or in conjunction with NYSIM’s other simulation technologies that draw on computerized “human” mannequins and partial task trainers to provide hands-on Immersive and Simulation Learning experiences.
Standardized patients—who are either professional actors or lay community members—are trained to play the role of a patient who has a scripted “illness,” or another person in a clinical setting such as a family member or another healthcare provider. They are also frequently trained to rate each learner’s performance, based on a checklist.
When teaching with a standardized patient, each faculty member designs simulation-based activities to assess each learner on specific aspects of a patient encounter, such as taking a medical history, conducting the physical exam, or listening and communication skills. At NYSIM, the faculty member can observe the encounter through a one-way mirror; it is also videotaped and can be used in a debriefing session or for quality control.
In collaboration with the Standardized Patient Program leaders, NYSIM associate directors will guide and support you in creating cases and checklists to meet the learning objectives of your SP program, and in recruiting and training the appropriate standardized patients.
NYSIM regularly recruits standardized patients for various activities. If you are interested in being a standardized patient in the NYSIM program, please email us at firstname.lastname@example.org.
Standardized patients are a critical component of the Objective Structured Clinical Examination (OSCE—pronounced os-key), which is the most comprehensive tool available for assessing learner performance. The OSCE is designed to evaluate and rate different competencies that are needed to be a successful healthcare practitioner.
During an OSCE, the learner goes to several stations—adjacent locations in the NYSIM Center— where he or she completes 3 to 10 different clinical tasks or encounters. For example, at one station the student may interact with an SP in an outpatient interview, delivering bad news, and counseling a patient based on the best available evidence.
At the end of the simulation, the faculty member and the standardized patient give the learner feedback on the areas that were assessed in various formats. A debriefing session may follow low stakes, formative assessment OSCEs. For higher stakes (for grade or promotion) OSCEs feedback is typically delivered via written reports.
Effective debriefing plays an important role in simulation education. Learners—and especially adult learners—often learn best when actively engaged in a process that gives them tangible experience followed by reflection, analysis, and an opportunity to draw on what was learned to improve the process. Debriefing with a trained instructor provides this opportunity in a safe and supportive setting.
There are many different styles and types of debriefing.
Debriefing methods for police, military, first responders and emergency care healthcare workers address performance quality issues and psychological effects of crises. They are known as critical incident debriefing, after-action debriefing, or root cause analysis.
In healthcare education, debriefing has a different purpose. It is frequently done after a simulation session to help learners reflect on their actions, gain new understandings and knowledge, and receive formative feedback that they can apply with growing confidence in their knowledge and skills.
NYSIM recommends the following best practices:*
Be explicit and clear with learners in the briefing introduction and discuss:
NYSIM offers various faculty development opportunities to develop and improve debriefing skills. Please visit our Faculty Development page (link) and the NYSIM Courses page (link) for more information.
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