Healthcare Simulation Research Get Involved, Make Discoveries, Save Lives Matt Lineberry, Ph.D. Zamierowski Institute for Experiential Learning Updated 10.13.2017
What is healthcare simulation?
Sim is Human patient simulators ( manikins ); real and/or simulated equipment & space https://www.youtube.com/watch?v=wxsjio18pfi
Sim is Standardized patients (or family members, colleagues, etc.), portrayed by actors Could even send these into the care environment unannounced... Weiner et al. (2010), Annals of Int Med: Contextual Errors and Failures in Individualizing Care: A Multicenter Study
Sim is Part-task trainers examination, needle access, catheter insertion, etc.
Sim is Virtual patients computer-based, case-based practice
Sim is Rapidprototyping of patient care spaces, workflow, etc.
Sim is Mathematical modeling of physiology, pathology, etc. Hester et al. (2011), Frontiers of Physiology: HumMod: A modeling environment for the simulation of integrative human physiology
Sim is Virtual or augmented reality Yudkowsky et al (2013), Sim in Healthcare: Practice on an augmented reality/haptic simulator and library of virtual brains improves residents ability to perform a ventriculostomy
Sim is Virtual or augmented reality
Sim is Combinations: e.g., standardized patient + moulage effects + wearable simulator + environmental effects
What is sim good for? Education, practice, reflection Both technical and non-technical Performance assessment Evaluation Devices, processes, etc. Patient-specific care planning &/or practice Etc.
Sim at KU Med Center & Health System
Zamierowski Institute for Experiential Learning ( ZIEL ) Sudler Hall First event: Central line insertion training, 09/2015
Zamierowski Institute for Experiential Learning ( ZIEL ) Health Education Building (HEB) 07/2017 opening. Top 3 floors are sim (40,000 ft 2 )
HEB Floor 3
HEB Floor 4
HEB Floor 5
What s wonderfully weird about ZIEL Joint robust KUMC/TUKHS venture (not silo-ed by school, dept., etc.) Learners span professions and stages Early, strong commitment to research Both evidenced-based and evidence-generating Tremendous support of Drs. David and Mary Zamierowski
Research in Healthcare Simulation
How does sim fit into research? As subject of research (e.g., optimizing learning using simulation) A tool for research (e.g., studying physician practice variation, non-verbal communication you name it)
What is the question? Largely not does it work? (treatment/control work has been done to death) Otherwise: Tons of great questions remain Cook DA. How much evidence does it take? A cumulative meta-analysis of outcomes of simulation-based education. Med Educ. 2014 Aug 1;48(8):750 60. About 404 unnecessary studies and counting!
What disciplines are relevant? Health professions & biomedical sciences Psychology (educational, industrial/organizational, quantitative, human factors, cognitive, social ) Education (tech, measurement, etc.) Engineering Computer science Statistics, Modeling Sociology, Anthropology, Economics, etc. And the list goes on...
Where is the research community? Society for Simulation in Healthcare INSPIRE Network Sim-specific journals (e.g., Simulation in Healthcare, Advances in Simulation, Clinical Simulation in Nursing) Publications also distributed all over the place, of varying rigor
How is funding? Awesome (for good work, especially inter-disciplinary) Agency for Healthcare Research and Quality American Heart Association Anesthesia Patient Safety Foundation Department of Defense (ONR, TATRC, etc.) Health Resources and Services Administration Josiah Macy Jr. Foundation Laerdal Foundation National Board of Medical Examiners National Institutes of Health (e.g. NICHD, NIMHD, etc.) National Science Foundation R Baby Foundation Robert Wood Johnson Foundation And the list goes on
ZIEL Sim Research Collaboratory The Co-Lab Housed in Sudler G005 (Stop by! We have espresso.)
Co-Lab Mission To grow diverse applied research teams whose insights transform healthcare and the science of learning and performance.
Strategic Priorities Clinical Topic Crisis Teamwork (Code Blue) Risky Procedures (CVC) Teamwork & Culture in the OR Complex Behavioral Health Scholarly Lens Interprofessional/ Teamwork Science Psychometrics + Assessment for Learning Understanding & Supporting Self- Regulated Learning Learner-adaptive Training Technology Ever-tighter bi-directional link to health system outcomes data
Funded Work (+1 under review) Agency Topic With Amount Period DOD NSF Adaptive Tutor for Improving Visual Diagnosis Simulation For Physiology Learning Through Discovery & Authentic Research NYU, Mayo, UBC $1.5M 17-18 UF $250k 16-17 NBME Leveraging Assessment for Learning: Intelligent Study System for Medical Students UIC, UCF $150k 16-17 AHRQ Mixed Reality Proctor for Simulation and Training of Central Line Placement UIC ($2M if awarded) 19-24
Data Capabilities Structured observation, assessment, surveying, interviewing, etc. Clinical equipment data capture (defibrillator, ultrasound, etc.) Clinical informatics data capture (EHR computer, mobile devices, etc.) Simulator sensing (compression depth, ventilation, pulse check, jaw tilt ) Multi-angle video + audio (PTZ) Future possibilities: Learner physiology, eye tracking, machine audio analysis, etc.
ZIEL Research Central Line Insertion Modeling self-assessment, practice strategy, actual practice behaviors, learning gains (SRL micro-analysis ) Modeling skill acquisition and decay Optimizing psychometrics plus maximizing assessment for learning Automatic performance sensing and computer-intelligent tutoring
ZIEL Research Code Blue Cross-validating sim compression data Individual/team performance assessment & psychometrics Experimenting with part- vs. whole-task deliberate practice team roles (e.g. CPR coach; MD/RN co-leadership) automatic compression feedback in the wild Tech-enhanced refreshers
ZIEL Research OR Team Training Mixed-methods investigation of interprofessional attitude, belief, &/or behavior change
ZIEL Research Complex Behavioral Health Inductive research for rich scenario development using situational judgment test principles
Getting Involved An example collaborative team Simulation Center Ops; Clinical Learning Environment Clinician-Educator Clinical +++ Education ++/+++ Research +/++ Time + Graduate Student(s) Clinical? Education? Research +/++ Time +++ Embedded Researcher Clinical? Education? Research +++ Time +/++
Getting Involved Bring your expertise and commitment! And, be patient, humble, & curious align with strategic priorities It s not that we need a lot of disconnected new ideas per se. We need a few committed people with different and insightful ways of thinking and strong collaborative orientation + skills.
Every once in a while you get one of these Hi I wanted to give Kudos to you and the team that have organized the Code Blue Simulations. We have heard from our team that they are great but last night the team lived it. A patient lost a pulse and the team was fast, organized and delivered the first shock in far less than 2 minutes and before the code team arrived. They additionally were drawing up medications to proceed by the time the code team arrived. I had two very seasoned nurses on the unit that said they were amazed at how well it went and they felt it was directly due to the code simulation training. Thank you for your work on this it is making such an amazing impact!
Vaguely interested? Then don t stop there! Email right now: mlineberry@kumc.edu Subject: sim
mlineberry@kumc.edu