1. Medical SimulationSee one do one teach onejust not on my Mum Peter Brindley, MD FRCPC. Consultant Physician, Critical Care MedicineAssistant Professor and Program Director, CCMMedical Lead for Simulation, CH Vice-president, Canadian Resuscitation Institute Division of Critical Care Medicine

2. On a serious note- 3. More education, right 4. More realistic education 5. What Can Simulation Do?

Teaching knowledge and procedures

Teaching behaviours

• Crisis Resource Management (CRM Training)

• Leadership, communication, dealing with stress

Team training

Improved communication

See yourself at work

Practice without risk

6. What Can Simulation Do CTD

Our door to delivery times are too slow

Skills beyond knowledge are ignored

• Worlds worst compliment

CRM training is compulsory in other industries

• Airline, nuclear power, military,

IMG/ staff turnover

Social justice imperative

Building a safety-net around patient

7. A Modern Educational tool

Hands-on (experiential learning)

• Practice mistakes

Modify to learning styles

Reproducible, standardized

• On-call implications

Address the CanMeds objectives

Includes debrief

?An examination tool

? A licensing/competency tool

A CME tool

8. The Laerdal SimMan Intubatable/modifiable airway/surgical airway/voice/pneumatic lungs /cardiovert/defibrillate/mimic rhythms/produces urine/ 9. Urology 10. OB/Gyn 11. OB/Gyn 12. Task Trainers CTD 13. Teaching beyond Knowledge

Crisis Resource Management (CRM)

• Human factor engineering

• Dealing with stress/uncertainty

• Dealing with people

• Communication

14. Examples please..

Very senior 747 pilot begins taxiing

Copilots know he has not been cleared

Everyone too intimidated to say anything

Two planes collide- hundreds die

15. The ABCs

A

• Airway

B

• Breathing

C

• Circulation

16. The New ABCs

C.

• Crisis management

C.

• Concurrent ABCs

R.

• Resource utilization

17.

Crisis Management

• A) Leadership

Behaviour is contagious.

Be aware of how do you deal with stress

Declare an emergency without looking panicked

Where to stand

Realize when youre in charge and when not

Realize when a decision is needed.

18. Leadership Skills

Impulsive

• .We must do something, anything

Invulnerable/Macho

• .I can intubate anyone

Anti-authority

• Rules are for others

Resignation

• Its not my problem, what can you do

19.

Crisis Resource Management

• A) Leadership

• B)Communication

Communication loops

• 3 CsC larity

• • • • C ite names

• • • • C lose the loop

20. Avoid vague suggestions

ThereforeJohn, please intubate the trachea

NotPerhaps its time to intubate

21.

Crisis Management

• A) Leadership

• B) Communication

• C) Resource Utilization.

Utilize others

Declare priority

Maintain a global perspective

Be proactive not reactive

Prioritize/Delegate

22.

Crisis Management

• A) Leadership

• B) Communication

• C) Resource Utilization

Concurrent A, B, C s

• A) Airway

• B) Breathing

• C) Circulation

Simultaneous diagnosis and therapy

But disconcerting

Requires sounding the alarm

Requires a high index of suspicion

23. R and R Strategy

R & R

• A) Reassess

• B) Reevaluate

Why:

• Fluid nature of illness

• Initial therapy despite limited info

• Assessments are crude

• Fixation errors abound

24. Fixation Errors

These occur regardless of level of expertise

Fixation of diagnosis

• Failure to question diagnosis

• Failure to admit theres a problem

Fixation of task

25. Preventing Fixation errors

Maintaining aglobal perspective .

• Focus on big picture

• • • When moving patients

• • • When managing an unstable patient

• • • • Stand on the T

Call for help early; may include:

• Cognitive skills (a 2 ndopinion)

• Motor skills (a difficult line)

• Equipment

Realize what brain is good and bad at.

26. WHO is ELVIS?? 27. 13 x 39 = 28. Other Challenges Simulated Critical Care Line Calls.Brindley Crit Care 2007 Novel Critical care Education.Brindley CMAJ 2006 Telephone SimulationBrindley Crit Care 2007 Blindfolded Simulation Brindley et al. pedning ICM 2007 29. Research InsertCompellingEvidence Here 30. Research challenges

Kelvins Curse

• Anything that cant be expressed in numbers is meagre and inadequate

Did industry wait?

Not a departure from medical teaching

31. Some things are simple 32. Some things are not i.e. culture change

Nothing more difficult than introduction of a new order:

The innovator has for enemies all those who have done well under the old, and lukewarm defenders in those who may do well under the new. Machiavelli,

The Prince

33. Medical Simulation is:

Golden opportunity

• Education, error-reduction, and research

Complementary to traditional education

• High-tech, low-tech, no-tech

Likely to be an expectation

• We can lead or follow

Helps teach beyond facts

• CRM, communication, role modeling

Alberta can be a leader

• But challenges remain