SimTecT Health   Simulation - Beyond Technical Skills







SimTecT 2009 Health - Papers

Call for Abstracts

Download the Invitation to Attend / Call For Abstracts brochure (263KB PDF).

Abstracts are closed

Abstract Submission Requirements

Abstracts must conform to the following requirements:

  • Indicate preferred presentation format (Oral, Poster, Workshop, Ask the experts: research or Ask the experts: training)
  • Please select a sub-theme from the list which best describes the content of the presentation. Indicate this sub-theme in the space provided on the template
  • Provide authors’ names (asterisk the presenting author). Include presenting author’s contact details including institution, address, email, telephone and fax
  • Structure the abstract with the headings:
    • Title (up to 20 words)
    • Aims
    • Background
    • Methods
    • Results
    • Conclusions
    • References (optional)
  • Limit the abstract to a maximum of 250 words

Abstract Submission

Submit or revise your abstract here.

Take a note of the Passcode which is provided - you will need this to revise any details.

Please submit any documents in Word format (.DOC - not .DOCX), or plain text (.TXT).

Abstracts needed to be submitted by Friday 15th May 2009.


All presenting authors must register and pay for their attendance at the Meeting.

Abstract Selection

The Organising Committee will review abstracts suitable for presentation, based on content quality and relevance to the themes of the meeting. Given the limited number of oral presentation places available, the Committee may determine that some abstracts are better suited to poster rather than oral presentation.

Abstracts / Papers will be published in the Conference Handbook.

Presentation Formats

1. Oral Presentations

Authors wishing to present results of original research or report on educational or other projects are invited to submit in this section. Ten (10) minutes will be allocated for oral presentations with ten (10) minutes for questions. Papers should be presented using PowerPoint projection.

Presenters in the “Oral presentation” category should bring their PowerPoint presentations to the conference and give them to the AV people to load on the computers as soon as possible.

Overheads will not be permitted.

2. Posters

Posters should be 1m x 1m in dimension on laminated cardboard. Authors must attend their posters during the allocated time to answer questions. The poster should include author and co-authors’ names, a short title, the name of the institution where the work was carried out, and the following sections:

  • Abstract
  • Introduction
  • Methods
  • Results
  • Conclusions and Recommendations.
3. Workshops

A limited number of 90-minute sessions were available for presenters who wished to present small group educational sessions or conduct workshops.

4. Ask the experts: research I am trying to do

The main aim of this session is to assist researchers wishing to conduct research in one aspect of simulation. Members of the audience should benefit from shared ideas. Participants are invited to submit abstracts under this category to present work in progress for discussion among the audience and expert facilitators. The standard submission template should be used, including aims, background and proposed methods, but it is not expected that results or conclusions will be included.

5. Ask the experts: training

The main aim of this session is to develop training solutions for identified training needs for specific groups. Participants are invited to submit abstracts under this category to present work in progress for discussion among the audience and expert facilitators. The standard submission template should be used, including aims, background and proposed methods, but it is not expected that results or conclusions will be included.


  1. Education, Training and Assessment
    • Course design and evaluation
    • Inter-professional learning
    • Patient safety curricula
    • Integrating simulation in workplace learning
    • Mobile simulation
    • Credentialling
    • Performance assessment
    • Remediation
  2. Policy and Resource Issues
    • Workforce issues
    • Impact of simulation on length of training
    • Cost of simulation and simulation resources
    • Simulation centre operations
    • Computer modelling of health delivery processes
    • Quality improvement methodology
    • Safe systems design
    • New hospital design
  3. Patient Safety
    • Human Factors and Patient Safety research in synthetic environments
    • Testing new clinical equipment in a simulation environment
    • Simulated case re-enactment and review
    • Workplace culture and teamwork
  4. Innovation and New Technologies
    • Telemedicine
    • Robotics
    • Gaming
    • Virtual reality
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Accepted Papers

Note that Results and Conclusions for each paper will be listed following the SimTecT Conference.

Papers Session 1 - Curriculum Design - Tuesday 1100 - 1230

Assessing staff beliefs: Anticipating and navigating the obstacles when introducing simulation into an undergraduate nursing curriculum
Karen Livesay*, Karen Lawrence and Clive Miller
Aim: The aims of the study were to identify the barriers staff perceived about the integration of simulation into a new undergraduate nursing curriculum.

Background: Most schools of nursing are contemplating placing greater emphasis on the use of simulation, however as this presents a significant pedagogical change it is vital to identify the likely obstacles so that they may be addressed.

Method: Nineteen in-depth, semi–structured interviews were conducted with faculty in a school of nursing and midwifery. Thematic analysis of the data was carried out.

Results: A range of congruent and competing themes emerged from the data reflecting beliefs about the plan to introduce simulation to a large student population. These included pessimism related to self belief, students tolerating observation and the confronting nature of the learning. Additionally, inflexible timetables, class size and workload recognition were acknowledged as system related themes, while concern about the clinical currency of academic staff also emerged.

Conclusion: The themes reflect the knowledge and experience staff had of simulation and highlighted their anxiety or comfort about using this pedagogy whilst demonstrating a high level of knowledge and concern about student related issues. Addressing the perceived barriers to implementation is an important consideration when introducing change to teaching and learning methods.

Preparing academic staff for the introduction of simulation: Perceived needs and implications
Clive Miller*, Karen Lawrence and Karen Livesay

Aims: The aim of the study was to investigate the needs of academic staff prior to the introduction of simulation into a new undergraduate nursing curriculum.

Background: This work is part of a wider study into the introduction of simulation into all levels of a new undergraduate curriculum within a School of Nursing.

Methods: Nineteen in-depth, semi–structured interviews were conducted with faculty in a school of nursing and midwifery. Thematic analysis of the data was carried out.

Results: Two significant themes were identified in the data: (i) the need for staff development, (ii) the need for ongoing staff support.

The need for staff development was addressed directly and indirectly. Some participants expressed this as ‘need more knowledge’ and need for ‘written resources’. The need for staff support highlighted the perceived requirement for technical and ‘expert’ support, including assistance from clinical staff to develop scenarios, and the need for smaller tutorial groups.

Conclusions: Development of adequate resources is a strong factor in reducing the likelihood of resistance when introducing simulation. It is recommended that preparation to implement simulation include provision of both human and financial resources to support staff development throughout the implementation process

Observational Simulation: the key to meeting the learning needs of an inter-professional healthcare team
Christopher Churchouse and Kirsty Bayley
Aims: This presentation will examine the intricacies of developing and facilitating inter-professional observational simulation based training programs. Using an obstetric emergency based simulation, where over 100 staff were put through a training program, the presenters will provide participants with the resources necessary to implement this form of simulation within their own facilities.

Background: Simulation is used mostly to meet the needs of small groups of participants. This is incredibly resource intensive in term of staff, equipment, and time, which ultimately equals money. For health care facilities wishing to utilise simulation as an effective teaching methodology to educate a large number of staff, it becomes a logistical and financial impossibility. Edith Cowan University’s Health Simulation Centre has developed observational simulation as a means of meeting the clinical education goals of the health sector, address their needs in relation to providing:
  • Programs that are cost effective
  • Inter-professional learning opportunities
  • Course content focusing on the non-technical skills such as communication and teamwork
Methods: More than 100 obstetric & midwifery staff from a local obstetric unit where rostered over three separate days, to attend the 4 hr simulation. This involved observing the simulation and partaking in small facilitator guided discussion around the critical incident observed. The key learning objectives included:
  • Communication
  • Teamwork
  • Adherence to policy & procedure
Results/Conclusion: The results of the entire unit participating in this observational simulation based program will not be quantifiable in the short term. The health care facility involved will review their obstetric emergency management over the next 12 months to see if staff communication, teamwork and ultimately patient safety improves.

Cabin fever: In-situ simulation of airborne emergencies for the Royal Flying Doctor Service
Mark Baldwin and Victoria Brazil
Aims: The program used in-situ simulation in an operational aircraft to enable facilitated experiential learning of a range of in-flight emergencies.

Background: The Royal Flying Doctor Service (RFDS) comprises a heterogeneous group of practitioners providing primary care and aeromedical critical care.

The management of in-flight emergencies was recognized as a unique challenge that requires tailored education.

The Royal Flying Doctor Service contracted us to deliver an educational program including in-situ simulation within their aircraft.

Methods: An operational RFDS aircraft was positioned in the Cairns Base Hangar adjacent to office facilities. The aircraft was fitted with audiovisual equipment and a second generation Laerdal Simman. A control room was improvised in the medical equipment store and the lounge was configured as a debriefing room.

Simulated patients were established in the aircraft and two person (doctor/nurse) teams were given handover (consistent with usual practice at shift changeover) outside the aircraft.

The teams would manage their patient through crises of varied acuity and return for facilitated debrief with their peers, who observed the process throughout from the debrief room.

Results: 16 medical officers, 5 flight nurses and one paramedic participated in the program on August 16 and 17 2008. The in-situ component was rated the most valuable part of the program by the majority of participants and further sessions are planned in November 2009.

Conclusions: In-flight emergencies present unique cognitive and resource challenges for aeromedical staff. In-situ simulation as part of a larger program enables RFDS professionals to experience and review infrequent but critically important conditions within the context of their specialised environment.

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Papers Session 2 - Undergraduates - Tuesday 1100 - 1230

Cognitive Apprenticeship & Authentic Assessment within High Fidelity Simulated Clinical Environments: An Education Framework for Bridging the Gap between Higher Education and Practice Settings
Colin Torrance*, Keith Weeks and Peter Lewis
Background: A key driver behind the design and employment of authentic learning environments and authentic assessment is the requirement to bridge the perceived gap that exists between the processes of instruction, learning and assessment (Boud 1990, Gulikers et al 2004). Nowhere is this more critical than in the health care professions where learning and assessment schedules must support and measure the construction, synthesis and meaningful application of the knowledge, problem-solving and professional skills that underpin safe professional practice.

Previous and current work being undertaken in the field of simulation: Following 16 years of research and development of computer based authentic learning and assessment environments (Weeks et al 2000, 2001, 2006), our focus has now extended to application of the underpinning education model within high fidelity simulated clinical environments.

We will explore how a cognitive apprenticeship framework (Collins, Brown & Newman 1989) has been employed to:
  1. Model and capture expert problem-solving processes via demonstration and use of video technology;
  2. Support learning via the processes of coaching and scaffolding;
  3. Facilitate articulation of learner’s knowledge and skill;
  4. Support reflection upon learner performance and diagnosis of errors via comparison of student performance with expert models.
Presentation context: The context of the presentation will focus on the authentic assessment, reflection and feedback processes employed in the education of pre-registration nursing students when engaged in the management of an acute clinical emergency.

Conclusions: Performance outcomes and nursing student evaluations following engagement in this innovative immersive learning and assessment environment will be presented.

Take Home Messages: Employment of a cognitive apprenticeship and authentic assessment model offers a robust and practical education framework for both supporting learning and assessment within simulated clinical environments and bridging the gap between higher education and practice settings.

Novice to Expert: Nursing Assessment Using Human Patient Simulators
Carolyn Insley and Janet Willhaus
Aims: This presentation describes the use of simulators with beginning nursing students in a nursing health assessment lab. The method gives students an opportunity to assess abnormal lung, cardiac and bowel sounds.

Background: Simulation of clinical situations has become more sophisticated with the introduction of human patient simulators. Simulation is used in nursing education to provide students with a safe environment in which to practice and improve clinical skills, gain self confidence, and reduce fear in caring for real patients. Patricia E. Benner’s theory of novice to expert supports student skill acquisition with basic physical assessment. This course combines practice on fellow students with human patient simulators. David Kolb’s experiential learning theory provides a basis for a simulated patient scenario for learning abnormal findings. The use of a human patient simulator also appeals to the predominant psychomotor-kinesthetic learning style of many of today’s nursing students. This type of learning states that students learn best when doing actual hands-on activities. This method utilizes both the cognitive and psychomotor domain to practice skills.

Methods: Beginning nursing students learn basic assessment skills in a lab where they practice on fellow students after instructor demonstration and explanation. Simulators allow students to listen to normal and abnormal breath, heart and bowel sounds not present in peers. Near the course conclusion students receive scenarios and are instructed to do head-to-toe assessments of patient simulators. The scenarios include adult male, adult female and child simulators. The students then describe and document their findings of the simulated patients.

Results: Students report that they better grasp what they are listening for when assessing actual patients and report more confidence with assessment skills. Instructors report both advantages and disadvantages with this teaching method.

Conclusions: The use of simulators for teaching basic assessment skills to beginning nursing students positively enhances learning.

Structured clinical skills education adds value to self-directed learning during clinical placement time
Julia Harrison, Brendan Flanagan and Stuart Marshall
Clinical exposure for students is becoming a limited resource. This presentation will delineate some educational strategies that may help to optimally prime students for learning in the clinical environment.

Background: Final year medical students at Monash University undergo six six-week ward placements, plus a five day Patient Safety Unit interspersed throughout the year. The Patient Safety learning activities include simulation scenarios, workshops, lectures, discussion, games, readings and on-line activities(1).
Feedback from students during the first year (2006) of the Patient Safety unit suggested that the contact days were influencing the way they learned during subsequent clinical placements. This warranted further exploration.

Method: Student responses to a combination of open and closed questions were sought, (n = 161 and 92% response rate).

Results: This data revealed 84% of students strongly agreed that the Patient Safety Unit enhanced learning during clinical placements. The major themes emerging from the responses to the question “ If the Patient Safety unit enhanced your learning during clinical rotations please describe how” include improved confidence, better clinical skills, awareness of patient safety, ability to reflect and critique self and others, enhanced communication and clearer thought processes.
The authors will elaborate on this data and share their thoughts on what aspects of the Patient Safety program may be responsible for the effect on learning in the clinical environment.

Conclusion: Our data suggests that “time out” of the clinical environment, if well used, can enhance “time in” the clinical environment.


Cognitive apprenticeship: a model for the teaching non-technical skills to final year medical students
Tim Gray, Julia Harrison and Brendan Flanagan
Background: The acquisition of sound advanced life support (ALS) skills is an important component of making final year medical students ‘fit to practice’ as interns the following year. Traditionally students have been taught basic skills and are expected to learn the non-technical and cognitive aspects of managing unwell patients ‘on the job’.

This presentation outlines an alternative model for ALS skills teaching. Based on the principles of cognitive apprenticeship and situated cognition, the model aims to better prepare medical students for clinical practice by teaching the cognitive as well as the technical skills required for assessment and management of acutely unwell patients then allowing them to practice these skills in a realistic simulated clinical environment.

Methods: ALS is a core theme of a five day teaching module on Patient Safety in Healthcare run for final year medical students at our centre. Students learn and consolidate technical and non-technical ALS skills using techniques of modelling, coaching, and ‘scaffolding’ in small group workshops and simulator-based scenarios using a ‘pause and discuss’ format in a realistic clinical environment.

Results: The cognitive apprenticeship model is a useful framework to help shape meaningful simulation based education. It’s use has been described previously in the teaching of technical skills.

We have demonstrated that non-technical skills can be effectivey taught using this model Conclusion We have developed a model for ALS skills teaching that aims to improve final year medical students ‘fitness-to-practice’ by teaching them the technical as well as the non-technical skills needed to manage acutely unwell patients prior to commencing clinical practice as interns.

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Papers Session 3 - Surgical / Simulators - Tuesday 1330 - 1530

Differentiating levels of experience on a virtual reality temporal bone simulator
Yi Chen Zhao, Stephen O'Leary, Richard Hall and Gregor Kennedy
Background: Cadaver temporal bone dissection exercises are the foundation of otological surgical training. However with increasing number of trainees and shortage of cadaver temporal bones investigation of other surgical training tools has began. Virtual reality simulation is increasingly been incorporated into surgical training. We have developed a temporal bone simulator that immerses the user in a virtual environment where they can practice drilling a virtual temporal bone with auditory and tactile feedback. We aim to test whether measurements derived from the simulation can differentiate between levels of experience in the participants.

Methods: 20 participants were recruited for the study comprising of 9 participants experienced in temporal bone surgery and 11 participants who were novices. They were asked to perform a cortical mastoidectomy and a modified radical mastoidectomy on the simulator. The computer software logged every aspect of their performance such as force of the drill and distance to vital structures. Comparison of these values was made between the 2 groups to elucidate which specific metrics would discriminate experience level.

Results: Experts on average completed the task 20min faster (P <0.0001) and removed more bones (P =0.04) compared with novices.

Novice participants overexposed more dura (P =0.021) and overexposed more facial nerve (P=0.043) compared with experts.

Conclusion: This study shows that measurements of performance from within the virtual reality simulator can differentiate between levels of experience. These results will help in the development of "intelligent" tutor in the virtual reality simulator that can teach novices on how to perform temporal bone surgery.

Randomised Control Trial of Cognitive vs Directed Teaching Styles for Laparoscopic Suturing in Medical Students
Sarah Moore, Michael Murphy and Steve Smith
Background: With increasing pressure for quality teaching in the presence of diminishing surgical time combined with increasing public expectations regarding their surgery and its outcomes a need to maximise the quality and effectiveness of teaching registrars.

Method: 31 medical students were randomised to receive instruction in laparoscopic (intracorporeal) suturing technique in a training box using either a cognitive method (utilizes explicit teaching methods to form mental template of the process) or directed training (the more traditional method). No students had previously used such training aids nor been instructed on laparoscopic surgical techniques.

Students were randomised to the 2 study groups (15 to cognitive group, 16 to directed group) and were asked to watch a short video demonstrating the suture required with verbal descriptive cues for performance. Students were then taught using the appropriate method how to tie a single intracorporeal suture in a 20 minute supervised teaching session (maximal student to teacher ratio of 3:1). Videos were recorded of performance of 1st suture at this session, a distracted test and a final undistracted test. The knots were strength tested and the videos assessed for performance quality.

Results: The 2 groups were quite similar with the exception of female predominance in the cognitive learning group (n=10/15 compared to 6/16) – age, hand dominance, year of medical school, age and suturing experience were equally distributed. There was no statistically significant difference between the 2 groups when times taken to perform the task or strength of the suture generated were compared.

Conclusions: There is no demonstrated difference between students taught using a cognitive vs directed teaching method.

Using SimMan 3G to Enhance Healthcare Professionals’ Clinical Skills in the Neurological Assessment of the Deteriorating Patient
Lyn Taylor and Irwyn Shepherd
Aim: To provide participants the opportunity to develop and expand their neurological clinical assessment skills of the deteriorating patient using SimMan 3G.

Background: Box Hill Institute has developed and implemented simulation scenarios focusing on neurological assessment and management of the deteriorating patient for their undergraduate nursing students. This was developed and implemented using Sim Man and a standardised patient approach, as not all learning outcomes could be achieved by using Sim Man alone.
Since taking delivery of their first SimMan 3G, Box Hill Institute identified various scenarios as suitable for adapting and modifying for use with SimMan 3G. The neurological scenario was seen as particularly suitable for adaptation due to the increased specifications and fidelity of SimMan 3G. As a result a simulation scenario focusing on neurological symptoms and signs using SimMan 3G presenting as a deteriorating patient was developed and integrated into the nursing curriculum.

Methods: This presentation will discuss the strategic operational and application differences between SimMan and SimMan 3G, the adaptation process used, highlighting the positives, pitfalls and ongoing limitations. Outcomes to date of observed participant assessment skills using a modified Clinical Response Verification Tool (CRVT) © will also be presented as will thematic analysis of the participant’s perceptions of the SimMan 3G as a learning tool.

Conclusion: Early application of the Sim Man 3G and intervention outcome data would indicate that its specifications increase the fidelity of several pertinent factors in a scenario and thus facilitate the enhancement of participants’ neurological clinical assessment skills of the deteriorating patient.

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Papers Session 4 - Teams - Tuesday 1330 - 1530

The Team Emergency Assessment Measure (TEAM): Validity, reliability and feasibility?
Simon Cooper, Robyn Cant, Jo Porter, George Summers, Ken Sellick, Leigh Kinsman and Debra Nestell
Aim: To develop a valid, reliable and feasible non technical skill assessment measure for emergency team performance.

Background: Generic and profession specific team performance assessment measures are available (e.g ANTS1) but there are no measures for the assessment of emergency resuscitation team performance.

Methods: (1) An extensive review of the literature for teamwork/leadership instruments, and (2) development of a draft instrument with an expert clinical team. (3) Review by an international team of 7 independent experts for content validity. (4) Instrument pre-testing and (5) pilot testing on 3 previously video recorded hospital resuscitation events and 48 videoed simulated multi-professional events. (6) Secondary rating of 25% for inter-observer reliability, and (7) a final set of ratings (for feasibility) on 18 simulated 'live' events.

Results: Following expert review selected items were found to have a high content validity index of > 0.83. Internal consistency of the scale was high with a Cronbach alpha of .974 and all items were highly inter-correlated, including a significant correlation between the total score and global rating (r .974, p.001). The final 12 item (11 specific and 1 global rating) were rated on a five point scale and covered three domains, leadership, team work and task management, covering skills such as communication, adaptability and situation awareness.

Conclusion: In this primary study TEAM has been found to be a valid instrument and should be a useful addition to clinicians' tool set for the measurement of emergency non-technical skills.

A Typology for Healthcare Teams
Pamela Andreatta
Aims: To determine which team development and performance models are most applicable to interdisciplinary team training in healthcare contexts comprising all aspects patient care.

Background: The effectiveness of healthcare teams is critical to successful outcomes in patient care, as well as to the successful maintenance of practice across healthcare systems1-4. Because effective teamwork improves both clinical and financial outcomes, interdisciplinary team training to improve team efficiencies and accuracy5-7 and assessment of team-based competencies are central to establishing patient safety oriented practice8-10. Proposed competencies for healthcare teams are based on theoretical and empirical work derived from other professional domains11-14.

Methods: 25 healthcare teams were observed over a 6-month period in multiple public/private hospital and ambulatory care centers in the United States. Team composition and role behaviors were compared and categorized through the constant comparative method of analysis.

Results: Four types of healthcare teams were identified: stable role, stable personnel (Type SS); stable role, variable personnel (Type SV); variable role, stable personnel (Type VS); variable role, variable personnel (Type VV). Healthcare teams are more complicated than teams in other professions where teams are typically Type SS, i.e. a specific individual serves in an established capacity to benefit team performance.

Conclusions: A singular model derived from other professional domains will not adequately inform training specific to interdisciplinary healthcare teamwork. To achieve optimal performance, each team type will require adaptable training strategies. The 4-types of healthcare teams designated by this study will help inform the selection of appropriate team training and assessment of competencies.

  1. Dinka, TJK and Clark, PG., Health Care Teamwork: Interdisciplinary Practice and Teaching. 2000, Westport, CT: Auburn House. 38-40.
  2. Wears RL, Leape LL. Human error in emergency medicine. Ann Emerg Med 1999;34:370-372.
  3. Risser DT, Rice MM, Salisbury ML, Simon R, Jay GD, Berns SD. The potential for improved teamwork to reduce medical errors in the emergency department. Ann Emerg Med 1999; 34:373-383.
  4. Heinemann GD. Teams in Health Care Settings. In: Heinemann GD and Zeiss AM (Eds.) Team Performance in Health Care: Assessment and Development. New York: Kluwer Academic Plenum; 2002: 7-13.
  5. Salas E, Rosen MA, King HB. Managing teams managing crises: Principles for teamwork in the ER and beyond. Theor Iss Ergonomics Sci 2007; 8:381-394.
  6. Heinemann GD. Teams in Health Care Settings. In: Heinemann GD and Zeiss AM (Eds.) Team Performance in Health Care: Assessment and Development. New York: Kluwer Academic Plenum; 2002: 6-7.?
  7. Dinka, TJK and Clark, PG., Health Care Teamwork: Interdisciplinary Practice and Teaching. 2000, Westport, CT: Auburn House. 8-9.
  8. Morey JC, Simon R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37:1553-1581.
  9. Shapiro MJ, Morey JC, Small SD, et al. Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Qual Saf Health Care 2004;13:417-421.
  10. Gaba DM. The future vision of simulation in health care. Qual Saf Health Care 2004;13(suppl 1):i2-i10.
  11. Lemieux-Charles L, McGuire WL. What do we know about health care team effectiveness? A review of the literature. Med Care Res Rev 2006;63:263-300.
  12. Salas E, Sims DE, Burke CS. Is there a big five in teamwork? Small Group Res 2005;36:555-599.
  13. Rosen MA, Salas E, Wilson KA, et al. Measuring team performance in simulation-based training: adopting best practices for healthcare. Simulation in Healthcare Spring 2008; 3(1): 33-41.
  14. Dinka, TJK and Clark, PG., Health Care Teamwork: Interdisciplinary Practice and Teaching. 2000, Westport, CT: Auburn House. 18-35.

Centre Operation’s Report: How we built a Simulation Centre within the Emergency Department. The grass roots approach.
Jon Hayman
Aim: To develop a simulation centre with high fidelity, full environment simulation capability within the Emergency Department (ED) for the Royal Prince Alfred Hospital (RPAH) Emergency staff. The centre set up to be operated internally by existing clinical staff.

Background: The department of Emergency Medicine considered simulation to be an important component of medical and nursing education. We set out to build a cost effective and easily operated centre where our staff could be trained.

Method: A business plan was developed that involved seeking funding from potential stakeholders. The Dean of the Central Clinical School of Medicine, University of Sydney and the RPAH Director of Prevocational Training provided funding for the Laerdal Simman and contributed to audiovisual requirements. Hospital administration agreed to build the infrastructure for the centre by converting existing rooms.

Results: Two Years after the initial concept was envisaged we have a functioning ED simulation centre with around 80 participants using it each month. We have 8 clinical staff who can technically drive the centre and use it regularly for ACLS, trauma and complex medical and surgical education. Despite not having dedicated staff for the centre in the first 15 months we have experienced very few technical issues. The centre now has a 2-day per week Clinical Nurse Educator provided by the RPAH Centre for Education and Workforce Development.

Conclusion: Whilst most simulation centres capable of high fidelity simulation in Australia are set up on a larger scale, we have demonstrated that it is possible to have an internally driven centre capable of full environment immersive simulation within an ED managed by existing clinical staff.

Raise the Red Blanket: Rapid transfer to theatre for simulated critically ill trauma patients
Mark Baldwin and Victoria Brazil
Aim: To introduce, inform on and review a new protocol expediting surgical intervention in critically unstable trauma patients, including:
  • Multidisciplinary decision making in emergency
  • Immediate transit to theatre bypassing normal process
  • Graduated handover from emergency physicians to anaesthetists
Background: Trauma review at Royal Brisbane and Women’s Hospital recognized a subset of presentations requiring immediate surgical intervention for haemorrhage control.

A ‘Red Blanket’ protocol is activated when life threatening haemorrhage and critical instability are present. The patient is identified with a strong visual cue – the ‘Red Blanket’ - en route to theatre.

In the operating room, emergency and theatre staff form resuscitation and intervention teams. Handover is graduated as resuscitation progresses.

Method: A series of trauma presentations were simulated in-situ in emergency using Laerdal’s original Simman.

Two simulated patients met ‘Red Blanket’ activation criteria and were transferred immediately to theatre, powered by an uninterruptable power supply and controlled by a networked personal digital assistant.

Participants in emergency observed events in theatre via video conference link and assembled for facilitated debrief.

Results: Participants acknowledged the subjective realism and value of the experience in feedback survey. Other perceived benefits included greater awareness of the roles and challenges of other staff in trauma care, enhanced communication and greater acceptance of the new protocol.

Conclusion: In situ simulation enabled clinical teams to practice applying a new ‘Red Blanket’ protocol across a health facility – from emergency via hallways and a lift to theatre. The communication challenges, resource difficulties, leadership transfer and handover process were explored in a uniquely effective way.

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Papers Session 5 - Inter-professional Education - Wednesday 1100 - 1200

Does SBAR actually work? Initial findings from a 2 year prospective trial
Neil Cunningham, Julian van Dijk, Tracey Weiland, Nicole Shilkovski, Paul Paddle and Nicola Cunningham
Aims: To test the effectiveness of the SBAR communication tool in training junior doctors to transfer critical information up a hierarchical chain.

Background: SBAR (Situation-Background-Assessment-Recommendation) is a tool that provides a framework for communication between health professionals. Medical students are taught to present a clinical case in the form of a thorough structured systematic history and examination. This presentation can take 15 minutes or more which is unsuitable for rapid and effective transfer of critical information in an urgent or semi-urgent situation such as a telephone referral to a more senior doctor. This study looks at whether the implementation of SBAR training improves the ability of a first year doctor (intern) to discuss and refer a moderately urgent case to a more senior doctor (registrar).

Methods: Randomised controlled trial with participants and rating clinicians blinded to group allocation. Two evenly balanced simulated cases were created. Participants were given a set time to review a simulated case, and then asked to contact a registrar to discuss the case. All calls were recorded and scored by a blinded clinician for content and effectiveness.

Results: Data currently being analysed, results to be presented on the day.

Conclusion: The presenter will discuss the utility and effectiveness of the SBAR tool in improving critical information transfer among junior doctors.

The First 5 Minutes: An Inter-professional Learning (IPL) Project Using Simulation
Katherine Holmes, Nicola Deacy, Carole Watson, Alicia Massarotto, Maggie Briggs and Ted Stewart-Wynne
Aims: The primary objective is to improve the quality of team work by enhancing communication and collaboration between health professionals, whilst providing an introduction to IPL, in a simulation environment.

Background: In health care harm to patients may occur as a result of errors in communication. With the increasing complexity of delivery of health care the promotion of close, collaborative and inter-professional team work is recommended.

Methods: Mixed teams of six (doctors, nurses and physiotherapists) will be provided with a pre-reading package consisting of IPL concepts, basic life support algorithm, MET calling criteria and iSoBAR handover checklist. Following a brief introduction the participants will familiarise themselves with the training room and facilities. An emergency scenario will be discussed and then run by the facilitator. Participants will be expected to contribute to immediate management of the patient. At 4 1/2 minutes the MET leader will arrive, expecting a concise handover of information gathered. A video recording of the scenario will be used for debriefing. The focus will be on communication, leadership, teamwork and inter-professional attitudes. The scenario will then be re-run and a further debrief will occur. The participants will complete the assessment tool. Training sessions will run weekly over a three month period.

Results: The information gathered from approximately 72 participants will be presented, including participant self-evaluation of their non-technical skills and attitudes to inter-professional team-work and details of the evaluation form and iSoBAR checklist.

Conclusions: It is anticipated that the study will confirm the importance of communication and effective team work as integral to an optimal clinical outcome, in the simulation environment. The next step is to design a study to assess improvement in patient outcomes, using the same methodology.

Applying a psychological model to analysis of behaviour in a simulation
Elyssebeth Leigh and Werner Naef

In a recent publication (Leigh, Naef, & Blakelock, 2009) we explored some key features of the psychological model know as Process Communication Management (PCM™) and its relevance to analysis of behaviour in simulation for learning contexts. That paper was the first concerning an intended research process designed to extend the broader societal understanding of how simulations and models like PCM™ can be combined to create learning contexts that are powerful, insightful and greatly extend the capability of non-technical skills training.

In this – the second paper – we report on using PCM to analyse the behaviours of a group of health professionals taking part in an extended simulation as part of their non-technical skills training. We are expecting the analysis to reaffirm the manner in which PCM predicts individual descent into stressful/dysfunctional behaviours. The sequence of human behaviour along a predictable path into distress is explored and means of recovery from such a condition are explored – in particular appropriate interventions focusing on communication and motivation.

The paper will present the findings of the research and contribute to a broader understanding of how awareness of behavioural indicators can assist both the person, and those observing them, to draw back from inappropriate or damaging actions.

Reference: Leigh, E., Naef, W., & Blakelock, R. (2009). This Strange Dominant Logic – Decoding Behaviour Under Stress. Paper presented at SimTecT 2009.

Learning about interprofessional clinical practice in a simulated ward environment
Debra Kiegaldie
Aims: This paper will report on findings from an interprofessional teaching and learning activity for final year medical and nursing students using simulated older patients with delirium in a simulated ward environment. The aims of the study were to develop, trial and evaluate an interprofessional learning (IPL) approach. This was then compared to standard educational approaches used for medical and nursing students provided separately. Students’ performance in an authentic simulated scenario was evaluated.

The objectives of the proposal were to:
  1. Determine if final year medical and nursing students were ready for interprofessional learning.
  2. Determine if an interprofessional approach:
    • developed students’ appreciation of the roles of doctors, nurses and the health care team in the management of delirium;
    • increases students' confidence in managing patients with delirium;
    • develops medical and nursing students’ collaborative team working skills, communication skills, patient centeredness skills, and professional identify.
  3. Measure the effect of case based learning, simulation and the use of simulated patients on the development of effective interprofessional practices.
  4. Investigate the feasibility of using interprofessional learning in teaching undergraduate medical and nursing students.
Background: Hall and Weaver (2001) identify health professional collaboration as a highly significant area of clinical practice in complex health care settings. The use of simulated environments and IPL in undergraduate education is emerging as a way to foster interpersonal, communication and team working skills amongst health professionals. Simulated patients have been used in undergraduate and postgraduate medical education for over 30 years for the teaching of communication and clinical skills and for monitoring the performance of doctors for clinical examinations (Wallace et al., 2002). Delirium is probably the single most common acute neurological disorder affecting adults in general hospitals affecting 10-20% of all adults in hospital and 30-40% of older patients in hospital. Effective management of delirium is contingent upon a multiprofessional approach necessitating among other things clear communication and an understanding of the respective health care team members' roles.

Methods: This study compared the experiences of two groups of learners:
  • A discipline specific group consisting of two subgroups each comprised of medical and nursing students (n=100 students)
  • An interprofessional group of 100 medical and nursing students together
Measures: Prior to and on completion of the clinical simulation two tests were administered. First, all students completed a pre-validated survey - “The Readiness for Interprofessional Learning Scale” to measure their attitudes and perceptions towards IPL. Second, a knowledge test determined what the students knew about delirium.

Following the pre-test, the discipline specific group underwent a 1 hour discipline specific lecture on delirium followed by a discipline specific case based tutorial. The interprofessional group participated in the same activities; however, this was achieved using a fully integrated interprofessional approach.

All students then participated in a simulation activity of delirium using a simulated ward setting and simulated patients. Students remained in their groups but were further divided into groups of 10 (4 participants and 6 observers). Video recording and observation of the simulation measured the team work, communication and patient centeredness skills of medical and nursing students after learning about delirium either within disciplines or via IPL.

Follow up surveys determined the perceptions of the students during this experience (self reporting of benefits/constraints) and individual interviews provided an opportunity for further exploration of perceptions of the students during this experience.

Results: Results are currently being analyzed and will be presented at the conference but initial findings indicate positive feedback about the experience from students and tutors. Those students not involved in the interprofessional groups felt they missed out and the interprofessional groups appeared to perform better in the simulation. Comments from follow up telephone interviews reveal the value of the experience:
…you could see the value of having the two working side by side…(medical student) I really began to see how much patient contact the nurses have in comparison to the medical students (medical student) …the main thing was learning communication between doctors and nurses… (nursing student) If we can work together or learn to work together while we are still at uni with scenarios, by the time we hit the wards we have a better idea of what each one does and therefore provide better care for the patient…(nursing student)

Conclusions: A complex interprofessional intervention is logistically possible and highly valued by students.

  1. Commonwealth of Australia (2006) Aged Care in Australia. Canberra: Department of Health and Ageing.
  2. Hall, P. & Weaver, L. (2001). Interdisciplinary education and teamwork: a long and winding road. Medical Education, 35: 867 – 875.
  3. Wallace, J., Rao, R., & Haslan, R. (2002). Simulated patients and objective structured clinical examinations: review of their use in medical education. Advanced in Psychiatric Treatment, 8, 342 – 350.

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Papers Session 6 - Simulated Patients - Wednesday 1330 - 1500

A novel use of simulation to increase attention to patient-centred care for vaginal examination
Maureen Harris, Joyce Hendricks and Sheila Kimzczyk*
Introduction: Students have little opportunity to build essential skills before undertaking vaginal examinations during childbirth. Even with increased use of simulation there are capacity and resource constraints. We designed an on-line reflective action clinical learning environment (ORACLE) to augment the development of patient-centred care for vaginal examination.

Methods: Students were allocated to either ORACLE or standard teaching. The ORACLE site comprised four audio-video recordings of vaginal examination scenarios (exemplary to poor) using a patient actor 'integrated' with a realistic vaginal examination model. Student observation was guided using a checklist to explore aspects of patient-centred care. On completion of the learning activities all students undertook a simulated 'patient actor' vaginal examination, which was captured to audio-video recording. An independent expert rated students' performance against the patient-centred care checklist. Between-group comparison was by Mann-Whitney U Test.

Findings: Eight student midwives completed the study. The expert reviewer, who was blind to allocation, rated the ORACLE group (n = 4) higher than the control group (n = 4) for patient-centred care. The median score for the ORACLE group was 54 versus 41 for the control group (p = 0.029 Mann-Whitney U test).

Conclusion: This new approach is designed to provide structured learning to accelerate skill development in simulations, and ultimately, in clinical practice. The small sample size limits the generalisability of the findings. However, the results do contribute to proof of concept. Further work is required to establish proof of principle for this approach, which has the potential to increase the effectiveness of simulation-based learning, and to contribute to patient-centred professionalism.

Triage Training: Virtual Reality vs. Standardized Patients
Jen Frankel and Pamela Andreatta
Aims: The aim of this study was to determine the relative impact of two simulation-based methods for training emergency medicine residents in disaster triage; full immersion virtual reality and standardized patients.

Background: Properly performed triage is a determinant of survival in critically injured casualties. Although no current training modality can absolutely prepare clinicians to perform disaster triage for a true mass casualty, practice and familiarity with the process can increase practitioner confidence and help physicians respond more efficiently to triage tasks. Optimal cost effective disaster triage training methods are presently indeterminate.

Methods: 16 PGY1-PGY4 Emergency Medicine residents were randomly assigned to two groups. One group participated in an immersive virtual reality scenario using avatars to perform triage of a mass disaster. The second group participated in a live disaster drill using standardized patients. The setting and patient presentations were identical between the two modalities. Resident performance and knowledge of disaster triage was assessed pre/post and after one week.

Results: There were no significant differences between the virtual-reality and the standardized patient triage training group performance. Standardized patient training is more resource intensive than virtual reality training. Situational modifications are both feasible and desirable to expand the contextual aspects of mass disasters in the virtual reality environment to include multiple scenarios and levels of clinician-patient engagement.

Conclusions: Virtual reality may provide a reliable, expandable and affordable solution for mass disaster triage training for first responders to mass casualty events, thus increasing the availability and impact of such training globally.

  1. Hogan, David E and Burstein, Jonathan L. Disaster Medicine 2nd Edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2007. 12-28.
  2. Risavi, Brian L; Salen, Philip N; Heller, Michael B; and Arcona, Stephen. “A Two-Hour Intervention Using START Improves Prehospital Triage Of Mass Casualty Incidents.” Prehospital Emergency Care. 2001; 5(2): 197-9.
  3. Hsu, EB et al. “Effectiveness of Hospital Staff Mass-Casualty Incident Training Methods: A Systematic Literature Review.” Prehospital and Disaster Medicine. 2004; 19(3): 191-9.
  4. Kizakevich, Paul N et al. “Virtual Simulation-Enhanced Triage Training for Iraqi Medical Personnel.” Stud Health Technol Inform. 2007; 125: 223-8.
  5. Freeman, Karen M; Thompson, Scott F; Allely, Eric B; Sobel, Annette L, Stansfield, Sharon A. and Pugh, William M. “A Virtual Reality Patient Simulation System for Teaching Emergency Response Skills to U.S. Navy Medical Providers.” Prehospital and Disaster Medicine. 2001; 16(1): 3-8.
  6. Idrose, AM; Adnan, WAW; Villa, GF; and Abdullah, AHA. “The use of classroom training and simulation in the training of medical responders for airport disaster.” Emergency Medicine Journal. 2007; 24: 7-11.
  7. Baez, Amado A; Sztajnkrycer, Matthew D; Smester, Pablo; Giraldez, Ediza; and Vargas, Luis E. “Effectiveness of a Simple Internet-Based Disaster Triage Educational Tool Directed Toward Latin-American EMS Providers.” Prehospital Emergency Care. 2005; 9(2): 227-30.
  8. Chi, Chih-Hsien; Chao, Wen-Hsin; Chuang, Chia-Chang; Tsai, Ming-Che; and Tsai, Liang-Miin. “Emergency medical technicians’ disaster training by tabletop exercise.” American Journal of Emergency Medicine. 2001; 19(5): 433-6.

Using human Simulated patients (SPs) in medical, nursing and health professional education – a review of the literature
Debra Nestel and Tracy Morrison
Aims: This paper presents a review of the literature of simulated patients.

Background: Simulation is a widely used for the development of clinical skills of medical and health professional skills. Effective patient interaction is a vital skill for safe clinical practice. Simulated patients (SPs) are one method by which these skills can be taught and assessed in a ‘safe’ environment.

Methods: An electronic search of databases CINAHL, ERIC, Medline, PubMed and Web of Science using the key words ‘simulated patient’, ‘standardized patient’, ‘actor patients’ and ‘human simulators’ was performed. All key words were searched with term ‘education’. Only articles using human SPs were included for review. All articles were evaluated for educational impact.

Results: The search generated 1892 articles. Inclusion criteria reduced the number of relevant papers to 151. The results show that SPs regularly contribute to education, mainly in medicine. However, there are examples from other professions (nursing, pharmacy). SPs are also used in skills based training and examinations. Students largely rate SP based work favourably.

Conclusions: Although expanding rapidly, the literature on SP based education has many gaps and often lacks theoretical foundation. Few studies measure changes to behaviour in practice or longer term impact focusing instead on participant reaction to training. It is an exciting field to explore and is rich in research opportunities.

Evaluation of a University wide simulated patient database – MonSim
Debra Nestel, Tracy Morrison, Brian Chapman, Sheryl Cardozo, Jenny Keating, Cathy Haigh, Laura Dean, Jonathan McConnell, Jill French, George Somers and Chris Browne

Aims: Develop a University wide simulated patient database
Describe the process and report challenges

Background: Simulated patient (SP) methodology enables students to practise and receive feedback on skills essential for clinical practice. At Monash University, Australia SPs are integral to programmes in medicine and pharmacy. Recent and predicted changes in health service delivery in Victoria will necessitate a greater, more fully developed reliance on SPs at all levels of health professional education, expanding into nursing, midwifery, physiotherapy and radiography.

This paper describes the development of an SP database (MonSim) as a central repository of SP based information.


  • Phased project (December 2008-June 2009)
  • Initial stakeholder meeting to outline MonSim’s purpose and discuss schools needs and challenges
  • Prototype development based on Phase I outcomes
  • Rapid cycle test MonSim with stakeholders, obtain feedback and revise prototype
  • Pilot MonSim in selected schools
  • Evaluate MonSim from multiple stakeholder perspective

Results: Content and functionality of database identified and created using ToolBook.
Pilot database entered to Excel and imported into ToolBook database application enabling access to SP personal information, photos and audio recordings. Conclusions: The improved administration of the SP programme improves quality and extent of SP based education.

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Papers Session 7 - Virtual Reality - Wednesday 1330 - 1500

The Impact of Non-Verbal Communication in Virtual-Environment-Based Teamwork Training
Stefan Marks, John Windsor and Burkhard Wünsche

Aims: To present a simple method to use a webcam to enhance non-verbal communication in virtual-environment-based teamwork training.

Background: Over the last decade, healthcare profession training has been enriched by educational technology such as virtual-reality simulators for skills training and mannequins for team training. More recently, there has been the development of several metaverses that are now being used for virtual-environment-based teamwork simulations. This type of simulation lends itself to networking, allowing participants to participate from remote locations.

The significant drawback of training in virtual worlds is that the avatars, in-world representatives of the participants, are capable of very limited non-verbal communication. Of note there is no facial expression, gaze control or head movement. Our thesis is that enhanced non-verbal communication will improve training outcomes.

Methods: We have developed a model of the aspects of non-verbal communication that a simple webcam (Creative Live! Cam Video IM Pro) can capture. This model has been integrated into a program that monitors and evaluates the webcam input. The data is fed into a simulation based on Valve’s Source Engine that has been modified to mirror the information on the avatar.

Results: Initial tests suggest a more realistic and effective communication between users in virtual world simulation. Feedback from medical and other professionals suggests that this approach has significant advantages and potential to enhance team training.

Conclusions: Using additional input from a webcam to control the avatar, we have achieved enhanced non-verbal communication. Initial feedback is very positive. The next step is to conduct extended user studies.

A Decade of Developing Virtual Reality Medical Simulators: Mistakes Made and Lessons Learned
Alan Liu and Gilbert Muniz

Aims: Virtual reality medical simulators lie at the confluence of four major disciplines: medicine, engineering, cognitive sciences, and the arts. Building educationally relevant simulators require finding a balance between them.
This presentation highlights lessons learned in almost a decade of VR-based simulation development at the National Capital Area Medical Simulation Center (SimCen).

Background: The SimCen is one of the largest and oldest integrated medical simulation facilities in the United States. The SimCen has developed many first-in-kind simulators. They include craniotomy, cricothyroidotomy, peritoneal lavage, and pericardiocentesis. The SimCen is presently developing the world’s largest virtual reality theater for medical team training.

Many lessons were learned during the development. We discuss some in the following section. If accepted as an oral presentation, we will expand on these themes.

Methods: The requirements analysis process is an essential first step in simulator development. Factors include the nature and scope of the problem, and identifying stakeholders and educational goals. Pitfalls arise when technology triumphs learning needs. Our presentation, will further explore issues surrounding the requirements analysis process.

Consumer-grade computers now have multiple CPU cores and massively parallel graphics processors (GPUs). Fully utilizing their capabilities requires a rethinking of how medical simulators are developed. We have developed novel a pipelined architecture that dynamically balances workload between CPU-cores yet remains transparent to the application developer.

Good visual sense is necessary for developing virtual patient models. The 3D medical illustrator blends artistry with anatomical knowledge. Preserving the visual fidelity of the artist in a real-time simulator is non-trivial.

In the presentation, we describe some of the techniques that help bridge this gap.

Results and Conclusions: In this abstract, we have outlined some key areas to consider when developing simulation applications. The insight we hope to share can benefit simulator developers and others planning to enter the field.

3D ROSE: A Virtual Reality Radiation Oncology Simulation Environment
Iwan Cornelius*, Laz Kastanis, Darren Pack, Andy Boud, Chris Poole and Christian Langton
Aims: To develop an immersive virtual reality environment of a radiotherapy treatment room to be used for the training of health care professionals and patient awareness.

Background: Linear Accelerators (LINACs) are used to deliver a dose of radiation to a tumour whilst sparing surrounding healthy tissue. The training of health care professionals in the operation of these machines can take up valuable time that could be used for treating patients; some of this training could take place in a virtual environment. Moreover, many patients have no contact with the treatment room prior to a course of radiation treatment. The foreign sights and sounds of the treatment room can cause significant anxiety during the first irradiation. Over the course of treatment this anxiety subsides, which can lead to a change in patient posture. As patient position is crucial to accurate dose delivery, this may increase the radiation dose received by healthy tissue.

Methods: 3D-ROSE is composed of a 3D model of a treatment room projected onto a 240cm x 180cm display wall. Users wear 3D glasses to view the resulting stereoscopic image. A tracking system detects the position of the user on the floor space as well the direction in which they are looking; software then adjusts the projected image accordingly. The full functionality of the machine is reproduced, with replica hardware controllers being used to operate the LINAC and treatment bed. Sounds sampled from the actual room are reproduced in stereo. This completely immerses the user in a virtual reality radiotherapy room.

Results: A prototype system has been established at Queensland University of Technology. The system is currently being tested by Radiation Oncologists, Radiation Therapists, and Medical Physicists, along with Cancer Consumer Groups in order to optimize design and operation.

Conclusions: Funding from Queensland Health has enabled the creation of a prototype immersive virtual reality radiotherapy facility. Further developments will enable this tool to be used to train Radiation Therapists and Physicists, as well as provide valuable patient awareness in order to reduce patient anxiety. Future work will focus on measurable outcomes such as patient wellbeing and the effect on patient positioning.

What components of simulation courses can be optimised by e-learning
Niall Higgins, Stephen Francis, Richard Campbell, Joshua Harvey and Marcus Watson
Aim: To examine systematic approaches to implementing pre e-learning packages to improve simulation based training. Reducing the time and resources spent in preparing for simulation scenarios will provide opportunity for better use of clinician instruction time. Learner preparation that is spent on self-directed e-learning establishes a better baseline understanding of the requisite material needed for simulation courses.

Method: The centre engages instructors using a standard approach in order for the e-learning team to have a clear understanding of education approach used and desired salient educational outcomes. The use of existing on line simulations helps the instructors to explore the potential for ability of e-learning to augment their simulation courses. In addition to this, equipment based practical skills are explored for generic methods of use. Pre and post assessments are included to help instructors understand their learning group prior to commencing simulation training.

Results: Learners benefit from e-learning using an interactive approach to assist their understanding of abstract clinical concepts that are often necessary for simulation scenarios. E-learning simulation models have been constructed for learners to enhance engagement with complex material that has been traditionally presented as tables or charts. For example a learner may change the type of intravenous infusion prescribed for a patient with shock and view the resulting level of extra cellular fluid shift with explanatory comments. Using a modular approach allows re-use of e-learning material that reduces the time needed to develop material and helps to standardise components of training. The presentation will include both example of the generic on-line simulations and the process of engaging with instructors.

Conclusion: Better communication between simulation instructors and technical designers has enhanced the transferability of e-learning modules across different clinical simulation courses.

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Papers Session 8 - Operations and Logistics - Wednesday 1330 - 1500

The Operationalisation of a Simulation Centre in a New Graduate-Entry Medical School in Regional Australia
Kathleen Cartwright, David Birks, Caroline Rossetti, George Somers, Debra Nestel and Chris Browne
Aims: There is a distinct gap in the literature about the operationalisation of new Simulation Centres. To this end, we documented the opportunities and challenges of establishing and managing such a Simulation Centre in an equally new medical school.

Background: The Gippsland Medical School (GMS) - Monash University’s graduate-entry medical program based in regional Victoria – received its first student intake in 2008. A purpose-built Simulation Centre featuring a wide range of technological fidelity (from fully animated manikins driven by sophisticated software in immersive environments to low fidelity manikins and part-task trainers) was an integral part of the curriculum delivered to students.

Methods: We documented simulation activities during 2008, exploring student and staff experience and stakeholder feedback on the conduct and delivery of simulation activities.

Results: The high fidelity manikin, SimMan (Laerdal P/L, Oakleigh, Victoria), captured the imagination of the cohort, resulting in high expectations of its integration in the teaching program. The possibility of embedding the technology in the curriculum exposed areas of unmet need (staff training, management of student expectations). Supporting operational documentation was incomplete and complex.
Our results suggest that the following are important during the early initial phases of operationalisation of a Simulation Centre: rapid-cycle infrastructure testing, comprehensive user training, and complete documentation in an accessible form.

Conclusions: Our experience in the operationalisation of a new Simulation Centre highlights the limited value of technology as an end to itself. Adequate support, skills integration, trained staff, and cross-disciplinary involvement will provide opportunities for improvement in curriculum delivery.

CRM Behind the Screen: Planning and Logistics Template for Multi-scenario Research
Kaylene Henderson
Introduction: Use of multi-scenario simulation as a research tool requires planning, consultation, consistency, teamwork and a sense of humour. We undertook a major research project which staged 14 different complex ICU scenarios each study day. Absolute consistency in all aspects was required on more than 20 study days over 15 months.

Nine ICU’s in 4 cities provided more than 40 critical care teams (1 doctor, 3 nurses) as study volunteers.

Methodology: In the planning stage, with the challenge of limited time and grant budget (AU$35,000), a core team of four planned, programmed and documented 14 complex scenarios. These mandated the creation of a generic ICU with a very high level of fidelity including use of real drugs. Tight scripting was developed for the conduct of the day including orientation process, scenario staging and supporting presentations.

Each day was delivered by the same 4 faculty following the exhaustive template and developed check lists. CRM principles were explicitly applied for successful delivery of these very high activity days. This included clear leadership by a designated coordinator, role allocation, closed loop communication and cross monitoring.

Given the complexity of requirements, the group expected unanticipated events which indeed occurred. Resolution came from tight teamwork and dynamic decision making (ironically the subject of the research).

Discussion: We present a template which may assist others with the extensive planning, development and delivery of research using simulation. Creating a consistent environment suitable for research requires a dedicated team with a very clear understanding of the research project.

Introduction to Simulation Instruction and Facilitation Program
Irwyn Shepherd
Aim: To deliver a vocationally-based beginner simulation instruction and facilitation program that provides participants opportunity to begin using a range of education theories and simulation information, techniques and technologies in developing and delivering simulation education programs.

Background: This three (3) day program was designed to fill a gap in the current clinical teaching environment where there is an identified dearth of healthcare personnel with the necessary fundamental knowledge and skills for designing, delivering and evaluating simulation –based education programs.

Methods: The program format was designed around current evidence, benchmarking and a need analysis. It is learner-focused towards generating a beginning understanding of the role of a Facilitator and Instructor, with practical applications for participants to now build on. The program covered what was deemed to be the essentials to get started using simulation as a teaching and learning process. The format of the program provided sequenced opportunities for the participants to link theory to practice as individuals and as a group.

Results: Pre-program data indicates they all identified limited understanding of simulation and its applications. Post program data demonstrates a measurable shift in their understanding of simulation and its applications. Responses are based on a self-judgement/self-efficacy education model. Thematic analysis of qualitative data reinforces this outcome.

Conclusions: We have been able to design, deliver and evaluate a quite unique program in the sense that it has a solid underpinning educational modelling and paradigm necessary to maximize the use and impact of simulation. Some modifications will be generated based on customer input.

US Military Medical Simulation: State of the Art
Gilbert Muniz and Alan Liu

The experience of military medical simulation in the United States has been quite different than that of the Australian Defense Forces (ADF). The ADF military medical simulation has been driven by a cohesive Defence Simulation Strategy expressed in the 2006 Defence Simulation Roadmap. On the other hand, the experience of the United States armed forces (i.e., the Department of Defense, the U.S. Army, the US Air Force and the US Navy) began as an ad hoc, piecemeal, fragmented approach with many costly failures.

More recently, the US military experience has begun to evolve in a more cohesive effort but still driven by individual service specific initiatives. More specifically, each of the armed services in the US have over the past ten years developed a curriculum based medical simulation training platforms to address specific training needs of specific medical personnel. Much of the focus has been on skills and procedure based training and is only today beginning to concern itself with comprehensive medical simulation team training. But they lack a strategic policy. As such, they lack a roadmap that identifies the key policy makers and shareholders and defines and details the resources which can be targeted to stated, measureable aims.

This presentation will focus on the evolution of the US military medical simulation experience to see where it stands today and how it might benefit from the experience of the ADF. Specifically, the discussion will tease out the experience at the corporate level which is the Department of Defense and then follow suit with the Army, Air Force and Navy experience. Lastly, the discussion will turn to a brief list of policy recommendations to guide subsequent development of the US military medical simulation effort.

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Papers Session 9 - Technical - Thursday 0900 - 1030

The Development of a Haptic Device for Abdominal Palpations in Colonoscopy Simulation
Mario Cheng, Marcus Watson, Stephan Riek, Josh Passenger and Olivier Salvado
Aims: We aim to develop a pneumatic haptic device for implementation in a mannequin for simulation of abdominal palpations during colonoscopy procedures.

Background: Abdominal palpation is a technique used in 15-20%1 of cases to aid the gastroenterologist when loops form in the colon causing paradoxical motion. The assistant places hand pressure on the abdomen as directed by the gastroenterologist to facilitate colonoscope progress past troublesome flexures. Current colonoscopy simulators cater only for the gastroenterologist and neglect team training. A novel pneumatic haptic device utilising air bladders2 to simulate abdominal palpations may improve colonoscopy team training.

Method: To verify the accuracy and fidelity of the haptic device, we measured forces applied by an assistant. We have conducted a pilot study with a single subject placed in the prone position on a force plate. In addition, 6 infra-red LEDs were attached to the surface of the abdomen to map the deformation.

Results: The pilot study results show high sensitivity in measuring light to medium abdominal pressures which reach a maximum of 40N. Similar force curves were used as inputs to evaluate the haptic device performance. The measured force showed strong correlation with the input force during palpation. However, weak correlations with post-palpation forces were measured. This limits time between palpation simulations but does not affect the forces experienced by the user.

Conclusion: The results show that the device was capable of reproducing forces of an average palpation. The study population will be expanded to better understand the variations and range of forces involved with different body types.

  1. J. Prechel, C. Young, R. Hucke, T. Young-Fadok, and D. Fleischer. “The Importance of Abdominal Pressure During Colonoscopy: Techniques to Assist the Physician and to Minimize Injury to the Patient and Assistant.” Gastroenterology Nursing, 28(3):232, 2005.
  2. M. Cheng, S. Riek, M. Watson, S. Ourselin, J. Passenger, O. Salvado. “Pneumatic Haptic Interface Fuzzy controller for Simulation of Abdominal Palpations During Colonoscopy.” Proceedings of the Third Joint Eurohaptic Conference and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems, IEEE Press (2009), 250-255.

Evaluation of the Trucorp and iSTAN as a Training Tool for Supraglottic Airways
Colin Torrance*, Alan Jones and Alun Jenkins

In the past few years a range of supraglottic airway devices (SADs) have been introduced. SADs are used by anaesthetists to overcome some of the disadvantages associated with endotracheal intubation or when there are problems with intubation. Increasingly SADs are also being used by paramedics when endotracheal intubation fails.

Currently paramedics in the UK are expected to perform 25 intubations during a hospital placement as part of their criteria for requalification. However, hospital placements may provide only limited opportunities for paramedics and other health professionals to gain experience with using SADs as rescue devices for non-intubatable patients and for paediatric airway management.

The Glamorgan Clinical Simulation Centre in collaboration with the Welsh Ambulance Service’s Pre-Hospital Emergency Research Unit (PERU) is evaluating practical and educational aspects of preparing paramedics and other professional groups to use SAD for problematic intubation. Participants will be educated in the use of SADs using the AirSim (Trucorp) part-task trainer and METI high fidelity manikins.

Preliminary results from this study focusing on assessing the fidelity of the part-task trainer and manikin airways, ease of use, correct insertion of SADs and adequacy of ventilation will be presented.

Comparison of Respiratory Mechanics on the METI Emergency Care Simulator and Human Patient Simulator using Physiologically Modeled Lung Volumes
David Liu, Dylan Campher, Lara Brewer and Simon Jenkins

Aims: We compared the respiratory mechanics of the METI (Medical Education Technologies, Inc., Sarasota, FL) Emergency Care Simulator (ECS) and Human Patient Simulator (HPS).

Background: The HPS incorporates a high-fidelity mechanical lung that simulates consumption of oxygen/anesthetic gases and exhalation of carbon dioxide1, whereas the ECS is portable and inexpensive but uses a lower fidelity lung that simply simulates carbon dioxide exhalation.

Methods: Simulator lung volumes were measured in a 2x2x3x3 factorial design. The independent variables were Simulator (HPS, ECS) and Ventilation Mode (Spontaneous, Volume Controlled Mechanical), and the controlled variables were Respiratory Rate (5, 10, 20 bpm) and Tidal Volume (200, 500, 800 mL). The dependent variable was the total lung volume reported by the physiological models. For each condition, the Left Vol. and Right Vol. parameters in the METI software2 were recorded at 20 Hz for 180 seconds. The data were analyzed by comparing plots of the total lung volumes versus time.

Results: Measured RR was accurate for all conditions. Measured TV was lower than expected for all ECS-Mechanical, HPS-Spontaneous and HPS-Mechanical conditions.

Graphic plots of lung volume versus time approximated “normal” under all ECS-Spontaneous conditions, but the expiratory phase of the ECS-Mechanical conditions had excessively rapid expirations and “overshot” expiration below the Functional Residual Capacity (FRC).

Expiratory phases of all HPS conditions were realistic, including lung volumes consistent with the presence of intrinsic PEEP3, which was present in the HPS-Mechanical condition when RR=20 bpm and TV=500 mL. However, HPS-Spontaneous showed a reduced FRC compared to expected, and there were high frequency oscillations during all HPS conditions.

Conclusions:The higher fidelity of the mechanics in the HPS lung model is demonstrated by its realistic expiratory phases and simulation of intrinsic PEEP, although the high frequency oscillations through inspiratory and expiratory phases are difficult to interpret. The lower-fidelity ECS lung model resulted in expiratory phases more consistent with poorly compliant lungs than “normal” during mechanical ventilation (as found in [4]), despite highly realistic TV versus time curves during spontaneous ventilation.


  1. van Meurs WL, Good ML, Lampotang S. Functional anatomy of full-scale patient simulators. J Clin Monit 1997;13:317-324.
  2. Medical Education Technologies, Inc. Patient Parameters. In: ECS User Guide, Rev. 5. Sarasota, FL: Medical Education Technologies, Inc. 2004:8.8-8.10.
  3. Brochard L. Intrinsic (or auto-) PEEP during controlled mechanical ventilation. Intensive Care Med 2002;28:1376-1378.
  4. Liu D, Jenkins S. Simulating capnography in software on the METI Emergency Care Simulator. Sim Healthcare 2009;4(2).

Are mannequin chests an accurate representation of a human chest?
Malcolm Boyle and Brett Williams
Aims: To identify if mannequin chests are an accurate representation of a human chest for decompression of a tension pneumothorax.

Background: The presentation of traumatic tension pneumothorax in the Victorian prehospital setting is <1%. It is important this uncommon presentation, managed by needle decompression, is practiced by paramedics and undergraduate paramedics using a range of educationally sound and realistic mannequins.

Methods: This is a two part study. A review of the literature to identify chest wall thickness in humans and measurement of chest wall thickness on two commonly used mannequins. The literature search was conducted using the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, and EMBASE databases from their beginning until the end of March 2009. Keywords included chest wall thickness, tension pneumothorax, pneumothorax, thoracostomy, needle thoracostomy, decompression, and needle test. Studies were included if they reported chest wall thickness.

Results: For the literature review 3,109 articles were located with 7 meeting the inclusion criteria. Chest wall thickness in adults varied between 3cm and 9.3cm at the area of the second intercostal space mid clavicular line. The Laerdal manikin in the area of the second intercostal space mid clavicular line, right side of the chest was 1.1cm thick with the left 1.5cm. The MPL manikin in the same area, right side of the chest was 1.4cm thick with the left 1.0cm.

Conclusion: Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.

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Papers Session 10 - Program Evaluation - Thursday 0900 - 1030

Particpant or Observer - Is the learning the same? A student perspective
Monica Peddle
Background: Simulation based education methodology in the education of health professionals, improves the cognitive, psychomotor, affective and professional domains. Literature related to teaching and learning in simulated based education experiences claim that smaller groups facilitate more effective learning for those participants. However in a large school of nursing with over 1600 undergraduate students enrolled in total, and over 800 enrolled on one campus it necessitated introducing innovative methods to ensure the large numbers of students could be accommodated.

Methods: The principle of Legitimate Peripheral Participation was utilised to support the use of large group simulated learning experiences in which half the group was allocated as observers and half participants. In this theory the learner moves from the periphery of the action to the central hub and learning is seen as a process of social participation.

A Pilot study utilizing large groups of up to ten members in simulated learning experiences was conducted in the first semester 2008. Second year nursing students experienced educationally sound simulated learning experiences. Participants within the group were allocated a role either participant or observer.

An evaluation was carried out post simulated learning experience to compare the learning of the participants with the observers.

Result: Preliminary results indicate that 62% of those student who were in the observers group felt their clinical decision making skills improved and 62% felt they learnt as much from observing the session as those who were participating in it.

Conclusions: This pilot indicates that simulated learning experiences in large groups do have the potential to accommodate large numbers with simular learning outcomes for all students whether they are participants or observers. Further investigation of this process is warranted with the use of experimental research to compare the learning outcomes of each group of learners.

Manikin To The Market : Insitu Paediatric Simulation using Simbaby and SimnewB
Irwyn Shepherd and Lyn Taylor
Aims: To provide a client based simulation experience embedded in the workplace. Background: A client was experiencing increases in paediatric presentations to their organisation. Staff indicated they were not comfortable and competent in dealing with potential paediatric emergencies. As a result the client requested a specific simulation workshop on high risk paediatric scenarios for nursing and medical staff. Because of operational factors and our simulation mobility it was agreed to deliver the program within their clinical setting.

The program was designed, constructed, tested and validated collaboratively with the senior educator of the organisation. To help contextualise the scenarios the setting was in the recovery room of their operating theatre complex.

Methods: Two simulation scenarios dealing with the deteriorating baby and the child with laryngospasm were provided. Following a sequenced orientation, participants undertook two roles of intervention and observation and vice versa. Structured debriefing was subsequently facilitated to encourage reflection on practice.

Results: Evaluation was based on program delivery and identified learning outcomes. Using a likert scale format all participants indicated a high degree of positive outcomes for both. Data and comments will be presented.

Conclusions: The use of insitu learning using simulation is expanding and diversifying as simulation becomes more mobile. It also provides a further opportunity to engage clinicians in contextualised immersive, interactive, experiential and reflective learning, especially where the clinicians have only periodic exposure to high risk issues. If the workforce cannot find opportunities to go to a dedicated simulation centre then the simulator can come to the workplace. It just needs planning.

The Clinical Impact of a Pediatric Mock-Code Program
Pamela Andreatta, Michael Marsh and Gail Annich
Aims: The aim of this study was to determine the impact of a simulation-based mock code program for pediatric medicine residents on clinical outcomes of pediatric patients in cardiopulmonary arrest.

Background: Rapid and accurate clinical response is a critical factor in the successful management of cardiopulmonary arrest. This clinical response is often referred to as a “code” and is a coordinated effort of multiple specialists performing emergency procedures under the direction of a senior resident. The resident’s leadership ability is integral to accurate and efficient clinical response to the patient. Experience managing codes is a contributing factor to a resident’s leadership ability.

Methods: Mock codes for pediatric medicine residents were randomly called at least monthly. All code team members responded to the mock event as they would an actual event. 36 mock code events were called over 18 months. Mock codes were recorded and used for immediate debriefing facilitated by clinical faculty and including other team members whenever possible. Hospital records for pediatric resuscitations were examined for two years beginning 6-months prior to the mock code program and continuing for 18 months after its start.

Results: Resuscitation rates for pediatric patients increased from 3% to 48% after the initiation of the simulation-based mock code program.

Conclusions: A mock code program can significantly benefit patient outcomes in the clinical response to cardiopulmonary arrest in pediatric patients. This study provides clinical evidence of the value of simulation-based training for the benefit of patient care.

  1. Abella, B. S., J. P. Alvarado, et al. (2005). "Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest." JAMA 293(3): 305-10.
  2. Eisenberg, M. S. and T. J. Mengert (2001). "Cardiac resuscitation." N Engl J Med 344(17): 1304-13.
  3. Hunt, E. A., A. R. Walker, et al. (2008). "Simulation of in-hospital pediatric medical emergencies and cardiopulmonary arrests: highlighting the importance of the first 5 minutes." Pediatrics 121(1): e34-43.
  4. Risser, D. T., M. M. Rice, et al. (1999). "The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium." Ann Emerg Med 34(3): 373-83.
  5. Roback, M., S. Teach, et al. (1998). Handbook of Pediatric Mock Codes. St Louis, Mosby.
  6. Su, E., T. A. Schmidt, et al. (2000). "A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course." Acad Emerg Med 7(7): 779-86.

Watch and Learn: Evaluating Scenario Based Learning Outcomes in Participant and Observer Groups
Andrea Thompson, Victoria Hynes, Dane Barclay, Stephanie Fox-Young, Elesha Toscano, Pauline Varghese and Tracey Brandis
Aims: To examine the value of facilitated observation for a group of medical and nursing students during an inter-professional simulated ward exercise.

Background: A series of inter professional simulated ward exercises were developed, conducted and evaluated in a joint Skills Development Centre and University of Queensland Faculty of Health Sciences project. Overarching objectives of the exercise included introducing students to a inter professional learning environment, the management of clinical challenges and developing students’ awareness and understanding of non technical skills and their impact on clinical performance.

Method: Each ward exercise featured nine standardised patients managed by three nursing and two medical students, with senior staff available as appropriate. Prior to the exercise, students were allocated a participant or observer role. Participants performed as newly graduated practitioners through three related scenarios, with “ward time” suspended during the debriefing phase. The observer group were facilitated by a member of the faculty whilst observing the ward simulation. All students actively participated in the debrief process. Pre and post course questionnaires and post course telephone interviews were conducted.

Results: Pre ward exercise questionnaires indicated high levels of readiness for inter-professional learning. Analysis of questionnaires and students’ reports exhibited increases in both the participant and observer groups in attitudinal changes towards inter-professional learning. Preliminary findings of student interviews indicated similar learning perceptions and perceived benefit of the experience between participants and observers.

Conclusions: Evaluation data suggests that facilitated observation of a simulated event can produce perceived learning outcomes comparable to that of participation. This may benefit areas where large numbers of students are required to undertake an activity which is traditionally conducted on a high faculty to student ratio.

  • Parsell G, Bligh J. The development of a questionnaire to assess the readiness of health care students for inter professional learning (RIPLS). Medical Education. 1999;33:95-100.

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Breakfast: Thursday 0730 - 0900 Ask the Experts: Research I am Trying to do?
Chair: Peter Dieckmann and Marcus Watson

If you wish to attend the breakfast, for catering purposes, please register here (free for conference delegates).

Simulation and its Effect on Clinical Decision Making: A Constructivist Investigation
Jacinta Secomb
The objective of this research is to explore knowledge development and clinical decision making in undergraduate nursing students using self instructive computer based simulation activities.

Currently in nursing education the use of technology is self limiting. Previous research on simulation education activities has failed to fully inform pedagogies and its effect on clinical decision making.

This study involves two investigations that follow a logical sequence of mixed methods. The theoretical perspective that underpins both investigations is William Perry's (1970) cognitive constructivist theory. It is an assumption of this study that the higher the cognitive score, the greater the ability of the nursing student to make informed valid decisions in their clinical practice.

Firstly, the objective scoring instrument of cognitive development based on Perry's scheme the Learning Environment Preferences (LEP) will be used in a group parallel randomised controlled trial design, to refute the null hypothesis that self instructive computer based simulation activities have a negative effect on cognitive abilities.

Secondly, Perry's scheme and previous research will provide the initial coding framework in a directed content analysis of focus group transcripts. This second investigation will explore factors reported by students that relate to knowledge development and increased abilities to make decisions in their real world clinical practice from the use of simulation activities. This approach stands to make a contribution to current understandings of online self instructive simulation technology and clinical decision making in health science education.
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Software Framework for Performance Assessment in Medical Training Simulations
Greg Ruthenbeck and Fabian Lim
Aims: The Software Framework for Performance Assessment (SoFPA) provides a system for adding standardised assessment capabilities to medical simulation software. Background As the acceptance and usage of medical simulation training increases, there is a growing need for a standardised method for competency evaluation. Medical tasks and procedures typically consist of interactions between surgical instrument and tissue. Interactions can be decomposed into measurable elements which will provide a basis for standardised assessment measures. Since most medical procedures can be decomposed in this way, SoFPA can be applied to a wide range of computer based medical simulations

Methods: The initial implementation of SoFPA will be integrated with our medical training simulations. This includes simulations for endotracheal intubation and ablation tonsillectomy. Performance assessment measures to be included are:
  • Accuracy of movement (path tracking)
  • Accuracy of interaction (identifying key anatomies and pathologies)
  • Appropriate use of force
  • Timing (task completion and reaction times)
SoFPA will be trialled on medical students through both procedures to demonstrate its capabilities and flexibility. SoFPA also provides an effective means for determining which measures are important for assessing competency for specific procedures.
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Introducing Team STEPPS into Medical Education via Clinical Simulation
Peter Loa
Up to 70% of clinical errors has been associated with poor communication and teamwork (Kohn, Corrigan & Donaldson, 1999). However, assessing teamwork and communication has been fraught with difficulty. The efficacy of training programs can also be difficult to prove.

However, TeamSTEPPs (Team Strategies and Tools to Enhance Performance and Patient Safety) is a comprehensive teamwork and communication program developed by the AHRQ in the United States (Agency for Healthcare Research and Quality) and the DoD (Department of Defense) in the US (Clancy & Tornberg, 2007). Training systems such as TeamSTEPPs have been shown to reduce observed clinical errors by 50% (Morey et al., 2002).

In the October 2004 supplement of the Quality and Health Care journal, there are numerous examples of simulation training being used to teach teamwork and communication skills successfully. Aggarwal et al. (2004) reports simulating an operating theatre to teach junior residents safety and human factor issues that may make the operation difficult. Features of simulation training is conductive to teaching communication and teamwork skills are its flexible delivery via various scenarios, ability to create new group formation and reinforcement over many years throughout medical.

Simulation training can be used to teach TeamSTEPPs principles. The evaluation of its efficacy and how it can be integrated throughout the medical school curriculum and later throughout junior doctor training and continuing medical education programs is ripe for further discussion and research.

  1. Clancy, CM and Tornberg DM, 2007. “TeamSTEPPS: Assuring Optimal Teamwork in Clinical Settings”, American Journal of Medical Quality, Vol. 22, No. 3, 214.
  2. Kohn LT, Corrigan JM & Donaldson MS, 1999. “To err is human: Building a safer health system”. Washington, DC: National Academy Press
  3. Aggarwal R, Undre S, Moorthy M, Vincent D, Darzi A 2004, “The simulated operating theatre: comprehensive training for surgical teams” Quality Safety Health Care; 13 (Supplement 1 ), i27-i32.
  4. Morey, J.C., Simon, R., Jay, G.D et al., 2002. “Error reduction and performance improvement in the Emergency Department through formal teamwork Training: Evaluation Reports from the MedTeams project”. Health Services Research, Vol. 37, No. 6, 1553-1581.
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Development of the Monash University Simulation Network
Jennifer Keast and Brendan Flanagan
Aims: This poster visually plots the course of the Monash University Simulation Network from its inception to its current state.

Background: During 2008 it was recognised that Monash University had an opportunity to establish a national leadership role with respect to simulation in healthcare through establishment of a faculty wide simulation network. Aims included organizing, standardizing and formalizing simulation based delivery within the faculty, to form partnerships with potential health services, to recognize research opportunities and to address the burgeoning clinical placement challenges. From an educational perspective, the crucial component of the development of sustainable vertically integrated curricula, interprofessional learning opportunities and development of workplace-based assessment techniques was identified as key drivers.

Method: Issues identified:
  • Aims, objectives and purpose
  • Governance issues
  • Clinical sites
  • Site visits
  • Existence of overseas networks
  • Mapping exercise
  • Basic needs analysis
Results: Data was collected and collated from all sites and an action plan for each site developed in order to harness existing enthusiasm at sites, plan for short and long term goals, and assist in supporting existing programs.

Conclusions: Where to from here? There is still much work to be done. This poster describes the challenges, successes, trials and tribulations to date of the implementation of a faculty wide simulation network, and also describes future planning and anticipated outcomes.
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The Potential of Simulation for Aero-Medical Mission Rehearsal
Anthony Hopcraft, Sandra Riley and Marcus Watson
Aims: The Royal Australian Air Force's (RAAF) Health Operational Conversion Unit, wishes to explore the potential of simulation for Aero-Medical Evacuation (AME) mission rehearsal.

Background: The RAAF has a long history of using simulation to conduct potentially hazardous training in risk-mitigated environments. It has realised the capabilities and cost-containment potential of simulation and expanded its employment to a multitude of other roles. Notable inclusions include the delivery of healthcare and mission rehearsal. In response to real-world operations, there is often little time to prepare for more complicated AME missions. Simulation may be applied to such circumstances to achieve near real-time mission rehearsal.

Method: Subject to AME mission requirements, carrying a medical simulator mannequin on-board the aircraft may allow team members to rehearse caring for the patient in-flight. Familiarising the AME team with the anticipated physiology, prior to retrieving the actual patient, may help focus the AME team for the mission ahead. Simulation may also allow the team to rehearse their response to patient deterioration in-flight. Allowing a synergy of preparedness to be achieved between the clinicians and the aircrew.

Results: Previous trials of carrying a medical simulator mannequin on-board have shown promise in creating a more immersive environment for the AME team to train in.

Conclusions: Simulation has provided a capable vehicle to predict the effects of change and to rehearse the required tasks. It prepares the health worker for the challenge ahead and helps them achieve the desired mindset in an environment tolerant to mistakes and error.

  1. Australian Broadcasting Corporation. 2006. F-111 fleet grounded after emergency landing. Available at:
  2. Hayden M., Watson M. 2008. Simulation to manage a major relocation of Paediatric Cardiac Services. Proceedings of: SimTecT 2008. Brisbane, Australia.
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Actor training for surgical team simulations in a portable simulation environment
Eva S Kassab, Dominic King, Louise M Hull, Nick Sevdalis, Sonal Arora, Roger L Kneebone and Debra Nestel
Aims: To evaluate a training programme for actors to play roles of surgical team members (anaesthetist, scrub nurse and surgical assistant) in the context of a portable OT simulation environment.

Background: Surgical training provides opportunities for structured learning of the complex set of skills required for safe surgical practice. Simulations enable surgeons to practise these skills without risk to patients. However, recruiting healthcare professionals to recreate a full surgical team is difficult and resource intensive. We trained professional actors to portray members of a surgical team in a portable surgical environment, which recreates a fully-equipped operating theatre (OT) by using portable, low-cost equipment.

Method: The iterative one-day-programme comprised written materials, video discussion and experiential activities. Evaluation methods consisted of post-simulation interviews and questionnaires with actors and participating surgeons. Participants were recruited by convenience sampling. Quantitative data were analysed using descriptive statistics and interviews by thematic extraction.

Results: Three actors underwent training for simulations. Six surgeons completed six simulations. Surgeons’ perceived realism of actors was 4.7 (SD= 1.4; 6-point scale 1=not at all realistic to 6=completely realistic). Feedback, rehearsal and a video of the surgical procedure were highlighted as particularly valuable. Suggestions to improve training include watching real operations and talking to healthcare professionals.

Conclusions: After relatively brief training actors can realistically portray members of a surgical team in simulations designed to support surgical training. Although the study has some limitations, its findings have relevance to the growing field of high fidelity, simulation-based surgical team training.
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Creating an immersive simulation to support the development of non-technical skills in surgical trainees
Jennifer Keast, Adrian Anthony, Margaret Bearman, David Birks, Sheryl Cardozo, Ian Civil, Kathleen Hickey, Brendan Flanagan, Brian Jolly, Mary Langcake, Liz Molloy, Debra Nestel and Cathy Steele
Aims: This presentation describes an inexpensive and rudimentary part- task trainer interfaced with a SimMan mannequin to engage surgical trainees in an immersive simulation to explore non-technical skills.

Background: Immersive simulation can provide an ideal setting to teach non-technical skills in a realistic environment. However, without a relevant clinical context, it is harder to engage trainees in learning. Our research focus was the extent to which surgical trainees engaged in the simulation designed for the development of non-technical skills.

Method: A simple, low cost device was aligned with SimMan in an operating theatre environment. This was the "hook" to engage surgical trainees and we hypothesized that this simple device would be an additional and critical trigger. It was important that the device complimented rather than distracted from the learning objectives of the scenario.

Results: Two trainees completed the scenario with twelve others observing. Trainees reported that the environment was realistic whilst observers could not tell that it was a simulation. Genuine discourse between the surgeons occurred with respect to the immediate management of the patient-their shared priority was achieving haemostasis. In parallel a secondary conversation took place between nurses on management of uncertain intra operative instrument sterility. These two groups had differing priorities which highlighted the use of skills such as communication and leadership, graded assertiveness and situation awareness to achieve a common goal.

Conclusions: This scenario demonstrated that with simple adjustments to SimMan a scenario was created that engaged trainee surgeons in learning activities designed to support the development of non-technical skills.
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Development of a device for improving the fidelity of respiratory auscultation during simulations
Peter Thomas, Daniel Host, Andrea Thompson and Dylan Campher
Aims: To develop a device that could be used with standardised patients and manikins to improve the fidelity of respiratory auscultation during simulations.

Background: Limitations in the design of many commercially available manikins impair the fidelity of respiratory auscultation and may prevent the attainment of associated learning outcomes. These limitations include the inaccurate replication of lung sounds; manikin designs that hamper transmission of lung sounds to a clinicians' stethoscope; and poor reproduction of normal anatomical / physiological variations in lung sounds.

Method: A computer engineer was employed to develop software that allowed selection of lung sounds from a remote computer. The computer was linked to fourteen switches that can concealed and positioned on a manikin to reflect common anatomical auscultation points. A range of wireless transmission devices were trialled for range/clarity/interference to transmit the lung sounds to a modified stethoscope.

Results: The auscultation device allowed the fidelity of auscultation during simulations to be significantly improved and increased the ability to interpret lung sounds. The software allowed selection of lung sounds that can be different over the fourteen triggers/switches. Additionally, the software allowed lung sounds to be pre-set for specific scenario set-ups and easy modification during scenarios.

Conclusions: The design of the auscultation device has been effective in improving the fidelity of simulations that require the reproduction of lung sounds on manikins (e.g. SimMan™) or standardised patients/actors. It is affordable and can be integrated with manikins that are currently available commercially.
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Multi-Parameter Fully Wireless Physiological Monitoring System For A Simulation Training Environment
Joshua Khoo, Ke Ma and Ian Brown

Aims: This paper concerns the development of a non-invasive, non-intrusive fully wireless physiological monitoring system in a simulation-training environment to observe physiological variances during periods of high emotional stress in physicians.

Background: Wireless monitoring systems have been developed for countless ambulatory applications and have the advantage of being less intrusive [1]and being more mobile than their wired counterparts [2]. Implementing a wireless physiological monitoring system in a simulation-training environment enables transparent monitoring of a subject or multiple subjects simultaneously for example, physicians and nurses undergoing simulation training.

Method: An integrated multi-parameter signal conditioning board, micro power board and sensor node expansion board have been developed for this application and is capable of wirelessly monitoring stress related parameters such as heart rate, heart rate variability, respiration depth and rate, temperature, activity, upper body posture and skin conductance. The Bluetooth sensor node is based on the MULLE platform designed in collaboration with Lulea Institute of Technology, Sweden. Figure 2 illustrates the system's implementation for this application.

Results: The waveforms below highlight the physiological signal variances observed from a subject during rest and subsequent emotional stress related activity.

Figure 1:  On body network’ external network connections Figure 2: Block Diagram of the Monitoring System

Conclusions: This system has been validated with the traditional gold standard measures for physiological signals and is proven to be accurate and robust even with significant subject activity. This system can be used to analyze the effectiveness of training in a simulation environment without the intrusive need for wires 'on' and 'off' the subject under study.

Figure 3: Ground truth measurements Figure 4: Emotional Stress Related Activity


  1. Hurford, R., A. Martin, and P. Larsen. Designing Wearables. in Wearable Computers, 2006 10th IEEE International Symposium on. 2006.
  2. Sungmee, P. and S. Jayaraman, Enhancing the quality of life through wearable technology. Engineering in Medicine and Biology Magazine, IEEE, 2003. 22(3): p. 41-48.
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Infection Control: Don't Spread the Glow
Carolyn Insley, Chavonne Wyatt and Janet Willhaus
Aims: The simulation’s aim was to help nursing students prioritize care in an infection control environment and to provide a review of specific skills learned in the prior semester.

Background: Using Patricia E. Benner’s “Novice to Expert” theory, nursing students progress through levels of expertise. In this scenario, nursing students were expected to prioritize care from tasks requiring various levels of infection control. This simulation was conducted prior to beginning hospital clinicals for the semester.

Method: A static manikin was prepared with a central line, a gastric tube, a foley catheter and a leg wound with a known Methicillin-resistant Staphylococcus aureus (MRSA) infection. The students provided care to the patient from a set of written physician’s orders. Contact isolation precautions were in effect. The physician orders were written without specific sequence. The students gathered supplies to perform central intravenous line care, gastric tube care, foley catheter care and a dressing change. The leg dressing had been saturated with light-sensitive dye that becomes visible under a ultraviolet light. After the scenario and during the debriefing time, the instructor used a ultraviolet light to detect stray fluorescence "glow" dye on the central line, gastric tube or foley catheter as well as the patient gown and bedding and student gowns and faces.

Results: Students did not always prioritize care from “clean to dirty”. Light-sensitive dye was found primarily on patient’s gown and bed linens. The instructor redirected students when initiated care was improperly prioritized.

Conclusions: This instructional scenario received positive feedback from the nursing students. Critical thinking about infection control is minimally developed in this level of student. Instructor prompting was limited to asking the student to rethink their sequence of tasks. This scenario could potentially be used as an assessment for more advanced students or for competency of practicing nurses.
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Phlebology Emergency Crisis Management Course: A pilot Study
Martin Rochford
Aims: This pilot study aimed to assess whether participant confidence in life-saving techniques and CRM would increase after Simulation training.

Background: Phlebology is a medical discipline involving the treatment of venous disorders in the practitioner's rooms. This new 1-day course was designed to provide training in crisis resource management (CRM) and management of medical emergencies.

Method: The course began with a teamwork ball-game and Leadership training. Participants then recieved hands-on training in airway management and advanced cardiac life support using an ALS simulator. The afternoon involved 4 scenarios using a Laerdel SimMan and an actor. A 10-question pre and post-course questionnaire examined Participant confidence in life-saving techniques and their perception of medical Simulation as a training tool using a 5-point Likert scale. Participants rated each section of the course on a Likert scale as well as their perceived level of skill in resuscitative techniques before and after the course.

Results: 11 participants were surveyed (median years practicing 30). None had prior experience of medical Simulation. There was a significant increase in confidence in life-saving techniques as well as acceptance of Simulation as a training method (P < 0.05). All sections of the course were rated in the "good" to "excellent" range while subjective rating of skill in resuscitation showed a significant increase from "fair" to "good" [(2.36±1.03 vs. 4.0±0.43) ( P < 0.05)].

Conclusions: This course significantly improved participant's confidence in dealing with medical emergencies and CRM while medical Simulation was highly accepted as a training method.
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The Deteriorating Patient – Simulation Training for Medical Students and Junior Doctors
Adam Rehak, Stephanie O'Regan, Jenny Ludeman and Jacqui Langeris
Aims: Describes and evaluates a curriculum conducted for final year medical students addressing their imminent role in management of the acutely deteriorating ward patient.

Background: Early and effective management of acutely deteriorating patients is an important issue that has traditionally been ignored in undergraduate medical teaching. Although multiple hospital-specific models for managing the deteriorating patient exist, they are all predicated on certain fundamental principles of rapid, simultaneous assessment and stabilisation. A grounding in these principles could prepare undergraduate medical student for their imminent role irrespective of the destination hospital.

Method: Curriculum was delivered over four hours using a range of simulation based activities designed to both introduce new knowledge, skills and behaviours, and to allow immersive practice of these in a realistic environment. Each station required independent curriculum so they could be completed in any order, but have core themes developed throughout the session. Course evaluation involved a pre and post-course self-assessment measuring participants’ confidence and preparedness to assess and manage acutely deteriorating patients.

Results: The comparison of pre and post questionnaires demonstrated a mean improvement in the participants’ level of confidence and preparedness in all the aspects of managing the deteriorating patient included in the self-assessment.

Conclusions: This curriculum addresses an identified need within undergraduate training and also, by the generic nature of its content, integrates with a broader program of activities aimed to prepare various levels of medical and nursing personnel, from the bedside nurse through to the resuscitation team, for care of the deteriorating patient.
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Multidisciplinary Crew Resource Management (CRM) in Health Care: Is Combined Classroom and Simulation-based Training Additive or Synergistic?
Robyn Clay-Williams, Catherine McIntosh, Ross Kerridge and Jeffrey Braithwaite
Aims: This study aims to determine the synergy of combined classroom and simulation-based teamwork training, by investigating attitude and behavioural changes in multi-disciplinary teams resulting from implementation of a CRM intervention.

Background: A growing body of published literature supports delivery of CRM-based teamwork training as an appropriate strategy to address the issue of patient safety in health care. Although studies have attempted to assess the contribution of various CRM training courses to improved teamwork attitudes and behaviours, few health care studies have examined classroom and simulation-based courses in combination. Teamwork training is constrained largely in health care by limited time and resources, so it is important to establish whether a synergy exists by combining the two forms of training in a similar manner to aviation.

Method: 160 doctors and nurses working in selected complex, time-critical hospital environments within an Area Health Service were randomised to receive no training, or training in the classroom, simulator, or both. Pre- and post-intervention attitudes will be measured via a modified and validated version of Sexton and colleague’s ‘Safety Attitudes Questionnaire’ Participant teamwork behaviours will be measured via observation of team performance in two simulated scenarios, and assessed using the Mayo High Performance Team Scale (MHPTS). Participants will self-assess behaviours using the MHPTS, for comparison with observer scores. Participant knowledge and reaction data will also be gathered via questionnaire.

Results: Training and assessment commenced in Dec 2008, and are expected to be completed by Jul 2009. It is anticipated that sufficient data will be available to enable presentation of preliminary findings at SimTecT Health 2009, alongside some of the major lessons learned in implementing this type of research intervention.
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Simulation Training for RMOs – Evaluating the effectiveness in transferring theory into practice
Jon Hayman and Paul Hudson
Aims: To determine the effectivelness of simulation training of RMOs in the management of the deteriorating patient.

Background: It is universally acknowledge that the recognition, escalation and treatment of the deteriorating patient is a significant health issue. This has lead to the introduction of emergency response systems in many institutions. Identifying deterioration and having confidence to escalate treatment is key to activate any emergency response team. In 2009 Registered Medical Officers (RMO) at RPAH attended a designated educational session focusing on the deteriorating patient. This course included a combination of conventional small group work and simulation scenarios. The simulation created an opportunity to apply theory into practice, while facilitating an avenue for the introduction and application of crisis resource management into daily practice. From initial evaluations the participants indicated that simulation scenarios were an effective tool for the application of theory into practice, developing confidence, and motivating individuals to further their clinical education.

Method: Participants completed a quantitative evaluation at the completion of the course, with a follow up evalution planned after 5 months. The follow up evaluations aim to identify the effectiveness of the simulation, identifying if the initial results are consistent with result after participants have had an opportunity to apply knowledge and skills into their daily practice.

Results: Refer to presentation.
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Pencil to Practice: Nursing Student recognition of an emergent patient condition
Rebecca Sander and Janet Willhaus
Aims: This assessment scenario measured senior nursing student ability to assess, evaluate and recognize the development of an emergent patient condition.

Background: In a traditional paper/pencil test, nursing students had difficulty recognizing the signs and symptoms of a pulmonary embolism early in the spring semester 2009. The lead instructor wanted to evaluate whether students would act and independently administer appropriate care in the simulation lab setting when given the same signs and symptoms.

Method: Using the Blackboard platform, a patient chart was prepared for students. This chart was made available to the student one hour prior to the simulation. The simulation was a hybrid product of an NLN developed scenario and the instructor's objectives. Twenty minute sessions were allotted for each of the 27 students. The instructor did not participate in the simulation, but debriefed each student individually afterwards. Students took a computer post test and turned in written paperwork following the debriefing.

Results: Of the 27 students assessed, four did not meet the instructors established criteria for standard of care. An unexpected finding from this simulation indicated that students at this level could not prioritize care from written orders. The post-test score mean was 21 out of 25.

Conclusions: Student feedback indicated this was an opportunity for self-evaluation. Students who did poorly recognized their own errors without prompting during the debriefing. The implication for practice is that students should be given more opportunity to prioritize care in the clinical setting without instructor or preceptor prompting.
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Contextualising a generic trauma team training curriculum for one organisation’s local practices and environment
Stephanie O'Regan, James Kwan, Duncan Reed and Leonie Watterson
Aims: We aim to develop a pneumatic haptic device for implementation in a mannequin for simulation of abdominal palpations during colonoscopy procedures.

Background: Abdominal palpation is a technique used in 15-20%1 of cases to aid the gastroenterologist when loops form in the colon causing paradoxical motion. The assistant places hand pressure on the abdomen as directed by the gastroenterologist to facilitate colonoscope progress past troublesome flexures. Current colonoscopy simulators cater only for the gastroenterologist and neglect team training. A novel pneumatic haptic device utilising air bladders2 to simulate abdominal palpations may improve colonoscopy team training.

Method: To verify the accuracy and fidelity of the haptic device, we measured forces applied by an assistant. We have conducted a pilot study with a single subject placed in the prone position on a force plate. In addition, 6 infra-red LEDs were attached to the surface of the abdomen to map the deformation.

Results: The pilot study results show high sensitivity in measuring light to medium abdominal pressures which reach a maximum of 40N. Similar force curves were used as inputs to evaluate the haptic device performance. The measured force showed strong correlation with the input force during palpation. However, weak correlations with post-palpation forces were measured. This limits time between palpation simulations but does not affect the forces experienced by the user.

Conclusions: The results show that the device was capable of reproducing forces of an average palpation. The study population will be expanded to better understand the variations and range of forces involved with different body types.

  1. J. Prechel, C. Young, R. Hucke, T. Young-Fadok, and D. Fleischer. "The Importance of Abdominal Pressure During Colonoscopy: Techniques to Assist the Physician and to Minimize Injury to the Patient and Assistant." Gastroenterology Nursing, 28(3):232, 2005.
  2. M. Cheng, S. Riek, M. Watson, S. Ourselin, J. Passenger, O. Salvado. "Pneumatic Haptic Interface Fuzzy controller for Simulation of Abdominal Palpations During Colonoscopy." Proceedings of the Third Joint Eurohaptic Conference and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems, IEEE Press (2009), 250-255.
Number 13

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Actor Training for Surgical Team Simulations in a Simulated Operating Suite
Eva S Kassab, Louise M Hull, Dominic King, Sonal Arora, Nick Sevdalis, Roger L Kneebone and Debra Nestel
Aims: To evaluate a training programme for actors to play roles of surgical team members to support surgeons learning new skills in a simulated operating suite (SOS).

Background: As high fidelity simulation-based surgical training is becoming increasingly more common, operating theatre (OT) teams are needed to provide a realistic context for trainee surgeons to train (e.g., in surgical crisis management skills). However, removing full OT teams from service is expensive and impractical. We created a simulated OT team by training actors to play the roles of anaesthetist, scrub nurse and surgical assistant. The training programme for the actors was developed by a multidisciplinary team and facilitated by psychologists.

Method: The half-day programme included written materials, video discussion and experiential activities. Evaluation consisted of evaluation forms and focus group with actors. Surgeons were required to rate the team's authenticity on a 6-point-scale. Participants were recruited by convenience sampling. Quantitative data were analysed using descriptive statistics and interviews by thematic extraction.

Results: Four actors completed training and three scenarios with surgeons. Surgeons’ ratings of realism were 4.7 (SD=0.6; 6-point scale 1=not at all realistic to 6=completely realistic). Actors identified the video, rehearsals of task, role and full scenarios as highly valuable. Suggestions for improvement include observation of real operations and talking to surgeons.

Conclusions: Training actors in half-a-day to realistically portray members of a surgical team for simulations was possible. These findings suggest that our training programme for actors has potential for wider application to simulation-based surgical team training.
Number 14

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Three Phases of Simulation and Influence of Bloom’s Domains Embedded in Effective Simulation
Chris Huggins
Aims: Simulation is often looked at as the practical application of skills in a scenario based application. However, is it more that this? A simulation can be divided into three distinct elements and this study looked at what each of these part plays in the effectiveness of simulation in the development of clinical reasoning.

Background: These are three logical elements of simulation; the briefing (the affective domain, setting the scene and emotional preparing the participant) the scenario (the psychomotor domain, with some cognitive analysis) the debriefing (cognitive domain, critical analysis through public reflection). Each of these parts plays an important role in the effectiveness of a simulation and can be linked to Bloom’s three domains. These domains can play an important part the development of effective simulations and set the scene for the desired outcome of the simulation.

Method: Nineteen health care students across five disciplines were interviewed and ten hours video observation was analysed. The data is triangulated through different data sources and professional groups.

Results: When the simulation divided into three sections, and the participants asked which if the three section they saw as the most important section, the debriefing was identified as being as important or more important that the scenario itself.

Conclusions: When you divide a simulation into its three elements and look at in conjunction with Bloom’s three domains there is a clear link between the elements and the domains. This linkage helps us in developing simulations to achieve effective outcomes.
Number 15

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Evaluating the Impact of Multiple Critical Care Simulations Within a Large Cohort of Undergraduate Nursing Students
Jon Mould and Haidee White
Aims: To assess whether the use of multiple simulated clinical scenarios is an effective way of enhancing competence and confidence in an undergraduate critical care nursing unit.

Background: Since 2005, Edith Cowan University has incorporated medium fidelity mannequins as a teaching and learning tool within a third year undergraduate critical care nursing unit. Students were exposed to nine scenarios, across a semester but due to large numbers, could only be immersed in a maximum of three. Anecdotally, the feedback has been positive but faculty staff felt that they could augment the experience by increasing the number of scenarios within the same teaching time. It was expected that the use of multiple simulation scenarios, as opposed to a single scenario would enhance problem based learning.

Method: Within each tutorial, students were divided into clinical teams. Two Sim-men were programmed with different scenarios each week. The simulations involved the use of moulage and relevant equipment. Prompts were used, for example the mannequin would complain of chest pain prior to a cardiac arrest. These scenarios were video recorded, and then debriefed with the students afterwards. Following debriefing, a third scenario was given in the simulation suite to another team of students to problem-solve.

Results: Multiple simulations have imbedded the Australian Resuscitation Council (ARC) guidelines of advanced life support and have been a valuable learning tool. Anecdotally, faculty staff observed improvement in comparison to previous semesters.

Conclusions: The nursing students' have expressed increased clinical competence and confidence prior to attending practicum. This is evident from the students' evaluations of using multiple scenarios within a tutorial.
Number 16

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Workplace-based Simulation Training: How to combine Off-JT and OJT as a Human Performance Improvement (HPI) program
Daisuke Sugiki, Toshirou Kamisasanuki, Hiroko Iwashita, Toshio Miyanohara, Koujirou Yamada and Keiichi Ikegami
Background: Simulation-based education has been rapidly recognized in Japan. Therefore we need to have some kind of HPI program in our Trauma Center to train young doctors and nurses in an effective, efficient and engaging way. It is needed to develop such kind of instructional systems in terms of HPI. With such systems, simulation-based education in healthcare in Japan can be more popular.

Method: We have developed a spiral-up training program which consists of workplace-based simulation (WBS) as an Off-JT and OJT. The good things of the program is that facilitator of Off-JT and a coach in OJT are the same person (faculty of our Trauma Center), thus, what young doctors learn in the simulation setting can be used in a real world. And learners and facilitators do not need to move way from their workplace.
Training was done in a small step beginning from simulation then had a real experience in our emergency room. Faculty facilitates learning using scenario-based simulation, and then coaches the learner in the real world to do tasks they learned in the simulation. Video debriefing system was used in both Off-JT and OJT.

Results: Twenty four residents participated in WBS in three years. Learning objectives were to successfully lead CPR team as a leader and successfully resuscitate trauma patients with faculty as a coach. They were interviewed after leading a real task in our emergency room. Evaluation of WBS indicated a positive response and two thirds of learners found themselves to be able to lead a team in a real situation.

Conclusions: New type of faculty who can facilitate learning and training in both simulated environment and real world is very much needed in medicine. Such faculty can be called Training Professional in Healthcare and we need to have a program to obtain such professionals.
Number 17

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Recognising, Escalating and treating the deteriorating patient – Instilling Confidence in New Graduate Nurses using Simulation
Paul Hudson, Amanda Yates and Aaron Jones
Aims: Through using simulation, the New Graduate nurse will develop both the knowledge and confidence to recognize, escalate and treat the deteriorating patient.

Background: It has been well recognized within recent literature (both locally and internationally) that there are deficits in the recognition, escalation and treatment of the deteriorating patients. This has lead to the introduction of emergency response systems in many institutions. As the recognition of the deteriorating patient is key to the activation of any emergency response team, education and the confidence to identify, assess, escalate and treat the deteriorating patient is vital. In 2008, the New Graduate Nurses Coordinator and the CPR Clinical Nurse Consultants at Royal Prince Alfred Hospital, developed a course for the New Graduate Nurse including the rapid core assessment, orientation to the cardiac arrest trolley, and team roles during an emergency response. High fidelity simulation was introduced to this course in 2009 with an aim to create a time sensitive opportunity to apply and solidify and develop the nurse confidence in their clinical knowledge and practice.

Method: Participants complete both a pre and post quiz, and a course satisfaction survey, measuring the knowledge gain during the 1 day course and participant’s satisfaction with the individual sessions. The survey and quiz is than repeated 6 month after completing the course identifying knowledge and skills retained and utilized since completing the course.

Results: Refer to presentation.
Number 18

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International collaboration to develop a new web-based recourse centre for simulation educators – introducing the SIRC
Michelle Kelly
Aims: To develop a web-based learning and resource centre to assist development and integration of simulation into curricula and facilitate dialogue with experts and peers.

Background: The Simulation and Innovation Resource Center (SIRC) is the second simulation based project, a collaborative alliance between the National League for Nursing (NLN) and Laerdal Medical. Lead by a project director, nine USA and seven international simulation experts together with a technical team developed online courses and various areas of the SIRC.

Method: The SIRC concept began in 2007 with nine USA simulation experts selected from a field of 169. International divisions of Laerdal (Australia, Canada, Chile, China, Japan and Norway) sourced local nursing simulation experts to provide international perspectives. Following the first face-to-face meeting in June 2007, work began on course development. Courses were reviewed by the international and external simulation experts. Audiovisual resources were created to complement website design. Public domains were created to enable benefit for those not taking the course options.

Results: Three courses were launched in June 2008 at a simulation conference in San Jose, California. The remaining six courses were launched in September 2008 at the NLN summit in San Antonio, Texas. Four additional courses are due for launch in June 2009. A paper on the experiences of the international participants with the project has been accepted for publication.

Conclusions: This innovative project has provided nurse educators the opportunity to engage in an international community of simulation practice and to advance the integration of simulation in nursing curricula.
Number 19

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Crisis Management Training Course for Nurses in Japan: How to teach 6th sense of experienced nurses to novice?
Emiko Asaka, Izumi Kawai, Daisuke Sugiki and Keiichi Ikegami
Background: It is well recognized that Rapid response system (RRS) is a MUST to have for every hospital, however, no consensus has been made on how to train healthcare providers as an effective member of Rapid Response Team (RRT). RRS works best when patients are found several hours ahead of cardiopulmonary arrest. We have challenged to develop a course to teach 6th sense to detect slight deterioration of patient physiological stability to novice nurses as the first step of RRT training.

Method: We have adopted models of instructional design and Gagne's taxonomy. A course is divided into two parts. As a first part, learners see movie showing a patient with slight deterioration and they are asked to present what they heard or saw. Learners are expected to acquire mental skills to make a rapid assessment quickly. As next step of this part, additional information about vital signs and findings of quick physical exanimation is given and learners are challenged to make next assessment and report the situation using SBAR format. As a second part, scenario-based simulation in action is performed to see if learners can perform what they have learnt in the first part in real situation.

Results: We have performed beta test on four hundreds nurses and questionnaires have been studied. More than ninety percent of learners reported that 1) this course is useful to obtain assessment skills in critical situation, 2) fun to participate, 3) three to four hours is good enough to cover learning points without getting bored.

Conclusions: This course seems to fit learner's needs and instructional methods are useful for learners to get the points. This course is the first RRT Training program in Japan and it is expected that nurses take this course in addition to BLS/ACLS arm for cardiac arrest situation.
Number 20

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Use of Two Tools to Objectively and Subjectively Assess the Efficacy of Simulation in Critical Care Scenarios
Graham Reece
The world of Medical Simulation is divided into those who believe that it provides a useful learning experience and those who do not. This uncertainty also extends into the field of Critical Care Medicine. The literature providing the evidence base to supprt the usefulness of Simulation in the Australain Critical Care situation, is similarly sparse.

The O.A.S.I.S. Simulation Centre at Blacktown Hospital, in western Sydney has trialled a number of tools, which together have demonstrated usefulnness in multidisciplinary Critical Care settings in providing evidence of the efficacy of a number of simulated scenarios. These tools allows both the candidates involved in scenarios and their observers to measure performance across a number of fundamental dimensions, as well as to trend progress over time. The evidence generated contains both objective and subjective data points. Immediate feedback is therefore available for both those immersed in the scenario, as well as the trained observers.

These simple tools can be used to study the performance of individuals over time, groups of trainees within and across various disciplines and specialties in multidisciplinary environments, as well as to review the efficacy of certain training programs.
Number 21

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Novice Nurses E-learning and Mannequin Simulator-based Training Design and Evaluation
Takako Yoshizato, Dennis Arturo Ludeña Romaña and Maria Luisa Catalan
Recently, nursing training has become very important in ensuring health of patients inside hospitals. Particularly in Japan where there is no standard nursing educational system, physical assessment diagnosis procedure problems appear as soon as novice nurses begin their job at hospitals. Some of these problems are directly related to the undergraduate education in view of the fact that they were not able to get enough actual nursing practice during their study period. In view of this reason, a training system for new nurses has been implemented with the aim of increasing the knowledge and skills of novice nurses at Kumamoto University Hospital. The result of the evaluation after the training of novice nurses shows that the training time is inadequate. Knowledge is also insufficient to do a fast, efficient and confident diagnosis of patients' condition. This improper diagnosis may lead to lower survival rate of patients. It is very well known that a successful initial diagnosis of an illness will lead to successful treatment. Based on this principle, in this paper, we propose the fundamental steps, design concepts and implementation procedures of a more efficient training and evaluation process using information technologies, such as; e-learning systems, video-based training and utilization of mannequin simulator. All these tools together, with proper and efficient training design will lead to a successful training process. This new approach is more effective because novice nurses will be able to access the course anytime and study or review topics necessary for them to improve their knowledge and skills.
Number 22

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Clinical Alignment Workshops for Doctors-in-Training
Marnie Connolly
  • Provide opportunity for Doctors in training in rural locations in East Gippsland to upgrade and maintain their emergency skills through an evening emergency skills workshop
  • Strengthen local emergency care networks through involving local care practitioners in collaborative learning activity
  • To recognise the importance of a team approach to achieve optimal outcomes for patients

Background: Doctors in training in East Gippsland are required to provide a range of emergency skills to rural and remote communities. There is an increased focus in medicine, nursing and paramedic education on the use of simulation for skill acquisition and maintaining skill level. This is a new method of collaboration and a new model of learning to support, educate and train rural and remote doctors in training in East Gippsland.

  • These workshops commenced in June 2008
  • A 3 hour evening emergency skills workshop is held every 11 weeks and is part of the orientation program for new interns
  • All interns, 4th & 5th year medical students and GP registrars are invited to attend
  • Scenarios and emergency skills are derived from the feedback obtained from supervisors and participants

  • Participants indicate through the post workshop evaluation form, the information presented and emergency skills practiced was highly relevant and provided not only consolidation of knowledge, furthermore helped prepare participants for emergency situations
  • Integration of medical educational activities in the East Gippsland Region has been successful with all Doctor in training attending
Number 23

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International doctors in the workplace: Supporting Victoria’s IMGs through clinical skills and simulation based training
Stuart Dilley, Con Georgakas, Neil Cunningham, Robert O'Brien and Julian Van Dijk
International Medical Graduates (IMG) account for a large proportion of hospital-based doctors working in Victoria's public hospital system. Most of these doctors have trained in systems very different to Australian medical schools and begin work in Victoria's hospitals with little time to familiarise themselves with local work practices and cultures. Few have had any exposure to simulation based training, teamwork training or crisis resource management.
In 2008, the Post Graduate Medical Council of Victoria provided funding to allow IMGs to attend one of a number of two day clinical skills and simulation courses at St Vincent's Hospital Education Centre. IMGs working in Victoria's public hospital system were invited to attend. The course comprised one day of advanced life support training and another devoted to trauma management. Clinical skills relating to these specific topics were refreshed, but the course also endeavoured to improve skills in the areas of teamwork, communication, leadership and crisis resource managment so that these doctors would feel comfortable dealing with any critical patient regardless of their reason for presentation.
This presentation outlines the development and implementation of this course. Expected and actual challenges or difficulties are discussed and subjective participant evaluation will be presented.
Number 24

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The Deteriorating Patient: Simulation Training for Junior Registered Nurses and Endorsed Enrolled Nurses
Stephanie O'Regan, Adam Rehak, Leonie Watterson, Jenny Neilsen and Jacinta Kilpatrick
Aims: Describe a pilot course for 130 junior nursing staff to equip them with the skills required in the recognition, communication and management of the acutely deteriorating patient on the ward.

Background: Timely recognition of the acutely deteriorating patient is an issue in all organisations, and multiple models of care have been developed to address this. Implicit in all models is the reliance upon the skills and abilities of the bedside nurse to identify, appropriately triage, initially manage and effectively communicate the relative urgency of the situation to the appropriate health care team. These bedside nurses are often the most junior members of the health care team.

Method: A range of simulation based activities which introduce and then rehearse key skills and concepts were developed specifically for ward based nurses within their scope of professional practice in the organisation. The challenge of relatively large numbers for simulation based learning (32 per group) was met with the use of simulation stations. These stations required independent curriculum so they could be completed in any order, but have core themes developed throughout the day. Participant assessment consists of a pre and post course test and a post course workbook.

Results: The use of simulation stations has been successful in other large number courses and should adapt well to this group. The course pilots in June with four courses planned over the ongoing months.
Number 25

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Planting seeds: Fostering undergraduate interprofessional practice through scenario based simulation
Tracey Brandis*, Elesha Toscano*, Pauline Varghese*, Andi Thompson, Fiona Bogossian, Kevin Forbes, Phillipa Neads, Victoria Hynes, Dane Barclay and Stephanie Fox-Young
Aims: To provide final year medical and nursing students with learning opportunities covering communication with colleagues and patients, scope of practice, reflection on practice and collaborative decision making.

Background: Emerging from the University of Queensland’s Faculty of Health Sciences’ commitment to interprofessional learning and the opportunity to work with the Queensland Health Skills Development Centre (SDC), the objective was to encourage interprofessional practice in ward based scenarios focussed on nontechnical skills.

Method: A pilot, involving two iterations of five hours of simulation and debriefing, was undertaken in March and May 2009. Two medical and three nursing students were recruited to participate in each of the pilot exercises, with ten students undertaking observational roles. Nine patient scenarios simulating common medical, surgical and emergent events were developed by the Faculty and SDC staff.

The environment, a nine bed general medical surgical unit on a weekend, presented health related challenges, with particular themes in each of three segments – time management, challenging communication, management of crises – immediately followed by debriefing.

Results: Pre and post questionnaires and telephone interviews with students, staff and patients were used for evaluation to inform potential future developments e.g., expanding participation to include other professional groups, and extending the scenarios. Results of the evaluation and plans for future development of the simulation experience will be presented.

Conclusions: Overall it was a positive and valuable learning experience, albeit a staff and resource intensive exercise, with a number of recommendations for improvement in the future.
Number 26
*indicates that this author is presenting the paper
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Basic Life Support Education through the Use of High Fidelity Simman and Immersive Simulation: Improving Confidence and Competence in Resuscitation Technique
Nigel Chong and Mark Zasadny
A preliminary study of BLS education incorporating immersive simulation conducted at the University of Tasmania School of Nursing & Midwifery Simulation Centre, indicated undergraduate nursing students were better equipped, in terms of skill, knowledge and confidence, to deal with the complexities of delivering BLS in challenging situations.

The pilot study of third year undergraduate nursing students completing an acute care placement within a major regional hospital endeavoured to not only increase the tactile and procedural execution of BLS, but also use High Fidelity Simman to increase their confidence to perform BLS in stressful situations.

Baseline data was gathered when students performed BLS on high fidelity manikins without prior educational preparation. Pre and post BLS education questionnaires collected information concerning theoretical knowledge, competence, confidence, and previous BLS training. A theory and practical educational program was then provided to participants, culminating in an immersive BLS scenario. Following this, all participants acknowledged increased confidence and control of the BLS situation even when unforeseeable problems were introduced.
Number 27

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Emergency Airway Management Course for Nurses Using High-Fidelity Simulation in Korea
Junho Cho and Hyun Soo Chung
Background: There has been a tremendous growth in the use of high-fidelity simulator(HFS) in Korea. Nursing education is also undergoing a paradigm change as well. But no certain action was taken trying to achieve this paradigm shift. The parallel growth of HFS and nursing education shift resulted in a course on emergency airway management for nurse.

Method: The Korean Emergency Airway Management Society is a non-profit group dedicated to education and research in airway management. Group of emergency physicians and emergency nurses gathered together to develop the course for nurses. It is a one day course consisting of didactic lectures (Airway Anatomy & Physiology, Rapid Sequence Intubation), skill stations (basic airway maneuvers, rescue airway devices, postintubation management strategies) and simulation training (head trauma, pediatric, asthma, pregnant, shock, using nondepolarizing neuromuscular agent). There were 30 and 23 participants for each two courses, respectively. The pre- and post-course score on whether the simulation improved their confidence and knowledge for airway nursing was also done using the 5-point Likert scale.

Results: The scores for overall satisfaction, interest, and recommendation to others were 4.1±1.1, 5.0±1.1, and 5.0±1.1, respectively. Improvement was observed between the pre- and post-course survey on confidency (1.8±1.2 to 2.6±0.8) and knowledge (1.5±0.9 to 2.6±1) for the simulation cases.

Conclusions: High-fidelity patient simulation is becoming an essential component of nursing education. The use of HFS and other forms of simulation provide a valuable adjunct to traditional clinical nursing education. Korea nursing education has yet to utilize simulation in emergency airway nursing education. This course was the first of its kind in Korea. The curriculum was developed with emergency nurses with prior experience in airway simulation training. This helped us develop a program that we think was ‘fit for purpose’ for the nurses.
Number 28

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The analysis of Team Performance Factors during Critical Care Scenarios Using Colour-Coded, Three-Dimensional Graphical Profiling - the H.E.A.T. Profile
Graham REECE
In many Medical Emergencies, the technically correct procedures can be completed, however the team itself may appear dysfunctional and uncoordianted, leading to an unneccesarily suboptimal patient outcome. The concern in these particular settings is not usually the absence of purely technical skills such as the ability to cannulate or intubate a patient, but rather inadequate expertise with regards "Non Technical skills". These skills are essentially a variety of inter personal skills which are necessary for effective interpersonal relationships - which become more poignant due to the consequences of ineffectual team responses, in most emeergency situations. The evaluation of the performance of a multidisciplinary, heirachial team is important in many acute hosptial settings, such as Medical Emergencies or in the context of a major Trauma. However, the meaningful analysis of human behavour in these complex emergencies can produce datasets and coding outputs which are so exhaustive that their shear size precludes their usefulness to either the supervisor, or the candidate. The O.A.S.I.S. Simulation Centre at Blacktown Hospital, Sydney, has been able to develop a colour coded, three dimensional graphical representation of performance called "The H.E.A.T. (Health professional's Education and Assessment Template) Profile", which provides both simple and immediate feedback for the candidate, as well as the potential for the trainer to trend performance of the "Non Technical Skills", over extended periods of time and over a range of Scenarios.
Number 29

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Integration of simulated learning activities to improve student satisfaction
Joanne Gray, Smith Rachel, Homer Caroline and Raymond Jane
Aims: This project aimed to increase midwifery student satisfaction in a compulsory theoretical subject through the use of simulated learning activities. The project also aimed to assist midwifery students to identify professional, legal and ethical issues related to the midwifery practice environment.

Background: Students within the Graduate Diploma in Midwifery program at the University of Technology Sydney poorly evaluated a subject over a three year period, despite a number of changes to both subject delivery and content. Student evaluation identified dissatisfaction with this subject as they viewed it as largely irrelevant to their everyday practice. The midwifery teaching team used the UTS quality cycle ‘plan, do, review, improve’, in an attempt to better engage students over this three year period, however little improvement in student satisfaction scores was noted. In 2008 we implemented a program of simulated learning activities into this subject in a deliberate attempt to meet student demand for more clinically relevant subject content.

Method: Through discussions with NSW Health and review of the literature several midwifery quality and safety issues were identified. Scenarios were developed related to a number of these, including shoulder dystocia, maternal collapse and communication. Students participated in these simulated learning activities and debriefing included identification of key legal, professional and ethical issues related to these incidents.

Results: Students were asked to complete the UTS student feedback survey. The results of this indicated an improvement in the evaluation of the subject with students giving increased satisfaction scores. Qualitative responses also identified their enjoyment of participating in the simulation activities.

Conclusions: The use of simulated learning activities has been demonstrated to be a useful means to improve student satisfaction in their learning.
Number 30

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Simulation Beyond Skills to Clinical Reasoning
Chris Huggins
Aims: Simulation is used as a tool to provide training and skills acquisition, and for this purpose, it is powerful and well utilised. However, as an instrument to develop judgment the evidence is not so clear. This study aimed to identify any links between simulation and the development of clinical reasoning.

Background: Simulation has been utilised in the education of Health Care Professions for many years. However, they have mostly focused on the accusation of technical skills, such as, intubation, CPR, insertion of chest drain tubes etc. While these are important skills to acquire, and it is appropriate that these are rehearsed in the safety of a simulation laboratory where there is no risk to patients. However, these skills do not occur without the appropriate decision making prior to the skill being performed in the authentic workplace. This raises the question: Can we develop clinical reasoning in the pseudo-authentic workplace?

Method: Eighteen educators were interviewed using semi-structured interviews, also seven hours of video observation was analysed. The data is triangulated through different data sources and professional groups.

Results: When asked to describe the benefits of simulations the educators quickly focused on the technical skills. However, through more focused questions they were able to drawn a link between simulation and clinical reasoning. Moreover, they identified clinical reasoning as a skill, which can be developed through a simulation.

Conclusions: Simulation is an important instrument in the development of technical skills and clinical reasoning. This is achieved through a well designed simulation.
Number 31

Innovative Use of Simulation with Masters' Students – Purpose Built Team Scenarios to Improve Practice
Michelle Kelly
Aims: To provide experienced clinicians and advanced adult learners with appropriate yet challenging experiences related to simulation.

To offer contemporary, authentic and clinically relevant learning experiences.

Background: A Master of Nursing subject was transformed to incorporate simulation strategies. The change enabled the subject to "come alive" and opportunity to model innovative learning strategies.

Method: Through layered exposure, students became familiar with the applicability of simulation in health care. Individually, students undertook a literature review focussed on simulation in the context of patient safety. Working in small groups, students designed their own scenarios. Groups enacted their scenarios and received feedback from student and academic observers. The final iteration of the scenario was peer reviewed, and the recorded scenario was critiqued by a panel of academics and an external simulation expert. A reflective essay of students' experiences of designing and using simulation scenarios completed subject assessment requirements.

Results: Data from formal feedback indicated students' positive experiences: "subject was structured in a clever way; engaging and interesting; great introduction to simulation and scenario development; a new realistic concept of teaching". Analysis of written reflections revealed that initial anxieties were replaced by powerful learning experiences; previous clinical experiences were able to be relived, shared and debriefed; and the process exposed students to new ways of thinking, learning and engaging.

Conclusions: This innovative use of simulation in a university subject provided powerful, real life learning experiences for advanced clinicians and narrows the gap between practice and theory.
Number 32

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Extending patient simulation capabilities Addition of a tympanic thermal output simulator for a low fidelity patient simulator mannequin
John Forbes and Chris Carpenter
Aims: To develop a functionally simple, reliable and realistic tympanic thermal simulator to allow tympanic ear thermometers to be used on patient simulators for the purpose of health care practitioner education.

Background: The Faculty of Nursing, Midwifery and Health at the University of Technology, Sydney use human patient simulators in a number of subjects across curricula. The inclusion of this simulator function is aimed at enriching the learning experiences of students and extending the teaching capabilities of the equipment already owned by the Faculty.

Method: Tympanic thermometers function by reading the intensity and/or frequency of black-body radiation emitted from a patient's tympanic membrane. By simulating the radiation emission of the inner ear, temperature readings can be obtained through commonly used thermometers. The simulated radiation is produced by an infra red light emitting diode (IRLED) and controlled by limiting the current flow. Measurements were taken using two thermometers. Data were taken over a range of currents and each data sample was taken over a reasonable period of time. This data was taken in order to determine whether the prototype consistently produced desired temperature readings.

Results: Initial measurements indicated that the design of the circuit was not producing a sufficiently intense infra-red signal. However, the prototype was a proof of concept and a direct correlation between applied current and temperature measured was observed.

Conclusions: The prototype functioned as designed but further development is required in order to appropriately simulate inner ear thermal radiation and allow the device to be installed in a patient simulator.
Number 33

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An Australian National Health Innovation and Training Network
Mike Rebbechi
Aims: To describe the proposed Network and its objectives.

Background: In 1990 the Australian research and education sector came together to create a high speed networking entity now know as the Australian Academic and Research Network (AARNet).
Through AARNet, members of the Australian Research & Education sector have access to a national broadband network at speeds from 1 Gbps to 10 Gbps.
Many health campuses in Australia already have high speed connectivity to AARNet but even though research, innovation and training in the health sector meet the “acceptable use” policies of AARNet, effective use of cannot be made of them because of firewall constraints.
In an attempt to satisfy the needs for national, high speed connectivity and in particular to alleviate the firewall issues between health and Research & Education campuses, AARNet has proposed the establishment of an Australian National Health Innovation and Training Network as an overlay of the existing AARNet infrastructure. It incorporates an auditable firewall connections agreement system to oversee connections across the network.
This network will enable Australian health innovators and trainers to operate on a national scale beyond their immediate jurisdictions.

Method: The intention is to:
  • establish a small scale pilot network
  • Demonstrate the potential of such a network
  • Seek funds for an extended pilot
  • Build a full scale network over AARNet infrastructure

    • Results: At this time a number of sites have been identified for the pilot.
Number 34

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A good simulation spoilt by the real world
Stewart Montano
This presentation details a situation where previous real world experience negatively affects the value of the simulation. It is the opposite of the common concern that the non-realistic aspect of simulation training could cause problems if acted upon; outside the simulator This is one of the reasons why we strive for careful debriefing and maximum simulator fidelity. A consultant radiologist had previously qualified as a gastroenterologist, with considerable endoscopic experience. A new helical CT scanner was installed in her dept which was able to provide a "fly through" virtual colonoscopy. A quirk of the reconstruction algorithm was to render all lumenal material, in contact with the bowel wall, as similar in colour to the wall. By referring to the slice images and the different radiologic densities, such masses can be differentiated from each other. However, to an experienced endoscopist, such masses arising from the bowel wall appear to be polyps or other pathology. This will cause a significant difference in the report written about the study. Here we see prior real world experence interferring with the value of the simulated experience. The naive radiologist is best suited to learn to interact with the simulated world, using the rules of the simulated world.
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The contribution of simulation-based training in paediatric sedation to the institutional quality improvement process
Susan M Lord, Cate McIntosh and Kathryn Davies
Aims: To explore the contribution of a simulation-based training course for non-anaesthetist providers of paediatric sedation to the institutional quality improvement process.

Background: Our campus incorporates co-located tertiary adult and paediatric hospitals, sharing emergency, imaging and surgical services. Children are sedated in all these contexts by specialist and non-specialist providers. Hitherto, there existed various ad-hoc models of care with co-existent patient safety concerns. Audit and quality improvement were stymied by organisational fragmentation, deficiencies in documentation relating to sedation, and poor compliance with reporting of sedation-related incidents.

In 2007, we were commissioned to develop a simulation-enhanced curriculum to train non-specialist providers to manage sedation-related adverse events.1 This curriculum needed revision because many participants lacked pre-requisite skills for managing moderate-deep sedation. Furthermore, participation did not translate to enhanced service because service infrastructure remained inadequate.

Method: We reviewed paediatric sedation clinical improvement initiatives and achievements between April 2007 - April 2009 and examined the contribution of the simulation course.

Results: An evidence-based argument for the need for a paediatric simulation-based course1 raised management awareness of sedation risks and pro-active risk management. Involvement of clinical leaders from disparate services on simulation faculty facilitated team building and strategic planning. Course progress reports highlighted system issues that continued to contribute to patient safety risk. Consequently, management approved a multidisciplinary / multiservice Paediatric Sedation Committee to coordinate audit, clinical improvement initiatives and advise on guidelines, training and infrastructure issues. Simulation will have an ongoing role in a tiered training and credentialing system, and might be used in future sedation site evaluations.

Conclusions: The simulation-based training course has been a catalyst for quality improvement and institutional change.

References: 1. Lord SM, McIntosh C, Davies K. NAPS: Simulation enhanced curriculum redesign for non-anaesthetist administration of paediatric sedation (poster). SimTecT 2007
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Introducing Clinical Safety Early in the Undergraduate Curriculum: A Pilot of a Simulation-Based Course
Stuart Marshall and Helen Kolawole
Aims: To develop, deliver and evaluate a pilot course for medical students starting out on their clinical placements to help them maintain the safety of their patients by simple actions.

Background: Medical students starting in the clinical environment are frequently tasked to see patients by themselves or in pairs and report back to their tutor. If the patient rapidly becomes unwell, the students are often unsure about how and when and how to call for help.

Method: Sixteen post-graduate entry, third-year medical students attended a half-day session at the simulation centre. The learning objectives were to be able to:
  1. Identify an unwell patient
  2. Know how to call for help
  3. Perform basic resuscitation actions until help arrived
These pilot sessions were evaluated by free text questionnaires at the end of the session.

Results: All sixteen students completed the session and completed the questionnaire. All rated the session as worthwhile and well structured, and were keen for further similar sessions. The majority reported feeling more confident and prepared to see patients on the ward, and to know when and how to call for help. More detailed data will be available at the time of the presentation.

Conclusions: A short, half-day session introducing students to safety in the clinical environment improves confidence of the students to call for help and perform basic measures until experienced assistance arrives. This course could be used for other junior health professionals.
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A Private Healthcare Service Best Practice Patient Safety Strategy Using Simulation
Irwyn Shepherd, Lyn Taylor, Sam Ho and Louise O'Connor
Aims: To prepare the nursing workforce to identify and respond effectively to the deteriorating patient.

Background: Our client identified needs to improve on patient safety as part of their Quality Improvement (QI) activities. While the organisation is proactive in clinical risk management there was a view that more could be done educationally to 'close the gap' between the perceived service delivery and the reality. While there is a Medical Emergency Team (MET) policy in place and MET calls occur regularly, it was considered a simulation intervention would be of QI benefit.

The cohort was the Associate Nurse Unit Managers (ANUM), identified as the pivotally strategic group in a clinical management role across most shifts in the hospital. It was also deemed that ANUM's would demonstrate a high level of engagement within the simulation program. The program was designed using the Box Hill Institute Simulation Education Framework.

Method: The program incorporated:
  • a pre-simulation MET tutorial
  • orientation
  • two groups: one observing, one undertaking intervention (then rotated)
  • two different scenarios where the MET becomes necessary
  • a varied scenario focus: one medical simulation, one surgical simulation
  • two reflective practice debriefing sessions -one after each scenario
  • pre and post-test questionnaires based on the MET policy
  • a post-scenario evaluation of the simulation session by participants
  • a post-program review of the BHI framework for program validity.
Results: All relevant data from this pilot program and recommendations for future simulation programs will be presented.

Conclusions: Simulation to support QI activity is strategically effective.
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Take a Step to the Left: The benefits of cross-training in the simulation environment
Melinda (Min) Berry
Background: Good team work can reduce error due to human factors and thereby improve patient safety(1). Cross monitoring actions of other team members is a powerful tool for avoiding serious errors(2). This educational exercise uses cross training within the safety of the simulation environment to give team players a broader experience of team roles and increase reliance on other team members. It is hoped this will improve real life team performance by increasing mutual respect and creating a climate where cross monitoring is accepted practice.

Method: Emergency registrars and nursing staff with previous simulation participated in an uncomplicated cardiac arrest scenario in their usual roles. The scenario was paused part way through and roles reallocated by getting all the participants to “step to the left” and take up the role of the person to their immediate left, regardless of discipline or familiarity with that role. The scenario recommenced in this way until the end.

Results: Most participants reported feelings of anxiety about their new role but all had positive comments about the experience immediately afterwards. Participants felt there was an improvement in team function and situational awareness and that it was useful to experience a scenario from a different perspective.

Conclusions: The safety of the simulation environment allows educators to be creative with the experiences provided to learners. This was a productive team training exercise that will continue to be used at the Don Harrison Patient Safety Simulation Centre.

  1. Rall M, Dieckmann P. Crisis Resource Management to Improve Patient Safety. Society in Europe for Simulation Applied to Medicine (SESAM) 2005, May 28.
  2. Risser DT, Rice MM, Salisbury ML, Simon R, Jay GD, Berns SD (1999) The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium. Ann Emerg Med 34:373-383.
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Exercising Surge Management with Simulated Scenarios
Nick Howden, Julie Trpkovski, Dan Zikovitz and Richard Hodge
Aims: Development of a simulation environment to exercise the surge management plans across Ontario’s hospitals and Local Hospital Integrated Networks.

Background: Canada’s battle with SARS revealed significant weaknesses in the Ontario healthcare system, including a limited ability to manage critical care resources across hospitals in response to a sudden spike in demand. In response to this, Ontario is running a new surge management program to help hospitals better manage spikes in demand for critical care services without affecting day to day hospital services. As part of this program, Ontario has engaged CAE to build a simulation capability to exercise surge management plans within and between hospitals.

The project begins with simple categorization of responses into a framework that classifies surges as minor if they can be managed by a single hospital, moderate if they require the cooperation of several hospitals across a Local Hospital Integrated Network (LHIN) and major if the response requires the combined critical care resources of several LHINs or the entire province of Ontario. The main objective of this project is to test and exercise implementation of a principled approach to manage surge capacity and leverage critical care resources across the LHIN to ensure patients have access to care. Through participation in this program, each participating hospital will strengthen communication, improve partnerships and ensure access to critical care resources in a timely manner.

Method: In order to effectively exercise surge management plans within hospitals and LHINs, CAE is building a simulation environment that will provide the capability to run through a range of surge scenarios at the minor, moderate and major levels. In the longer term, the simulation capability will be able to create exercise scenarios based around a wide range of surge events, from disease outbreaks to mass casualty events and natural disasters. This paper describes the approach for the development of the simulation system, and provides an update on the current progress.

Results: No results as yet – this paper is reporting on the development of the simulation system and its goals rather than its utilization.
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'The Drugs Don't Work': Or Maybe They Do
Lisa McCoy and Dylan Campher
Aims: To go beyond technical skills and explore the indications for and implications of using real, expired or simulated drugs to address drug errors in anaesthetic practice through scenario based learning.

Background: In anaesthetic practice, medication errors occur at the rate of approximately 1 per 133 anaesthetics,1 for varying reasons.2 While very few of these errors cause permanent damage to patients, the physical, psychological and economical cost to patients, staff or institutions can be high.

Within our centre, we have considered the debate of fake vs expired vs real drugs in simulation. Real drugs provide maximum fidelity, but can be expensive and controlled/restricted drugs present inherent risks. Expired drugs promote fidelity and are free, but supply is random. Commercially produced simulated drugs can be expensive, come in a limited range and, like expired drugs, pose significant patient risk in the event that they enter a real clinical setting.

Method: A literature review of drug errors, simulation and human factors in anaesthesia was conducted. Web-based research was undertaken to ascertain approximate prices for commercially produced simulated drugs.

Results: We have decided that, as an offsite training facility, it is appropriate to utilise expired drugs wherever possible. A specific policy regarding the sorting and storage of donated expired drugs was created to minimise the risks that these drugs may pose to staff or participants.

Conclusions: By highlighting the human factors involved in medication errors in anaesthesia, we hope to increase anaesthetist awareness and consequently patient safety. Using expired stock where appropriate increases the fidelity of our scenarios and reduces costs.

  1. C. S. Webster and others, "The Frequency and Nature of Drug Administration Error During Anaesthesia." Anaesthesia and Intensive Care, 2001; 29:494.
  2. Webster and others, "The Frequency and Nature of Drug Administration Error", 496; A. Abeysekera and others, "Drug Error in anaesthetic practice: a review of 896 reports from the Australian Incident Monitoring Study database", Anaesthesia, 2005, 60:222; S. J. Wheeler and D. W. Wheeler, "Medication errors in anaesthesia", Anaesthesia, 2005, 60:264-5.
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Further Information

For further information on Abstracts, please contact the Conference Convenor, .

SimTecT 2008: Chih-Wei Yang, National Taiwan University Hospital

SimTecT 2008: Vinette Langford, Dynamic Research Corporation

SimTecT 2008: Kulliyyah of Nursing International Islamic University Malaysia

SimTecT 2008: Thabani Sibanda

SimTecT 2008: Brian Robertson

SimTecT 2007: Session 1: Maureen Harris

SimTecT 2007: Session 1: Benjamin Loveday

SimTecT 2007: Session 1: David Liu

SimTecT 2007: Session 1: Patricia Régo

SimTecT 2007: Session 1: Claire Chinnery

SimTecT 2007: Session 2: Jonny Taitz

©2009 Simulation Industry Association of Australia
Updated: 19 August 2009