"Now you ask, she does look like she is in pain" - Manikins vs SP's
Thanks again to all those people who have commented and helped my blogs to evolve. The conversations around human bias, its predictability and also a tangent looking at bias in AI were fascinating.
This week I want to move back to a simulation focus - really so I can get to the stage of linking the themes together. I am going to focus on the benefits and challenges of working with Simulated Persons and what that can bring to simulation based learning events.
If you work in clinical practice you are constantly gathering information from around you and this includes those subtle assessments of our patients. If you are walking over to a patient you are are looking at how they are laying in bed, how they move and breathing pattern.We do a lot of this information gathering sub consciously often only aware of it in more acute cases. The trouble is that the majority of our manikins do not do these things so we have some one standing beside them to tell us these things if they ask. Further more we can loose sight of the patient and instead the focus becomes more on using the technology and learning how to interpret and treat the manikin. This can explain why sometimes we see confident, competent staff struggle with the simulation.
It is also not easy for individuals to have a conversation with an inanimate object, indeed all those non verbal feedback cues we gather interacting with a person are not there. At times I think some of the difficulty or lack of comfort we see in scenarios using manikins may be because of this. But the preferred model still seems to be simulation with a manikin. Indeed people will spend more and more money for a manikin that can blink.
Recently in the NW, NHS HEE has commissioned a local HEI to develop a process to train people to take on the role of a simulated person. I better explain my choice of terms as there are a variety of terms in use. These individuals can portray the role of different people ie patients, but also relatives and carers calling them a person though also is an attempt to identify them as an individual not just a condition. These roles just contain an understanding of the individual they do not provide a script or list of answers to learn so are not standardised as can be seen used sometimes in OSCE applications.
So the process is embedded in a performing arts background and shows them how to take on a role and understand that person and how they react. Additionally there is a separate training session for staff coordinating a local SP programme to cover how to develop these individuals but also how to manage risks etc. The idea is very much that local organisations recruit a pool of volunteers (ideally) or students. These individuals learn specific SP roles. This becomes a form there for of Patient Public Engagement - now these volunteers can engage and work with staff but can also feed back on the organisation.
Clearly not all scenarios will work with SP's. Those that require invasive skills, advanced airway or defibrillation will normally use a manikin, however an SP led scenario using a monitor emulator and even casualty makeup can become very realistic and also allows focus on areas like values based care.
So as an example we may have Amy a 36 year old white female - you can recruit several people who will be suitable at being Amy, thus increasing the resilience of delivery. They are given a document which contains information about Amy. Once the SP's are happy with this role you can write scenarios for Amy in a variety of settings or scenarios. You can invite the SP to give feedback, an element that is explained in their training, to the participants on the interaction - this is always seems more sincere than a faculty member saying "I don't think that I would have..."
Clearly there are both logistical issues to arranging SP's to attend, there also seems to be an initial concern from faculty members that they will loose control of the simulation. With the use of the SP profile and training for the SP and staff it doesn't take long for them to witness the benefits. Just as with any simulation a really important element is the orientation and this needs to include how to work with the SP. For instance what are the limitations to examinations and how will the faculty feed in elements like the findings in cardiac and respiratory auscultation even with this candidates will often palpate a radial pulse and will need prompting that the pulse rate they feel is the same as is seen on the monitor.
The advantages of using a real person in a simulation can allow the interaction to become more natural and person focussed. The manikin will always be used but it would be useful to see the majority of simulations delivered with people. Potentially SP's can allow the patient to come back to the center of what we do rather than being seen as a technically focused event.
This week I want to move back to a simulation focus - really so I can get to the stage of linking the themes together. I am going to focus on the benefits and challenges of working with Simulated Persons and what that can bring to simulation based learning events.
If you work in clinical practice you are constantly gathering information from around you and this includes those subtle assessments of our patients. If you are walking over to a patient you are are looking at how they are laying in bed, how they move and breathing pattern.We do a lot of this information gathering sub consciously often only aware of it in more acute cases. The trouble is that the majority of our manikins do not do these things so we have some one standing beside them to tell us these things if they ask. Further more we can loose sight of the patient and instead the focus becomes more on using the technology and learning how to interpret and treat the manikin. This can explain why sometimes we see confident, competent staff struggle with the simulation.
It is also not easy for individuals to have a conversation with an inanimate object, indeed all those non verbal feedback cues we gather interacting with a person are not there. At times I think some of the difficulty or lack of comfort we see in scenarios using manikins may be because of this. But the preferred model still seems to be simulation with a manikin. Indeed people will spend more and more money for a manikin that can blink.
Recently in the NW, NHS HEE has commissioned a local HEI to develop a process to train people to take on the role of a simulated person. I better explain my choice of terms as there are a variety of terms in use. These individuals can portray the role of different people ie patients, but also relatives and carers calling them a person though also is an attempt to identify them as an individual not just a condition. These roles just contain an understanding of the individual they do not provide a script or list of answers to learn so are not standardised as can be seen used sometimes in OSCE applications.
So the process is embedded in a performing arts background and shows them how to take on a role and understand that person and how they react. Additionally there is a separate training session for staff coordinating a local SP programme to cover how to develop these individuals but also how to manage risks etc. The idea is very much that local organisations recruit a pool of volunteers (ideally) or students. These individuals learn specific SP roles. This becomes a form there for of Patient Public Engagement - now these volunteers can engage and work with staff but can also feed back on the organisation.
Clearly not all scenarios will work with SP's. Those that require invasive skills, advanced airway or defibrillation will normally use a manikin, however an SP led scenario using a monitor emulator and even casualty makeup can become very realistic and also allows focus on areas like values based care.
So as an example we may have Amy a 36 year old white female - you can recruit several people who will be suitable at being Amy, thus increasing the resilience of delivery. They are given a document which contains information about Amy. Once the SP's are happy with this role you can write scenarios for Amy in a variety of settings or scenarios. You can invite the SP to give feedback, an element that is explained in their training, to the participants on the interaction - this is always seems more sincere than a faculty member saying "I don't think that I would have..."
Clearly there are both logistical issues to arranging SP's to attend, there also seems to be an initial concern from faculty members that they will loose control of the simulation. With the use of the SP profile and training for the SP and staff it doesn't take long for them to witness the benefits. Just as with any simulation a really important element is the orientation and this needs to include how to work with the SP. For instance what are the limitations to examinations and how will the faculty feed in elements like the findings in cardiac and respiratory auscultation even with this candidates will often palpate a radial pulse and will need prompting that the pulse rate they feel is the same as is seen on the monitor.
The advantages of using a real person in a simulation can allow the interaction to become more natural and person focussed. The manikin will always be used but it would be useful to see the majority of simulations delivered with people. Potentially SP's can allow the patient to come back to the center of what we do rather than being seen as a technically focused event.
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