Couturier on a K-Mart Budget: My Review of the Rural Norther California Simulation Center

Nestled in a little college town, two hours North of Sacramento, California, is one of simulation training's hidden gems; the Rural Northern California Simulation Center. As a part of our faculty development program, myself and two others had the great pleasure of heading to Chico, California, and not just for the magnificent Thursday night farmers market, OR the unprecedented food & specialty drinks at Gencarelli & Wellman's "CRUSH" restaurant & lounge. If you've never heard of Becky Damazo, and this simulation center, it's high time you do, book-mark their page, and plan on a visit; this little gem's got a lot of sparkle! You're going to be seeing it listed right up there with the big dogs in no time. Becky Damazo, of California State University, and her highly effective, efficient staff of 2 (YES, I really did say 2), along with some help from her sons, run an Ivy-League institution on a state-tight budget.

While on my own quest for quality faculty development in simulation methodology, I was confronted with many "designer" labels that carry expensive price tags. Even though one other faculty member and myself have both been trained at some of these first-class programs, either of us had time to develop the depth of exercises we required. Not to mention, those holding the check books always prefer the fare that goes with "generic" labels, especially if the same quality can be procured. Because of time, and more-so because we wanted to send several faculty members, we chose Becky's "Intermediate Conference on Simulation Methodology" (AKA the "Simulation Spa" [pedicure, manicure, and massage are surprisingly available]). I never expected to walk away so pleased with the outcome.

Serving the simulation needs for many educational and health care organizations in the surrounding areas, they're soon to be regional leaders is simulation methodology. They currently occupy only 4 patient-care rooms, a nurses station, and some storage space in this relatively vacant hospital, but they fill them with simulators from METI, Laerdal, & Gaumard, not to mention standardized patients, computer based learning, and lecture animation capabilities. Although they may not be "blinged" out like more established centers, they prove that it's not about the technology, it's about the methodology! The beauty of their location is that they're literally in a fully functional, almost empty hospital building. With so much space at their finger tips, I can only imaging that soon they may become a full-sized simulated hospital with every potential service imaginable. If Governor Schwarzenegger ever reads this... he'd be a wise man to invest. It's only a matter of time until the merits of simulation training in health care proves itself as effective means by which lives & money can be saved, evidence can be built, and outcomes in education can be greatly improved (amongst other things).

Damazo & her team offer a two-day conference focusing on best practices in simulation methodology. The first day focuses on the theories behind the practice, the second day focuses on putting the theory into practice. They cover everything the novice faculty facilitator needs to know; scenario design, basic scenario programming, moulage, introductory and intermediate debriefing concepts, how to avoid bad habits, and they give you the chance to practice. You build a scenario from scratch, validate it, run it with living participants & human-patient-simulators, debrief it, then debrief the debriefing. To top it off, you walk away with 12 continuing education credits! How great is that!?! The only drawback to the two-day conference is... it's only two days. Each of these topics could easily be full day topics, if not longer. But Ms. Damazo, and her team, effectively provide the content, details, and information in a manner that any adult learner can take and master in their own environments.

While designer labels often provide excellence in quality, are aesthetically pleasing, have the latest technology and the biggest budgets, this center proves that the generic label can be just as good. Though they don't currently provide the many specialty programs you may find with some of the Ivy-League programs, I have no doubt they'll catch up soon. If your time & budget are short, check out the amazing work that Becky Damazo & her team have done at the Rural Northern California Simulation Center.

When you get there, enjoy a beautiful evening in downtown Chico and a stroll through the fragrant farmer's market. Cool off with a refreshing swim at 1-mile swimming hole just a few blocks away (very, very nice, very very clean, very very cool!!!! [trust me]). To make your day complete, head on over to CRUSH for a gin martini (with two of their a-a-amazing olives), the terrific fried green tomatoes (HELLO! Farmers Market), and my choice - the cedar plank salmon; grilled med-rare or "Cheeky" @ Chico's choice - the amazing home-made butternut ravioli with those tomatoes from God! When you're done... not only will your appetite be satiated, but you'll also understand why they call this the "Simulation Spa!"

World Builder ~ For Maya

So, this video has had such an impact on me, I want to make sure it's at the top of my blog list. I am re-posting it, and my blog thoughts. I really want people that come to my blog to see this first... at least for the next few days... before they see Lady Gaga.

Have you ever wondered where we are with simulation? Better yet, do you wonder where we're going? I am always searching for material that not only teaches, but also 'touches.' I have a lot of friends that know the details of my complicated past, and those friends are always looking for 'things' for me as well. Interestingly, a friend of mine stumbled upon this video and sent it this morning. It's phenomenal, and it represents, to me, a great deal of what simulation is, where it's going, and what OUR potential is. On the other hand, it also points out that simulation is also about heart, it's not all about computers, dolls, and fake blood. There is often times a lot of compassion that goes into the simulation that we create. The amount of work that goes into 'creating' that and expressing that 'love' is often times missed, and the reality is the reward may be something internal rather than external.

I dedicate this little video to my Maya... "and she played on."

World Builder from BranitVFX on Vimeo.

Collab Video?

OK, so here's the deal. I've been watching collab videos on youtube lately. Alas! What's a collab video? you ask. Well... it's a video, that's built in collaboration. Typically what happens is a song and a theme is selected, then many people make a music video based around the same theme using the same song... THEN they all send their home made music videos to one individual who then compiles them into a single collaborative video (thus the term "collab video").

SO... A Collab Video, YES! I want to do a collab video... with YOU! Here's the premise, the official participation guidelines will be posted on my blog and youtube within the next two weeks, but if you want to get those creative juices pumping here are some things to get you started.

THEME: Simulation (of course!). This can be any kind of simulation related to health care education. You can use yourselves and/or any students (that choose to volunteer). Perhaps you have students that want to do it as a class project, perhaps your simulation staff want to do it, or perhaps you just want to do it yourself. You can use any props, make-up, landscapes you so desire, and you can get as creative as you so desire.

SONG: Poker Face (Lady Gaga). Here, watch her music video... it might give you and your simulators some dance steps, make-up tips, and costume ideas.



BASIC RULES:

First of all, this is my personal blog, I am not affiliated with any group. This collab video is being done as something fun, to let you (and me) share some of our creativity in simulation!

The collab video, when compiled will be appropriate for all audiences, but your creativity is highly encouraged.

If you choose to participate, small video clips of whatever you send me may end up in the collab video. The collab video will be going on my public blog and youtube. That means the whole wide world will be able to see it.

All participants in the collab video will have the opportunity to have their names included in the participants list.

I'm not going to make this any longer than it already is... so keep watching my blog for more information on the details as to how to send me your digital POKER FACE music video files!

World Builder ~ For Maya

Have you ever wondered where we are with simulation? Better yet, do you wonder where we are going? I am always searching for material that not only teaches, but also 'touches.' I have a lot of friends that know the details of my complicated past, and those friends are always looking for 'thing' for me as well. Interestingly, a friend of mine stumbled upon this video and sent it to me this morning. It's phenomenal, and it represents, to me, a great deal of what simulation is and where it's going, and what OUR potential is. On the other hand, it also points out that simulation is also about heart, it's not all about computers, dolls, and fake blood. There is often times a lot of compassion that goes into the simulation that we create. The amount of work that goes into creating that and expressing that love is often times missed, and the reality is the reward is often something internal.

I dedicate this little video to my Maya... "and she played on."

World Builder from BranitVFX on Vimeo.

I finally found a sim man 3G movie that gives sim man a bit more "clout." here it is. Now I think they are both a bit more on the same playing field on my blog since I don't play partial to either.

iStan vs. 3G

I tried to find an example of an immersive scenario demonstrating iStan in an attempt to not show bias toward any particular vendor. There was one video that I came upon in youtube, but the quality was not very good. So, in all fairness to iStan, here is a relatively funny spoof. To those of you that have 3G, what are your thoughts about the battery life? - Up-date- So you'll notice part of this video is cut off. To see the whole thing, just click on the video after you start playing it and it'll hyperlink you to youtube so you can see the "bigscreen" version.

Demonstration of a Paramedic Scenario with Simulator

In my attempts to find some examples of immersive learning experiences with simulators I did run into a few youtube videos that seem to come close. This one is from Australia, a group of paramedics working on SimMan 3G.

The Ten Commandments

A colleague of mine shared the Ten commandments with me as prescribed by Issenberg, S.B, and Scalese R.J. (2008). If you would like them in more detail, the reference is included below.

Best Practices in high-fidelity simulation

1. Feedback.

2. Repetitive practice.

3. Range of difficulty level.

4. Multiple Learning strategies.

5. Clinical variation.

6. Controlled environment.

7. Individualized learning.

8. Defined outcomes/benchmarks.

9. Simulator validity/realism.

10. Curricular integration.

Issenberg, S.B, and Scalese R.J. (2008). Simulation in health care education. Perspectives in Biology and Medicine, 51 (1). Pg 35. Report from Best Evidence Medical Education (BEME) Collaboration.

Post INACSL thoughts

My name is Allen, formally known as Dr. Hanberg. For years I have been wanting to create a blog based around my work with simulation. I began teaching nursing in 2002, and simulation became the obvious fit for my academic and research career. You see, I'm a Gen-X'er, early adopter, and fascinated with technology and cognition. I began studying best practices for simulation utilization early, and have attempted to prioritize that. Now, after 7 years in higher education, the pains and perils of doctoral studies, grant writing, and research endeavors, I am finally building my blog. I originally started it in 2007. Now, two years later, I am finally taking the steps to make this blog an immersive and real experience. My first official post welcomes you and I would like to take this opportunity to reflect on us nurse's recent INACSL conference. Please join me, follow along, and comment as you see fit. I will make every attempt to up-date at least once a week. Here we go... here is my first post to "The Simulation Nation."

The 8th Annual INACSL conference was held this year in St. Louis, Missouri. It was a huge success, and I am grateful to have been a part of it. I also attended the SSiH conference this year as well, which was held in Orlando during the month of January. Both conferences present some very valuable and useful information, and both are unique.

After having attended both, the realization of one of the greatest challenges regarding simulation and education struck me like a bolt of lightening. It was simple really. As educators using simulation technologies, we're not all speaking the same language. Even the term "simulation" seems to be interpreted differently from state to state, school to school, educator to educator. This concerned me. At both conferences, I heard Dr. Sharon Decker, amongst others, discuss the need for setting standards of practice within simulation learning, methodology & practice. That must also address some basic definitions that guide users in the methodology and delivery of the learning experiences they are offering.

One of the round table discussions, that I was a part of, discussed utilizing high fidelity simulation for high stakes testing. It was this discussion where the glaring lack of consistent definitions struck me so profoundly. Based on that discussion, I identified 5 key terms that appear to have inconsistent and vague definitions. These were the top 5 (based on this discussion) that I feel need clarity and defining.

1. High Fidelity Simulation
2. Mid Fidelity Simulation
   
3. Low Fidelity Simulation
4. Immersive Simulation Experiences
   
5. High Stakes Testing

As I mentioned previously, the round table was initially planned to look at using more high-fidelity/immersive simulation experiences for high stakes testing (something similar to what aviation does). The three of us on the panel each shared our ideas and beliefs about why it should or should not be used, then the discussion was turned over to the audience. I was shocked to hear how many people advocated FOR it, but then I understood why. They were defining high fidelity/immersive simulation experiences as being equal to task training and lecture animation, where skill checklists and rubrics could be used to check the learners off and allocate points based on skill performance. In my mind, this is not high-fidelity immersion. Rather, it's merely using a high fidelity simulator to do the same thing we've been doing for the past 40+ years; skills pass off's. It fails to take into account the broader perspective of nursing practice, the skills that students are really exiting our programs without; behavioral, cognitive, communication, leadership, prioritzation, and team working skills. As the discussion progresssed I began to hear, that many were perceiving high fidelity and immersive to be synonymous, that since they were using a "high fidelity" simulator then it instantly becomes immersive. That simply is not the case, technology will never trump methodology. What I failed to hear was the application of appropriate simulation methodology that would make high-fidelity simulators truly valuable in immersive experiences thus making it possible to use them in high stakes testing in nursing. To this day, I have yet to see how (with our current resources and shortages) nursing education can successfully use it for high stakes testing.

With that in mind, I remind you that when it comes to using any pedagogical tool emphasis must be placed on the methodology not the technology. Simulators are merely the vehicle, it's the faculty member that drives the vehicle. High fidelity, immersive experiences can, and do, occur without high fidelity "simulators". On the other hand, they more commonly don't occur with them.

So what do I mean when I say "high-fidelity, immersive experience"? By no means is this a refined definition, but in essence it's the closest thing to real the student can experience outside of reality. These experiences are planned, the objectives are clear, the content is well aligned. The learners experience pre, intra, and post experiences. Debriefing is key, well planned and delivered in a methodologically sound manner. The experience does not focus on skills and/or task training, but includes cognitive, behavioral, and psychomotor skill. These are just some of the elements that quickly come to mind as I think about this. I am certain that as I continue blogging about it, and writing about it, that some of these ideas will become more concrete.

In the mean time, I am going to stand firm in my belief that high-fidelity, immersive simulation experiences should not be used for high stakes testing in nursing education at this point in time. Is it possible? I certainly believe anything, with the right circumstances, resources, and approach is possible. Should we use it for high stakes testing today? Not until the methodology can be validated and the resources exist to make the experience ethical and equitable to all participants. When that is accomplished, then truly new nurses will emerge practicing as safely as new pilots flying passenger planes.