Liam McCollow MBBS FACEM

Medical Education Fellow – Gold Coast Hospital & Health Service

Educators know the importance of communities of practice, of coming together as colleagues, collaborators, experts, and novices to learn from, with and about each other. In that spirit, a passionate group of Simulation enthusiasts gathered at Bond University on the Gold Coast to share the latest evidence and experiences in healthcare simulation at Simulation: Reconnect 2023.

This year’s first keynote speaker was Vicki LeBlanc, Chair and Professor of Medical Education at the University of Ottawa. She is a world-leader in research looking at the effects of stress and emotion on learning and performance, especially in the field of healthcare simulation. Her presentation “Predictable Chaos – How Emotions Guide Learning and Performance” was an illuminating glimpse into this complex field of research. We heard how stress and emotion are neither good nor bad, equal asset and liability depending on intent and how we choose to adapt. I must admit, even with some prior reading on the topic, I continue to grapple with the practical application in my own work. I suspect that practical strategies for consciously regulating emotions will have a major impact on the future of education design and delivery, and how healthcare professionals optimise performance in stressful situations.

The next presentation was “Value-based Simulation: Thoughts on Impact Measures”, with Katie Walker and Ben Symon from Mater Education. The liveliest discussion in the room was around the placement of the assessment of cost-effectiveness at the top of the Hierarchy of Evaluation model (Rossi, Lipsey, & Freeman, 2003). The takeaway from that discussion was around the ubiquity of the pyramid graphic, both for hierarchies and taxonomies, and a central misapprehension that higher position on the pyramid implies a higher importance or worthiness. Rather, the base of the pyramid, in this case the assessment of need, should be seen as the vital foundation and the consideration of cost takes its position only because it cannot be considered until the foundational considerations have been addressed.

The second keynote speaker was Ellen Davies from Adelaide Health Simulation. In her talk, “The art and science of designing recommendations for an organisation wide simulation program” she shared core insights from her recently published paper (Davies, Montagu & Brazil, 2023), around the evolving practical and philosophical considerations of health care simulation. Among other reflections, there was an emphasis on sim services delivering more than individual learning outcomes, but also addressing organisation and systems objectives, including safety and quality improvement, and the implications of this expanded role on planning, resourcing, and governance of simulation services.

Next, Debra Nestel, Professor of Surgical Education, University of Melbourne, Professor of Simulation Education in Healthcare, and Editor-in-Chief of the International Journal of Healthcare Simulation presented a brief but thought-provoking audit of the types of research currently being published in the simulation research space with “What I learnt from healthcare simulation research published last year…”. I‘m certain publication is forthcoming but, as well as serving as a useful guide to which journals are best for reading and/or publishing specific kinds of research, I detected some  personal lamentation for the relative paucity of recent qualitative research.

Critical Care Nurse, Educator, and podcast producer (Simulcast, Injectable Orange), Jesse Spurr shared some of his experience with creating, improving, promoting, and maintaining podcast audio excellence in his presentation “Finding our voices as clinicians and educators”. For me the key messages were (1) don’t just jump in, and (2) if you have a clear vision and you’re genuinely willing to commit the time, then absolutely jump in.

After lunch, Simulation Educator, Zach Buxton presented “Demystifying 3D printing for simulation educators” where he displayed some of his impressive simulation innovations while mendaciously insisting that he is no expert in the field. Essentially, for those willing to commit to an indeterminate period of trial and error, as well as the initial financial outlay, there is true value to be gained, limited only by your willingness to try.

In her talk, “Working with older adults as simulated participants: Optimizing learning for everyone”, Dr Nemat Alsaba, Assistant Professor of Medical Education & Simulation and Director of the Simulation Program at Bond University, gave an impassioned and well-reasoned argument for the benefits of expanded utilisation of real older participants in healthcare simulation.

Ian Summers and his team from Monash Simulation gave a practical demonstration of what a simulation team can achieve with simulated patients/participants, including insights into cultural considerations for international medical graduates, in his presentation “Confessions of a mannequin addict”. This team gets a special mention, both for having the most dynamic presentation of the day, and for making me reflect on my use of manikins without explicit consideration of the modality.

Next, Dr Nicole Sng presented “TACT: Building a high-performance teamwork strategy at Royal Brisbane and Women’s Hospital” – a fascinating insight into the process of establishing a new initiative within an established institution. I enjoyed their reflection on the initial assumption that translational simulation would be the cornerstone of the program, only to discover the absolute necessity of a multi-modal approach.

Finally, the famous voices of Simulcast, Victoria Brazil, Jessica Stokes-Parish, and Ben Symons, hosted special guest Vicki LeBlanc in a live and interactive Journal Club where attendees could join the conversation by posting live comments for discussion. There was an interesting dichotomy around one of the papers (https://rdcu.be/dsk7p), where most, if not all, agreed that subjective assessment of the quality of CPR is very unreliable, but many were critical of the objective measures chosen as a surrogate markers, both for CPR efficacy and team collaboration, in this study. Perhaps non-invasive measures will always be less objective than invasive haemodynamic monitoring but there was a general feeling that pose estimation may not be the next best option.

After this incredible line-up of speakers, the day concluded with drinks and canapes. The lively and collegial discussion was a testament to the success of the event. Speaking with other attendees, the thing I heard over and over again was “I can’t wait for next year”.

NOTE: There were optional masterclasses held on the previous day. Unfortunately, I could not attend, but those who did gave rave reviews.

Simulation: Reconnect 2023 was jointly hosted by the Bond Translational Simulation Collaborative and Simulcast with additional support from Laerdal Australia. Simulation: Reconnect 2024 will be held on November 27, 2024 – See https://bond.edu.au/research/research-centres-and-institute/translational-simulation-collaborative

Collaborate, Connect & Chat—three powerful words chosen by the conference organising committee to
encapsulate and establish the tone for the inaugural Transpacific Simulation Alliance Event. Convened by the
California Simulation Alliance, the Hawai'i State Simulation Collaborative, and the Victorian Simulation
Alliance, this boutique conference was held against the magnificent backdrop of Waikiki, Hawai’i, 17-20
October 2023.

Opening with the breathtakingly beautiful Oli (Hawaiian chant) by Nalani Minton, SimHuddle was a coming
together of ideas, inspirations, and innovations in health with healthcare simulation educators attending from
Hawaii, California, Michigan, Australia, Canada, and the United Kingdom.

The warm atmosphere (and weather) at SimHuddle was paired with insightful conversation, evidenced also by
the exceptional keynotes from Adam Cheng, Susan Eller, and Stephanie O’Regan. Being a huge fan of the
PEARLS Healthcare Debriefing Tool, and a paediatric intensive care nurse, I found Adam Cheng’s keynote on
maximising the impact of Simulation-based research both engaging and informative.

Optional pre-conference workshops addressing directed observer roles, navigating the research journey,
psychological safety in debriefing and integrating simulated participant methodology into simulation programs
were run by internationally recognised speakers.

One of the stand-out features of SimHuddle for me was the additional research writing retreat led by Debra
Nestel, Gabriel Reedy, and Nicole Harder, all Editors-In-Chief of international simulation journals. The retreat
consisted of 12 hours dedicated to healthcare simulation research with follow-up sessions scheduled for the
coming months. As an aspiring PhD student, the writing retreat provided an opportunity to develop my
academic writing skills in an environment of mentorship and peer support. Thank you Debra Nestel for this
wonderful initiative!

Unique to the Transpacific Simulation Alliance Conference was four opportunities to connect with your
allocated ‘huddle’. These intimate sessions provided an opportunity to explore challenges and solutions for
simulation programs, collaborate, share best practice, network, and meet new colleagues.

We were encouraged in the opening remarks to gather and share our Naau—our hearts—with each other,
ensuring intelligence is brought together to make decisions with the greatest impact and blessings for all. I
journeyed back to Australia with a sense of belonging to a wonderful international simulation community of
practice, and also with abundant opportunities, invaluable learnings, fresh ideas, and genuine connections
with new colleagues interested in collaborative research.

The inaugural Transpacific Simulation Alliance SimHuddle was a friendly, welcoming, feel-good conference. An
exceptional event where innovation thrived and passions were shared, a testament to the power of
collaboration, learning and innovation in shaping the future of healthcare.

Mahalu SimHuddle, thank you. A hui hou—until we meet again.

Melissa Ciardulli

This year's conference theme has been selected to help all of us focus on becoming more mindful of how we develop, use and succession plan within our healthcare simulation services.

We want to focus on sustainability to help support quality in simulation activity that enhances patient and team safety. This means we need to think about how we undertake service and learning needs analyses, how we plan our training and how to invest in our resources including staff, patients and colleagues, networking and educational equipment and software. And how we build our knowledge base, through the use of simulation as a research tool.

The really exciting part is that you are invited to join us through abstract submissions to share your work, and by attending and joining in the conference events including our keynote presentations and breakout sessions. The conference content and discussions will shape additional conversations that will form future healthcare simulation practices amongst our ASPiH network and beyond.

Check out the programme, keynote speakers, pre-conference workshops, venue information and more here https://aspihconference.co.uk/

This is the first writing retreat that we are aware of that specifically supports healthcare simulation researchers. The retreat occurs before and after a simulation conference in Honolulu, Hawai’i. Led by three editors of simulation-focused journals, Prof Gabriel Reedy, Prof Nicole Harder and Prof Debra Nestel - participants will be supported in completing an academic writing a task, most likely preparing a journal manuscript. Attendees are expected to bring a writing task to the retreat. Close in-person supervision will be offered to support the development of the manuscript. Several weeks later, the editors will check in with you via a webinar to support you in completing the writing.  The retreat will also foster peer review between attendees and we are confident a productive writing community will be established that will offer support well beyond the retreat.

More information is available on https://web.cvent.com/event/57814473-5530-4ad4-b8ae-90202e9fb64d/summary Go to the tab for the Writing Retreat.

Please join us for our 3^rd annual conference in the South East, this time held at the imposing Southampton Solent University venue with a Safety and Simulation focus.

We will embark on 2 exciting days of a 3 course dinner, Keynote Dr Dawn Benson, multiple workshops, e-posters and oral presentations. There will be plenty of time to network, you can sign up for the ‘Meet the Deans’ session as well as enjoy a buzzing industry exhibition hall over lunch. Take tours of this wonderful facility, relax in the wellbeing space, win prizes and even engage with Maritime Simulation! We hope to see you there!

Tickets are limited, early bird and abstracts close on midnight on the 1^st January 2024.

Website: https://www.simnetse.com/

Tickets: https://www.simnetse.com/conference-registration

On the 7th December 2022, the Faculty of Health Sciences at the Australian Catholic University (ACU) ran its 12th Simulation Health Education Showcase. The Simulation Showcase is built on the philosophy of collaboration, which is why for the last 12 years, it has been delivered in partnership with the Australian and New Zealand Laerdal Medical team and offered free to all attendees. The theme this year was Innovation and inclusion for continuing learner centred simulation which was reflected by the attendee representation from nine health disciplines, from both industry and academia. 

Prof. Michelle Kelly led the way, discussing the use of AV simulations in assessing pain within culturally diverse patients. Occupational therapist Jessica Rafanelli shared a small project using SimCapture that had a big impact on student learning during their simulated placement.

The 12 presentations within the concurrent sessions showed innovative ways that simulation was used and how simulation activities were adapted during the pandemic. The expert panel session was a highlight for many. Bringing together industry and the tertiary sector to discuss: Simulation Evolution or Adaptation – impact of a pandemic on simulation design and delivery. Panel members: Michelle Kelly (University of South Australia), Monica Peddle (Deakin University), Bradley Chesham (Bundle of Rays), Daniel Chalkley (ACU), and Mark Rosenthal (Laerdal Medical). 

The day was rounded off by concurrent workshops on using data to inform your simulations, and the importance of psychological safety for establishing an optimal learning environment.

The 2023 ACU Simulation Showcase will be held on the 6th December in Brisbane, Queensland.

Michelle Kelly (Professor of Nursing at University of South Australia) recently delivered a keynote presentation at the 12^th ACU Simulation in Health Education Showcase in Melbourne. Michelle shared aspects from an ongoing body of work based on co-design and co-production to inform the simulation content. The context for these simulations was pain assessment, with the intent of surfacing learners’ personal and professional biases on patients' experiences. In creating the case studies, the research team worked with health consumers, pain service nurse consultants, and other clinicians to ensure that the design and focus of the resources were authentic and accurate representations of clinical scenarios. Working with actors and a director who was also a nurse and actor, the team developed contemporary, realistic AV simulations and evaluated these with nursing students and new graduate nurses. A particular technique of ‘talking to camera’ added a personal touch of the actor nurse sharing their thinking with those watching the simulation. The intent was always to model ideal professional practices, and feedback from participants reflects this technique as a powerful and impactful way to promote learning.

Related publications

Slatyer, S., Myers, H. and Kelly, M.A. Understanding Nurse Characteristics that Influence Assessment and Intention to Treat Pain in Postoperative Patients: An Integrative Literature Review Pain Manag Nurs 2022 DOI: https://doi.org/10.1016/j.pmn.2022.03.003

Kelly, M.A., Slatyer, S., Myers, H. Gower, S., Mason, J. and Lasater, K. Using Audio-Visual Simulation to Elicit Nursing Students’ Noticing and Interpreting Skills to Assess Pain in Culturally Diverse Patients Clinical Simulation in Nursing 2022 Vol. 71, pages 31–40 DOI: https://doi.org/10.1016/j.ecns.2022.06.003

Simulation-based education (SBE) is “massively on the rise, highly technological, but under-theorised” (p. 905) [1]. Discussion of potential and actual applications [2, 3], often focus on methods and technologies [4, 5], seeing SBE sessions as an “add on” to an existing curriculum [6], without paying much attention to how SBE sits within its wider ecosystem. Important questions include: how does SBE work in combination with other activities (e.g. lectures, tutorials, and clinical placements)? How do external forces (e.g. accreditation requirements, research evidence, available resources) influence the design, facilitation and experience of simulation? What is the influence of the different purposes and values of teachers, learners and other stakeholders?

Our cross-institutional team in Scotland was recently awarded a Scottish Medical Education Research Consortium (SMERC) grant to explore these questions. Figure 1 shows our initial thoughts about how a simulation session is “entangled” [7] in not just methods and technologies but in how simulation sessions are situated in the wider context, where purposes and values are in play. As members of the IJoHS community we would be delighted to have your thoughts and input into shaping this early proposal of an entangled view of simulation.

References

1. Johnston JL, Kearney GP, Gormley GJ, Reid H. Into the uncanny valley: Simulation versus simulacrum? Med Educ. 2020; 54(10): 903–7.

2. Walsh C, Lydon S, Byrne D, Madden C, Fox S, O’Connor P. The 100 Most Cited Articles on Healthcare Simulation: A Bibliometric Review. Simul Healthc. 2018; 13(3): 211–20.

3. Nestel D, Hui J, Kunkler K, Scerbo MW, Editors AWC. Healthcare Simulation Research. Nestel D, Hui J, Kunkler K, Scerbo MW, Editors AWC, editors. Healthcare Simulation Research. A Pracitcal Guide. Springer; 2019.

4. Issenberg SB, Ringsted C, Øostergaard D, Dieckmann P. Setting a research agenda for simulation-based healthcare education a synthesis of the outcome from an utstein style meeting. Simul Healthc. 2011; 6(3): 155–67.

5. Battista A, Nestel D. Simulation in Medical Education. In: Understanding Medical Education: Evidence, Theory, and Practice. Oxford: Wiley-Blackwell; 2019. pp. 151–62.

6. Gaba DM. The future vision of simulation in health care. Qual Saf Heal Care. 2004; 13(SUPPL. 1): 2–10.

7. Fawns T, Hislop J, Oliver N, Somerville S. An entangled view of an educational activity. [Internet]. 2022. Available from: https://open.ed.ac.uk/an-entangled-view-of-an-educational-activity. 

Healthcare simulation educators live with the tension of wanting to develop their understanding of simulation-based education and their clinical and teaching commitments. Eager to respond to this tension, a community of practice was devised as a partnership between the Scottish Centre for Simulation and Clinical Human Factors and the Lothian Simulation Service in Edinburgh. The Scottish Simulation Journal Club (SSJC) group curated a virtual, monthly journal club designed for busy but intellectually hungry people. Recent articles are selected, presented, and explored (both practically and academically) in an inclusive, lively, and conversational format. 

Launched in 2020, SSJC struck a chord in the broad community of simulation enthusiasts across Scotland, and increasingly internationally. SSJC now has over 200 members, with regular contributions from the United Kingdom, the United States, South Africa, and Australia.

Our latest edition explored the IJoHS editorial by Paul Murphy and Debra Nestel entitled "Healthcare simulation terms: promoting critical reflection.”¹ We were delighted to have Paul join us and unpack the proposed limitations of some engrained terminology in simulation vernacular and challenge us to think differently about the evolving nature of language. To join part two of this important conversation, email Nathan.Oliver@nhslothian.scot.nhs.uk or Samantha.Smith7@nhs.scot.

References

1. Murphy P, Nestel D. Healthcare simulation terms: promoting critical reflection. International Journal of Healthcare Simulation. Published online 2022. https://www.ijohs.com/article/doi/10.54531/MHGI6358

The King Fahd Armed Forces Hospital organised the first Medical Education: Transformation & Innovation Conference. Held in Jeddah, Saudi Arabia, the conference attracted delegates from across the Kingdom.

Distinguished speakers included Prof David Cook (Mayo Clinic College of Medicine, US) who spoke on validity arguments for learner assessments and the under-reported but critical role of measuring cost-effectiveness of continuing professional development.

Prof Henk Schmidt (Erasmus University Rotterdam, The Netherlands) offered fascinating insights into how students learn and a history of problem-based learning. The latter was framed as an example of an innovation in medical education with seemingly global uptake with Dr Sofana Al Mashhadi (Saudi National Institute of Health, KSA) providing a lens through which we could analyse its implementation.

Dr Mary Collins (RCSI Graduate School of Healthcare Management, Republic of Ireland) spoke on a range of topics related to leadership, touching on resilience and emotional intelligence.

Prof. Dina El-Metwally (University of Maryland School of Medicine, US) shared experiences of pandemic work, reminding delegates of the importance of self-care.

Prof Debra Nestel (IJoHS, Editor in Chief, Monash University & University of Melbourne, Australia) spoke on theories that inform educational practice and on the role of psychological safety in clinical and simulated settings to optimise learning.

Invited speakers offered workshop activities on the topics on which they spoke. The hospital-based simulation centre at King Fahd Armed Forces Hospital is an excellent venue to facilitate the uptake of their simulation faculty development program.

Following the implementation of findings from their recent study [1], the Western Sydney Local Health District (WSLHD)/University of Sydney research team are now testing a new iteration of their VR-based AI driven verbal de-escalation trainer.

The VR-based simulation places the user in front of a patient showing aggressive behaviours who will respond either positively or negatively depending on what the user says. If a user says something that would be inflammatory, the conversational agent will become increasingly frustrated with corresponding animations. Conversely, saying de-escalatory statements will lower the frustration level.

Findings from the initial research study highlighted limitations in the complexity of the responses the agent was able to provide. The original response system was programmed with predicted responses drawn from the AI algorithm which were hardcoded into the application. To combat these limitations, the team have now implemented a direct link to the AI algorithm being utilised to drive the agent’s conversation, broadening the responses available.

While not without its challenges, such as keeping the conversation on track to meet the educational outcomes, the research team is excited at the potential improvements this innovation could deliver. The team have also expanded the number of available scenarios to increase the versatility of the application. You can also read about this research team’s work published in IJoHS: https://ijohs.com/article/doi/10.54531/DNZC8446.

1. Moore, N., et al., Designing Virtual Reality–Based Conversational Agents to Train Clinicians in Verbal De-escalation Skills: Exploratory Usability Study. JMIR Serious Games, 2022. 10(3): p. e38669.

2. Moore, N., et al. Designing virtual reality experiences to supplement clinician Code Black education. International Journal of Healthcare Simulation. 2022;1(Supplement SRSIS 1):S12-S14.

“All things being equitable” – Simulation conference in Birmingham