How a learning and research center uses simulation games to help caregivers work better together
“The tension in the army tent is palpable. The medical officer assesses victims swiftly while the military nurse and the military aid are taking care of the many wounded, stopping bleedings, intubating victims and stabilizing vital signs. Their helmets and bulletproofs vests are heavy and keep getting in the way of their movements. Flashes and vibrations indicate yet another wave of shells has hit the ground a few meters away. The smell of burnt flesh is almost unbearable but the team’s focus on the wounded is unwavering.”
Quite dramatic but, fortunately, it is not real. This is just one of the many scenarios developed at the CESIM healthcare simulation center in Brest, France to support the training of healthcare professionals. “Managing complex care decisions is not something you learn in books,” says Pr. Erwan L’Her, director of the CESIM healthcare simulation center in Brest, France.
“Medical students learn first procedures such as suturing a wound or putting on a plaster cast,” Pr. L’Her continues. “After six years at medical school, the training shifts from practical to more relational. We help students learn how to handle the patient-caregiver relationship.”
The center employs professional actors to recreate care situations. The medical student would sit in an examination room with a “patient,” leading a consultation the way they would normally do. From examining the patient and asking the right questions to writing a prescription, all the steps of the process are enacted and analyzed. It is also an opportunity for students to be confronted with difficult situations.
“There is a session in which the student has to inform the “patient” that he has a cancer,” explains Pr. L’Her. “Delivering bad news is part of the life of any healthcare professional. It is not easy to do. Learning how to handle such a situation is essential.”
The hands-on experience isn’t restricted to future caregivers alone; the center also provides training for more experienced healthcare professionals.
“We recently trained the entire anesthesia team of a hospital. The nurses, residents and doctors came to perform a procedure in our staged operating room on a dummy. Our focus was not so much on the procedure, but on managing the various incidents that can happen and on improving the team’s communication.”
Pr. L’Her and his team create immersive environments that are as realistic as possible by leveraging visual, light and sound effects.
Healthcare professionals will experience an environment that mimics their day-to-day work.
“For an immersive sequence in an operating room or intensive care unit, we use real respiratory equipment and complex procedures,” Pr. L’Her notes. “The challenge will be on team dynamics. It is really situational, about relationships, communications, crisis management and team management.” The format and scenario of every simulation training are developed specifically for a key objective and a predetermined audience.
Groups of about 20 people will usually spend two days at the center and roleplay six to eight scenarios. A couple of participants are immersed in a real-life like scenario with either a dummy or an actor portraying a patient, while the others are watching what’s happening on a screen in the room next door.
“The debriefing is very important and lasts about 45 minutes. We review the entire session from both perspectives of both the trainees and observers,” Pr L’Her adds. “The real value comes from confronting the two groups. The impressions of those in action is always very different from that of those who were comfortably watching from the other room.”
“These simulation games have a real impact on trainees’ learning curve,” says Pr L’Her. A recent study1 has shown that cardiac echography competency can be achieved in half the time (from an average of 32.5 supervised studies to 13.6) by introducing computerized echocardiographic simulators in students’ training.
“A few countries have introduced simulation programs for student to learn medical procedures, but simulation for relational trainings and continuous education is not widely used even though it’s a real opportunity for caregivers to improve their practice,” he concludes.
1 “The use of computerized echocardiographic simulation improves the learning curve for transesophageal hemodynamic assessment in critically ill patients.”
Gwénaël Prat, Cyril Charron, Xavier Repesse, Pierre Coriat, Pierre Bailly, Erwan L’Her, Antoine Vieillard-Baron. Ann Intensive Care. 2016; 6: 27. Published online 2016 Apr 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824699/