Category Archives: Future of Simulation

Future of Simulation, Healthcare simulation

Can maternity simulation really be pain-free?

Posted on by Oxford Medical Simulation
Virtual Reality OBGYN simulation
26
Jan
Virtual Maternity Obstetric Scenarios Oxford Medical Simulation

As a simulation professional, you or your team have likely considered the possibility of adding maternal simulation to your curriculum.

There are many benefits to doing so – providing sought after opportunities to learn ‘hands-on’ techniques, preparing learners for certification and making-up for missed clinical opportunities, just to name a few.

However, many quickly learn that the obstacles can outweigh the opportunities. Maternity manikins are expensive, require specialist knowledge to set-up and are challenging to maintain. From creating artificial blood to properly lubricating the fetus, creating realistic maternity simulation requires unique accessories and takes exponentially longer to set up than traditional simulation scenarios.

Maternity simulation requires multiple technicians to manage the computer, control manikin movements and sometimes vocally role-playing a laboring mother.  Once a simulation is complete, there is the arduous task of cleaning and preparing the manikin for reuse or storage. By the end of the scenario, many techs are cursing the day their maternity simulation lab was born!

So, why would anyone stick it out to create maternity simulation?

Maternal mortality impacts an astonishingly high number of women. In 2017, 295,000 women worldwide died from preventable causes related to pregnancy and childbirth. That is a staggering 810 women per day. In the United States, maternal mortality is 14:100,000; in the United Kingdom, 7:100,000. Shockingly, maternal mortality among black women is more than double that of white women in the United States and five times more likely in the United Kingdom.

Increasing numbers of women with high-risk conditions with inherent risks of complications as well as institutional policies limit opportunities for nursing students to gain hands-on training in maternal care. Yet, all nursing students, including LPN and nurses, trained in a 2-year program must prove MCH competency on NCLEX.

Governing bodies, such as JCAHO, are also seeking to decrease maternal mortality with compliance directives. Hospitals will be required to increase staff education, emphasizing hemorrhage and hypertension and preeclampsia (PPH and PreE). As part of the directive to increase education, annual drills will be standard procedure to help identify and improve quality issues. These will be in addition to any hospital system requirements already in place.

As sobering as these figures are, the most impactful is that an estimated 60% of maternal deaths are preventable.

VR maternity nurse training
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Virtual EFM obstetric scenarios
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If you could improve maternal outcomes, would you? If the data proved that skilled care before, during and after childbirth saved lives, would you create an opportunity to train more practitioners? That, simply put, is why simulation labs endure the cost, difficulties and agony of maternity simulation. 

Our team saw an opportunity to deliver pain-free simulation – no epidural needed.

At OMS, we strive to improve patient outcomes by helping nursing students and hospitals meet their educational goals through immersive Virtual Reality (VR) simulation. In the first of a new library of Maternal Care scenarios, participants can gain much-needed practice in caring for a high-risk obstetric patient. 

Patricia is the first patient, presenting with preeclampsia. The OMS VR system allows participants to fully assess Patricia through history, examination, vitals and investigations, and provide management efficiently, effectively and sensitively.  The comprehensive scenario hones critical care pathways, including:

  • Caring for the ‘invisible patient’ through fetal monitoring
  • Dynamic EFM for strip review
  • Delivering medication in pregnancy 
  • Exploring risks around preeclampsia (placental abruption, stroke, eclampsia etc.) and markers of deterioration
  • Exploration of potential next steps depending on both maternal and fetal condition

The immersive scenario delivers an incredibly realistic virtual clinical experience, providing a real opportunity for learners to engage in the global initiative to improve maternal health outcomes.

Point-by-point, VR provides the experience learners need to provide care that returns more moms and babies safely home.

For a demo of the software, or to get a free trial of the maternity scenarios in your insitution, please use the link below.

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Future of Simulation, Interprofessional VR simulation, Video

Video: OMS Interprofessional at IMSH 2020

Posted on by Oxford Medical Simulation
IMSH 2020 VR - OMS
03
Feb

Dr. Jack Pottle outlines OMS Interprofessional during the IMSH 2020 conference

Interprofessional Education (IPE) in VR

Dr. Jack Pottle, Chief Medical Officer of Oxford Medical Simulation, speaks with the team at HealthySimulation about the OMS VR simulation system.

“OMS is taking the traditional way we do simulation and scaling it – saving time, saving space and saving money” 

Designed for medical and nursing professionals of all levels, Dr Pottle outlines the development of OMS Interprofessional – the IPE mode that allows clinicians to treat virtual patients together wherever they are in the world. OMS is helping healthcare system expand and optimize their simulation delivery to improve patient care…

“Allowing hospitals, hospital systems and simulation centers deliver training that is objective, standardized and of seriously high quality. It feels real; it improves performance”

Learn more about the OMS platform here, or discover more about interprofessional simulation below.

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Future of Simulation, Virtual Reality Medical Training, Virtual Reality Software

The Importance of Simulation

Posted on by Oxford Medical Simulation
Types of simulation
18
Sep

This week is Healthcare Simulation week and as part of the celebrations we take a look at five reasons to salute the wonderful practice of simulation…

 

 

1. Simulation improves patient care 

By far the most compelling benefit of simulation in healthcare is the positive impact that it can have on patients. After all, a drive to  improve patient outcomes and the quality of their care is at the basis of healthcare education systems worldwide…

Providing future healthcare workers with the resources to optimize patient care – be that through effective clinical acumen, time management, communication and everything else in between – is the bedrock of a successful healthcare system.

Essentially, simulation sets trainee doctors and nurses up to effectively make people better when they come to practice in real life. In 2012, Benjamin Zendejas (Mayo Medical School, Rochester) set out to prove how far simulation training promotes positive results for patients. The findings were powerful; simulation-based education was shown to be directly linked to patient benefits when compared to both non-simulation-based training and instances where no intervention was given at all. 

Linked to this is the propensity for simulation to reduce patient harm. No clinician wants to inadvertently complicate or worsen a patient’s condition but medical error is the third leading cause of death in hospitals worldwide. With simulation, we are able to reproduce patient care sequences with all the clinical complexities of real life scenarios allowing clinicians to cover all the bases when treating real people. 

Ultimately, simulation-based training produces more competent healthcare professionals which can only be beneficial in improving the quality and safety of patient care. 

 

2. Simulation inspires confidence

Few on-boarding periods of a new job can be as daunting as starting out as a junior doctor or nurse. Fetching coffees, navigating the intricacies of a Kafkaesque office bureaucracy, whilst remembering not to raid Belinda from Accounts’ personal HobNob stash seem like a walk in the park compared to a 12-hour shift filled with hundreds of patients with complaints ranging from the utterly absurd to the genuinely life-threatening. 

To make matters worse, strained resources, overcrowded hospitals and staff shortages mean that most junior healthcare professionals face much of this without the necessary support.   With simulation, clinicians are able to practice managing acutely unwell patients without causing real patient harm if it goes wrong. In this way, practicing emergency care during training can take the edge off the intimidating world of real life practice.

This is something we’ve been made directly aware of at Oxford Medical Simulation through the roll-out of our virtual reality simulation platform at Oxford University. There, learners told us that, “it’s really good to get the experience of being put in the driver’s seat, of making the decisions…I think it will give me more confidence to make those decisions [in real life]”.

 

What is more, simulation-based training as been shown to improve junior clincian’s confidence in pushing for improved patient outcomes within real life treatment. Healthcare training is inherently hierarchical and this can often mean that trainees are afraid to speak up when they think a senior colleague is not administering the right kind of treatment. 

In a study carried out by the University of Harvard and Massachusetts General Hospital, simulation was shown to increase the frequency and quality of interventions by Residents in the care suggested by their seniors. 

Simulation can therefore be seen to not only improve patient care by bolstering the doctor or nurses confidence in their individual practice, but also promoting appropriate assertion in challenging a treatment plan when they think there might be a better way. 

 

3. Simulation lets us learn from our mistakes 

In our personal and professional lives we learn best from the mistakes we make. Cultivating an attitude that embraces mistakes as an inevitable part of life that can be mined for valuable lessons is an effective way to successfully avoid making mistakes in the future. Within the context of healthcare however – where the price of our mistakes can be fatal – this kind of philosophy can be hard to accept. 

In practicing simulation a safe-space is created in which healthcare professionals can refine their clinical skills without the risk of harming real patients. When effective debrief is built into simulation, the learnings taken from this form of training  are invaluable. With learners identifying strengths and areas for improvement in a supportive atmosphere. This is a powerful combination that mitigates against these mistakes being made in real life. 

Further, the emphasis on debrief engenders good habits of self-reflection for trainees to take through their entire professional careers. When clinicians are used to assessing their own practice regularly they are personally assuring the quality of the care they provide. 

 

4. Simulation works across all healthcare disciplines 

Simulation works effectively across all healthcare domains including; medicine, nursing, paediatrics, mental health, surgery, emergency care, life-saving and more. What is more, simulation surpasses all other training mechanisms in touching the most comprehensive set of skills ranging from specific procedures to communication and teamwork. 

The controlled nature of simulation means that institutions can ensure learners are exposed to as wide a range of clinical presentations as possible to build up depth of knowledge. Stress conditions can be put in place to mirror real life scenarios and test trainees ability to cope under pressure. The debrief that follows these experiences means that learnings are not lost or left open to individual interpretation. 

Simulation is also deliverable across multiple platforms. Mannequin-based simulation has long been used to produce life-like conditions in which learners can practice patient management. Similarly, the use of standardized patients in simulation is effective in creating a true-to-life environment where learners are able to interact with a real person. Increasingly, virtual reality is being used to deliver repeatable, immersive simulation at scale. 

 

5. Simulation is widely practiced worldwide

We’ve often heard it said that – if you do not work in healthcare – simulation is probably the biggest industry that you’ve never heard of. When you stop to think about it – it makes sense. You wouldn’t expect pilots to fly planes without practicing in simulators first – so why should we expect the people taking care of our health not to do so as well? 

There are hundreds of organisations, institutions and individuals doing wonderful things in simulation across the world.  Organisations such as SSH and ASPiH organise renowned international events like the International Meeting on Simulation in Healthcare (IMSH) to encourage knowledge sharing and best practice. 

As part of Healthcare Simulation Week, Boston Children’s Hospital hosted a Facebook Live event to give the community insights into how its state-of-the-art paediatric simulation center works. Having run an immeasurably impactful simulation programme for over a decade, BCH has now taken is simulation capabilities on the road. Offering over 50 courses at nine institutions across eastern Massachusetts – its SIM Network initiative shows that simulation best practice can be distributed at scale. 

In the UK, the NHS Diabetes Programme is using simulation to directly impact the treatment of people with Type 1 diabetes. Using the OMS virtual reality simulation platform, doctors are able to practice treatment before they see real life patients. Diabetes treatment can be notoriously tricky and for many doctors the first time they have to manage diabetes-related cases is in real life. Using simulation, the NHS is able to train doctors on the specific complexities to look out for, without compromising the quality of patient care. 

The healthcare team at St Luke’s University, Pennsylvania, have customised a freight truck to serve as a mobile simulation suite. Offering training opportunities across disciplines, people that live in remote areas that once may have been unable to access a healthcare education are now able to access valuable resources to further their careers. In this way, St Luke’s mobile simulation operation is promoting diversity and social mobility in healthcare and beyond.

These are just a few examples of the ways in which simulation is being leveraged to improve healthcare training and education, and in turn, our healthcare systems and standards of patient care. 

Happy Healthcare Simulation Week! 

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Future of Simulation, Virtual Reality Medical Training

Oxford University Partners with Oxford Medical Simulation to Transform Medical Education

Posted on by Oxford Medical Simulation
05
Aug

The world’s leading medical schools are embracing state of the art virtual reality software to push student’s learning to new heights.

Oxford University has partnered with Oxford Medical Simulation to train medical students using virtual reality. Students can now practice medical emergencies using true to life virtual scenarios without risking patients’ lives.

The technology, developed by Oxford Medical Simulation (OMS), allows medical students to practice treating acutely unwell patients in a simulated, virtual environment as often as they like. Training in this way improves patient care in real life by allowing repeated practice in simulation to build competence and confidence.

Why VR?

Oxford University decided to employ this innovative technology as a way to get more students through simulation. Simulation – where trainees practice medical emergencies as they would present in real life – is widely regarded as one of the most effective ways of training healthcare professionals. Simulation is traditionally practiced with high fidelity plastic mannequins in mocked up hospital wards. However, this form of simulation is time, space and budget consuming meaning medical students may only get to experience one physical simulation in an academic year. With virtual reality simulation, students are now able to practice simulated scenarios as often as they like.

The system is being used at the OxSTaR centre based at the John Radcliffe Hospital in Oxford – the main teaching hospital for Oxford University Medical School.

Rosemary Warren, Centre Manager at OxSTaR commented,

“As a world-leading institution, it is important for us to remain at the forefront of changes in the types of learning opportunities we offer our students. Embedding virtual reality simulation into what we do has enabled us to give a far greater number of learners access to simulation in a shorter space of time. It’s encouraging to see how quickly our students have adopted the technology. I’m excited to see how they progress clinically as they use it more and more. Simulation is a vital part of medical education and students just don’t get to do it enough. The OMS virtual reality platform allows learners to enter simulation as often as they like to transfer their knowledge to practice.”

The OMS system works by providing students access to libraries of medical emergencies that allows them to simulate the treatment of a range of conditions such as sepsis, diabetes, cardiac failure, pancreatitis and many more. Students enter the interactive virtual scenario using an Oculus headset and are greeted by a virtual nursing assistant and their patient. Learners are able to question, comfort, examine and treat the patient as they would in real life. Every action the learner takes up to – and including – diagnosis and resolution is recorded and fed into the system’s inbuilt feedback engine. Once the scenario is complete, the learner is taken through this feedback to understand what went well and what they need to improve on.

The emphasis is on training effective decision making, critical thinking and clinical reasoning. Healthcare learners have a safe space where they can apply their knowledge and learn from their mistakes.

Dr Jack Pottle, Founder and Chief Medical Officer at OMS said:

“We’re delighted to be working with world leading institutions like Oxford to bring our platform to medical students. We have developed OMS out of a belief that training healthcare professionals in a flexible, zero-risk environment will transform patient care around the world. We learn best when learning from experience and our system allows users to do just that – without putting patient’s lives at risk.”

OMS are currently providing free trial access to the platfrom to healthcare institutions – use the form below to contact the team. 

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Future of Simulation, Virtual Reality Medical Training

Is Embracing Human Error the Future of Healthcare?

Posted on by Oxford Medical Simulation
03
Jun

It’s a good job Frank Sinatra wasn’t a clinician…

Crooning “Regrets, I’ve had a few, but then again… I can never mention them because there’s an inherent denial of error in healthcare,” doesn’t exactly have the same ring to it, does it?

Ol’ Blue Eyes aside, I’ve been thinking a lot about mistakes recently. I’ve been thinking about the mistakes that we make as doctors and nurses and how they have irreversible effects on the lives of our patients. And I’ve been thinking about my own mistakes. How I have missed diagnoses, delayed treatments, discussed plans insufficiently and how this has impacted the lives of the patients who trusted me with their care.

And as well as reflecting on these errors and how they forever change the lives of our patients, I’ve been thinking about how they affect us as clinicians and how best to learn from them. And, paradoxically, how we never speak about them.

Humans make mistakes. Outside hospital we admit these mistakes, own up to them with people we trust and try not to repeat them again. Yet what is taken as normal in everyday life doesn’t work in healthcare.

Why don’t we discuss our mistakes?

Firstly, litigation. There’s an understandable sensitivity around talking about what’s gone wrong as it leaves us open to malpractice cases. Cases like that of Hazida Bawa-Garba – a doctor struck off for missing sepsis – does little to dispel this. There is a feeling that the legal vultures are just waiting to close in after every slip-up.

Then there is shame. There is a deep personal shame in making mistakes. We are taught that only juniors make mistakes and we grow out of them as they become more senior. There is therefore an inherent unwillingness to admit we make mistakes as we become more senior; we should be above this.

And in addition to the personal threat of shame is the societal threat of ridicule. Healthcare is a competitive field where we only show the best side of ourselves to our peers. In opening ourselves up to become ‘the guy who made that mistake’ there is a vulnerability we’re not prepared to accept.

The organisation threat of litigation, the personal threat of shame and the societal threat of ridicule by our peers is a powerful combination. And a combination that coalesces to form a more general fear – if we do admit our mistakes we will be alone.

The fear of ridicule distances us from our peers. We fear the institution we work in will distance itself from us in litigation. And the removal of these two vital supports – colleagues and organisation – leaves us alone and adrift when we are least prepared to deal with it.

Does discussing mistakes matter?

In short, yes. If we don’t discuss our mistakes, it is impossible to learn effectively from them. There is a wealth of evidence that debriefing on mistakes improves future performance. This effect comes not only from learning from our own mistakes, but learning from our colleagues’ errors. In not discussing our mistakes as a group we are depriving our colleagues of the knowledge they could have gleaned from our mistake and the rich vein of potential for broader error reduction has been lost.

This error reduction is not just in relation to other clinicians avoiding specific mistakes. Most errors are not due to a ‘bad clinician’, rather the same or similar medical errors have been made many times before in many different ways by many different clinicians. And errors are rarely due to one clinician happening to make a mistake. They are a combination of a huge number of factors that align to make an error. Therefore in not discussing as a group we are not only depriving our colleagues of knowledge, but we are leaving the system open to ongoing failures by not identifying system-wide faults.

Brian Goldman discusses the culture of mistake denial in medicine in his 2010 TEDX Talk: Doctors Make Mistakes. Can we talk about that? Goldman talks about his own experiences of making mistakes and argues we need to find a way to embrace that in a more constructive way.

Goldman closed his TED Talk with a call to action for the medical community to redefine its attitude to mistakes, to find ways to openly and sympathetically discuss them in order to better learn from them. That was almost ten years ago and I’m not sure we’ve answered his rallying cry yet.

So what can we do?

There is still hope, and it starts in medical and nursing school.

We must teach medical and nursing students that mistakes are inevitable in a high pressure field with exponentially increasing complexity and pressure. Only in doing this from the start, in teaching students to be comfortable with uncertainty and that mistakes are inevitable in an uncertain world, will we begin to change the tide.

Companies such as Oxford Medical Simulation are actively trying to create a safe space in which to consider clinical mistakes that Goldman so rightly encouraged us to cultivate.

OMS builds lifelike but non-judgemental virtual reality scenarios in which students can see and treat patients like in real life. This allows learners to make mistakes in the virtual world rather than in real life, without any sense of reprisal.

Reflection and debrief on performance is built into the system, guiding learners to discuss errors, before providing structured feedback on performance. In this way, learners are in control of building a culture of supportive discussion of error.

While it is key to embed a culture of discussing errors at medical or nursing school, this is not enough. Once clinicians have been taught that making mistakes is normal, that discussing them is vital, and that this can improve patient care, we need to have systems that support reporting of these errors, to disseminate knowledge.

Reporting of mistakes, reporting of near-misses, reporting of anything that might compromise patient care should be the norm. And this should be true from the porters through the clinicians to the CEO.

To do that, we have to extricate the shame loaded into such discussions of error. Though a broad culture change to make error reporting the norm will take time, one simple way to help this is anonymisation. Building simple, anonymised reporting systems into hospital infrastructure – where an error is reported to the patient safety team, a collaborative action plan is formed and reported back to the clinical team without fear of reprisal – is vital. None of this is difficult, and it will surprise many people outside healthcare that this is not the norm in more hospitals, but all will help create a system that helps identify and supports rather than punishes.

Finally, the systems above are worth nothing if not supported by patients. It is imperative that patients and the public support and can contribute to the structure of such systems – what clinicians and hospital managers feel is important can be very different from the patient voice.

Alongside this, patients and the public must begin to accept that in a complex system, doctors will make mistakes. Healthcare is an imperfect science – many of the decisions we make are based on little or no evidence. In a world where new treatments are being invented daily and conflicting evidence is produced at the rate of 1,000 papers per day, clinicians cannot know what the ‘correct’ course of action is in many cases.

Often the ‘correct’ course does not even exist so we make 50:50 calls.

Combine this with a workforce that is understaffed, overworked and burned out and there is no surprise that mistakes are made so frequently. That is not to accept mistakes – it is to accept what we cannot change, identify what we can change, and target this actively.

In summary…

Like the patients we harm, we carry our mistakes with us for the rest of our lives.

Arming our clinicians with the resources to acknowledge, reflect on and learn from their mistakes is crucial to identifying areas for growth and improving patient care.

Dr Jack Pottle is a practicing doctor, member of the Royal College of Physicians and Chief Medical Officer at Oxford Medical Simulation

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