Virtual simulation

Cite this article as:
Nick Peres + Tim Mason. Virtual simulation, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.26002

What do you think of when you hear the words Virtual Sim? If your mind goes to Neo (Editors note: Keanu was actually quite good in the first Matrix- feel free to argue) then we are of like mind. If you think of the stereotypes of mainstream media, you will likely think Ready Player One, Tron, or even Lawnmower Man!

COVID-19 has changed our world with “socially close” teaching universally banned. Simulation is no different and I, for one, miss it! We know sim has its benefits, in situ, and for hands-on practice. Can we get back to that reflective learning we know and love?

Medical simulation is a tactile, experiential teaching modality, however, as sim trainers, we are often told “the learning is in the debrief”. This leaves us to beg the question – can we re-create or port something like a debriefing session virtually? And if so, should we be pausing activity in our sim centres and giving all trainees a VR headset?

 

 Looking at the realm of Twitter and our practical experience, how have people tried to bridge this gap? What’s out there?

Remote sim

Passive: Watching a live simulation session streamed to a video conferencing application via the sim centre camera(s) (or mobile) whilst a team perform the sim. This is then followed by a facilitated debrief taking place remotely, again utilising a video conference platform.

Interactive: A simulation takes place but there may be some interactivity with a confederate in the room being directed via video by a learner as a team lead. The debrief then follows on the video conferencing platform. Pre-recorded video can be repeated as appropriate.

 

A quick note on cameras

We are investigating the types of camera that best convey a remote simulation scenario. These include fixed-angle cameras (such as utilising those cameras already within a simulation suite), handheld or accessible cameras, such as a body-worn GoPro or even utilising a 360-degree camera, which can then be explored by participants or debriefer using their mouse to navigate the 360 recorded space.


 

The advantage of the passive approach is that we do get to be involved in the process, however, there may only be one or two fixed-view cameras impacting on your impression of the scenario. It may recreate some of the visceral feelings we get in a resus but you are still physically and psychologically removed. The alternate scenario adds an element of interactivity but the action in the room won’t reflect reality as it won’t directly represent the real team. Both measures will need clear learning objectives that fit these new methods. One interesting thought is if this actually represents the way senior doctors view their department and “direct” their juniors remotely without the need to physically be present (i.e. overnight on calls)?

Others have tried methods such as Telesimbox where a video is played whilst a facilitator guides the learners (over video) through a pre-set scenario.

Other paid-for services include app-based 360° films which may have a degree of interactivity or higher-tech solutions using headsets.

 

360° Sim

We’ve been doing something a little bit different which is 360° Virtual sim. 360° video is filmed using a fancy camera that can record all the way around it with two fisheye lenses. The camera then stitches together the images into a sphere which you can then look around by swiping the screen on a tablet or moving your head around a VR headset. 360° video has been used as a debriefing tool in itself with some success. Medical students found it gave them a deeper appreciation of their communication skills during the simulation.

Two years ago I was helping run a Return to Paediatric Training Sim course in the south-west, We didn’t have any time to add in resus but felt that it was an area people worry about. With the expert help of Nick of the Torbay VR team, we made a Neonatal Life Support (NLS) and an Advanced Paediatric Life Support (APLS) simulation utilizing  360° video which participants could access at home. The learners on the course loved it, though some felt it was stressful or uncomfortable, The sights and sounds of the room meant everything soon felt familiar. For others, it inspired them or put them back in the zone.

 

When the world became socially distant, it gave us the opportunity to debrief these videos over a video conferencing platform. Using 360° videos, the viewer becomes an active observer right in the centre of the action.  Although they can’t truly interact with the scene, they are still placed in media res. This really helps to bring about discussion of non-technical skills, with associated feelings and humanistic considerations, in the debrief.

If you have content that is created and shared with you to use, it then essentially becomes an accessible and free setup with no need for manikins, faculty, or dealing with the frustrating lack of parking spaces. Here’s an example of a 360° sepsis sim we ran and debriefed remotely.

 

There is also the potential to teach larger groups than what would normally be run through an in-person simulation session.  

 

Making your own 360° content

  • Write your simulation with learning objectives appropriate to your learners – think, medical, technical and non-technical.
  • Think about which scenarios work. Emergencies with lots of different teams to follow may be fun, but think about the difficult communication scenarios (safeguarding, breaking bad news) as it may be a safe way to sharpen communication skills.
  • A 360° camera (roughly £400) and stand (grip/ microphone stand).
  • A computer capable of editing (it needs a good graphics card)
  • When filming, position your camera at eye height in the centre of the action (hanging from the curtain rail is good).
  • Take away all patient identifying info if in situ (the camera sees all).
  • Think if you are going to tell the sim participants the theme of the sim. It adds to psychological safety but you may not get the authentic simulation experience.
  • Film it again if things go wrong as it is harder to edit afterwards.
  • Editing- steep-ish learning curve but simple things can be done easily in free packages.

 

Running your remote or 360° virtual Sim teaching session

  • Planning is key- time and place are less of an issue but think of your learners. How is the session going to meet their learning needs? Is there something particular that you are going to focus on?
  • Pick your video conferencing application of choice – we all have our favourite/ the one our trust allows us to use. Are you sharing your screen? Are you using sim centre cameras or mobile phones?
  • Practice using the kit/ technology before you do it live – not once but a good few times.
  • Solid Pre brief/ ground rules for the session are important.
  • Beware of “Zoom Fatigue”- try not to run a session longer than 1 hour. Most of ours have been 45 minutes at most.
  • Is the Wifi good enough? Will the videos cut out?
  • During the sim think about allowing learners/ observers to type thoughts and feeling that come to mind that you can then cover in the debrief.

 

Some thoughts on the virtual debrief

In a study looking at debriefing after medical serious games, in-person and virtual debrief both rated highly (self was the lowest). Remote debriefing has been used to train teams and faculty  in countries that do not have access to resources or experience in simulation.

 Make sure someone is designated to lead the debrief. Use the standard sim structure- Defusing, Discovery and Deepening. This model is based on Kolb’s experiential learning theory. This has made its way into many different models including Diamond, Pearls and ITRUST.

Who’s watching the watchmen? We’ve had more consultants during our sessions than the usual weekly sim. This changes the dynamic of the discussion. It skipped the medicine and went straight to the communication and processes seen. This may not be a positive for the junior members who needed experiential medical learning.  If using pre-recorded 360° content that is not live make sure you make it personal exploring real-life experiences. Has anyone seen this before? How does this work in your ward? Where’s the protocol kept?

As with all forms of online facilitated tuition, it is important to set the ground rules at the offset. Do you have learners muted? This will depend on the numbers in the debrief considering microphone echo verus silence.  You may need to use a signal to talk (i.e. Zoom thumbs up!). Everyone should keep their cameras on so you can see everyone and try to “read the room” keeping all involved.

So what might the future hold? It may be live streaming 360° content (which a lot of 360 cameras can do), a virtual space we can easily watch 360° video together, or Mozilla hubs where our avatars we can meet to watch content together. I don’t see this a replacement for regular simulation. It is an adjunct, a complimentary tool for the SBE toolkit.le.

Virtual Reality: Camilla Sorensen at DFTB19

Cite this article as:
Team DFTB. Virtual Reality: Camilla Sorensen at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.21504

Imagine a world where you could teach CPR from a thousand miles away, a world where you can guide clinicians on the other side of the world. In this groundbreaking talk from DFTB19 Camilla Sørensen tackles another side of virtual reality. This one involves the clinician as power user.

 

 

©Ian Summers

(Editor’s note – I was so excited when I watched this talk that I promptly bought myself a VR headset)

 

This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. DFTB20 will be held in Brisbane, Australia.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

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Practice made perfect?

Cite this article as:
Sonia Twigg. Practice made perfect?, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20694

Okay, perhaps  not perfect but we think these bite sized chunks of simulation from Children’s Health Queensland are pretty good! They are free to download and play with. You can find access to all current OPTIMUS resources here. Enjoy!

 

Introducing BONUS – A Bank of Independently Useful Sims

 

 

 

What are they?

OPTIMUS BONUS is an ongoing project driven by Children’s Health Queensland involving the creation of simulation education packages on topics in paediatric resuscitation.  Each package contains;

  • An introduction by an expert explaining why the topic is important.
  • A simulation with clear learning objectives, instructions and hints for debriefing.
  • Pre-reading resources for participants. These are fun and easy to read resources including podcasts, videos, guidelines and apps.
  • An infographic summarising the topic. QR codes on the posters link to Just In Time Training resources including videos and guidelines.  Just point the camera on your smart phone at the poster and a link will appear to the website to see the video.

 

Who writes them?

The STORK team (Simulation Training Optimising Resuscitation in Kids) from Children’s Health Queensland provides simulation based education throughout Queensland.  We provide two courses as part of our OPTIMUS curriculum; Optimus CORE (for first responders) and Optimus PRIME (for mid phase care while awaiting retrieval).

 

 Why did we make them?

 

What we love about them

  • They’re free to download, expert reviewed, repeatedly tested and assessed by a statewide advisory group to ensure we’re providing a quality product.
  • Our infographics look awesome, summarise the key messages, are easy to share on social media and easy to store on your phone.
  • Some packages contain Just in Time Training JITT resources and videos via QR codes to give you the info you need when you need it :
    • Just scan the QR codes on your phone to see refresher videos before you go and perform that skill
  • We’ve curated great open access #FOAMed resources on paediatric topics for each Simulation, so you can deep dive into more learning before or after the Sim!

 

Love the simulations and want to help out?

Thanks!  We need your help to share these simulations and infographics online any way you can. Shout out to @childhealthqld @LankyTwig @Caroelearning @paedsem and @symon_ben on twitter if you’re using them!

The other thing that REALLY helps is getting good feedback.  So, if you have thoughts on them to share fill out the surveys via the QR codes in the package so we can keep making better simulations to share with the world.

If you’d like to know more, email us at stork@health.qld.gov.au

Other than that, retweet them, share them widely, and help us improve paediatric care everywhere in the world.

 

Enjoy!

Sonia and the BONUS team

Dr Sonia Twigg (@LankyTwig), Dr Benjamin Symon (@symon_ben), Dr Carolina Ardino Sarmiento (@caroelearning), Dr Ben Lawton (@paedsem) Ms Louise Dodson and Mrs Tricia Pilotto.

 

Selected references

Case, Nicky, “How to remember anything forever-ish.:  Oct 2018.  Available at: https://ncase.me/remember/

Cheng et al, “Resuscitation Education Science: Educational Strategies to Improve Outcomes from Cardiac Arrest; A Scientific Statement from the American Heart Association.”Circulation 2018; 138: e82-e122. Available at: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000583

Cheng et al, “Highlights from the 2018 AHA Statement on Resuscitation.” June 2018.  Available at: https://canadiem.org/aha-scientific-statement-on-resuscitation-education/

Dubner S.“Freakonomics Radio.  How to become great at just about anything (Ep 244).” Apr 2016.  Available at: https://freakonomics.com/podcast/peak/

Ericsson A,“Peak” Vintage 2017.

Trauma, Teams and Tribes: Vic Brazil at DFTB18

Cite this article as:
Team DFTB. Trauma, Teams and Tribes: Vic Brazil at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20194

Victoria Brazil is a senior staff specialist at the Gold Coast University Hospital. She is a world renowned expert in the role of simulation in medical education.

A Simulcast journal club: Ben, Vic and Jesse at DFTB18

Cite this article as:
Team DFTB. A Simulcast journal club: Ben, Vic and Jesse at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19640

We were very privileged to be joined in Melbourne by the team from Simulcast. This piece of radio theatre was recorded in front of a live studio audience.

The team discussed, amongst others, these papers…

Ben Symon, Jesse Spurr and Victoria Brazil

Bearman M, Molloy E. Intellectual streaking: The value of teachers exposing minds (and hearts). Medical teacher. 2017 Dec 2;39(12):1284-5.

Ingrassia PL, Franc JM, Carenzo L. A novel simulation competition format as an effective instructional tool in post-graduate medical education. Advances in Simulation. 2018 Dec;3(1):17.

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

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We’ve only just begun…

Cite this article as:
Andrew Tagg. We’ve only just begun…, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19490

As we prepare for the opening of #DFTB19 and meeting friends from all over the world it’s great to see everyone getting stuck into the workshops.

The Compassion Lab

Mary Freer is the Fairy Godmother of the DFTB conferences. Since she spoke at DFTB17 we have been awed at her passion for compassion. This year she ran a boutique Compassion Lab to help bring a little more kindness to our workplace.

In our time poor, resource poor workplaces it can be a challenge to be kind, both to ourselves, each other, and our patients.

If you couldn’t make it over to London then there are still some tickets left for her Compassion Revolution in Melbourne.

Presentation skills 2.0

We like to challenge our speakers to step out from behind the lectern and bring their ‘A’ game. This can be quite confronting when you are used to watching the usual ‘death-by-powerpoint’ type of talk. To make it easier for our speakers Grace Leo and Ross Fisher have, once again, acted as speaker coaches. But we didn’t want only just our speakers to benefit from their wisdom.

Over the course of the day they took delegates from the basics of the P3 methodology to the next level of presenting. We are really looking forward to hearing their pitches for next year.

The Power of POCUS

Ultrasound is the way forward in paediatric imaging and for our two workshops Cian McDermott and Russ Horowitz had an amazing team to help them. With the support of GE Healthcare and Jon Robinson delegates were rotated around a variety of stations to test their ultrasound chops.

They were joined by Resa Lewiss, Mike Griksaitis, Avi Sarfatti and Toni Hargadon-Lowe.

We were lucky to have some very patient paediatric models to tell our ultrascoundrels if they were pushing too hard or putting the probe in the wrong place. We even managed to come up with a new US sign – let’s hope the Toast sign of a full bladder catches on.

Let’s Play Make Believe

A crack team of simulationistas led by Ian Summers ran two sessions on Sunday. Starting with a simulation design workshop and ably abetted by Sandra Viggers, Camille Sorensen, Morten Lindkvist, Damian Roland and LifeCast the group were set the task of designing in situ simulation scenarios with the child in mind.

The afternoon session was led by Walter Eppich who took the delegates through the power of debriefing. He is a man who has spent a lot of time thinking about debriefing.

Bajaj K, Meguerdichian M, Thoma B, Huang S, Eppich W, Cheng A. The PEARLS Healthcare Debriefing Tool. Acad Med. 2018, 93(2), 336.

The day ended with another storytelling evening. Old friends and new gathered at the Sway Bay in central London to share tears and laughter.

What happens at Storytelling stays at Storytelling!