Simulcast Journal Club October 2017 – Catherine Winterbottom’s 13th Birthday


Introduction :  

Simulcast Journal Club is a monthly series heavily inspired by the ALiEM MEdIC Series.  It aims to encourage simulation educators to explore and learn from publications on Healthcare Simulation Education.  Each month we publish a case and link a paper with associated questions for discussion.  We moderate and summarise the discussion at the end of the month, including exploring the opinions of experts from the field. 

The journal club relies heavily on your participation and comments, and while it can be confronting to post your opinions on an article online, we hope we can generate a sense of “online psychological safety” enough to empower you to post!  Your thoughts are highly valued and appreciated, however in depth or whatever your level of experience.  We look forward to hearing from you! 

Copy of Journal Club (1)

Title :  “Catherine Winterbottom’s 13th Birthday 

The Case : 

When Cath was 13, she invited 6 of her dearest friends over for a birthday sleepover.  Despite spending several hours recording the perfect boy band mixtape and repeatedly mentioning the event in maths class, nobody had RSVP’d.  It had turned out that Samantha van den Brink was having a sleepover the same night and that her mother had allowed her to rent ‘I Know What You Did Last Summer’ on VHS.  Her friends had simply prioritised accordingly. 

Which was why, years later, the feeling of being somehow uncool was so familiar as Cath sat in the empty conference room and stared morosely at an untouched breakfast buffet.  The paediatric special interest group breakfast had been one of things she was most looking forward to this SIM conference, but it looked like she was the only one coming. 

Across the hallway, she could hear laughter coming from the Simulated Patient Breakfast.  As she’d wound her way into the conference centre, she’d passed a number of bubbly people heading in.  When they’d said they were heading to the ‘SP Breakfast’ it had taken her a few seconds to register the abbreviation, it wasn’t one she used on a day to day basis.  Her paediatric SIMs were exclusively mannequin based, and the world of Simulated Patients was mysterious to her.  She wasn’t quite sure what they’d even have to talk about. 

Faced with peer rejection, 13 year old Cath had stayed at home and watched ‘Spice World’.  But she’d done a lot of growing up since then.  As it became clear nobody was coming, Cath took a deep gulp of her champagne, and with a grim look of determination headed across the hall. 

It was time she learned about this Simulated Patient thing. 

The Article : 

Lewis, K., Bohnert, C., Gammon, W., Hölzer, H., Lyman, L., Smith, C., Thompson, T., Wallace, A. and Gliva-McConvey, G. (2017).
The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP)Advances in Simulation, 2(1). 

Discussion :  
As simulation education has boomed, specialisation in its various subgenres has become viable.  In particular, the Standardised Patient community has taken leaps and bounds in becoming it’s own community of expertise. 

In this month’s article, Lewis et al provide the Association of Standardized Patient Educators Standards of Best Practice, but in doing so provide an overview of the principles behind using SPs and the community that has developed around it. 

What have you learned from reading this article?  How have you found incorporating SPs into your practice?  What are the challenges and what can we get better at?  Are you an SP? What’s your perspective on this release? 

 

References : 

Lewis, K., Bohnert, C., Gammon, W., Hölzer, H., Lyman, L., Smith, C., Thompson, T., Wallace, A. and Gliva-McConvey, G. (2017).
The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP)Advances in Simulation, 2(1). 


About Ben Symon

Ben is a Paediatric Emergency Physician. He is based at The Prince Charles Hospital in Brisbane. In 2014 Ben was the first Simulation Fellow for Children's Health Queensland, and assisted in the statewide roll out of the SToRK Team's RMDDP program. He currently teaches on a variety of paediatric simulation based courses at Lady Cilento Children's Hospital on paediatric resuscitation, trauma and CRM principles. As a relatively new simulation educator, Ben has a growing interest in encouraging clinical educators to be more familiar with simulation research.


Leave a comment

Your email address will not be published. Required fields are marked *

21 thoughts on “Simulcast Journal Club October 2017 – Catherine Winterbottom’s 13th Birthday

  • Sami Rahman

    This is a great perspective. We have transitioned from volunteer family and friends to a healthy line item budget for SP’s because the value has been recognized by our faculty and leadership team. Just like this topic, many more opportunities for froth in our simulation environment lay ahead for us to explore. Thank you for starting this journal club.

    • Carrie A. Bohnert

      Welcome to the SP family, Sami! We are always looking to bring more simulationists into our practice. Please reach out if you would like to network or participate in more professional development.

      • Ben Symon Post author

        Thanks for your comments Sami and Carrie. What has struck me about the SP community is this sense of excitement and ‘family’ that Carrie mentions. As a relative outsider to the SP community I’m curious about why this subcommunity of SIM practitioners generates such passion and online connection! Why do you think this is?

  • Karenne Marr

    Yes , Catherine , listen up !
    I’m an SP and while I appreciate mannequins have their place in education, they are still a fake human . Everyone knows that .
    I have emotions, I ask questions, I have expectations, I give feedback,
    I’m a real human who possibly won’t remember what you say , I may not even understand. . However I will know , and I will always remember how you made me feel.
    In fact , how you make me feel is what makes me think how capable you are , and , unlike a mannequin, I have a lot of people to share this with .

  • Ben Symon Post author

    Hehe thanks Karenne, I can sense both your passion and your connection with your learners in your response.

    So having read the full article and lists, I think it’s so wonderful to have this article as an open access resource for both Simulation Educators to reflect on their practices and see how they’re doing with these ‘aspirational guides’ as the authors put it.

    I think there are a lot of good points within the guideline that your typical coal face simulationista such as myself would not consider or have thought of prior to reading this document, and I think we are lucky to have the experts involved provide their advice on the subject.

    What were the big take away points for me? There were a lot of little details I learned. I particularly liked some comments around Scenario Design : “Ensure that cases are based on authentic problems and respect the individuals represented in a case to avoid bias or stereotyping marginalized populations.” (Although I would personally argue we don’t need to specify marginalised populations, just avoid stereotyping all together.). I liked how much emphasis there was on involving SPs in the learner feedback process as well as the emphasis on adequate preparation of the team prior to the sim actually running : “Review with SPs the key objectives, responsibilities, context (e.g., formative, summative, level of learner, placement in curriculum) and format (e.g., length of encounter, type of encounter) of each activity.” . I wish all of us did that better, not just with respect to SPs. A lot of times my medical staff will not have even read the sim until 5 minutes prior to running it. I particularly enjoyed the article when it elicited some SP specific stuff I don’t think about, like specifying physical movements and behaviours that might be needed for the Sim to the SP prior to their involvement. Obvious in retrospect, I know.

    I think if I was to critique the article, I have concerns about how easily this information will translate to the sim community. With the utmost respect to all involved, I think by it’s nature the article is a pretty dry read, being both in depth, highly specific and difficult to summarise within a snapshot narrative. In many ways that’s not a fair critique as I think that’s just the reality of Best Practice Standards, but I wonder if there’s the possibility of streamlining or disseminating the information more effectively. (Hopefully this month’s journal club is one way! Which was part of my hidden agenda of choosing this article).

    But I found the overlap between different domains made it difficult for me to inherently understand the differences between them. E.g. What is the difference between Professional Development and SP training? The dot points within each domain make it clear, but the titles themselves feel blurry when I try and walk away from the article and encapsulate what it was about. Sounds picky? It is I guess, and motivated by the frame that I’m currently trying to summarise the article for our pdf summary. But I just feel like the branding of the domains could be slightly optimised. And my perspective is that’s important, because while SPs might be passionate about these standards, I’m concerned that passion might not be shared by a bunch of medical doctors who are rushing to do some SIM every now and again without a lot of formal training.

    It’d be great to have an infographic that maybe summarises some of the highlights or key principles of the article. The best example of which I think is the INACSL Standards of Best Practice at : https://www.inacsl.org/i4a/pages/index.cfm?pageID=3547
    A tall order to ask for I know, but I guess that summarises my response to this article :

    I loved it. I think it’s really important. I’m concerned that this article on its own won’t get the message out about all the valid points it raises.

    • Karenne Marr

      Hi Ben
      Your comments absolutely resonated with me . Although the article is very comprehensive and raises excellent guidelines, I found it a very long and it didn’t engage my interest .
      A very dry read indeed.
      I believe SP simulation to be a hugely effective educative tool .
      I am passionate in my belief that a 20 minute scenario will be a truly memorable experience for everyone involved .
      I am committed to providing a realistic impression, I research real case studies, dress appropriately , moulage, assimilate the personality and use props .
      I am always nervous about giving feedback, however I believe my words in the debrief are important . As the patient, I’m probably the most important person in the room and how I felt throughout the scenario is pertinent.
      I need to feel I am in capable kind hands , I need to feel safe and respected.
      I need to feel I’m in the care of a skilled team who are committed .
      If I do feel well cared for I will express my experience. Similarly I need to voice when I have felt less .

      • Ben Symon Post author

        Thanks for your thoughts Karenne. I worry that in re-reading my comments though that I have sounded too overly critical of an article I have huge respect for. I think any set of Best Practice Standards should aim to be comprehensive, expert led and of both high expectation and high quality. I think these guidelines achieve all of those things, while also being a great introduction to SP methodology for those that don’t practice it. I think in my first post I was sounding like I expected the article to be an easy read, and I don’t. I think I’m just trying to find the right words to explain that from my frame as a regular clinician, I really believe in these guidelines and want them to do well. As we’ve both stated, they’re not easy to skim through, which is not a flaw, they’re standards of best practice and as such they’ve got to be extensive and detailed. I’m just wanting to acknowledge that I think there will be some translational work that’s needed to get these embraced by a community that isn’t entirely academic.

  • Victoria Brazil

    Thanks again for the wonderful case Ben – hilarious for those of us who actually grew up in the 80s and were…. well….. ‘not cool’ !

    I agree these standard documents are hugely important, and have supported other initiatives for more consistent terminology, practice and research in this area.
    Although maybe not pure entertainment 🙂 , the paper describes a robust consensus process, similar to that i’ve observed at conferences/ summits on contemporary topics like social media and simulation based research, and of course is also the approach to the generation of ILCOR resuscitation guidelines and many other clinical ‘consensus’ work. A strength of the method often seems to be drawing together global perspectives, and approaches to other ‘cross context’ issues.

    The structure of these standard is pretty clear, and the notes on terminology also very helpful

    I suspect the safety issues are a very valuable addition – especially after just interviewing Ann Mullen from https://healthcaresimulationsafety.org/ about the various risks in healthcare simulation. ( look out for upcoming podcast episode)

    Training for feedback is very challenging area – as Karenne highlights – this feedback can be very powerful – and with great power comes great responsibility…..
    ..for both the SPs and the folks responsible for their faculty development
    At our medical school program, we’ve started doing joint faculty development sessions on feedback with both SPs and clinician tutors
    – i think it helps with a consistent and complementary approach.

    My only other comment is on the predominance of women working in these consensus groups, and then authoring the document. No idea why that is. Although when i think about it – it reflects the gender (non) mix in our clinical skills academics working with our SPs as well.?

    Thanks again Ben – and I hope Catherine finds her gang. Maybe she should have grown up in the 60s and learned she has to ” make her own kind of music..” https://www.youtube.com/watch?v=MkBwNEferV0

  • Rowan Duys

    Thanks again Ben for the case and to the team for the discussion. I’m a little concerned that my comments may de-rail some of the discussion about the SOBP, apologies, feel free to send me back to the paediatric special interest group. Like Ben, I will admit to having been surprised by some of the ‘I’ve never thought of that’ moments I had reading about how one may train up and use an SP to provide feedback or assessment, or the value of hearing from SP’s as they reflect on real emotions they encounter depending on the skill/technique/competency of learners. Really powerful stuff!

    But, in truth, this article has left me feeling a little frustrated, largely because of the distance I feel that exists between our programme, and where we’d need to be to even consider SOBP. If ‘perfect’ is the enemy of ‘good’, is ‘good’ the enemy of ‘just-get-started’?

    We use confederates in most of our sims, and have found them very useful vehicles for improving authenticity of learning experiences. But they are usually faculty clinicians drafted in on the day to portray the roles of family members, obstructive colleagues etc etc. No formal training, standards, feedback or assessment given. But I’d really like to use SP’s more.

    So I suppose, my question to the community is, how did you all get started? What lessons have you learned from drafting in medical-students as SP’s that you think are worth sharing or mistakes worth avoiding? Also, what does a sim look like when you start with an SP, who deteriorates clinically until requiring CPR or intubation? Do you pause, swap out the SP for a mannikin, and restart?

    A quick scan through the reading list reveals some very interesting titles, but I’m not sure I’ve come across anything for the ‘novice SP educator’ or ‘this is what we did when we had no SP budget and were tired of ventriloquist style conversations with mannikins’. I’d love to be pointed towards some starter-pack type references.

    In the meantime, I’ll just keep dreaming of a dingy night club somewhere with Ben, Ian and I crooning…..I want you back, I want you back, I want you back for goooood

    • Victoria Brazil

      Sounds like we need to do a ‘getting started with SPs’ episode for Simulcast !

      Your point well made i think Rowan.
      I was fortunate to walk into a fairly established SP program at the medical program i joined. Although they were mainly working on simple history taking for junior students, we could quickly make the leap with many to more complex simulation scenario work. And could already rely on many of the training, employment and educational processes established. For me it was an incredible eye opener after working with manikins for 10 years

      Our current challenges are looking at working with paediatric SPs and in trying to diversity the cultural mix of our SP group. Both of these are more complex than you might think.

      But yes – you’ve given me food for thought

      .

        • Jessica Stokes-Parish

          Hi Vic and Rowan – great discussion.

          Jan Roche and I have had the pleasure of working together on some of these practical challenges you both raise. It’s really challenging when our environments are ever-changing and quite diverse. In my previous role, my first job was to re-vamp/re-start a Simulated Patient program which used similar methods that you describe, Rowan – no particular standards, no particular training, often friends of friends coerced, some were paid, some were not – you get the picture! I’ll summarise our brief steps – there is a Masterclass on this and a paper sitting there waiting to be published, as it is a worthy topic of discussion.

          1. Assess what you do have (SP numbers, current payment approach, main use for SPs)
          2. Establish processes (recruitment, training, supervision, in-role approaches, finances, administration, performance review)
          3. Establish levels (what are your SPs doing – are they simply lying there for an exam, or are they providing feedback)
          4. Get started, and continually review

          It’s hard work – changing culture and maintaining a standard can go against the status quo. It took us well over 2 years to completely implement this program – but now it is widely accepted and here’s the kicker – it’s implemented and completely flexible across 5 different sites (metropolitan and rural, all with different needs and limitations).

          Hope this helps. Happy to chat further Rowan. You can catch me at jessica.stokes-parish@newcastle.edu.au

          As for the SOBP paper – here’s a new editorial https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-017-0051-4

    • Debra Nestel

      I’m really enjoying this journal club. I’ve read the SOBP article several times wearing a few hats. I’ve written an editorial. I’m preparing to write another piece with colleagues that identifies points of intersection and departure for an Australian healthcare simulation community article on SP programs. See https://www.ncbi.nlm.nih.gov/labs/articles/28845722/ This article might also be helpful in “getting started” in SP methodology. The article also had a different purpose to the SOBP! I’m working with a small group in the UK considering “contextualisation” of the SOBP for their contexts – watch that space. In summary, I’m promoting, challenging and celebrating the work of our ASPE colleagues.

      I’m also enjoying the responses to Ben’s opening comments and thereafter.

      I’ll share a few points.

      The way in which I most enjoy working with simulated patients (participants) is in their role as proxies for real patients. And, as co-teachers and human beings (!) I avoid the phrase “using” simulated patients because I think this immediately objectifies them. Yep, written about that too – http://www.tandfonline.com/doi/abs/10.3109/0142159X.2011.596590
      In short, although SPs are simulators, they are not objects to be used but functioning as experts and, in my ideal world, offering perspectives as “patients”. That is, not offering clinician perspectives. I like to value SPs for what they can bring that healthcare professionals may not be able and can sometimes no longer see. It’s curious how doctors write books about their experience of being a patient… It makes sense that as healthcare professionals it’s really hard to have the same gaze as those who are not immersed in healthcare systems and practices all day every day (acknowledging that some patients unfortunately have this experience).

      In terms of process, I love the idea that faculty and SPs are briefed and undergo professional development together. This really celebrates their co-teacher status. My only caution is that SPs be valued for their interpersonal content offerings in feedback and that feedback on “clinical” content is not positioned as superior (might not be the intention but we have to actively work at valuing BOTH). In London when I worked with SPs most days of the week, an important role for me was helping SPs stay focused on patient perspectives rather than their feedback drifting into clinical/technical elements of healthcare. In some parts of the world, SPs also function as proxies for clinical educators. Warning – Can of worms opened… I’ve written about this in a few places so will stop here.

      And as for “confederates” – a different type of simulated participant…. I think we need the same care for them (especially when they are our junior colleagues) as we do for SPs. http://www.nursingsimulation.org/article/S1876-1399(14)00169-8/abstract
      With Nancy McNaughton and Jill Sanko, we have written a chapter on humanism in SP methodology… Nestel, D., Sanko, J., & McNaughton, N. (2018). Simulated participant methodologies: Maintaining humanism in practice. In D. Nestel, M. Kelly, B. Jolly, & M. Watson (Eds.), Healthcare simulation: Theory, Evidence, Practice (pp. 45-53): John Wiley & Sons.

      Some free resources – http://www.simulatedpatientnetwork.org You might also want to follow the SPN on Facebook. I’m involved in the network but I don’t receive income from it…

  • Nemat Alsaba

    Thanks Ben for choosing another great topic /article for discussion.

    Most of the points in the article have been covered by the masters of Simulation in the previous responses 😊

    I would like to share some practical tips and thoughts from my humble experience from working with “Simulated participants “
    Almost all our simulation for the under graduates’ medical students and post graduates are delivered through working with SP and hybrid simulation.
    • The important question when working with SPs is “what are we trying to achieve in that simulation?”
    If we are trying to teach Recognition and response to clinical deterioration” RRCD” or communication skills then working with SPs should be our first choice and then we can make it hybrid simulation by using (part task trainers). That is apparent as a manikin can’t give or portray those significant cues that an SP can provide (body language, appearance, verbal and non-verbal communication… Etc) This topic is close to my heart as I have done a research with Victoria awaiting publication “Medical students ‘recognition and response to clinical deterioration in simulated patient scenarios”.

    We have combined working with SPs and using Mankins in the same scenario when a procedural skill acquisition is required as part of the learning outcome of that scenario such as intubation (hope that answer one of your questions Rowan)

    • We should be working more with SP in our simulation programs and not only limit their participation or work (to the difficult conversation or challenging patient) while in fact you could enrich your simulation scenario with covering routine consultations, conversations and day to day procedures.

    • We also should consider the diversity of our SPs in our SP programs (gender, cultural background, special needs and age) our SP programs should reflect our diverse community.

    • I am a big believer of joint faculty development sessions with our Sps to improve our simulation service and delivery (thank you Victoria for highlighting that in your response). They are a valuable member of the simulation team.

    • I really liked Jessica’s practical points and I might add couple of suggestions to Rowan when starting your SP program:
    -If finance is an issue to recruit and train SP at the beginning I suggest approaching medical, nursing and paramedics Schools and ask for volunteers. This will be a mutual benefit.
    -Think about sustainability of the program and how you are going to keep your SP interested and committed.
    -When a new SP is joining your program make sure you include them initially as an observer in their first simulation with your program (even if they had prior experience with other simulation service!) This include the pre- brief, actual simulation, debriefing session and post simulation reflection and feedback.

    And I would like to finish with adding this great resource
    ‘Simulated Patient Methodology: Theory, Evidence and Practice’
    http://au.wiley.com/WileyCDA/WileyTitle/productCd-1118761006.html

  • Shane Pritchard

    Thanks for the journal club post and for starting this discussion Ben – great to read so many perspectives on the SOBP and from so many contexts too.

    I appreciated in considering the SOBP the importance of articulating the underlying values (safety, quality, professionalism, accountability, collaboration) that ought to be considered in SP programs and interactions. As this approach to simulation-based education becomes more widely implemented by educators, and therefore more familiar to learners, I think it is important that these values are not neglected in the “rush” that can sometimes tie us up as busy educators/clinicians – for the benefit of both SPs and learners. Additionally I think it is important that learners appreciate the profound opportunity that they have to interact with real people portraying authentic patient roles (as we encourage them to do with “patients” – simulation is normal/expected for many undergraduate students now!), and SOBP with clear values (that honour the people who are directly involved) and procedures I think can only be a positive step on this quest.

    I echo the previous sentiments about challenges with start-up and practical application of best practice guidelines. This position motivated the study referenced in Debra’s comment earlier – “The pillars of well-constructed simulated patient programs: a qualitative study with simulated patient educators” – although admittedly this was submitted prior to the publication of the SOBP. We sought to find out what experts actually do and suggest with regards to the on-the-ground actioning of a SP program, to assist novices in the area or those looking to implement a program relevant to their unique context. We also attempted to summarise some resources that are available to SP educators (books, guidelines, descriptive reports, short courses), and I would be interested to know if the readers of this blog have any additional suggestions as to helpful resources here?

    In a physiotherapy education context we are having ongoing challenges with cost and access so hopefully innovations, guidelines and collaboration here continues…

    One thing that has indeed struck me in reading this post is that I might need to get along to a paediatric SIG at the next sim conference I attend – given that champagne is served at the breakfast buffet!?

  • Carrie Hamilton

    Sitting at my desk in rainy southern England with 547 things to do in the next hour and I have been waylaid by this Simulcast. I loved the case. And this site. And the journal club. I’m pleased to be working with Debra and a bunch of us from the SP community in the UK where we’ll be considering the SOBP in the UK context and in relation to our Association of Simulated Practice in Healthcare (ASPiH) standards
    http://aspih.org.uk/standards-framework-for-sbe/

    • Nemat Alsaba

      Dear Carrie
      I am so thrilled to see your response in the journal club 😊I have attended your workshop on peads SP at ASC 2016 and this has inspired me to add peads SP program to our simulation centre. I would like to get in touch with you to discuss further your successful experience with paeds SP.
      My email
      talk2nemat@hotmail.com
      Thanks
      Nemat