Journal Club March 2021 – Healthcare Consumers in Sim Design

Introduction :  

Welcome to simulcast journal club! Each month we discuss an article on simulation and discuss it with colleagues around the world.  Every comment is valued and appreciated, we hope you join us in our ongoing virtual community of practice. 

Title :  “Healthcare Consumers in Sim Design 

The Articles : 

Sagalowsky, S., Kester, K., Woodward, H., Bailey, B. and Catallozzi, M., 2019. Lessons learnt from piloting paediatric patient-focused and family-focused simulation methodology in a clerkship objective structured clinical experience. BMJ Simulation and Technology Enhanced Learning, 6(5), pp.306-307. 

Symon, B., Edwards, R., Twigg, S., Ardila Sarmiento, M. and Barwick, S., 2020. Practical reflections on a collaboration with healthcare consumers on the development of a simulation. BMJ Simulation and Technology Enhanced Learning, pp.bmjstel-2020-000753. 

Discussion :  

As our understanding about simulation and its impact on healthcare culture becomes more sophisticated our ability to intentionally design simulations that signal core cultural values also grows.  While there is increasing movement to ensure simulated patients and multidisciplinary staff are engaged in simulation design, a less frequent occurrence is the engagement of healthcare consumers themselves. 

Paediatrics is a place where the importance of engaging parents as part of a healthcare team is paramount.  As such it remains particularly fertile ground for the engagement of families and patients within simulation design.  In this month’s two papers, we look at two in practice reports from BMJ STEL that contain reflections and advice about successfully engaging patients in scenario design, and the opportunities for advocacy their different strategies highlight. 

We look forward to your thoughts regarding healthcare consumer engagement in simulation : When is it most appropriate? What have been your experiences?  What are the costs?  And why aren’t we doing more of it?  Is there risk of it becoming tokenistic? 

About Ben Symon

Ben is a Paediatric Emergency Physician at The Prince Charles Hospital in Brisbane and a Simulation Educator at Lady Cilento Children's Hospital. He currently teaches on a variety of paediatric simulation based courses on paediatric resuscitation, trauma and CRM principles. Ben has a growing interest in encouraging clinical educators to be more familiar with simulation research.

3 thoughts on “Journal Club March 2021 – Healthcare Consumers in Sim Design

  • Dan Hufton

    What a great topic for the journal club. We have recently been discussing some simulation education for neonatal communication skills and thinking about how to involve parents in the design development – both articles have given me lots of ideas – Thanks Ben!

    Both papers, illustrated nicely how vital the ideas of parents and patients are to our design and delivery – there were some nice examples of how their collaboration had led to meaningful emphasis change, reframing the learning outcomes to more patient-centred. (An analogy about ketchup comes to mind: Where do you look for the ketchup – cupboard or fridge? if you have all fridge or all cupboard people in your team you will only ever look for the ketchup in those locations – you need diversity (cupboard AND fridge people) to think of the best solutions! A slightly random analogy but hopefully it makes sense!!).

    In the Sagalowsky et al paper I admire how they involved patient’s/families at multiple time points, They must have created a strong collaborative environment listening to each other and a group receptive to changes and trying things differently – particular the example about changes they suggested to SP expressions stands out to me (something I’ve struggled to feedback previously!!). it was interesting that it was OSCE scenario so the patient groups were directly affecting the emphasis of assessment as well. I wonder how aware the students were that patients had co-written the station (this fact in itself might emphasise to the future practitioners the importance of co-design?). I was particularly intrigued by the paragraph about the changes the patient’s and families made to “staging (ie, room décor and props) for improved psychological fidelity”. Following last months discussion about functional task alignment and physical resemblance, it was fascinating to hear about important “props, such as primary care pamphlets and infant toys in the paediatrician’s office; motivational posters and condom bowls in the adolescent clinic”. I would love to understand this more, what difference did they see this making? I did wonder if there was any points of tension and how they were resolved? I also wondered how resource-intense (or not) this approach was.

    In your (Symon et al) group’s paper Ben I liked how you dealt with this educational tension between developing a resource for more novice practitioners and the parent’s request for expert/experienced port access. My thoughts about only involving one family would echo your conclusion – though my thought is not so much about tokenism. Tokenism to me means a superficial/lip service involvement – which is as much risk (or even more a risk) with involving a larger group. The attitude of why and how we listen, respect and co-design is what matters I think. It sounds like you had a deep meaningful collaboration with this one family – maybe that would be diluted by involving more? Each family’s experience is unique (and 100% of their experience) we, as practioners/educators, have had interactions with many different families and I think maybe some of the responsibility in co-designed projects is that we advocate for the other voices not in the room. With other QI projects involving charity groups/patient advocates there is sometimes a challenge in managing the varied frames of reference – maybe this is a new set of skills in facilitation that we need to develop? The WHY of involving patients in design seem clear to me, just the who? how? and what? to work out now!

    Great topic, inspired to read more and think really carefully about how to involve families in my future simulation projects.

    • Ben Symon Post author

      Thanks so much Dan, it was a great experience to collaborate with a family, and I loved that we you bring up that individual collaborations allow specificity, but group collaborations create more consistency and an opportunity to broaden / benchmark the average consumers goals. I agree both have value in different formats.

      One thing Id say I’ve learned after our last few collaborations is not in the paper: sometimes asking parents to relive stressful or sad events is empowering, but it can also be a little retraumatising. There have been times when I’ve been thrilled to have a parent willing to share the specifics of their story, and then realised half way through just how much they’re giving in that moment. What I had assumed would be an opportunity for advocacy and a positive experience for the parent can actually be reliving grief quite vividly.

      I have interviewed parents of a (survived) child with missed sepsis, for example, expecting anger at the health system, but instead the emotion I mostly picked up was guilt. Getting them to relive it was something I thought they wanted, and on one level I think they did, but on another level I was bring up emotions they had not reached peace with. It changed our dynamic and the way I approached the project.

      • Dan Hufton

        Thanks for those additional reflections Ben, that’s interesting – I suppose it’s about weighing up the balance of intended benefits (which seem clear) against the risks of additional psychological harm? Any reflections on how you might approach/mitigate these concerns? What preparation (and/or aftercare) for families would you consider?

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