Eight Critical Factors in Creating and Implementing a Successful Simulation Program from Joint Commission Journal on Quality and Patient Safety
Having just wrapped up our free posting of the HealthySimAdmin videos (8 recorded sessions focusing on the administration of medical simulation programs), we thought we might continue the series sharing other external resources on the topic, today sharing “Eight Critical Factors in Creating and Implementing a Successful Simulation Program” from The Joint Commission Journal on Quality and Patient Safety which was produced by Elizabeth H. Lazzara, PhD; Lauren E. Benishek; Aaron S. Dietz, MA; Eduardo Salas, PhD; and David J. Adriansen, EdD, NREMT.
Background: Recognizing the need to minimize human error and adverse events, clinicians, researchers, administrators, and educators have strived to enhance clinicians’ knowledge, skills, and attitudes through training. Given the risks inherent in learning new skills or advancing underdeveloped skills on actual patients, simulation-based training (SBT) has become an invaluable tool across the medical education spectrum. The large simulation, training, and learning literature was used to provide a synthesized yet innovative and “memorable” heuristic of the important facets of simulation program creation and implementation, as represented by eight critical “S” factors—science, staff, supplies, space, support, systems, success, and sustainability. These critical factors advance earlier work that primarily focused on the science of SBT success, to also include more practical, perhaps even seemingly obvious but significantly challenging components of SBT, such as resources, space, and supplies.
Conclusion: The eight factors—science, staff, supplies, space, support, systems, success, and sustainability—represent a synthesis of the most critical elements necessary for successful simulation programs. The order of the factors does not represent a deliberate prioritization or sequence, and the factors’ relative importance may change as the program evolves.
Consider specifically number 6: Systems
Systems should match fidelity requirements to training needs and ensure that technological infrastructure is in place! This is why considering events like SimGHOSTS is so important for your program!
For example, some simulators emphasize physical fidelity, in which the physical components of the task environment are replicated in the simulation. Physical fidelity, which can include not only equipment but even simulated patients, enables clinicians to practice technical and nontechnical skills in a safe environment that mirrors real-world conditions. Such simulators are most appropriate when trainees are learning how to use specific equipment or conduct specific procedures. The Center for Medical Simulation (Boston), for example, enhanced the physical realism of a critical care setting by including actual medical equipment and integrating oxygen and nitrogen systems. The center also uses a mannequin that has locking mechanisms to enable the instructor to control the positioning of the jaw and neck. Other types of simulations, such as personal computer–based systems, emphasize cognitive fidelity—the extent to which the skill in the real task is duplicated in the simulated task—over physical realism. High-cognitive-fidelity simulations are equally useful when the goal of training is to foster nontechnical skills such as problem solving and decision making that are needed in the task environment. For example, in a low-fidelity simulation, in which researchers at the Keck School of Medicine at the University of Southern California (Los Angeles) used material purchased from a craft store to develop a Total Abdominal Hysterectomy (TAH) teaching model, the simulation improved both knowledge and confidence among gynecology residents— illustrating that physical and cognitive fidelity are not necessarily mutually exclusive. Best practices for SBT in health care call for matching fidelity specifications to training requirements.
When determining the level of physical realism to incorporate in a simulation, system developers should partner with subject matter experts (for example, clinicians, nurses, administrators) and training experts to ensure that program objectives are realized. In addition to selecting the right type of simulator to employ during training, it is of paramount importance to ensure that the technological and organizational infrastructure is in place to support the training. For example, training systems that use laptops may require periodic software updates and are prone to all the familiar ills and frustrations of personal computers. Issues related to signal strength, server errors, and network security are also important considerations when using a local area network (LAN) or when using the Internet.