Thread by @caseyalbin

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A #tweetorial about simulation in NCC
Today @namorris opened his remarks on Sim in NCC @ #NCS2021 w/ a simple question about the correct first line treatment for SE? Everyone got it.

Then he posed a tougher question.

How often does that happen?

No one voted "always"

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Even the most groundbreaking research won’t benefit our patients if we aren’t delivering it correctly.

I so highly encourage you to check out Nick’s talk on-demand if you have access to #NCS2021.

It is 🚨critical🚨 that we teach more effectively!

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Convinced?

Some practical, take-aways from this talk about finding right Simulation Solution.

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Simulation is an amazing educational tool. But it can be used in other ways, too!

Simulation can be used to:
⭐️to evaluate trainees
⚡️ as a research tool to understand learners and systems
✨to understanding systems integration & improve care delivery.

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Defining the simulation’s goal is defining the “Why”.

And if you are interested in approaching this as research, it is crucial to approach it with a hypothesis and have a methodology in mind from the start. Another amazing pearl from @namorris.

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From the “why” you also will need to define the purpose of the sim -- the “what”:

“what is the learning object” “What are we trying to improve with this?”

Lots of options:

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What you want to accomplish defines “how” you should accomplish this. Simulation can be done through tissue models, task trainers, manikins, apps, virtual reality, standardized patient, and more

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It seems straight forward but the fidelity is only “high” or “low” in reference to your goal --
👉Teaching LPs on a task trainer is “high fidelity”
👉Teaching communication and leadership training with a task trainer…

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So we’ve got the “Why do this” & “What is the purpose” & “How are we going to do this”

But u also need “How are we going to run the case?”

A tradition model is to run the case & debrief @ the end
But, as @Capt_Ammonia loves, you can also rapid cycle & debrief as you go!

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Putting it all together. Each simulation:
👉has an overall goal: the “WHY” do this
👉has a purpose & specific learning objectives: the “WHAT” is it we are trying to accomplish
👉has a modality and method: the ”HOW” we are going to run the case

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Some examples I love that have used simulation in neurology/neurocrit care:
pubmed.ncbi.nlm.nih.gov/33005731/
pubmed.ncbi.nlm.nih.gov/22675080/
pubmed.ncbi.nlm.nih.gov/29467974/
pubmed.ncbi.nlm.nih.gov/25898887/
pubmed.ncbi.nlm.nih.gov/32424536/

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But simulation in neurocritical care has its own challenges.
1⃣How real is real enough?

A manikin falls short in the neuro exam.

Want to learn what the Babinski sign looks like?... manikin isn't going to cut it.

Check out @grepmeded instead

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But in the context of stroke, seizure, brain death, etc if you want to train learners to initiate a diagnostic workup, interpret radiology, correctly dose medications, screen for confounders, communicate findings… The manikin’s exam matters less.

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Work Sahar Zafar & I did @ MGH Learning Lab demonstrating that residents gained the same amount of confidence and knowledge in simulations with SPs as they did with a manikin. So glad @DanHarrisonMD and others are carrying this work forward @harvardneuromds!

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2⃣nd challenge: Does a learner’s performance in the sim lab correlate with how they are going to perform in real life?
This study (@namorris) suggests so! Sim-Based Assessment of Graduate Neurology Trainees' Performance Managing Acute Ischemic Stroke pubmed.ncbi.nlm.nih.gov/34706974/

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Finally – how are we going to prove that the work we do in a simulation lab translates to what really matters: improving patient outcomes.

It can be done but it's a challenge and requires a lot of accounting for confounders... the opposite of:

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But, I'm confident we in neuro/NCC we can overcome these challenges; there are so many awesome educators passionate about improving the delivery of care through sim @Tracey1milligan @captammonia @ghoshal_shivani @judyhtchang @aartisarwal @drdangayach @namorrismd and others!!

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I hope we can come together do multi-site studies and measure our impact!

And if you're new to sim, I cannot, cannot, cannot recommend the course at @MedSimulation more highly. Truly, it is LIFE CHANGING.

@GetCuriousNow @sim_podcast

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Thank you again, @namorris and @neurocritical for inviting me to speak. Its exciting to see #meded in #NCS2021! So excited for what the future of sim in neurocritical care!! #NCS2022
(And for fun sims @ @EmoryNeuroCrit! @JimmySuhMD @CajalButterfly @sigman_md @EricLawson90!)