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James Lipshaw

A Letter to Jenny Rudolph from Our Colleagues in Edmonton, Alberta

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Mary Fey with the CMS team and Albertan sim educators at MacEwan University in Edmonton.

Colette Foisy-Doll is a Registered Nurse (RN) and a Certified Healthcare Simulation Educator who has been on the faculty at MacEwan University in Edmonton, Alberta, where she now serves as Director of the Clinical Simulation Centre, since 1994. She was one of the first pioneers of simulation-based undergraduate nursing education in Canada and has served as a consultant for the development of more than 20 simulation programs in Canada and around the world, including programs in Jordan, Qatar, Saudi Arabia, and most recently in Turkey and Ukraine. She is also an alumna of the Center for Medical Simulation Comprehensive Instructor Workshop. MacEwan University has offered the Comprehensive Instructor Workshop twice, and most recently hosted the CMS Gateway Debriefing Workshop.

We recently received a touching letter from Colette Foisy-Doll, Director of the Clinical Simulation Centre at MacEwan University in Edmonton, Alberta. MacEwan had just hosted the CMS Gateway Debriefing Workshop, a one-day course which introduces healthcare education faculty to the foundational principles of “Debriefing with Good Judgement.”

Here’s what Colette had to say about the workshop:

Dear Jenny,

I trust that life is bringing heaps of goodness your way and I hope all is well in your world.

I am writing to send good news by letting you know what an amazing and transformational learning event Mary [Fey] and the CMS graduate facilitators provided for MacEwan University and our Interdisciplinary Healthcare Education Partnership community of practice. I was so very proud to be hosting this session and since last Thursday, have been barraged with wonderful remarks and positive feedback.

In keeping with the Center for Medical Simulation tradition of excellence through teaching Debriefing with Good Judgment, Mary provided us with a powerful and stimulating learning experience that was enhanced by the many gifts she so openly shares. She is amazing, and you already know that. It was especially meaningful to have Mary stay for our premier Sim-IPE HELP! Save Stan event where she got right in there, modeling debriefing and providing valued feedback for our facilitators.

She is a kindred spirit to all, not unlike other members of the CMS team. To me, this is one of the defining characteristics of your team and your collective work – you genuinely care about and for others and your commitment to empowering people fosters instant connections and life-long bonds that reach far beyond the outcomes of simple training sessions. Education is most valuable when it is emancipatory….

It is absolutely essential to spread the CMS word and to continue to transform our healthcare teams and environments one voice at a time while building capacity in our education/healthcare community. The Gateway course is very important because it brings the CMS experience to vast numbers of educators/HCPs that otherwise could not afford to partake. I hope many go on to taking the full course, but if they do not have access to funds, this is a huge opportunity to learn.

I am watching and noticing as CMS continues to expand and develop its programming and am excited to feel that I can play a small part of it!

All the very best to you and the team.

Cheers, Colette

 

And here is what Jenny Rudolph, Executive Director of CMS, had to say in response:

Dear Colette,

Thanks for this very touching and heartfelt message. It sounds like the Gateway course had a wonderful impact and that Mary Fey’s work was as magical as I know it to be.

You, of course, seeded the ground for this marvelous work with your long-standing commitment to excellence in debriefing, your skill, and of course heart!

What you describe below is the kind of impact and feeling that I think helps us all know why we are doing this work and inspires us to work hard to do more.

Thank you so much for taking the time to write.

Fondly,

Jenny

 

James Lipshaw

Jeff Cooper’s Letter to the Editor Provides Important Addendum to CRICO History

Jeffrey Cooper, PhD

On December 9, 2016, the journal Patient Safety & Quality in Healthcare published an article by Susan Carr, reflecting on the 40 years CRICO has served as malpractice insurance provider for Harvard medical institutions and their affiliate programs. (Full article: https://www.rmf.harvard.edu/About-CRICO/Media/In-the-News/News/2016/December/CRICO-Celebrates-40-Years-in-Patient-Safety)

On February 27, 2017, Jeff Cooper, Executive Director Emeritus of the Center for Medical Simulation, submitted a letter to the editors of Patient Safety & Quality in Healthcare, to address some critical pieces of the history of CRICO’s leadership in patient safety, which he felt were missing from the original article.

Thank you for giving visibility to the story of CRICO’s story of leadership in patient safety. It is worthy of praise and emulation. Yet, I think there are critical pieces of the story that perhaps space didn’t permit telling, although I think they are among the most important. Then again, I have a bias because I was there . . .

The other aspects of the CRICO patient safety story are important examples of how a forward-thinking insurance company can achieve a win-win-win-win (patient, provider, hospital, insurer). But, I believe it was the leadership of the HMS anesthesia Executive Committee that led to one of CRICO’s earliest and greatest successes, and that enabled the continued concentration on patient safety.

Dr. Cooper’s full letter, along with references, can be found at the Patient Safety & Quality in Healthcare website: http://www.psqh.com/analysis/letter-to-the-editor-cricos-patient-safety-leadership-a-missing-piece/

James Lipshaw

Participate in a Systematic Review of In Situ Simulation Debriefing

Are you an experienced simulation debriefer?

Victoria Brazil, Walter Eppich, and Margaret Bearman are looking for volunteers to participate in a systematic review of debriefing strategies for in situ simulations.

Please read their note below, and contact them at ISSdebriefing@gmail.com if you are interested in participating.

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The optimal debriefing strategies for in situ simulations (ISS) are unclear. The current practice of expert and experienced in situ debriefers has not been reviewed systematically. Most published reports of ISS programs lack detail as to how debriefing is conducted.

We’re conducting a study which aims to review the current practice of experienced in situ simulation debriefers – their context and approach, and the basis on which debriefing approach is determined. We’d like your help!

If you are interested in finding out more – please email ISSdebriefing@gmail.com

 

Many thanks

Victoria Brazil, Walter Eppich and Margaret Bearman

James Lipshaw

Behind the 2-Way Mirror with Dr. Crystal Tan

Dr Crystal Tan

Crystal Tan is a resident in Anesthesia at the Massachusetts General Hospital in Boston, MA. She spent the month of February at the Center for Medical Simulation on an elective rotation. The goal of the rotation program is to expose residents to the potential and operational use of simulation for education, clinical training and research. Over the course of the month, residents develop simulation scenarios including patient records, plot, setup, debriefing notes, and references.

“Have you ever wondered what happens behind the two-way mirror at a simulation center?

After spending a month at CMS, I can answer that question: wigs and fake blood, occasional burning smells, wonderful people dedicated to the art and theory of simulation, a willingness to roll with the punches and improvise, a philosophical approach to andragogy (a word I learned with Tony Dancel that means “adult education”), and a comically improbable amount of orange Tang.

I had a remarkable experience during my rotation. I learned about the technical ins and outs of staging simulations including setting up realistic scenarios, playing different operating room characters, and programming mannequins to have plummeting bradycardia or STEMIs. Through this supporting role, I watched (and sometimes helped) different groups of participants code a patient three times a day, three times a week. If repetition is the key to success, then I can’t think of a better way to practice ACLS protocols (not to mention the group dynamics intrinsic to crisis management).

A major component of the simulation experience is debriefing. After a simulation is completed, the team is given a chance to breathe, release their emotions, discuss the gritty details of the case, and perhaps learn something new. These sessions are run by debriefers trained to probe a participant’s thoughts with sincere interest and without judgment. I learned to set aside my preconceived notions as I observed and occasionally participated in these sessions. After each debriefing, I never doubted that each participant gave their full effort, and I believe each one walked away with at least one clinical or behavioral lesson they could incorporate into their practice.

The world of simulation is much larger than I realized; the depth of research, international collaboration, and even safety within simulation is incredible. Moreover, lessons from simulation are relevant not just in clinical practice but also in day-to-day life; if we could all set aside our assumptions and listen without judging, then we might all accomplish more.”

–Crystal Tan, MD

James Lipshaw

CMS Faculty Lead Four Courses at Australian Affiliates

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Center for Medical Simulation faculty, including Jenny Rudolph, Demian Szyld, Mary Fey, Walter Eppich, Julian van Dijk, Kate Morse, and Robert Simon trekked to Australia in February to help lead four sessions of CMS’ Simulation as a Teaching Tool courses.

Two courses took place at the Western Centre for Medical Education in Melbourne/St. Alban’s, Victoria, from February 14th to 17th and February 21st to 24th. Two took place at Mater Education in Brisbane, Queensland, from February 21st to 24th and from February 28th to March 3rd.

The Simulation as a Teaching Tool Simulation Instructor Workshop immerses healthcare simulation leaders and instructors in an inter-professional learning environment where participants learn to teach clinical, behavioral, and cognitive skills through simulation. This course draws from simulation-based pedagogy in field ranging from aviation to healthcare, psychology, experiential learning, and organizational behavior. Participants explore teaching methods that are applicable across the healthcare education spectrum, from undergraduate and graduate medical education to the nursing and allied health domains.

The day to day practice of the Simulation as a Teaching Tool course varies and includes simulation scenarios, lectures, small and large group discussions, and practical exercised on feedback and debriefing. The course also includes professional networking and events for sharing course and professional experiences.

James Lipshaw

Play “Simulation Go” at IMSH 2017 with #IMSHGo

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SIMULATION GO at IMSH 2017

The #1 point-getter will win a “DJ Simulationistas” vintage jacket!

The top 10 players will be entered into a random drawing to win CMS swag!

 

HOW TO PLAY:

1) Take photos of Simulationistas in the wild:

A photo of you being interviewed by the DJ Simulationistas team (Dan Raemer & Janice Palaganas) … 10 points

A photo of you at the CMS booth in the trade hall … 5 points

A photo of two CMS faculty or staff together … 3 points

A photo of three CMS course alumni together … 3 points

A photo of you at a workshop facilitated by CMS faculty … 2 points

A photo of CMS faculty running a workshop … 1 point

Follow CMS on Twitter or Instagram during IMSH 2017 … 1 point each

2) Send us the photo on Twitter (@MedSimulation) or Instagram (@centerformedicalsimulation) to earn points! Use #IMSHGo.

3) CMS will add up your points and post a leaderboard each night! Winners will be notified on Tuesday night.

James Lipshaw

The Center for Medical Simulation is at IMSH 2017 in Orlando!

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Please follow CMS on Twitter, Instagram, and Facebook for additional IMSH updates.

www.twitter.com/medsimulation

www.instagram.com/centerformedicalsimulation

www.facebook.com/medicalsimulation

 

CMS faculty and staff will be facilitating or co-facilitating the following workshops. Please make sure to check the IMSH website (www.IMSH2017.com) for up to date room locations and times!

 

Monday 1/30:

10:00-11:30AM: Simulator Death: Controversial Learning Tool Benefits and Consequences

Faculty Development – Barrell Spring l

Speakers: Andrew Goldberg, MD; Jennifer L Arnold, MD, MSc; Sam DeMaria, MD; Daniel Lemke, MD; Adam I. Levine, MD; Dan Raemer, PhD; Jeron Zerillo, MD

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10:00-11:30AM: Strategies for Successful Co-debriefing

Debriefing –  Celebration 14 and 15

Speakers: Adam Cheng, MD, FRCPC, FAAP; Gavin Burgess; Helen Catena, RN; Amy Cripps, RRT; Jonathan Duff, MD; Walter Eppich, MD, MEd; Kristin Fraser, MD, FRCPC; Vincent Grant, MD, FRCPC; Michaela Kolbe, PhD; Janice C Palaganas, PhD, RN, NP, ANEF; Traci Robinson, RN; Stuart C Rose; Jenny W Rudolph, PhD

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11:45AM-1:15PM: Speed Mentoring: Formal Training, Masters & Certificate Affinity Group Networking Event

Interprofessional Education – Bayhill 17 and 18

Speakers: Ambrose H Wong, MD, MS-HPEd; Amanda V Crichlow, MD; Sharon Griswold, MD, MPH, CHSE; Tiffany Moadel, MD; Deborah D Navedo, PhD, CPNP, FNAP; Janice C Palaganas, PhD, RN, NP, ANEF; Rami Ahmed, DO, MHPE; Lillian Emlet, MD, MS; James A. Gordon, MD, MPA; Joseph O. Lopreiato, MD, MPH; Grace M. Ng, MS, CNM, RN, C-EFM; Vivienne Ng, MD, MPH; Thomas Nowicki, MD; Mary Anne Rizzolo, EdD, RN, FAAN, ANEF; Janet K Willhaus, PhD, RN, CHSE

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3:00-4:30PM: Improve Debriefing Skills Through Peer Observation and Feedback

Faculty Development –  Celebration 12 and 13

Speakers: Grace M. Ng, MS, CNM, RN, C-EFM; Emily Diederich, MD; Dawn Taylor Peterson, PhD; Laura Rock, MD; Jenny W Rudolph, PhD; Robert Simon, EdD; Demian Szyld, MD, EdM; Penni Watts, PhD, RN, CHSE-A

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3:00-4:30PM: Improve Clinical Feedback Skills Using the FACE (Feedback Assessment for Clinical Education)

Faculty Development – Celebration 1

Speakers: Rachel Onello, PhD, RN, CHSE, CNE, CNL; Melanie Barlow, RN, MN, GradDipCritCare, GradCertEd, CertIV; Emily Diederich, MD; Mary Fey, PhD, RN, CHSE; Jose M Maestre, MD, PhD; Rebecca D Minehart, M.D.; Janice C Palaganas, PhD, RN, NP, ANEF; Laura Rock, MD; Robert Simon, EdD

 

 

Tuesday 1/31

10:00-11:30AM: Build Your Simulation Training Program from Scratch

Speakers: Michelle Marie McLean, MD; Sidhant Nagrani, MD; Ambrose H Wong, MD; Antoinette Golden; Demian Szyld, MD, EdM; Rami Ahmed, DO, MHPE; Thomas Nowicki, MD; Kimberly Schertzer, MD

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10:00-11:30AM: Peer Role Play to Improve Debriefing

Debriefing – Blue Spring II

Speakers: Dr. Usamah Saleh Alzoraigi, MD; Abdulrahman Y Sabbagh, MD; Abdullah Almarshed, MD; Dr Shadi Almoziny; Abeer Arab, MBBS, FRCPC; Charles Pozner, MD; Jenny W Rudolph, PhD

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10:00-11:30AM: Debriefing the Debriefer: Take Faculty Development to the Next Level

Faculty Development – Bayhill 22

Speakers: Rachel Onello, PhD, RN, CHSE, CNE, CNL; Amy L Daniels, MS, RN, CHSE; Michaela Kolbe, PhD; Kristian Krogh, MD; Dawn Taylor Peterson, PhD; Penni Watts, PhD, RN, CHSE-A; Nelson Wong, MD

 

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3:00-4:30PM: Peer Coaching to Improve Debriefing Skills

Speakers: Adam Cheng, MD, FRCPC, FAAP; Wendy E Bissett, RN, CNE; Gavin Burgess; Helen Catena, RN; Jonathan Duff, MD; Walter Eppich, MD, MEd; Tobias Everett, MBChB FRCA; Vincent Grant, MD, FRCPC; James Lewis Huffman, BSc, MD, FRCPC; Michaela Kolbe, PhD; Traci Robinson, RN; Stuart C Rose; Demian Szyld, MD, EdM

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3-4:30p – Giving Feedback on Feedback

Faculty Development – Bayhill 29 and 30

Speakers: Roxane Gardner, MD, MPH, DSc; Ignacio Del Moral, MD, PhD; Mary Fey, PhD, RN, CHSE; Kate Morse, PhD, ARNP-BC, CRNP, CCRN, CNE; Rachel Onello, PhD, RN, CHSE, CNE, CNL; Janice C Palaganas, PhD, RN, NP, ANEF; Dan Raemer, PhD; Laura Rock, MD; Jenny W Rudolph, PhD; Robert Simon, EdD

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3:00-4:30PM: Learner Deception: What’s More Important, Protection or Realism?

Faculty Development – Barrell Spring I

Speakers: Andrew Goldberg, MD; Jennifer L Arnold, MD, MSc; Sam DeMaria, MD; Daniel Lemke, MD; Adam I Levine, MD; Dan Raemer, PhD 

 

Wednesday 2/1

8:30-10:00AM: Navigating a Career in Simulation

Speakers: Michelle Marie McLean, MD; Sidhant Nagrani, MD; Ambrose H Wong, MD; Sara M Hock, MD; Roxane Gardner, MD, MPH, DSc; Sharon Griswold, MD, MPH, CHSE; Mary E. Holtschneider, RN-BC, BSN, MEd, MPA, NREMT-P, CPLP; Deborah D Navedo, PhD, CPNP, FNAP; Demian Szyld, MD, EdM

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10:30-11:30AM: Role of Emotion in Simulation Learning

Debriefing – Bayhill 21

Speakers: Gabriel B Reedy, PhD, CPsychol; Laura Rock, MD

James Lipshaw

Matt Vanneman on CMS Residency

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Matthew Vanneman is a resident in Anesthesia at the Massachusetts General Hospital in Boston, MA. He spent the month of October at the Center for Medical Simulation on an elective rotation. The goal of the rotation program is to expose residents to the potential and operational use of simulation for education, clinical training and research. Over the course of the month, residents develop simulation scenarios including patient records, plot, setup, debriefing notes, and references.

“My stay at CMS was one of the most pivotal moments of my medical career. When I first showed up to CMS, I thought I would receive some instruction on how to organize and perform medical simulation better, but instead my entire world view of medical education was completed upended. CMS taught me that much of the “conventional” methods of teaching medical education that I had experienced during my training were actually missing so many of the key elements of adult learning theory, and as a result, leaving learners behind. Since the course, I have completely change my own methodology for teaching (which, I found out, takes a lot of practice!), and I am now so excited to further develop my skills as an educator. Through the course, I was extremely lucky to meet such an incredibly diverse group of people, coming from Qatar, Saudi Arabia, New Zealand, Pakistan, as well as all over the United States, and to learn from their experiences and perspectives about medical education. These conversations have deeply shaped me, not only as an educator, but also as a person. IMS has opened my eyes to an enormous new world and method of medical education, and has driven me to continue to improve my teaching to reach my goal of becoming an expert in medical education.”

-Matt Vanneman, MD

James Lipshaw

Reflections on Two Months at CMS

Albert CollageAlbert Chan, MD, is an anesthesiologist and a Visiting Scholar at the Center for Medical Simulation.

“As I meandered down the hallways of the Center for Medical Simulation at the Navy Yard saying my final goodbyes, I could not help but marvel at the amazing intellectual journey the past nine weeks has taken me. Not only have I learned about the intricacies of medical simulation and education, I have gained completely new insights into myself.

When I first arrived at the CMS, it was a bit daunting as I did not know what to expect. I was at the very center of the simulation world, surrounded by experts in medical education. What will they think of me with my limited simulation experience? Will I be accepted by the staff and faculty? My concerns were alleviated in no time – in true CMS fashion, everyone embraced and welcomed me into the family and established the “safe container.” I was ready to become a learner once again.

There were many things that were impressive at the CMS – the flattened hierarchy, the openness of communication, the constant reflection and feedback to each other, the demand for improvement and excellence, the creativity of the sim techs (yes, Johnny Tsunami), the wealth of knowledge, the constant supply of soda (yes, it’s amazing). But if I had to pick one thing I learned the most from, it would undoubtedly be the Comprehensive Instructor Course.

I was fortunate enough to be both a participant in the course, as well as faculty observing from behind the scenes. I learned so much about the application of educational theories, the complexities of debriefing, and more about the adult learners’ mind. Not being a reflective person naturally, be it due to my culture or personality – the course has made me look within myself and explore my own psyche. I came to realize the frequent inferences and assumptions I have made about others in the past, and the effect it has had on communication and relationships. Being curious has taken on a whole new meaning.

The most remarkable thing was how the faculty and staff embodied the principles that they taught, and how the course was so carefully crafted and choreographed to center around the learners’ needs, and to build a strong sense of community among the participants. If I were to be a medical educator, that is exactly what I aspire to be.

“How can you just do simulation for such nine weeks? Doesn’t it get boring?” one of my good friends asked me. This notion did cross my mind before I came to CMS, but I was proven wrong. Medical simulation is not simply using mannequins to unnerve clinicians – it is an experiential and reflective process – as was my fellowship at the CMS. At the same time, I was able to personally witness the power of conversation – not only through practicing debriefing with good judgment in the courses, but also by talking to CMS faculty, staff, techs – I have truly expanded my horizons.

Harkening back to what Mary Fey said in the Instructor Courses, I have attained “threshold knowledge” – I cannot unlearn the knowledge I have acquired here. WTF forever means “What’s Their Frame?”, I shall always teach from a stance of curiosity, and assumptions is the mother of all [mistakes].

Thanks to all the faculty at the CMS who have given me the opportunity to join in the debriefings and provided me with valuable feedback, and thanks for sparing me some of their valuable time despite busy schedules to chat about my project – especially Jenny, Roxane, Jeff, Dan, Robert and Kate. And thanks to the awesome staff who hung out with me in the back all the time and have taught me so much – Johnny, Tony, Jenn, Matt, Emily and fellow visiting scholars! Hopefully we can maintain our relationships in the years to come!

Most importantly, have to thank my dear wife Christina for supporting me on this trip and helping me take care of the babies while I am at CMS! I know it must have been tough!

Looking up at the wall of the back debriefing room one last time as I walked out, “The Basic Assumption” has taken a completely different importance and meaning from nine weeks ago, and I hope that I can bring all that I have learned back home.”

–Albert Chan, MD

James Lipshaw

Reflections on My Month at CMS

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Emily Fish is a resident in Anesthesia at the Massachusetts General Hospital in Boston, MA. She spent the month of October at the Center for Medical Simulation on an elective rotation. The goal of the rotation program is to expose residents to the potential and operational use of simulation for education, clinical training and research. Over the course of the month, residents develop simulation scenarios including patient records, plot, setup, debriefing notes, and references.

“I am so grateful to have spent the past month at the Center for Medical Simulation–what a remarkable experience it has been! From gaining experience in the creation of high fidelity scenarios to improving my debriefing skills, the rotation was rich with learning opportunities. I was also fortunate to take the IMS instructor course, which was a truly transformative experience. The expert guidance of the instructors and the environment of teamwork and encouragement really foster the learning and growth of participants. Participating in the course has had a powerful effect on both the quantity and quality of introspection and self-evaluation I perform. I am more cognizant of potential assumptions I may have and will strive to be mindful of these and their potential impact in debriefing and elsewhere. The course has transformed the way I communicate not only with colleagues at work but in my daily life as well. I now find myself actively working on improving my communication skills using the techniques I learned in the course. I consider the course one of the most impactful experiences I have had in my medical training thus far. In fact, it has prompted a desire to incorporate simulation into my long-term career, and I hope to enter into sim fellowship as the next step in my growth as an educator.”

–Emily Fish, MD