Growing Pains: Expansion of a Simulation Program Mindi Anderson, PhD, ARNP, CPNP-PC, CNE, CHSE-A, ANEF Desiree Díaz, PhD, RN-BC, CNE, CHSE-A, ANEF
Disclosures • M. Anderson – current grant funding – National Science Foundation (NSF); Program Director of Nursing and Health Care Simulation MSN Graduate Program and Health Care Simulation Graduate Certificate • D. Díaz – no disclosures
Objectives • 1. Describe at least two different stages of simulation program development. • 2. Discuss at least three common issues of simulation program development within each stage. • 3. Develop practical strategies for common problems discussed.
Stages of Simulation Program Development
Full Disclosure • We are pediatric people!
Definition of Growing Pains • Description • Cause • Treatment • What is known • What does this have to do with simulation? (Mayo Clinic Staff, 2016)
Conception – Our Definition • Delusions of grandeur: • Thinking about/researching starting a simulation program • Beginning simulation program planning and forming a team • Using a little simulation scattered here and there, but not a “formal” program • Adding standardization to what you are doing (Seropian, Brown, Gavilanes, & Driggers, 2004)
Infancy – Our Definition • Characterized by: • Those with a program less than a year (possibly) • One to two people responsible for creation, content, set-up and quality assurance
Toddlerhood – Our Definition • We characterize by: • Programs a few years old; maybe up to four or five years old • Evaluation in many aspects of simulation but not all areas • Problems begin to arise as warranties run out
Childhood – Our Definition • We begin to characterize by outcome measures: • Programs more than five years old but may be beginning to see FTT (failure to thrive) • Administration wanting more with same resources • Outcome measures begin to be collected and discussed with no movement or changes
Adolescence – Our Definition • We characterize by outcomes and reach: • Programs with simulation in greater than 75% of courses • Outcome measures with valid instruments of simulation-based education (SBE) • Teams formed to evaluate, create and follow best practices
Adulthood – Our Definition • We characterize by: • Programs using evidence-based practice to enhance SBE • INACSL Standards of Best Practice SM (INACSL, n.d.a) are enforced, no longer just encouraged • SBE is in every aspect of clinical education • Evaluation of SBE and program is ongoing
Question? • What stage do you think your program is in?
Simulation-based Activity
Common Issues/Practical Strategies – Each Stage
Common Issues/Strategies • They may not follow the stages • May be more about what the program is doing/not doing than how long the program has been around • You may have the same issue in multiple stages • Strategies may work the first time, but you may need to vary the next time
Infancy Issues/Strategies • Where to begin • Mission/Vision • Business and strategic plans • Obtaining buy-in/garnering champions • Designing/building or re- designing/purchasing • Where are you going to get initial $$ • Strategies (HealthySimulation.com, n.d.; Society for Simulation in Healthcare [SSH], 2016b; Seropian et al., 2004)
Infancy Issues/Strategies • Initial faculty development • Many times, this is absent or not formal • INACSL Standards of Best Practice: Simulation SM Simulation facilitation (INACSL Standards Committee, 2016a) – provides support for need • Many ways to go about – initial training • Other considerations – concierge model (Anderson, Bond, Holmes, & Cason, 2012; Coffman, Doolen, & Llasus, 2015; Herrington & Schneidereith, 2017 ; Peterson, Watts, Epps, & White, 2017; Seropian et al., 2004)
Other Infancy Issues/Strategies • Drafting initial policies and procedures • Which ones? Examples • How to get them? • Join simulation groups - samples • Borrow/adapt (with permission!) • Bring in expert • Form simulation group/operations group • Map to accreditation standards (SSH, 2016a) and INACSL Standards of Best Practice (INACSL, n.d.a) (Coffman et al., 2015; HealthySimulation.com, n.d.; Seropian et al., 2004; SSH, 2016b)
Infancy – Policies and Procedures • Other issues: • Determining: • Process for approval • Storage • Education on/about • Enforcement • Strategies
Other Infancy Issues/Strategies • Curriculum • “Doing a sim” • Should be developing curriculum • Looking at where sim is done, how it is counted, knowing regulations • Strategies (Herrington & Schneidereith, 2017; INACSL, n.d.b; Seropian et al., 2004)
Other Infancy Issues/Strategies • Evaluation • How will program be evaluated? • Formative/summative • Different levels of Kirkpatrick (1998) • Need to start – lower levels? (Coffman et al., 2015; INACSL Standards Committee, 2016b)
Toddlerhood Issues/Strategies • Faculty development - continued • Should be: • Ongoing • Tiered • In addition to education, need to “develop” faculty • Strategies • Certification (SSH, n.d.a, n.d.b). (Peterson et al., 2017)
Other Toddlerhood Issues/Strategies • Policies and procedures – • Who is keeping them? • Working? • Re-writing needed? • Any missing? • What strategies could you use?
Other Toddlerhood Issues/Strategies • Curriculum • Strategies • Purchasing pre-written simulations; adapting for courses/curricula • Map it out • Plan it out • Simulation/curriculum committees • Faculty groups • Concierge model • Collaboration with faculty (Coffman et al., 2015; Herrington & Schneidereith, 2017; Seropian et al., 2004)
Other Toddler Issues/Strategies • How can you “step up” evaluation game? • Strategies • Determine what you are evaluating • Evaluating all areas? • What does the data show? • Present data to appropriate stakeholders • How can you achieve higher levels? • Research? • Collaborate with researchers • Specific hires? • Grants (Kirkpatrick, 1998)
Other Toddler Issues/Strategies • Warranties running out and problems • Strategies • Plan for assessment of • Need for additional funds/space • Grants – multiple types • Convincing stakeholders • Showing data • Bringing way to bring in funds (SSH, 2016b)
Other Toddler Issues/Strategies • Accreditation • Still on target? • Provisional? (Society for Simulation in Healthcare Accreditation, n.d.b) • Advantages (A. Spain, personal communication, October 6, 2018) • Strategies • Add to strategic plan • Accreditation committee
Childhood Issues/Strategies • Ongoing faculty development – noticing a pattern? • Strategies • Policies and procedures • Strategies • Adding to/integrating curriculum – still relevant? • Strategies (Peterson et al., 2017)
Other Childhood Issues/Strategies • Evaluation plan • Using outcomes data? • Strategies • Warranties/other problems • Strategies • Keeping staff happy and challenged • Keeping program “fresh” • Sustainability
Other Childhood Issues/Strategies • Accreditation • Provisional (Society for Simulation in Healthcare Accreditation, n.d.b) vs. Full (Society for Simulation in Healthcare Accreditation, n.d.a) • Strategies
Adolescence Issues/ Strategies • Faculty development (pattern continues) and “developing” faculty • Policies and procedures • Adding to/integrating curriculum • Scheduling “knight”mare • Evaluation • Increasing research/consider generating new knowledge; expanding field • Strategies (Peterson et al., 2017; SSH, 2016b)
Other Adolescence Issues/ Strategies • Warranties/Other problems • Enough staff • Keeping staff happy and challenged • Keeping program “fresh” • Sustainability • Accreditation • Strategies (SSH, 2016b)
Adulthood • Group activity
Things to Consider - Growth • New simulation modalities/technologies • Adding standardized patients and/or embedded participants – definitions (INACSL Standards Committee, 2016c) • Strategies • Additional training/organizations • Need for more space/people/hours • Strategies • Thinking “outside of the box” • Simulation clubs • More formalized simulation education
References • Anderson, M., Bond, M. L., Holmes, T. L., & Cason, C. (2012). Acquisition of simulation skills: Survey of users. Clinical Simulation in Nursing, 8 (2), e59-e65. https://doi- org.ezproxy.net.ucf.edu/10.1016/j.ecns.2010.0 7.002 • Coffman, S., Doolen, J. & Llasus, L. (2015). Program development and evaluation of the concierge model of simulation. Online Journal of Nursing Informatics (OJNI), 19(2). Retrieved from http://www.himss.org/ojni
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