The success of the simulation program at Johns Hopkins All Children’s Hospital depends on a fully-trained staff that keeps coming back for more.
The life of a mannequin at Johns Hopkins All Children’s Hospital can be a little rough.
Constant poking and prodding. Tubes down the throat. Chest compressions. Crying parents. Chaos.
But that chaos is helping to improve outcomes in pediatric health through simulation training like the recent Harvard-based Center for Medical Simulation training for medical staff arranged by the medical director of the simulation program at Johns Hopkins All Children’s Hospital, Jennifer Arnold, M.D.
“The purpose of bringing the Center of Medical Simulation here for a four-day training tool is to really help jump start our community of simulation educators and experts,” Arnold explains. “I first personally took the Harvard course nine years ago and realized how impactful it was for me. We then brought them to my old center in Texas. It was very impactful. Now that I’m at Johns Hopkins All Children’s, I didn’t want to miss the opportunity to start off our program here correctly.”
The intensive program, which quickly filled up with staff from multiple departments, involves several key steps that can help medical staff avoid errors, improve their processes and increase communications when they return to genuine care.
The first step in the training is to reenact a medical situation. The simulation program provides the most accurate and realistic scenarios possible. Mannequins can “breathe” and have heartbeats. Actual equipment is used. Often, the participants do not know what diagnosis they are dealing with until they discover it from the symptoms shown. “Parents,” portrayed by trained actors, are often in the simulation scenario behaving the way actual parents behave in a crisis: some are helpful, some are panicked, some provide incorrect information. It’s all about recreating reality.
The entire process is filmed and after the crisis is complete, the entire team sits down for the most important step for learning, the debriefing.
“The biggest part of this training is in the debriefing. This is a reflective dialog based on the learning objectives and what we wanted to accomplish and what we didn’t,” Arnold explains. Debriefing includes in-depth discussions about crucial steps throughout the simulation. What were your actions, what were you thinking, what was your emotional process ... and how can we improve upon that in real life?
Practice Makes Perfect
“We are actually training the trainers in this course,” explains Dan Raemer, Harvard faculty and course director for Simulation As A Teaching Tool. The Center for Medical Simulation is a founder in the modern health care simulation movement. “We realize it is a big deal for a medical professional to take four days out of their schedule, but this is a life-changing event. While our students are highly educated, they aren’t necessarily educated on simulation-based education. This training is giving a new skill set to the clinicians.”
Arnold agrees. “Simulation training is like a pit crew. Clinicians need to be doing it on a regular basis. My vision is that everyone in this hospital is doing simulation training as a part of their everyday work. The training becomes threaded and imbedded in everything you do. And it is improving outcomes. By continually working to improve best-practice care, we are providing even better treatment and care for our patients.
Some programs are house-wide like basic CPR, but others are customized to each area, to give each unit in the hospital the opportunity for best practice.
The leaders in the Johns Hopkins All Children's Maternal, Fetal & Neonatal Institute knew their team could benefit so they sent neonatologists, neonatal nurses and the medical director of obstetrics and gynecology, Suzanne Icely, M.D. She saw the potential for the medical staff.
“High-risk obstetrics offers an excellent opportunity for SIM training,” she said. “Many high-risk complications of delivery are relatively rare and the SIM concept of education allows a practitioner to deliberately focus on all of the necessary steps but not in a live setting, where emotions are peaked. It’s like having a ‘reset’ button. Resident learners and seasoned obstetricians alike can benefit from programs like this.”
New High-tech Facility Opening This Fall
The simulation program will get a big boost this fall when it moves into the new Research & Education Building on the hospital campus. The new location will give the program more space, new and improved equipment and mannequins, increased staff and a more ideal location for the critical debriefing phase of the training.
Arnold is already working closely with department heads to customize simulation training for each unique service that the hospital offers. The simulation team is also kicking off a program designed to train parents who are taking home children with chronic and life-long medical issues such as artificial ventilator support. It’s one thing to tell a parent the child's airway tube might clog, but it’s another thing to show them what to do when it happens and then give them an opportunity to be in that emergency situation. Several families already have taken part in the simulation training at Johns Hopkins All Children’s. Parents and caregivers are very grateful for the opportunity to experience a simulated emergency before they deal with a real one.
Between training families for home care and ongoing intense training for medical staff, it appears those simulation mannequins will continue to get a workout at Johns Hopkins All Children’s.