On the second floor of a hospital facility in Victoria, BC, patients repeatedly face medical distress hour after hour, day after day, just so others can learn how to best respond. The good news? The patients are sophisticated life-like mannequins, and the simulated in-hospital, operations, and critical-care rooms are training hundreds of people in the health professions.
Since the Centre for Interprofessional Clinical Simulation Learning, or CICSL, opened in September 2015 at Royal Jubilee Hospital, nearly 1300 nursing and medical students, residents, and other healthcare practitioners have learned valuable lessons.
“We’ve been very happy with the response,” said Darin Abbey, CICSL’s Director and an RN of 15 years. “We’ve had close to 300 registered nurses participate in simulations. We’ve had medical students from the UBC Faculty of Medicine’s Island Medical Program, Island Health teams, midwives, and even the Canadian Armed Forces take part. People recognize the value that simulation training offers. We’re busy every day, and it’s exciting.”
Planning for CICSL actually began five years earlier, in 2011, when the University of Victoria (UVic), the UBC Faculty of Medicine’s Island Medical Program, and Island Health formed a unique collaboration which resulted in the shared governance model that built and now supports the Centre. It took some time in those early days for the partnership to work through the financial, academic, and logistical hurdles, a daunting task given the size of the organizations involved. But thanks to dedicated efforts from leadership, the centre finally opened in September 2015.
Why this particular partnership? Because, explained Abbey, it was a clear opportunity to address overlapping goals for each organization. “Simulation training is recognized, through mounds of research, as a fantastic way to train nursing and medical students, as well as continue the education of established practitioners,” he said. “And because healthcare is constantly changing, as are learners and their expectations, we needed a safe place for collaborative learning. The simulation centre provides all of that.” CICSL’s large user base suggests that others agree. And as the Centre becomes more established, the number of users, not to mention the diversity of health professions involved, will expand.
It’s not hard to see why CICSL is so popular. Inside are learning laboratories that exactly replicate common healthcare environments, including an operating theatre, critical-care space, four-patient hospital ward, and a living room used to practice in-home care. Attached to these spaces are mini control rooms, where facilitators remotely control life-like mannequins to reproduce healthcare scenarios – anything from a heart attack to a mother giving birth.
Bringing the simulations to life are the sophisticated patient mannequins. These $100,000-plus life-size dolls do nearly everything one might expect of their human counterparts. They breathe, sweat, cry, and vomit. Their pupils react to light. They go into cardiac arrest. They require IVs and constant monitoring. And if the ailment is especially painful, they’ll even scream out – a jarring experience, especially for those interacting with the mannequins for the first time.
CICSL can also replicate large-scale disasters involving many patients, often all suffering from different injuries. For Anna Macdonald, CICSL’s Operations Manager, these multi-patient scenarios have been a highlight. “We’ve had anesthesia workshops, where everyone is dressed exactly like they’d be in a hospital,” she recalled. “The participants are running through many different emergency situations. It’s interesting to see what goes well and what errors are made, and how people react to these errors. It gets emotionally charged and very real for the people involved.”
Sometimes these simulations result in a patient’s recovery. Other times, like the reality CICSL works so hard to replicate, patients don’t make it. But what remains constant is a dedication to a safe learning environment – one where, no matter the outcome, people work together to learn, or improve, or get better at what they’re already experts in. “When a simulation goes exceptionally well, that’s excellent,” said Abbey. “When something happens that needs to be better understood, that’s also excellent. Either way, we’re provoking reflective practice with our teams. We’re constantly learning with, from, and about each other.”
This reflective practice, in the form of post-scenario debriefs, is the lifeblood of a successful sim session – and its longest component. Through a series of questions, facilitators review what happened during a simulation, then promote a group analysis in order to unpack people’s decision-making. “We try to understand what people were thinking during a session,” said Abbey. “Our goal, specifically, is to figure out why people made certain choices. Even when they did something right, they’re not always sure why they’re right. We’re interested in the why.” The hope is that such reflection, practiced regularly and in-depth, will carry over to the important work healthcare practitioners are doing each day – and with live patients. “At the end of each debrief,” said Anna Macdonald, “we ask people, how will this benefit your clinical practice? How will it benefit the people you’re serving? Because simulation is ultimately about improving the care for everyone.”
Despite how tough the simulation experience can be – from preparation to the lengthy debrief, not to mention the scenarios themselves – users recognize the value that CICSL and its facilities provide. In its recent “Inaugural Year in Review” report, CICSL shared some comments from its users: “Very supportive environment; good simulation scenarios. Enjoyable,” wrote a rural family physician. “Amazing and valuable learning experience,” said a BCIT specialty nursing student. “We all need more sim. It is the best way to learn outside reality,” mentioned a second-year medical resident.
But the positive reception also reverberates in the halls of CICSL itself. From his office, Abbey often hears the excitement – and apprehension – of those coming in for a session, especially from students and first-timers. Afterwards, there’s more than a sense of relief. “When they leave, I hear participants talk about how much they enjoyed the experience, that they learned a lot, that they discovered something about themselves or their team,” said Abbey. “It’s incredibly gratifying to hear.” But it’s not just talk: though not all healthcare professionals are required to use CICSL, or simulations in general, many return to practice.
Despite the success and the praise, Abbey and his team know there’s lots to be done, in no small part because healthcare itself is a moving target. New medical techniques and breakthroughs, changing expectations, interdisciplinary teams with different perspectives, flexible learning and outcomes, an increasing number of research projects – there’s a lot CICSL has to consider. But this hard work is made easier, said Abbey, because of the cohesive vision, not to mention the dedication, of the Centre and its supporters: “We have three committed partners, and they’re focused on the same thing: to provide the best, most impactful training for our users.”
With CICSL’s first year now complete, what’s the future for the Centre look like? Certainly an increase in capacity, in ground-breaking research, in the number of interprofessional teams working on any given simulation scenario, which reflects the reality of healthcare today. All of this growing activity will take a heavy toll on CICSL’s equipment – and for CICSL’s team, that’ll be a mark of success: “The Centre will feel well used,” said Abbey. “It will need to replace its gear, because it’s tired and beaten. It’ll have contributed significantly to the learning of our healthcare community. It will be a prime example of knowledge translation, research, and collaboration that benefits everyone.” Getting to that point will be a lot of work, Abbey admits. But the work is worthwhile, because of the benefits to be gained. “CICSL and its goals are pretty noteworthy to me. We’re grateful to be part of it.”
If you are interested in learning more about simulation, or utilizing the CICSL for teaching opportunities, please contact Darin and Anna through firstname.lastname@example.org