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Facilitation and debriefing: the backbone of simulation-based education

Presenter: Julie Cary, DVM, MS, DACVS-LA
Institution: Washington State University College of Veterinary Medicine
Integrating simulation into a veterinary curriculum requires creativity, time, resources, and appropriate personnel. Early efforts and discussion are often focused on the physical resources; models, task-trainers, mannequins, and physical environment, as those are tangible and are easier to “sell” to administration and donors. However, the power of simulation is facilitation and debriefing.

Effective facilitation provides structure, a pattern of self-reflection for participants, and further exploration of skills. Successful facilitators require continuing education and exposure to processes, theories, and best-evidence specific to simulation. While there are similarities between clinical teaching and simulation, there are enough differences that specific training is critical for clinicians and academicians in veterinary medicine. Facilitators must create an environment that supports safety, confidentiality, trust, reflection, and critical thinking while simultaneously encouraging experimentation and pushing boundaries. Facilitators must also consider and manage the influence emotion has on learning and engagement during the simulation.

Effective debriefing ensures simulations are not reduced to a game without real or lasting impact for the learner. Debriefing is crucial for learners to derive meaning from the simulation experience. Running effective and efficient debriefing exercises is as much an art as a science. The debriefing process, when done well allows for deliberate and mindful delivery and receipt of feedback leading to reflection and cognitive reframing. Reflection and cognitive reframing in turn transforms frustration into discovery and confusion into competence.

During this presentation, I will present the theoretical background and best evidence for simulation facilitation and debriefing, using examples from veterinary medicine as illustration.

Effective delivery of simulation with realism and teamwork

Presenters: Johnathan Greene, MBA, NR Paramedic, BSN, BSOM
                 Christopher Yonts DO
Institution: Lincoln Memorial University- DeBusk College of Osteopathic Medicine
Lincoln Memorial University- DeBusk College of Osteopathic Medicine, Center for Simulation and Training and the AHA Training Center delivers quality simulations utilizing state-of-the-art equipment, well-seasoned faculty, staff and instructors from the community who currently work in their specialty areas such as hospital, aeromedical, EMS and other healthcare facilities. Medical simulations provides a safe, controlled and strategically guided education and training to students in any medical field with a range from novice to expert levels. Providing realistic scenarios that are well written by those team members that have experienced many years of real life experiences strengthens the quality of simulations, enhances the excitement for the learner, and makes it easier to understand and perform. Experienced simulation educators can quickly identify scenarios that may have an alternate and correct management regime as the students steer away from the rubric but still provides acceptable, safe and correct treatment. Teamwork faculty, staff, students, standardized patients, operations specialist and other inter-professional educators are very important to a successful simulation. Having well written scenarios that match the situations, patient problems, management techniques and recovery will make is easier to adhere to the rubric that students must follow. Rubrics should flow well and define how the student is expected to perform and provide quick follow-up debriefings. Developing effective rubrics utilizing inter-professional educators creating a framework and important to skills, knowledge and behavioral assessment. This lecture will cover all of these facets discussed above and offer examples of LMU-DCOM’s Center for Simulation & Training course simulations.

Developing clinical reasoning - could simulation be the answer? 

Presenter: Claire Vinten BVMedSci BVM BVS PhD FHEA MRCVS
Institution: Royal Veterinary College, London, UK
Development of clinical reasoning is the ‘holy grail’ of veterinary education. It is a skill that students must master to succeed in in their future roles, but is notoriously hard to teach. Workplace-based learning, case-based learning and problem-based learning are used within curricula to develop clinical reasoning, but recent research has suggested that graduates are still struggling with this skill when entering practice (Vinten et al., 2016). Could simulation be the answer?

The use of simulation in veterinary education has grown in the last 10 years. This has been driven by the increasing importance placed on communication training (Gray et al., 2006) and clinical skills teaching, coupled with the overwhelming acceptance of the pedagogical value of simulation within human medicine and nursing. However, simulation use within veterinary schools remains very limited compared to other healthcare fields, particularly regarding development of clinical reasoning.

This talk focuses on the use of simulation to drive clinical reasoning development within veterinary curricula. It will explore current research and recent innovations, and introduce the concept of Situativity; a theoretical lens which emphasises the importance of contextualisation within clinical reasoning development (Durning and Artino, 2011; Patel, Sandars and Carr, 2014). Key elements of Situativity theory include fostering patient responsibility, promoting dual process reasoning, preserving the complexity of ‘real-world’ clinical problems and encouraging metacognition. Also important is the opportunity to practice managing uncertainty, information overload, anxiety and stress. The talk will finish by proposing a new veterinary curriculum model, where simulation replaces lectures to optimize reasoning development.


How to run a large scale pre-clinical objective structured clinical examination (OSCE) in a veterinary clinical skills training program

Presenters: Stacy Anderson1 DVM, MVSc, PhD, DACVS-LA
    Ashley Whitehead2 DVM, BSc, DACVIM-LA
    Julie Williamson1 DVM, MS, AFAMEE
Institutions: 1 Lincoln Memorial University
    2 University of Calgary
Objective structured clinical examinations (OSCEs) are commonly used in health sciences to assess proficiency in clinical and professional skills. In the past 10 years, they have been gaining popularity in the veterinary medical education field to assess veterinary medical students as veterinary colleges have enhanced clinical skills training during the pre-clinical curriculum. Most veterinary medical programs throughout the world are increasing class size to offset lack of government funding and to meet the demand for new veterinarian graduates.

The goal of an OSCE is to assess a selection of clinical skills that a student is expected to have mastered during their pre-clinical curriculum. An OSCE may be low stakes, where stations may be remediated and coached to master the skill, or it may be high stakes, where a student must pass the examination in order to move forward in the curriculum. Regardless, OSCEs are comprised of multiple stations to assess any number of clinical skills. Stations can be complex, in that they test multiple related or unrelated skills in one station, or they can be simple, only testing a single skill. Stations may also test a student’s procedural and/or theoretical knowledge on the related skill.

This workshop will discuss the challenges of large scale delivery of an OSCE including scheduling, facilities, grading, personnel, exam security, feedback and remediation. Facilitators from three veterinary schools that run large-scale OSCEs will share the different ways that they have met these challenges at their institutions.

Best Practices in Educational Technology: From Games to Virtual Reality 

Presenter: Eric Bauman PhD, FSSH, RN
Institution: AdTalem Global Education
Educational technology like Virtual Reality (VR) will become an extension of the simulation paradigm. Gaba’s article, The Future vision of simulation in health care foreshadowed simulation’s trajectory (1). Characters in the television and movie franchise Star Trek leveraged the fictional Holodeck for immersive training purposes. The Holodeck allowed for suspension of disbelief so that high risk, low incidence events could be rehearsed and debriefed. The Holodeck provided an immersive and situated experience for novices to gain competency and experts to maintain and hone skills.

As the educational paradigm catches up to popular culture, we must embrace best practices for GBTL and VR(2). Only recently have we established best practices for simulation and GBTL (3). VR requires educators to reframe teaching and evaluation processes.

This session provides an overview of the simulation GBTL and VR from a layered learning perspective (4). Participants will review GBTL applications and a VR experience to prepare them for analysis of the state of VR as teaching and learning tool.

1 Gaba, David M. "The future vision of simulation in health care." Quality and safety in Health care 13.suppl 1 (2004): i2-i10.
2 Bauman, E.B. & Ralston-Berg, P. “Virtual Simulation” Defining excellence in simulation programs. Lippincott Williams & Wilkins, 2014.
3 Bauman, Eric B. "Games, Virtual Environments, Mobile Applications and a Futurist's Crystal Ball." Clinical Simulation in Nursing 12.4 (2016): 109-114.
4 Bauman, E. B., et al. "Building a better donkey: A game-based layered learning approach to veterinary medical education. GLS 10 conference proceedings." (2014): 372-375. 

Realistic and reusable skin: multiple layer silicone suturing pad 

Presenter: Bea Biddinger LVT, VTS(ECC) 
Institution: Michigan State University 
Workshop will guide participants thru prepping, coloring, mixing, pouring, and curing a multiple layer, reusable silicone suturing pad. Each participant will work with the ingredients and construct a take home piece of realistic looking skin. The suture pad has a dermis layer, subcutaneous fatty layer, and a muscle layer. Take home instructions will be available along with product sources. Video will be available. Discussion will be centered around making various models using silicone, resin, and foam products. Interaction is very welcome to see how other institutions use outright ingenuity along with specialized ingredients or common hardware and fabric store items to construct their teaching models.

Using Serious Play to support Simulation-Based Education

Presenter: Julie Cary, DVM, MS, DACVS-LA
Institution: Washington State University
The financial and time resources required to develop and implement simulation training are considerable. For some learners, the simulation construct initially can be unnerving and impede learning. Having other experiential learning opportunities to introduce or augment simulation may be useful to bridge the gap for learners.
Participants will be invited to engage in Serious Play activities associated with team work and communication for half the workshop. Following the interactive participation, groups will be asked to brainstorm ideas for using Serious Play in their own simulation-based education environments.
5 minutes: introductions and overview of session plan
20 minutes: engage in round one of Serious Play-focused on teamwork and team communication. Each round will have multiple components to it, allowing participants to experience the Serious Play from multiple aspects.
20 minutes: engage in round two of Serious Play-focused on client communication. The same process will be repeated as in round one.
15 minutes: discuss take home messages from the two rounds of Serious Play
20 minutes: work in small groups to brainstorm Serious Play ideas that would augment their own program
10 minutes: wrap up, question and answer
Implications: Participants will be have a strong understanding of the impact and potential uses of Serious Play for use in their own contexts and environments.

Pros, cons, and how-tos of building models in-house 

Presenters: Bill Collingsworth 
    Ashley Tipton LVT 
Institution: Lincoln Memorial University 
This workshop will be an open discussion on the design, construction, cost, and validation of in-house built clinical skills models. The workshop will be held in the DVTC model building garage. Using LMU-CVM in-house models as props, the group will discuss why models are used, what precipitates the need, and what impacts the design and the degrees of fidelity. The prototype, research, and the WOW factor will be reviewed. A cost comparison with commercially available models and direct cost of in-house construction will be examined. This will include recycling and ‘bells and whistles.’ A very important part of the group discussion will center around model validation. Are in-house built clinical skills models worth it? (For the students, for the college, for the animals). How do we know?

The Use of Standardized Clients in Veterinary Communication OSCE: Standardization of Role and Assessment

Presenters: Linda Dascanio1 LVT
     Dustin Pulliam1 DVM
     Elpida Artemiou2 BSc, MSc, PhD, AFAMEE
     Mary Pereira2 DVM
     Beth Dronson3 VMD
     Institutions 1 Lincoln Memorial University
     2 Ross University School of Veterinary Medicine
     3 University of Pennsylvania
Standardized clients (SCs) offer a valid and reliable approach in assessing learners’ communication skills in high stakes examinations such as the Objective Structured Clinical Examination (OSCE). Critical to using SCs in assessment requires standardization of role, use of validated rubrics, as well as training in assessing thus ensuring accuracy and reliability. This workshop will focus on training simulated clients on assessing communication skills including discussion and application of various assessment rubrics. The workshop will begin with an orientation describing baseline communication skills outlined in the Calgary Cambridge Guide (CCG). Following, in small groups, participants will practice assessing communication skills through vignettes and live simulations, as well as engage in discussions on pitfalls surrounding assessment. This workshop will enhance any stage of communications program and will be of interest and value to novice as well as experts in communication skills assessment. 

Creation, implementation and assessment of a small animal general abdominal surgery simulation course for veterinary students 

Presenter: Galina Hayes BVSc, MRCVS, PhD 
Institution: Cornell University 
Background/ Objectives: Final year veterinary students have limited opportunity for hands-on skill acquisition of general abdominal surgical skills beyond routine ovariohysterectomy, yet are expected to have competency in these procedures at graduation. The primary objective of this study was to develop a general abdominal procedures surgical simulation course and determine whether conducting abdominal surgery simulation accelerated general abdominal surgery skill acquisition by final year veterinary students and improved the confidence of student participants in their ability to perform these procedures. 
Methods: Three custom training models were created for use in the setting of a clinical rotation in a veterinary teaching hospital. A website with training videos and notes was created as a supplement to on-site teaching. Teaching of gastrotomy, gastropexy, eneterotomy, intestinal resection and anastomosis and cystotomy on the simulators was supervised by surgical faculty and residents. All participants completed pre and post simulation course knowledge assessment and feedback/ confidence surveys. 
Results: The experience of developing and delivering the course will be described, together with difficulties/ pitfalls encountered. Data from the participants to date will be presented. 
Conclusions: Simulators appear to offer a practical, efficient and effective solution to providing surgical training. The experience of implementing such a course and the data on the first wave of participants will be presented. 

Beyond iBooks Author 

Presenter: Jamie Perkins DVM 
Institution: Lincoln Memorial University 
Ibooks Author, released in 2012, has been described in Apple's marketing materials as "a tool that allows educators to create textbooks for the iPad, iPhone, and Mac. These books can contain photo galleries, videos, interactive elements, and more which brings content to life in ways printed books never could.”  Educators who create content with this development tool now have the potential to move beyond traditional static reference material creation and expand offerings to create truly immersive instructional materials. 

While iBooks Author is a very robust tool that allows novice developers, with minimal computer experience, a means to create digital content, it does have a number of limitations.  One of these limits, support for smooth animation, can be overcome by the use of the "widget" object combined with an HTML generator. HTML material can be developed by hand coding, as well as with commercially available products for non coders (such as Tumult Hype 3 Professional) to create interactive animation elements that can be output as HTML5 scripts. 

Tumult-Hype’s software provides a powerful set of features including user controllable animation, timing functions, scene creation and timelines.  The basic program does not require extensive coding experience but it does provide support for JavaScript actions to extend its functionality.  This software supports implementing an additional layer of interactivity and user engagement in an iBook. 

VUI’s from simple to complicated: and their potential role in veterinary education?

Presenter: Jamie Perkins DVM
Institution: Lincoln Memorial University
Voice user interfaces (VUI’s) allow human interaction with a compute through a voice/speech interface.  There are currently several products on the market such as Amazon’s Alexa, Google’s Home and Apple’s HomePod.

This new disruptive technology was designed to offer the user a faster, easier way of interacting with technology in the home.  The individual programs on these devices are known as ‘skills’, and while there are 30,000 skills available in the marketplace, to date, there are few available for the veterinary field and even fewer available for veterinary education.

These devices have the potential to change how education is delivered in the veterinary curriculum.  This new form of human-computer interaction moves beyond click and touch interface and allows the user to engage with the computer as if they are speaking with a seasoned clinician or to use the device for independent study and practice testing.

From a design standpoint there are challenges to maintaining this type of processing in a logical flow, to keeping it simple but sufficiently complex to be challenging for the student.  While advances in the programs are allowing VUI’s to learn and adapt to users speech patterns and preferences through natural language processing, the devices do not ‘think’.  The experience must be designed in a fashion that allows the user to engage with the device and receive feedback where necessary.

Getting started with simulation research 

Presenter: Claire Vinten BVMedSci, BVM, BVS, PhD, FHEA, MRCVS 
Institution: Royal Veterinary College
As the use of simulation within veterinary education grows, so does the need for robust evidence of the effectiveness of the methods employed – particularly when there is a start-up cost involved. However, researching the impact of simulation within a veterinary curriculum is fraught with complexities.  

This workshop aims to introduce the principles of simulation-based veterinary education research to beginners in the field. The workshop will involve group activities and discussion, examples of best (and worst!) practice, and the opportunity to network and form collaborations with peers. Participants are encouraged to bring along a project idea that they would like to explore with the help of the group (although those without one are very welcome too).  
By the end of the workshop, participants should be able to: 
• Develop an educational research question 
• Design an achievable research project to address that question 
• Identify potential threats to validity and reliability, and develop a creative approach to overcoming challenges

The use of Natural Language Processing for Clinical Decision Support: case study, interactive demo and shared exploration of the future

Presenters: Patrick Welch DVM, DACVO, MBA 
     Jeff Johnson MEd 
     Ed Carlson CVT, VTS (Nutrition) 
     Ken Hubbell MS, ITE 
     Andrea Looney DVM, DACVAA, CCRP, DACVSMR 
     Jamie Maher CVT, VTS (ECC, Anesthesia) 
Institution: Ethos Veterinary Health and VetBloom 
The integration of natural language processing (NLP) into clinical decision support (CDS) provides tremendous opportunity to create hands free, conversational, algorithmic tools to support clinical team members as they provide care to patients in a multitude of environments.  
Our team has created a beta platform that utilizes NLP and an algorithmic approach to generate anesthetic risk assessments and drug protocol recommendations based on patient signalment and co-morbidities. We have tested this platform with a group of veterinary technicians in a private practice multi-specialty environment and have integrated the tool with a Learning Record Store (LRS) in order to capture, aggregate and analyze user data. 
This session will provide attendees a brief introduction and background to this technology, the ability to explore this tool in an interactive setting, and finally, a facilitated visioning exercise to explore future potential for development focused on data capture and aggregation, utilization in a teaching hospital environment, use of machine learning technology, and integration with hospital information systems. 


Click here for the poster abstracts.