Gaining insight through simulation scenarios

A family of high-fidelity mannequins

High-fidelity mannequins, like this family, are used at our hospital as part of simulations that help our clinical teams practise and hone their skills so they can react like clockwork when faced with an actual patient care situation. Simulations are part of the overall culture of learning at North York General


Across North York General Hospital (NYGH), clinical teams are gaining valuable experience and insight through simulated scenarios, be it through role playing with actors or even high-fidelity mannequins. The Pulse spoke with Karen Fleming, Clinical Nurse Educator in Paediatrics and Simulation Project Lead, and Dr. Rick Penciner, Director of Medical Education and the Centre for Education at NYGH, about why this training is so vital to health care professionals.

The team races to the patient room, members bracing themselves for the unknown. Inside, they find a young child with a rattling cough who is having difficulty breathing. A nurse notes the child's pulse has slowed to an alarming rate. The respiratory therapist reaches for the oxygen mask.

After several long minutes, the child's pulse quickens and he starts to have deeper, more even breaths. The fact that the event was a simulation and the child was a high-fidelity mannequin, does not impact the seriousness this situation presented to the participants. There is always room for improvement: perhaps team members could switch positions or equipment could be located more strategically.

“Whatever the simulation, we encourage people to ask as many questions as possible or put forward any idea that may enhance our care,” says Karen Fleming, Clinical Nurse Educator in the Paediatrics Department and NYGH's Simulation Program Lead. “It's all about practising and honing skills so that when a challenge presents itself in reality, we've been there so many times our reactions are like clockwork.”

As a registered nurse, Karen was first acquainted with simulation training early in her career at another institution. She says that participating in a simulation that was focused on how to use medical interpreters when communicating with patients with limited English proficiency was the trigger for her love of simulation. While simulation was usually associated with technical skill practice, this was the first time she had realized the power simulation held even for non-technical skill practice and beyond.

Now at North York General, Karen conducts simulations with high-fidelity mannequins not only in the Paediatrics Department, but in areas such as the Emergency Department and the Critical Care Unit. “We hold mock codes pulling from real-life cases that a team found particularly challenging,” Karen says. “The actual simulation is really only a small part of the learning. It's the conversation that follows where the real learning happens. Interprofessional team members relay their experiences and perspectives so everyone has a holistic view of what happened and what we can improve.”

Embracing curiosity and building confidence

Dr. Rick Penciner, Director of Medical Education at North York General's Centre for Education, explains that learning through simulations was first used in aviation and military exercises to train in high-stake situations. “It was really in the early 2000s that health care professionals started to use advanced technology, such as life-size mannequins, to simulate situations,” Dr. Penciner says, although he points out actor simulations and low-tech simulations were already in use. “Virtual reality is another area that we'll no doubt explore in the future but the technology itself is secondary. It's the concept of gaining skill and experience through real-world representation in an artificial setting.”

According to Dr. Penciner, the possible applications of simulations are limitless — including role play to test new policies or using mannequins in falls prevention. “Recently, we used simulations as part of the interview process for new Emergency Department nurses,” he says. “We were able to see how individuals performed in different situations, which is obviously invaluable.”

Simulations are part of the overall culture of learning at North York General, Dr. Penciner says, a focus that benefits both patients and professionals alike. “It's about emphasizing and embracing curiosity and building confidence, it's about trying new approaches or tweaking old ones,” he says. “There are always ways to grow professionally and there are always to improve patient care.”

This article was first published in the June 2019 issue of The Pulse.

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