1
00:00:11,440 --> 00:00:13,640
Welcome to the Clinical
Center Grand Rounds,

2
00:00:13,640 --> 00:00:17,440
a weekly series of educational
lectures for physicians and

3
00:00:17,440 --> 00:00:20,080
health care professionals
broadcast from the Clinical

4
00:00:20,080 --> 00:00:23,040
Center at the National
Institutes of Health in

5
00:00:23,040 --> 00:00:24,840
Bethesda, MD.

6
00:00:24,840 --> 00:00:28,400
The NIH Clinical Center is the
world's largest hospital totally

7
00:00:28,400 --> 00:00:32,080
dedicated to investigational
research and leads the global

8
00:00:32,080 --> 00:00:35,040
effort in training today's
investigators and discovering

9
00:00:35,040 --> 00:00:37,200
tomorrow's cures.

10
00:00:37,200 --> 00:00:46,800
Learn more by visiting us online
at http://clinicalcenter.nih.gov

11
00:00:46,800 --> 00:00:47,840
>> TODAY WE'RE

12
00:00:47,840 --> 00:00:50,600
HONORED TO OUR SPEAKERS

13
00:00:50,600 --> 00:00:53,720
DR. JOSEPH LOPRIEATO, WITH THE

14
00:00:53,720 --> 00:00:54,680
UNIVERSITY OF HEALTH SCIENCES

15
00:00:54,680 --> 00:00:58,320
ISSUES DR. NITINSEAM CRITICAL

16
00:00:58,320 --> 00:00:59,600
MEDICINE DEPARTMENT NIEKS H

17
00:00:59,600 --> 00:01:02,360
CLINICAL CENTER AND DR. MABEL

18
00:01:02,360 --> 00:01:04,040
GOMEZ FACILITATOR FOR THE NIH

19
00:01:04,040 --> 00:01:06,600
CLINICAL CENTER.

20
00:01:06,600 --> 00:01:09,760
DR. LOP REIATO AND A NATIONAL

21
00:01:09,760 --> 00:01:11,240
RECOGNIZE TD HEALTHCARE

22
00:01:11,240 --> 00:01:12,760
SIMULATOR, HE EARNED HIS DEGREE

23
00:01:12,760 --> 00:01:15,000
FROM GEORGE TOWN IN 1981 AND

24
00:01:15,000 --> 00:01:17,240
MASTERS OF PUBLIC HEALTH FROM

25
00:01:17,240 --> 00:01:18,720
UNIVERSITY OF TEXAS.

26
00:01:18,720 --> 00:01:22,040
HE COMPLETED HIS RESIDENCY IN

27
00:01:22,040 --> 00:01:25,040
BETHESDA MARYLAND IN 1984 AND

28
00:01:25,040 --> 00:01:27,480
FELLOWSHIPS AND DEVELOPED ACTIVE

29
00:01:27,480 --> 00:01:28,840
PEDIATRICS AT MICHIGAN STATE

30
00:01:28,840 --> 00:01:30,000
UNIVERSITY AND UNIVERSITY OF

31
00:01:30,000 --> 00:01:32,080
TEXAS HELT SCIENCE CENTER SAN

32
00:01:32,080 --> 00:01:34,400
ANTONIO.

33
00:01:34,400 --> 00:01:38,200
DR. LOPREIATO, SERVED A 31

34
00:01:38,200 --> 00:01:40,240
DISTINGUISHED CAREER IN

35
00:01:40,240 --> 00:01:42,720
PEDIATRIC MEDICINE AS A EDUCATOR

36
00:01:42,720 --> 00:01:45,800
AND PRACTITIONER.

37
00:01:45,800 --> 00:01:47,680
DR. SEAM IS A PROFESSOR OF

38
00:01:47,680 --> 00:01:49,320
MEDICINE AND NURSING AT

39
00:01:49,320 --> 00:01:50,200
[INDISCERNIBLE] UNIVERSITY AS A

40
00:01:50,200 --> 00:01:53,040
MEDICAL DIRECTOR AT THE

41
00:01:53,040 --> 00:01:54,840
[INDISCERNIBLE] SIMULATION

42
00:01:54,840 --> 00:01:57,400
CENTER.

43
00:01:57,400 --> 00:01:59,040
DR. LOPREIATO WITH THE FELLOW OF

44
00:01:59,040 --> 00:02:00,720
AMERICAN PEDIATRICS WITH THE

45
00:02:00,720 --> 00:02:02,040
AMERICAN PEDIATRIC SOCIETY,

46
00:02:02,040 --> 00:02:04,120
ASSOCIATION OF STANDARDIZED

47
00:02:04,120 --> 00:02:05,800
PATIENT EDUCATORS IS PAST

48
00:02:05,800 --> 00:02:07,880
PRESIDENT FOR THE SOCIETY OF

49
00:02:07,880 --> 00:02:08,480
SIMULATION HEALTHCARE.

50
00:02:08,480 --> 00:02:10,240
HE IS CERTIFIED AT THE

51
00:02:10,240 --> 00:02:12,200
HEALTHCARE SIMULATOR HEALTHCARE

52
00:02:12,200 --> 00:02:12,720
BY SOCIETY.

53
00:02:12,720 --> 00:02:14,680
HE COMPLETED CONSULTATIONS FOR

54
00:02:14,680 --> 00:02:15,680
PEDIATRIC TRAINING PROGRAMS FOR

55
00:02:15,680 --> 00:02:18,160
THE ASSOCIATION OF PEDIATRIC

56
00:02:18,160 --> 00:02:20,600
PROGRAM DIRECTOR AND IS A CASE

57
00:02:20,600 --> 00:02:22,640
DIRECTOR FOR NATIONAL BOARD

58
00:02:22,640 --> 00:02:25,400
MEDICAL EXAMINER STEP 2 CLINICAL

59
00:02:25,400 --> 00:02:28,240
SKILLS EXAM NATION,

60
00:02:28,240 --> 00:02:30,280
DR. LOPRIEATO IS A RECIPIENT OF

61
00:02:30,280 --> 00:02:32,840
SEVERAL WARKSDS INCLUDING THE

62
00:02:32,840 --> 00:02:35,360
PEDIATRIC RAY HELPER AWARD FOR

63
00:02:35,360 --> 00:02:37,600
CLINICAL EDUCATION, AMERICAN

64
00:02:37,600 --> 00:02:39,400
PEDIATRIC EDUCATION AWARD AND

65
00:02:39,400 --> 00:02:41,640
ASSOCIATION OF PEDIATRIC PROGRAM

66
00:02:41,640 --> 00:02:43,280
DIRECTORS WALTER TENNISON AWARD

67
00:02:43,280 --> 00:02:45,080
FOR EXTRAORDINARY OR INNOVATIVE

68
00:02:45,080 --> 00:02:46,760
CONTRIBUTIONS IN PEDIATRIC

69
00:02:46,760 --> 00:02:48,160
GRADUATE MEDICAL EDUCATION.

70
00:02:48,160 --> 00:02:51,960
OUR SECOND SPEAKER IS DR. NITIN

71
00:02:51,960 --> 00:02:54,120
SEAM, ASSOCIATE CHIEF CRITICAL

72
00:02:54,120 --> 00:02:56,240
CARE MEDICINE AT NIH CLINICAL

73
00:02:56,240 --> 00:02:58,280
KACCT, FELLOWSHIP FOR THE

74
00:02:58,280 --> 00:02:59,720
CRITICAL CARE FELLOWSHIP AND THE

75
00:02:59,720 --> 00:03:00,360
SENIOR RESEARCH PHYSICIAN.

76
00:03:00,360 --> 00:03:02,200
HE IS A CLINICAL PROFESSOR OF

77
00:03:02,200 --> 00:03:04,240
MEDICINE AT GEORGE WASHINGTON

78
00:03:04,240 --> 00:03:06,800
UNIVERSITY AND [INDISCERNIBLE]

79
00:03:06,800 --> 00:03:07,800
UNIVERSITY.

80
00:03:07,800 --> 00:03:09,320
DR. SEAM COMPLETES HIS

81
00:03:09,320 --> 00:03:10,680
UNDERGRADUATE EDUCATION AT JOHNS

82
00:03:10,680 --> 00:03:11,880
HOPKINS AND EARNED HIS MEDICAL

83
00:03:11,880 --> 00:03:13,080
DEGREE AT GEORGE WASHINGTON

84
00:03:13,080 --> 00:03:14,800
UNIVERSITY AND GRADUATE WITH

85
00:03:14,800 --> 00:03:15,160
DISTINCTION.

86
00:03:15,160 --> 00:03:17,600
HE COMPLETED HIS TRAINING IN A

87
00:03:17,600 --> 00:03:18,760
TERMUS ALONG WITH CHIEF

88
00:03:18,760 --> 00:03:20,920
RESIDENCY AT GEORGE WASHINGTON

89
00:03:20,920 --> 00:03:22,640
HOSPITAL FOLLOWED BY CRITICAL

90
00:03:22,640 --> 00:03:24,240
CARE MEDICINE FELLOWSHIP AT NIH

91
00:03:24,240 --> 00:03:25,720
ALONG WITH SOCIAL, TRAINING AND

92
00:03:25,720 --> 00:03:30,000
MULL MONITORARY MEDICINE AND TW,

93
00:03:30,000 --> 00:03:32,000
IT RELATES TO INNOVATION AND

94
00:03:32,000 --> 00:03:34,800
PROFESSION EDUCATION INCLUDING

95
00:03:34,800 --> 00:03:36,520
WEB BASED LEARNING AND

96
00:03:36,520 --> 00:03:37,680
SIMULATION, CLINICAL EXPERTISE

97
00:03:37,680 --> 00:03:41,240
IN VENTILATION AND ACUTE

98
00:03:41,240 --> 00:03:43,240
RESPIRATORY SIS DROAM AND

99
00:03:43,240 --> 00:03:44,480
NATIONALLY RECOGNIZED AND HAS

100
00:03:44,480 --> 00:03:45,800
GIVEN SEVERAL TALKS ON THESE

101
00:03:45,800 --> 00:03:47,320
TOPICS.

102
00:03:47,320 --> 00:03:49,800
HE IS CURRENTLY THE INTERIM

103
00:03:49,800 --> 00:03:53,200
CHIEF OF HEF COLSCHOLAR A HEALTH

104
00:03:53,200 --> 00:03:54,680
EDUCATION JOURNAL AND PREVIOUS

105
00:03:54,680 --> 00:03:56,680
SERVED AS ASSOCIATE EDITOR OF

106
00:03:56,680 --> 00:03:59,320
THE AMERICAN JOURNAL REZONING

107
00:03:59,320 --> 00:04:00,560
PIRATTORY CLINICAL CARE

108
00:04:00,560 --> 00:04:01,200
MEDICINE.

109
00:04:01,200 --> 00:04:02,800
PAST CHAIR OF PLINICAL CARE

110
00:04:02,800 --> 00:04:04,520
SECTION OF THE SOCIETY FOR

111
00:04:04,520 --> 00:04:06,400
SIMULATION AND HEALTHCARE.

112
00:04:06,400 --> 00:04:10,040
OUR THIRD SPEAKER IS DR. MABEL

113
00:04:10,040 --> 00:04:11,200
GOMEZ, CLINICAL FACILITATOR AT

114
00:04:11,200 --> 00:04:14,280
THE NIH CLINICAL FACILITATOR.

115
00:04:14,280 --> 00:04:17,720
DR. GOMEZ IS THE GRADUATE OF THE

116
00:04:17,720 --> 00:04:19,960
[INDISCERNIBLE] UNIVERSITY IN

117
00:04:19,960 --> 00:04:22,160
BOGOTA, COLUMBIA, FOLLOWING HER

118
00:04:22,160 --> 00:04:25,640
RESIDENCY IN BOGATA IN 2004, SHE

119
00:04:25,640 --> 00:04:36,280
BECAME AN CARDIOLOGIST IN BOGGAO

120
00:04:38,920 --> 00:04:40,200
BOGOTA, DR. GOMEZ HELD

121
00:04:40,200 --> 00:04:41,000
INCREASING LEVEL OF

122
00:04:41,000 --> 00:04:42,520
RESPONSIBILITY IN CARDIOLOGY AND

123
00:04:42,520 --> 00:04:45,400
CRITICAL CARE DEPARTMENTS ULRICH

124
00:04:45,400 --> 00:04:46,840
MINNATING AS ASSOCIATE DIRECTOR

125
00:04:46,840 --> 00:04:50,080
FOR CRITICAL CARE DEPARTMENT OF

126
00:04:50,080 --> 00:04:52,800
[INDISCERNIBLE] BOGOTA.

127
00:04:52,800 --> 00:04:55,000
IN 2019 DR. GOMEZ COMPLETED A

128
00:04:55,000 --> 00:04:57,520
FELLOWSHIP IN CLINICAL MEDICAL

129
00:04:57,520 --> 00:04:59,280
CANNED WHAT, CLINICAL MEDICAL

130
00:04:59,280 --> 00:05:00,640
SIMULATION AT THE CENTER FOR

131
00:05:00,640 --> 00:05:02,360
MEDICAL SIMULATION AT HARVARD

132
00:05:02,360 --> 00:05:02,760
UNIVERSITY.

133
00:05:02,760 --> 00:05:04,760
FOLLOWING HER FOLLOW OSHIP IN

134
00:05:04,760 --> 00:05:06,760
2019 SHE JOINED THE NIH CLINICAL

135
00:05:06,760 --> 00:05:11,640
CENTERS OF AS A CLINICAL

136
00:05:11,640 --> 00:05:12,680
SIMULATION FACILITATOR.

137
00:05:12,680 --> 00:05:14,320
SHE FOLLOWED THE IMPLEMENTATION

138
00:05:14,320 --> 00:05:15,920
OF THE CLINICAL WIDICISMULATION

139
00:05:15,920 --> 00:05:17,360
PROGRAM, STANDARDIZING AND

140
00:05:17,360 --> 00:05:19,080
APPROVING EXISTING SIMULATION

141
00:05:19,080 --> 00:05:20,840
CAPABILITIES WITHIN THE CLINICAL

142
00:05:20,840 --> 00:05:23,080
CENTER AND LED A TEAM OF FAC

143
00:05:23,080 --> 00:05:25,960
FACULTY AND DEVELOPED EXECUTION

144
00:05:25,960 --> 00:05:27,280
OF SIMILAR INITTIAIVE ITS

145
00:05:27,280 --> 00:05:29,360
FOCUSING ON HIGH VOLUME PATIENT

146
00:05:29,360 --> 00:05:31,120
MIX OF THE NIH AND SUPPORTING

147
00:05:31,120 --> 00:05:33,640
HIGHLY SPECIALIZED CONCRETE

148
00:05:33,640 --> 00:05:35,400
RESEARCH TRAINING PROTOCOLS.

149
00:05:35,400 --> 00:05:38,920
PLEASE WELCOME OUR FIRST SPEAKER

150
00:05:38,920 --> 00:05:40,160
DR. LOPRIEATO, WHO WILL SPEAK ON

151
00:05:40,160 --> 00:05:41,360
THE EVIDENCE SUPPORTING

152
00:05:41,360 --> 00:05:43,520
SIMULATION BASED MEDICAL

153
00:05:43,520 --> 00:05:43,800
EDUCATION.

154
00:05:43,800 --> 00:05:47,120
WELCOME DR. LOPREIATO.

155
00:05:47,120 --> 00:05:48,160
>> THANK YOU DOCTOR FOR
THAT

156
00:05:48,160 --> 00:05:52,480
WARM INTRODUCTION.

157
00:05:52,480 --> 00:05:54,440
THANK YOU FOR THE INVITATION FOR

158
00:05:54,440 --> 00:05:56,200
THIS TRIO ON HEALTHCARE

159
00:05:56,200 --> 00:05:58,520
SIMULATION DURING HEALTHCARE

160
00:05:58,520 --> 00:06:01,000
SIMULATION WEEK WHICH IS AN

161
00:06:01,000 --> 00:06:02,240
INTERNATIONALLY HIGHLIGHTED WEEK

162
00:06:02,240 --> 00:06:03,880
WHERE WE HIGHLIGHT SIMULATION IN

163
00:06:03,880 --> 00:06:04,280
HEALTHCARE.

164
00:06:04,280 --> 00:06:08,480
I AM JOSEPH LOPREIATO, AT THE

165
00:06:08,480 --> 00:06:09,880
UNIVERSITY SERVICES UNIVERSITY,

166
00:06:09,880 --> 00:06:11,440
I'M THE ASSOCIATE DEAN FOR

167
00:06:11,440 --> 00:06:13,440
ASSOCIATE EDUCATION, THIS

168
00:06:13,440 --> 00:06:14,400
PRESENTATION IN THIS

169
00:06:14,400 --> 00:06:16,000
PRESENTATION MYSELF AND THE

170
00:06:16,000 --> 00:06:17,880
OTHER 3 SPEAKER VS NO FINANCIAL

171
00:06:17,880 --> 00:06:20,800
DISCLOSURES OR CONFLICTS OF

172
00:06:20,800 --> 00:06:24,400
INTEREST TO DECLARE AND THIS

173
00:06:24,400 --> 00:06:25,880
PRESENTATION REPRESENTS MY

174
00:06:25,880 --> 00:06:27,720
OPINIONS AND DOES NOT REFLECT

175
00:06:27,720 --> 00:06:28,880
THE OFFICIAL POLICY OF THE

176
00:06:28,880 --> 00:06:31,880
DEPARTMENT OF DEFENSE OR THE

177
00:06:31,880 --> 00:06:33,800
UNIFORM SERVICES UNIVERSITY.

178
00:06:33,800 --> 00:06:35,560
SO MY JOB WAS TO GIVE YOU AN

179
00:06:35,560 --> 00:06:38,120
OVERVIEW OF HEALTHCARE

180
00:06:38,120 --> 00:06:40,160
SIMULATION, WHAT IT IS AND SO I

181
00:06:40,160 --> 00:06:41,440
WANT TO BRING EVERYBODY UP TO

182
00:06:41,440 --> 00:06:42,520
SPEED AND TALK ABOUT THE HIGH

183
00:06:42,520 --> 00:06:45,280
LEVEL TOPICS IN THE SIMULATION

184
00:06:45,280 --> 00:06:46,560
BASED MEDICAL EDUCATION.

185
00:06:46,560 --> 00:06:49,040
LET'S START OFF WITH

186
00:06:49,040 --> 00:06:49,360
DEFINITIONS.

187
00:06:49,360 --> 00:06:51,600
SO HEALTHCARE SIMULATION IS NOT

188
00:06:51,600 --> 00:06:53,520
A TECHNOLOGY, IT'S REALLY A

189
00:06:53,520 --> 00:06:55,640
METHODOLOGY AND IT'S SIMPLY A

190
00:06:55,640 --> 00:06:58,000
PROCESS OF RECREATING A MEDICAL

191
00:06:58,000 --> 00:06:59,440
ENVIRONMENT EITHER USING PEOPLE,

192
00:06:59,440 --> 00:07:01,120
HUMANS, MACHINES, LIKE

193
00:07:01,120 --> 00:07:04,800
MANNEQUINS OR COMPUTERS TO

194
00:07:04,800 --> 00:07:06,080
RECREATE THAT MEDICAL

195
00:07:06,080 --> 00:07:07,400
ENVIRONMENT AND IT'S USED TO

196
00:07:07,400 --> 00:07:09,280
EITHER TEACH A SKILL OR TO

197
00:07:09,280 --> 00:07:10,320
REFRESH A SKILL.

198
00:07:10,320 --> 00:07:12,720
I KIND OF LIKEN HEALTHCARE

199
00:07:12,720 --> 00:07:13,920
SIMULATION TO BATTING PRACTICE

200
00:07:13,920 --> 00:07:15,200
BEFORE A BIG BALL GAME WHERE YOU

201
00:07:15,200 --> 00:07:16,640
SEE THE BALL PLAYERS TAKING

202
00:07:16,640 --> 00:07:18,960
SWINGS AT THE BAT IN A SIMULATED

203
00:07:18,960 --> 00:07:20,920
GAME WITH THEIR COACHES

204
00:07:20,920 --> 00:07:22,120
WATCHING, ALL IN PREPARATION FOR

205
00:07:22,120 --> 00:07:23,720
THE BIG GAME IN THE EVENING.

206
00:07:23,720 --> 00:07:25,480
SO IN THIS CASE, HEALTHCARE

207
00:07:25,480 --> 00:07:26,680
SIMULATION IS BATTING PRACTICE

208
00:07:26,680 --> 00:07:28,080
BEFORE WE GO TO THE BIG GAME AND

209
00:07:28,080 --> 00:07:30,640
WORK ON REAL PATIENTS IN THE

210
00:07:30,640 --> 00:07:30,920
HOSPITAL.

211
00:07:30,920 --> 00:07:32,960
IF YOU WANT MORE DEFINITIONS

212
00:07:32,960 --> 00:07:34,280
ABOUT HEBLGHT CARE SIMULATION, I

213
00:07:34,280 --> 00:07:36,720
WILL PUT A PLUG IN HERE FOR THE

214
00:07:36,720 --> 00:07:39,080
HEALTHCARE SIMULATION DICTIONARY

215
00:07:39,080 --> 00:07:40,080
PRODUCED FOR HEALTHCARE QUALITY

216
00:07:40,080 --> 00:07:40,560
AND RESEARCH.

217
00:07:40,560 --> 00:07:42,960
IF YOU GOOGLE HEALTHCARE

218
00:07:42,960 --> 00:07:44,400
SIMULATION DICTIONIONARY, YOU

219
00:07:44,400 --> 00:07:45,920
WILL GET VERSION 2.1 AND YOU

220
00:07:45,920 --> 00:07:48,120
WILL HAVE THE COPY OF THE LATEST

221
00:07:48,120 --> 00:07:50,640
DEFINITIONS FOR HEALTHCARE

222
00:07:50,640 --> 00:07:50,920
SIMULATION.

223
00:07:50,920 --> 00:07:53,080
WE IN THE HEALTHCARE SIMULATION

224
00:07:53,080 --> 00:07:54,680
COMMUNITY HAVE MOWR MAIN

225
00:07:54,680 --> 00:07:57,560
METHODOLOGIES WE USE TO EMPLOY

226
00:07:57,560 --> 00:08:00,200
HEALTHCARE SIMULATION IN MEDICAL

227
00:08:00,200 --> 00:08:01,440
EDUCATION AND THESE 4

228
00:08:01,440 --> 00:08:02,680
METHODOLOGIES ARE STANDARDIZED

229
00:08:02,680 --> 00:08:04,840
OR SIMULATED PATIENTS, THESE ARE

230
00:08:04,840 --> 00:08:06,480
HUMANS, HUMAN BEINGS SO WE

231
00:08:06,480 --> 00:08:08,440
RECRUIT TO PORTRAY PATIENTS AND

232
00:08:08,440 --> 00:08:10,560
TO ASSESS WHETHER THE LIMITED

233
00:08:10,560 --> 00:08:11,400
PARTNERSHIPPER INTERACTING WITH

234
00:08:11,400 --> 00:08:13,720
THAT PATIENT DONE A GOOD JOB

235
00:08:13,720 --> 00:08:15,920
ACCORDING TO USUALLY A CHECK

236
00:08:15,920 --> 00:08:17,880
LIST SO WE CALL THOSE SPs, THE

237
00:08:17,880 --> 00:08:20,280
NEXT 1 IS NOT SCREEN BASED

238
00:08:20,280 --> 00:08:21,720
SIMULATION AND SHOULD BE

239
00:08:21,720 --> 00:08:22,560
MANNEQUIN BASED SIMULATION,

240
00:08:22,560 --> 00:08:24,240
THESE ARE FULL SIZED PLASTIC

241
00:08:24,240 --> 00:08:25,560
HUMANS WHO HAVE ALL THE

242
00:08:25,560 --> 00:08:27,280
PHYSIOLOGY OF A HUMAN SO THEY

243
00:08:27,280 --> 00:08:29,280
LOOK LIKE A HUMAN, ALTHOUGH

244
00:08:29,280 --> 00:08:31,200
THEIR SKIN IS PLASTIC, THEY HAVE

245
00:08:31,200 --> 00:08:32,960
PULSES, THEY CAN HAVE A BLOOD

246
00:08:32,960 --> 00:08:34,480
PRESSURE, THAT CAN BE INTUBATED,

247
00:08:34,480 --> 00:08:35,640
THEY CAN BE SHOCKED.

248
00:08:35,640 --> 00:08:37,520
SO THINGS WE CAN'T DO TO HUMANS

249
00:08:37,520 --> 00:08:39,160
NOR WOULD WE EVER WANT TO DO TO

250
00:08:39,160 --> 00:08:42,000
HUMANS WE CAN DO ON THESE

251
00:08:42,000 --> 00:08:43,440
HUMANOID PLASTIC MANNEQUINS.

252
00:08:43,440 --> 00:08:46,120
THE NEXT METHODOLOGY OF TASK

253
00:08:46,120 --> 00:08:47,280
TRAINING, THESE ARE PIECES OF

254
00:08:47,280 --> 00:08:49,880
BODY PARTS WE USE TO PRACTICE

255
00:08:49,880 --> 00:08:51,760
PROCEDURES, THINK A PORTION OF A

256
00:08:51,760 --> 00:08:54,000
BACK TO PRACTICE LUMBAR PUNCTURE

257
00:08:54,000 --> 00:08:56,640
OR A PORTION OF THE CHEST TO

258
00:08:56,640 --> 00:08:59,080
PRACTICE CENTRAL LINE INSERTION,

259
00:08:59,080 --> 00:09:01,000
OR KNEE TO PRACTICE KNEE

260
00:09:01,000 --> 00:09:02,120
INJECTIONS, THESE ARE CONSIDERED

261
00:09:02,120 --> 00:09:05,160
TASK TRAINERS AND LAST WE WE

262
00:09:05,160 --> 00:09:06,080
HAVE SCREEN BASED SIMULATION

263
00:09:06,080 --> 00:09:07,920
WHICH INCLUDE THE ENTITIES OF

264
00:09:07,920 --> 00:09:09,600
VIRTUAL REALITY, AUGMENTED

265
00:09:09,600 --> 00:09:11,000
REALITY AND MIXED REALITY IN

266
00:09:11,000 --> 00:09:13,120
COME A COMPUTER CREATES THE

267
00:09:13,120 --> 00:09:14,720
SCENARIO OR THE ENVIRONMENT

268
00:09:14,720 --> 00:09:16,840
RATHER THAN A PLASTIC MANNEQUIN

269
00:09:16,840 --> 00:09:18,280
OR RATHER THAN A HUMAN.

270
00:09:18,280 --> 00:09:20,440
THOSE ARE THE 4 MAIN

271
00:09:20,440 --> 00:09:22,280
METHODOLOGIES THAT WE CURRENTLY

272
00:09:22,280 --> 00:09:22,600
USE.

273
00:09:22,600 --> 00:09:23,520
THESE METHODOLOGIES ARE

274
00:09:23,520 --> 00:09:26,040
IMPORTANT BECAUSE NOW THE

275
00:09:26,040 --> 00:09:27,080
EDUCATIONAL LANDSCAPE AS SHIFTED

276
00:09:27,080 --> 00:09:29,280
IN THE LAST DECADE FROM SIMPLY

277
00:09:29,280 --> 00:09:31,920
KNOWLEDGE IN YOUR HEAD TO

278
00:09:31,920 --> 00:09:33,120
COMPETENCIES, WHAT CAN YOU

279
00:09:33,120 --> 00:09:34,040
ACTUALLY DO IN THE CLINICAL

280
00:09:34,040 --> 00:09:35,600
WORLD AND HOW ARE WE MEASURING

281
00:09:35,600 --> 00:09:36,920
THE OUTCOMES OF WHAT WE DO AND

282
00:09:36,920 --> 00:09:38,240
WHAT YOU DO, WHETHER YOU'RE IN

283
00:09:38,240 --> 00:09:40,680
TRAINING OR WHETHER YOU'RE IN

284
00:09:40,680 --> 00:09:40,960
PRACTICE.

285
00:09:40,960 --> 00:09:42,040
THERE'S MUCH MORE EMPHASIS NOW

286
00:09:42,040 --> 00:09:45,200
ON CLINICAL SKILLS, CLINICAL

287
00:09:45,200 --> 00:09:46,160
SKILLS BEING COMMUNICATIONS WITH

288
00:09:46,160 --> 00:09:50,280
THE PATIENTS, PROFICIENCY AND

289
00:09:50,280 --> 00:09:52,680
PROCEDURES, AND TEAM TRAINING

290
00:09:52,680 --> 00:09:55,200
AND TEAM LEADERSHIP AND THERE'S

291
00:09:55,200 --> 00:09:57,400
MUCH MORE OF PATIENT SAFETY

292
00:09:57,400 --> 00:09:59,040
INITIATIVES, SO ALL OF THESE

293
00:09:59,040 --> 00:10:00,680
COMBINED TO MAKE HEALTHCARE

294
00:10:00,680 --> 00:10:01,800
SIMULATION REALLY A GROWTH

295
00:10:01,800 --> 00:10:04,480
INDUSTRY AND PREVALENT AMONG ALL

296
00:10:04,480 --> 00:10:06,280
HEALTHCARE ENTITIES PRETTY MUCH

297
00:10:06,280 --> 00:10:07,800
NATIONWIDE TODAY.

298
00:10:07,800 --> 00:10:10,240
SO IF WE GO TO USE SIMULATION,

299
00:10:10,240 --> 00:10:11,560
WHERE DOES IT FIT IN THE

300
00:10:11,560 --> 00:10:12,600
ASSESSMENT OF CLINICAL

301
00:10:12,600 --> 00:10:14,600
COMPETENCE WHICH IS, AGAIN, 1 OF

302
00:10:14,600 --> 00:10:16,000
THE HALLMARKS OF MEDICAL

303
00:10:16,000 --> 00:10:17,800
EDUCATION TODAY.

304
00:10:17,800 --> 00:10:20,040
GEORGE MILLER IN 1990 PROPOSED

305
00:10:20,040 --> 00:10:20,720
THIS PYRAMID.

306
00:10:20,720 --> 00:10:22,040
HE WAS DISTRAWOF THE BY THE FACT

307
00:10:22,040 --> 00:10:25,080
THAT IN 1990 MOST CLINICAL

308
00:10:25,080 --> 00:10:27,080
COMPETENTS WAS MEASUREMENT OF

309
00:10:27,080 --> 00:10:28,480
KNOWLEDGE ALONE, THINK MULTIPLE

310
00:10:28,480 --> 00:10:31,360
CHOICE QUESTIONS, FORWARD

311
00:10:31,360 --> 00:10:32,440
QUESTIONS, THINGS LIKE THAT SO

312
00:10:32,440 --> 00:10:34,880
HE PUT THAT AT THE BOTTOM OF

313
00:10:34,880 --> 00:10:36,440
THIS PYRAMID THAT YES WE CAN

314
00:10:36,440 --> 00:10:38,040
MEASURE CLINICAL COMPETENCE BY

315
00:10:38,040 --> 00:10:38,760
WALKING AROUND HOW MUCH

316
00:10:38,760 --> 00:10:39,720
KNOWLEDGE YOU HAVE IN YOUR HEAD

317
00:10:39,720 --> 00:10:41,360
AND MEMORIZED OVER THE YEARS SO

318
00:10:41,360 --> 00:10:43,840
THAT'S KNOWS AT THE BOTTOM.

319
00:10:43,840 --> 00:10:45,680
PRETTY POSITIVE THERE ARE OTHER

320
00:10:45,680 --> 00:10:47,080
ELEMENTS OF CLINICAL COMPETENCE

321
00:10:47,080 --> 00:10:48,760
THAT NEED MORE EMPHASIS.

322
00:10:48,760 --> 00:10:50,120
AGAIN, THIS WAS NOW 30 YEARS AGO

323
00:10:50,120 --> 00:10:51,480
AND I AM HAPPY TO SAY WE HAVE

324
00:10:51,480 --> 00:10:53,160
MOVED UP THIS PYRAMID SINCE

325
00:10:53,160 --> 00:10:53,480
THEN.

326
00:10:53,480 --> 00:10:56,040
BUT THE NEXT LEVEL UP IN

327
00:10:56,040 --> 00:10:56,640
ASSESSING CLINICAL COMPETENCE

328
00:10:56,640 --> 00:10:58,680
KNOWS HOW, IN OTHER WORDS,

329
00:10:58,680 --> 00:10:59,840
DEMONSTRATE THAT YOU KNOW THE

330
00:10:59,840 --> 00:11:03,680
STEPS, SO THESE ARE ESSAYS THAT

331
00:11:03,680 --> 00:11:05,000
YOU USED TO WRITE IN BLUE BOOKS

332
00:11:05,000 --> 00:11:06,320
OR YOU MAY HAVE TO DIAGRAM

333
00:11:06,320 --> 00:11:07,680
SOMETHING OR GO THROUGH A

334
00:11:07,680 --> 00:11:08,960
PATIENT CASE SCENARIO.

335
00:11:08,960 --> 00:11:12,680
OR YOU MIGHT HAVE AN ORAL EXAM

336
00:11:12,680 --> 00:11:14,280
NATION, THESE ARE AN ATTEMPT TO

337
00:11:14,280 --> 00:11:15,840
TRY TO EXPLAIN, DO YOU KNOW HOW

338
00:11:15,840 --> 00:11:17,960
TO DO THINGS, NOT ONLY DO YOU

339
00:11:17,960 --> 00:11:19,120
HAVE THE KNOWLEDGE BUT DO YOU

340
00:11:19,120 --> 00:11:21,600
KNOW HOW TO APPLY IT?

341
00:11:21,600 --> 00:11:23,800
SHOWS HOUSE IS WHERE MILLER

342
00:11:23,800 --> 00:11:26,440
POSITED THE SIMULATION HAS THE

343
00:11:26,440 --> 00:11:26,800
STRENGTH.

344
00:11:26,800 --> 00:11:28,400
YOU HAVE TO SHOW ME YOU CAN

345
00:11:28,400 --> 00:11:29,600
INTEGRATE WHAT YOU KNOW AND THE

346
00:11:29,600 --> 00:11:30,840
STEPS INTO HOW AND ACTUALLY

347
00:11:30,840 --> 00:11:34,040
DOING IN THE SIM LAB OR THE REAL

348
00:11:34,040 --> 00:11:35,480
CLINICAL WORLD FOR THAT MATTER,

349
00:11:35,480 --> 00:11:36,640
WHAT IT IS THAT WE'RE WE'RE

350
00:11:36,640 --> 00:11:38,440
TRYING TO MEASURE CONFIDENCE IN,

351
00:11:38,440 --> 00:11:39,960
SO SHOW ME AND THEN DOES IS WHAT

352
00:11:39,960 --> 00:11:41,040
HAPPENS EVERY DAY IN THE

353
00:11:41,040 --> 00:11:42,520
CLINICAL WORLD, WHAT YOU DO, AND

354
00:11:42,520 --> 00:11:44,400
WHETHER OR NOT YOU GET ANY

355
00:11:44,400 --> 00:11:45,800
COACHING AND WHETHER OR NOT YOU

356
00:11:45,800 --> 00:11:47,760
IMPROVE YOURSELF ON YOUR OWN IS

357
00:11:47,760 --> 00:11:50,720
THE SORT OF TOP OF THE PYRAMID.

358
00:11:50,720 --> 00:11:52,840
THE PYRAMID ALSO REP ARE SENTS

359
00:11:52,840 --> 00:11:54,720
HOW FREQUENTLY THESE CLINICAL

360
00:11:54,720 --> 00:11:55,880
COMPETENCIES ARE ASSESSED.

361
00:11:55,880 --> 00:11:57,560
WE KNOW KNOWLEDGE IS ASSESSED

362
00:11:57,560 --> 00:11:59,160
VERY, VERY FREQUENTLY THROUGHOUT

363
00:11:59,160 --> 00:12:00,920
TRAINING AND POST TRAINING, ORAL

364
00:12:00,920 --> 00:12:03,200
XASMS AND ESAYS ARE NOT AS

365
00:12:03,200 --> 00:12:04,840
POPULAR AS THEY USED TO BE BUT

366
00:12:04,840 --> 00:12:06,120
SHOWING HOW, SIMULATION IS NOW

367
00:12:06,120 --> 00:12:08,200
WHERE WE DO MOST OF OUR

368
00:12:08,200 --> 00:12:09,280
ASSESSMENT OF CLINICAL

369
00:12:09,280 --> 00:12:12,560
COMPETENCE IN ADDITION TO

370
00:12:12,560 --> 00:12:12,960
KNOWLEDGE.

371
00:12:12,960 --> 00:12:16,520
IF YOUME YOU WANT TO KNOW OR RE1

372
00:12:16,520 --> 00:12:17,760
PAPER TO DESCRIBE THE BEST

373
00:12:17,760 --> 00:12:19,760
PRINCIPLES AND PRACTICES IN

374
00:12:19,760 --> 00:12:21,400
MODERN HEALTHCARE SIMULATION,

375
00:12:21,400 --> 00:12:31,840
READ THIS PAPER BY YVETTE

376
00:12:35,320 --> 00:12:36,360
MOTOLA, SHE AND HER COLLEAGUES

377
00:12:36,360 --> 00:12:39,680
HERE FROM THE UNIVERSITY OF

378
00:12:39,680 --> 00:12:42,600
MIAMI FROM MT. SINAI HOSPITAL IN

379
00:12:42,600 --> 00:12:45,280
TORONTO LOOK AT THE HEALTHCARE

380
00:12:45,280 --> 00:12:46,400
SIMULATION OVER THE MAN YEARS

381
00:12:46,400 --> 00:12:48,600
SINCE IT BEGAN THE MODERN ERA IN

382
00:12:48,600 --> 00:12:51,240
THE MID80S AND TRIED TO

383
00:12:51,240 --> 00:12:52,160
SUMMARIZE PRINCIPLES AND

384
00:12:52,160 --> 00:12:53,520
PRACTICES THAT WE ALL SHOULD,A

385
00:12:53,520 --> 00:12:55,160
BY BY WHEN WE PRACTICE

386
00:12:55,160 --> 00:12:56,160
HEALTHCARE SIMULATION AND THERE

387
00:12:56,160 --> 00:12:57,960
ARE A NUMBER OF IMPORTANT

388
00:12:57,960 --> 00:12:59,200
PRACTICES BUT I WANT TO

389
00:12:59,200 --> 00:13:00,800
HIGHLIGHT 2 FOR YOU AND THEN 2

390
00:13:00,800 --> 00:13:01,760
PRACTICE POINTS THAT THAT

391
00:13:01,760 --> 00:13:04,240
SIMULATION IS A METHODOLOGY THAT

392
00:13:04,240 --> 00:13:05,800
IS DIFFERENT THAN OTHER

393
00:13:05,800 --> 00:13:06,600
METHODOLOGIES LIKE LECTURE IN

394
00:13:06,600 --> 00:13:08,120
THAT IT ALLOWS FOR DELIBERATE

395
00:13:08,120 --> 00:13:10,360
PRACTICE AND ASSESSMENT, THINK

396
00:13:10,360 --> 00:13:11,560
BATTING PRACTICE, SO YOU CAN

397
00:13:11,560 --> 00:13:13,520
PRACTICE AS MANY TIMES AS YOU

398
00:13:13,520 --> 00:13:15,480
WANT IN HEALTHCARE SIMULATION IN

399
00:13:15,480 --> 00:13:16,880
A SAFE ENVIRONMENT, USUALLY A

400
00:13:16,880 --> 00:13:18,760
SIM LAB OR WITH A TASK TRAINER

401
00:13:18,760 --> 00:13:20,440
OR WITH A VIRTUAL REALITY HEAD

402
00:13:20,440 --> 00:13:21,560
SET, WHATEVER YOU WOULD LIKE AND

403
00:13:21,560 --> 00:13:22,800
YOU SHOULD BE ABLE TO GET A

404
00:13:22,800 --> 00:13:26,960
COACHING AND FEEDBACK AND THIS

405
00:13:26,960 --> 00:13:28,240
DELIBERATE PRACTICE AND

406
00:13:28,240 --> 00:13:29,640
ASSESSMENT IS AT THE HEART OF

407
00:13:29,640 --> 00:13:32,400
ALL GOOD PRACTICES IN HEALTHCARE

408
00:13:32,400 --> 00:13:33,200
SIMULATION.

409
00:13:33,200 --> 00:13:34,200
WE REALLY SHOULDN'T DO 1 SIM AND

410
00:13:34,200 --> 00:13:36,520
BE DONE AND GO BACK TO WORK, WE

411
00:13:36,520 --> 00:13:37,920
SHOULD DO SEVERAL SIMS IN

412
00:13:37,920 --> 00:13:38,960
PRACTICE WITH COACHING BEFORE WE

413
00:13:38,960 --> 00:13:49,480
GO BACK TO THE CLINICAL WORL FOR

414
00:13:57,520 --> 00:13:58,840
XMPLE, PROCEDURES YOU DON'T HAVE

415
00:13:58,840 --> 00:14:01,040
RETENTION IF YOU DO 1, SEE 1,

416
00:14:01,040 --> 00:14:03,080
TEACH 1 AS WE LEARNED IN MY

417
00:14:03,080 --> 00:14:04,560
GENERATION HOW TO DO PROCEDURES

418
00:14:04,560 --> 00:14:06,000
THAT REALLY TO GET GOOD AT

419
00:14:06,000 --> 00:14:07,240
SOMETHING, YOU NEED TO PRACTICE,

420
00:14:07,240 --> 00:14:09,000
MANY, MANY, MANY TIMES UNDER THE

421
00:14:09,000 --> 00:14:12,080
GUIDANCE OF A TUTOR OR COACH.

422
00:14:12,080 --> 00:14:15,000
AND TEST OUT, SO WE CALL THIS

423
00:14:15,000 --> 00:14:15,840
MYSTERIRY BASED LEARNING AND

424
00:14:15,840 --> 00:14:18,840
THAT MASTERY BASED LEARNING HAS

425
00:14:18,840 --> 00:14:20,080
GOOD EVIDENCE TO SUGGIEST THAT

426
00:14:20,080 --> 00:14:21,520
IT IMPRIEWS THE SKILL

427
00:14:21,520 --> 00:14:23,680
ACQUISITION AND MORE

428
00:14:23,680 --> 00:14:25,120
IMPORTANTLY, SKILL RETENTION IS

429
00:14:25,120 --> 00:14:26,960
LONGER THAN IF WE DID SKILL

430
00:14:26,960 --> 00:14:28,720
TRAINING JUST SIMPLY BY 1 AND

431
00:14:28,720 --> 00:14:32,000
DONE OR SEE 1 DO 1 TEACH 1.

432
00:14:32,000 --> 00:14:33,680
SO THESE ARE 2 MAJOR PRINCIPLES

433
00:14:33,680 --> 00:14:35,760
IN PRACTICE WE TRY ABIETD BY

434
00:14:35,760 --> 00:14:41,600
WITH HEALTHCARE SIMULATIONS.

435
00:14:41,600 --> 00:14:43,120
DOES IT WORK AND IS IT ANY

436
00:14:43,120 --> 00:14:44,920
BETTER THAN WHAT WE USED TO DO,

437
00:14:44,920 --> 00:14:46,040
WELL DAVID COOK AND HIS

438
00:14:46,040 --> 00:14:47,840
COLLEAGUES TRIED TO ANSWER THIS

439
00:14:47,840 --> 00:14:51,880
QUESTION, A FEW YEARS AGO WITH A

440
00:14:51,880 --> 00:14:55,840
CLASSIC PAPER WHERE HE DID A

441
00:14:55,840 --> 00:14:58,280
SYSTEMATIC REVIEW OF OVER 10,000

442
00:14:58,280 --> 00:14:59,920
ARTICLES THAT LOOKED AT A

443
00:14:59,920 --> 00:15:01,120
HEALTHCARE SIMULATION, SO HERE

444
00:15:01,120 --> 00:15:03,040
HE MEANS, SIMULATION OTHER THAN

445
00:15:03,040 --> 00:15:05,920
HUMAN SIMULATION WITH SP, SO

446
00:15:05,920 --> 00:15:07,320
MANNEQUIN SIMULATION, TASK

447
00:15:07,320 --> 00:15:09,320
TRAINER SIMULATION, AND THE

448
00:15:09,320 --> 00:15:12,160
BURGEONING FEEL AT THIS TIME

449
00:15:12,160 --> 00:15:13,960
COMPUTER BASED SIMULATION.

450
00:15:13,960 --> 00:15:15,800
IT WASN'T ANY BETTER OR WORSE,

451
00:15:15,800 --> 00:15:19,320
THAN THE USUAL,--DURING USUAL

452
00:15:19,320 --> 00:15:20,560
METHODS, SO WE LOOKED AT A

453
00:15:20,560 --> 00:15:22,040
VARIETY OF LEARNERS, CAN YOU SEE

454
00:15:22,040 --> 00:15:24,240
HERE IN THESE--AMONG THESE

455
00:15:24,240 --> 00:15:26,000
10,000 ARTICLES WE PICKED OUT

456
00:15:26,000 --> 00:15:28,040
ABOUT 92 IS 92 STUDIES THAT COMD

457
00:15:28,040 --> 00:15:29,200
SIMULATION TO TRADITIONAL

458
00:15:29,200 --> 00:15:30,280
METHODS OF LEARNING.

459
00:15:30,280 --> 00:15:31,960
HERE YOU SEE THE VARIETY OF

460
00:15:31,960 --> 00:15:33,640
PARTICIPANTS, MEDICAL STUDENTS,

461
00:15:33,640 --> 00:15:34,560
RESIDENTS,INOUSS AND OTHERS.

462
00:15:34,560 --> 00:15:36,600
THAT THE THESE STUDIES COVERED

463
00:15:36,600 --> 00:15:39,560
AND HERE ON THE BOTTOM, YOU SEE

464
00:15:39,560 --> 00:15:41,320
TECHNOLOGY ENHANCED SIMULATION

465
00:15:41,320 --> 00:15:43,080
COMPARED TO JUST TRADITIONAL

466
00:15:43,080 --> 00:15:44,760
LECTURE, SMALL GROUP LEARNING,

467
00:15:44,760 --> 00:15:47,800
PAPER AND PENCIL TESTS, VIDEOS,

468
00:15:47,800 --> 00:15:49,320
SOME OF THESE VARIETY IN

469
00:15:49,320 --> 00:15:51,400
DIFFERENT TRADITIONAL METHODS.

470
00:15:51,400 --> 00:15:55,520
HOW DID SIMULATIONS STACK UP.

471
00:15:55,520 --> 00:15:56,720
AND WHEN YOU LOOK AT THESE PLOTS

472
00:15:56,720 --> 00:15:59,000
ON THE RIGHT, YOU CAN SEE AT THE

473
00:15:59,000 --> 00:16:01,160
MOST PART, THE TECHNOLOGY AND

474
00:16:01,160 --> 00:16:03,200
SIMULATION FAVORED THAT METHOD

475
00:16:03,200 --> 00:16:05,480
AMONG THESE VARIED LEARNERS TO

476
00:16:05,480 --> 00:16:07,920
LEARN BETTER COMPARED TO SOME

477
00:16:07,920 --> 00:16:10,120
TRADITIONAL LEARNING.

478
00:16:10,120 --> 00:16:12,720
AND THE POOL EFFECT SIZE HERE

479
00:16:12,720 --> 00:16:15,120
APPROACHES .6 WITH THE A RANGE

480
00:16:15,120 --> 00:16:17,240
OF .27 TO .97.

481
00:16:17,240 --> 00:16:18,960
BUT .6 EFFECT SIZE IS A FAIRLY

482
00:16:18,960 --> 00:16:20,640
MODERATE EFFECT SIZE FOR

483
00:16:20,640 --> 00:16:22,560
SIMULATION COMPARED TO OTHER

484
00:16:22,560 --> 00:16:23,720
METHODOLOGIES, SO YES,

485
00:16:23,720 --> 00:16:24,800
SIMULATION AND HEALTHCARE DOES

486
00:16:24,800 --> 00:16:27,440
WORK AND YES, IT IS MODERATELY

487
00:16:27,440 --> 00:16:29,080
AFFECTED COMPARED TO TRADITIONAL

488
00:16:29,080 --> 00:16:33,680
METHODS TO LEARN CLINICAL

489
00:16:33,680 --> 00:16:34,200
SKILLS.

490
00:16:34,200 --> 00:16:37,080
SO IF YOU ARE GOING TO PRACTICE

491
00:16:37,080 --> 00:16:37,880
HEALTHCARE STIMULATION OR IF YOU

492
00:16:37,880 --> 00:16:40,280
ARE A VICTIM OF HEALTHCARE

493
00:16:40,280 --> 00:16:41,120
STIMULATION AS A LEARNER AND YOU

494
00:16:41,120 --> 00:16:48,760
WANT TO PUBLISH YOUR RESULTS,

495
00:16:48,760 --> 00:16:50,960
THIS TRIANGLE OR PYRAMID IS VERY

496
00:16:50,960 --> 00:16:51,240
HELPFUL.

497
00:16:51,240 --> 00:16:54,600
SO IN THE PAST WHEN SIMULATION

498
00:16:54,600 --> 00:16:56,200
FIRST BEGAN, MUCH OF THE

499
00:16:56,200 --> 00:16:57,600
LITERATURE ON THE EFFECT OF

500
00:16:57,600 --> 00:16:59,480
SIMULATION WAS BASED ON THE

501
00:16:59,480 --> 00:17:01,120
BOTTOM PYRAMID OF SATISFACTION,

502
00:17:01,120 --> 00:17:02,080
THEY WOULD ASK THE LEARNER DID

503
00:17:02,080 --> 00:17:04,080
YOU LIKE THE SIMULATION, DID YOU

504
00:17:04,080 --> 00:17:05,480
FEEL CONFIDENT AFTER YOU

505
00:17:05,480 --> 00:17:07,040
FINISHED THE SIMULATION, WE CALL

506
00:17:07,040 --> 00:17:08,320
THESE THE FEEL GOOD SURVEYS AND

507
00:17:08,320 --> 00:17:11,200
A LOT OF EARLY LITERATURE WAS IN

508
00:17:11,200 --> 00:17:12,240
THIS SATISFACTION, DID YOU ENJOY

509
00:17:12,240 --> 00:17:13,400
THE TRAINING, WHICH IS

510
00:17:13,400 --> 00:17:16,000
INTERESTING AND USEFUL TO GATHER

511
00:17:16,000 --> 00:17:18,000
BUT DOESN'T ADVANCE THE FIELD

512
00:17:18,000 --> 00:17:18,480
MUCH.

513
00:17:18,480 --> 00:17:20,720
NOW MOST JOURNAL EDITORS, AND

514
00:17:20,720 --> 00:17:24,360
MOST RESEARCHERS WHO PUBLISH IN

515
00:17:24,360 --> 00:17:27,520
SIM STRIE TO GO UP THIS

516
00:17:27,520 --> 00:17:28,200
KIRKPATRICK HIRE ARCH EXPE TRY

517
00:17:28,200 --> 00:17:29,840
TO MEASURE THINGS LIKE WAS THERE

518
00:17:29,840 --> 00:17:30,840
AN INCREASE IN KNOWLEDGE BEFORE

519
00:17:30,840 --> 00:17:32,640
AND AFTER THE SIMULATION?

520
00:17:32,640 --> 00:17:34,640
THIS IS USUALLY MEASURED BY

521
00:17:34,640 --> 00:17:38,440
MULTIPLE CHOICE QUESTIONS BEFORE

522
00:17:38,440 --> 00:17:39,720
ORAL EXAM NATIONS SO WE'RE

523
00:17:39,720 --> 00:17:42,280
MOVING UP THE FOOD CHAIN HERE OF

524
00:17:42,280 --> 00:17:43,080
ASSESSMENT OF SIMULATION.

525
00:17:43,080 --> 00:17:45,120
MORE AND MORE PAPERS ARE

526
00:17:45,120 --> 00:17:49,880
STRARTSTARTING TO NOW REPORT BER

527
00:17:49,880 --> 00:17:51,280
CHANGE IN THE CLINICAL WORLD

528
00:17:51,280 --> 00:17:52,480
BECAUSE OF SIMULATION, A HIGHER

529
00:17:52,480 --> 00:17:54,120
LEVEL OF ASSESSMENT AND A MUCH

530
00:17:54,120 --> 00:17:56,880
MORE IMPORTANT 1 CLINICALLY, THE

531
00:17:56,880 --> 00:17:59,400
ABSOLUTE TOP OF THE PYRAMID,

532
00:17:59,400 --> 00:18:00,960
THESE 2 TOP PYRAMIDS HERE ARE

533
00:18:00,960 --> 00:18:04,120
THE SORT OF GOLD STANDARD AND WE

534
00:18:04,120 --> 00:18:06,040
ALL STRIVE FOR, GOALS OF

535
00:18:06,040 --> 00:18:07,240
HEALTHCARE RESEARCH AND THAT IS

536
00:18:07,240 --> 00:18:11,280
DO THOSE FOLKS WHO HAVE A CHANGE

537
00:18:11,280 --> 00:18:12,520
IN THEIR BEHAVIOR IN THE SIM

538
00:18:12,520 --> 00:18:13,880
LAB, WHEN THEY GO OUT TO THE

539
00:18:13,880 --> 00:18:15,280
CLINICAL WORLD, DOES ANYBODY GET

540
00:18:15,280 --> 00:18:18,480
ANY BETTER?

541
00:18:18,480 --> 00:18:21,760
AND THEN EVERY CEO AND KMO IN

542
00:18:21,760 --> 00:18:23,000
ANY HEALTH ORGANIZATION IS

543
00:18:23,000 --> 00:18:24,840
WHAT'S MY RETURN ON INVESTMENT

544
00:18:24,840 --> 00:18:25,960
AFTER INVESTING ALL THIS TIME

545
00:18:25,960 --> 00:18:27,760
AND MONEY ON SIMULATION, DID THE

546
00:18:27,760 --> 00:18:29,160
TRAINING IMPACT THE RESULTS OF

547
00:18:29,160 --> 00:18:30,760
THE HOSPITAL OPERATIONS OR THE

548
00:18:30,760 --> 00:18:31,680
CLINICAL OPERATIONS FOR THE

549
00:18:31,680 --> 00:18:34,480
HEALTH OF A POPULATION.

550
00:18:34,480 --> 00:18:38,920
THAT IS A VERY DIFFICULT AND

551
00:18:38,920 --> 00:18:40,000
HARD ASSESSMENT TO MAKE AS YOU

552
00:18:40,000 --> 00:18:41,440
WILL SEE IN A MINUTE BUT IT IS

553
00:18:41,440 --> 00:18:44,320
THE TOP OF THE PYRAMID IN WHAT

554
00:18:44,320 --> 00:18:46,080
WE ALL STRIVE FOR, SO RIGHT NOW

555
00:18:46,080 --> 00:18:50,120
I THINK THE MAJORITY AND

556
00:18:50,120 --> 00:18:52,000
PUBLISHED ACCORDINGLY, IN THE

557
00:18:52,000 --> 00:18:53,560
IMPACT OR SO WE COME UP THE FOOD

558
00:18:53,560 --> 00:18:55,520
CHAIN HERE A BIT BUT WE HAVE

559
00:18:55,520 --> 00:18:57,480
SOME WAYS TO GO.

560
00:18:57,480 --> 00:18:59,280
AND THIS IS THE KIRKPATRICK

561
00:18:59,280 --> 00:19:03,840
TRIANGLE OF ASSESSMENT.

562
00:19:03,840 --> 00:19:06,400
BILL [INDISCERNIBLE] WHO IS A

563
00:19:06,400 --> 00:19:07,640
WELL PUBLISHED MEDICAL

564
00:19:07,640 --> 00:19:08,960
RESEARCHER AND SIMULATIONIST

565
00:19:08,960 --> 00:19:11,000
WITH COLLEAGUES OUT THE AT

566
00:19:11,000 --> 00:19:11,880
NORTHWESTERN UNIVERSITY TOOK A

567
00:19:11,880 --> 00:19:12,240
DIFFERENT TACT.

568
00:19:12,240 --> 00:19:13,400
HE SAID IF YOU ARE GOING TO DO

569
00:19:13,400 --> 00:19:14,720
RESEARCH IN HEALTHCARE

570
00:19:14,720 --> 00:19:15,680
SIMULATION, THINK OF IT THE WAY

571
00:19:15,680 --> 00:19:17,560
WE THINK OF ALL OTHER

572
00:19:17,560 --> 00:19:20,280
TRANSLATIONAL RESEARCH AS T1, T2

573
00:19:20,280 --> 00:19:30,400
AND T3.

574
00:19:31,680 --> 00:19:34,360
THIS IS THE MAJORITY OF THE WORK

575
00:19:34,360 --> 00:19:35,200
BEING DONE RIGHT NOW.

576
00:19:35,200 --> 00:19:36,720
THIS IS 1 RESEARCH WHERE WE CAN

577
00:19:36,720 --> 00:19:38,360
SHOW THAT PEOPLE GET BETTER OR

578
00:19:38,360 --> 00:19:39,880
HAVE DIFFERENT PRACTICES OR

579
00:19:39,880 --> 00:19:42,160
SKILL IMPROVES IN THE SINGLE

580
00:19:42,160 --> 00:19:43,600
LAB, AGAIN USING THE SIMULATION

581
00:19:43,600 --> 00:19:46,440
AND ASSESSMENT TOOLS WE TALKED

582
00:19:46,440 --> 00:19:47,800
ABOUT PREVIOUSLY BUT HE URGED US

583
00:19:47,800 --> 00:19:50,360
TO DO MORE T2 AND T3 RESEARCH.

584
00:19:50,360 --> 00:19:52,960
SO T2 RESEARCH AND HEALTHCARE

585
00:19:52,960 --> 00:19:54,000
SIMULATION HE WOULD SAY IS CAN

586
00:19:54,000 --> 00:19:56,080
THE IMPROVE UPON WANTS WE SEE IN

587
00:19:56,080 --> 00:19:59,240
THE SIM LAB TRANSFER TO IMPROVED

588
00:19:59,240 --> 00:20:02,240
DOWN STREAM PATIENT CARE

589
00:20:02,240 --> 00:20:02,960
PRACTICES.

590
00:20:02,960 --> 00:20:05,760
SO FOR INDIVIDUALS GROUPS, DOES

591
00:20:05,760 --> 00:20:06,600
ANYBODY GET ANY BETTER BECAUSE

592
00:20:06,600 --> 00:20:08,400
OF WHAT WE DID IN THE SIM LAB

593
00:20:08,400 --> 00:20:10,160
WITH INDIVIDUALS AND TEAMS.

594
00:20:10,160 --> 00:20:12,040
THAT'S T2 TRANSLATIONAL RESEARCH

595
00:20:12,040 --> 00:20:14,400
AND THE HOLY GRAIL IS THE T3

596
00:20:14,400 --> 00:20:17,080
RESEARCH WHICH IS NOT VERY

597
00:20:17,080 --> 00:20:18,880
FREQUENT BUT WHEN WE SEE IT,

598
00:20:18,880 --> 00:20:21,120
REALLY APPLAUD, AND THAT IS CAN

599
00:20:21,120 --> 00:20:22,840
WE IMPROVE PATIENT IN PUBLIC

600
00:20:22,840 --> 00:20:23,960
HEALTH BECAUSE OF WHAT WE HAVE

601
00:20:23,960 --> 00:20:25,520
DONE IN HEALTHCARE SIMULATION

602
00:20:25,520 --> 00:20:30,040
WITH INDIVIDUALS OR WITH TEAMS.

603
00:20:30,040 --> 00:20:32,040
SO THIS TYPE OF HIERARCHY CAN

604
00:20:32,040 --> 00:20:33,920
GUIDE RESEARCHERS AS THEY PLAN

605
00:20:33,920 --> 00:20:35,880
STUDIES AND REPORT STUDIES, A

606
00:20:35,880 --> 00:20:37,720
LOT OF T1 AND TRY TO GET MORE T2

607
00:20:37,720 --> 00:20:39,960
AND WE ULTIMATELY WANT TO GET TO

608
00:20:39,960 --> 00:20:40,360
T3.

609
00:20:40,360 --> 00:20:42,600
BUT IT IS NOT EASY.

610
00:20:42,600 --> 00:20:44,600
I WILL GIVE YOU AN EXAMPLE.

611
00:20:44,600 --> 00:20:47,160
SO JEFF BARSICK AND CLEANINGS AT

612
00:20:47,160 --> 00:20:48,440
NORTHWESTERN HAD A PROBLEM, AND

613
00:20:48,440 --> 00:20:51,640
THEY RECOGNIZED IN THEIR

614
00:20:51,640 --> 00:20:53,440
HOSPITAL, THE CENTRAL LINE

615
00:20:53,440 --> 00:20:55,440
ASSOCIATED BLOOD STREAM

616
00:20:55,440 --> 00:20:57,120
INFECTIONS OR COLLAB Cs, IN

617
00:20:57,120 --> 00:21:00,680
THE ICU AND IN THE ER, WERE

618
00:21:00,680 --> 00:21:02,560
UNACCEPTABLY HIGH IN THEIR

619
00:21:02,560 --> 00:21:03,560
HOSPITAL SYSTEM AND THEY WANTED

620
00:21:03,560 --> 00:21:04,720
TO DO SOMETHING ABOUT IT SO THEY

621
00:21:04,720 --> 00:21:07,520
THOUGHT THAT PERHAPS HEALTHCARE

622
00:21:07,520 --> 00:21:10,360
SIMULATION DELIVERED PRACTICE

623
00:21:10,360 --> 00:21:11,920
INSERTING AND CARING FOR CENTRAL

624
00:21:11,920 --> 00:21:13,320
LINES MIGHT HELP WITH THIS

625
00:21:13,320 --> 00:21:13,640
PROBLEM.

626
00:21:13,640 --> 00:21:16,640
SO WHAT THEY DID WAS THEY LOOKED

627
00:21:16,640 --> 00:21:20,040
AT THEIR CLABSI RATE FOR 2 YEARS

628
00:21:20,040 --> 00:21:21,720
PRIOR TO STARTING AN

629
00:21:21,720 --> 00:21:23,280
INTERVENTION AND THEN FOR EVERY

630
00:21:23,280 --> 00:21:24,800
INTERNAL MEDICINE RESIDENT AND

631
00:21:24,800 --> 00:21:25,640
EVERY EMERGENCY MEDICINE

632
00:21:25,640 --> 00:21:26,480
RESIDENT WHO WOULD ROTATE

633
00:21:26,480 --> 00:21:31,040
THROUGH THE IRU OR THE ER,

634
00:21:31,040 --> 00:21:37,680
UNDERWENT IN THEIR SIM LAWS HOW

635
00:21:37,680 --> 00:21:39,400
THEY CARE PER IT SO THEY

636
00:21:39,400 --> 00:21:41,080
PRACTICE OVER AND OVER AND OVER

637
00:21:41,080 --> 00:21:43,480
AGAIN USING TASK TRAINERS AND

638
00:21:43,480 --> 00:21:45,200
CENTRAL LINE EQUIPMENT AS THEY

639
00:21:45,200 --> 00:21:47,400
WOULD IN THE E. R. OR ICU AND

640
00:21:47,400 --> 00:21:49,000
THEY DID NOT LEAVE THE SIM LAB

641
00:21:49,000 --> 00:21:50,360
UNTIL THEY WERE VERY GOOD AND

642
00:21:50,360 --> 00:21:51,800
PERFECT AND PUTTING IN AND

643
00:21:51,800 --> 00:21:52,840
MAINTAINING CENTRAL LINES

644
00:21:52,840 --> 00:21:54,040
ACCORDING TO A CHECK LIST AND

645
00:21:54,040 --> 00:21:56,600
THEN HE MEASURED THE CLABSI RATE

646
00:21:56,600 --> 00:21:58,840
IN THE HOSPITAL AFTER THESE

647
00:21:58,840 --> 00:22:00,000
RESIDENTS ROTATED THROUGH THE E.

648
00:22:00,000 --> 00:22:03,000
R. AND THE EMERGENCY ROOM, I'M

649
00:22:03,000 --> 00:22:04,760
SORRY THE EMERGENCY ROOM AND ICU

650
00:22:04,760 --> 00:22:05,240
AFTER 2 YEARS.

651
00:22:05,240 --> 00:22:07,640
SO HERE'S THE RESULTS HE

652
00:22:07,640 --> 00:22:07,960
REPORTED.

653
00:22:07,960 --> 00:22:09,600
SO WHAT YOU CAN SEE ON THESE

654
00:22:09,600 --> 00:22:10,840
ISSUES AT LEAST THE GRAPH ON THE

655
00:22:10,840 --> 00:22:13,080
BOTTOM, THIS IS THE CLABSI RATE

656
00:22:13,080 --> 00:22:14,960
IN THE HOSPITAL THAT HOVERED

657
00:22:14,960 --> 00:22:16,560
HERE AROUND 5 INFECTIONS FOR A

658
00:22:16,560 --> 00:22:17,960
THOUSAND LINE DAYS, WHERE I HAVE

659
00:22:17,960 --> 00:22:20,560
A GREN LINE HERE AND THIS IS THE

660
00:22:20,560 --> 00:22:21,200
PREINTERVENTION, 2 YEARS BEFORE

661
00:22:21,200 --> 00:22:23,000
THEY STARTED TRAINING RESIDENTS

662
00:22:23,000 --> 00:22:24,960
IN HOW TO CARE FOR AND INSERT

663
00:22:24,960 --> 00:22:26,280
CENTRAL LINES WITH SIMULATION.

664
00:22:26,280 --> 00:22:29,080
THIS WAS USUAL TRAINING WHICH IS

665
00:22:29,080 --> 00:22:31,760
PROBABLY SEE 1, DO 1, TEACH 1 IF

666
00:22:31,760 --> 00:22:32,880
I REMEMBER HOW THAT USED TO

667
00:22:32,880 --> 00:22:33,360
WORK.

668
00:22:33,360 --> 00:22:36,200
AND THEN HE INSTITUTED THIS

669
00:22:36,200 --> 00:22:37,800
INTENSIVE SIMULATION TRAINING IN

670
00:22:37,800 --> 00:22:39,440
CENTRAL LINES, JUST AMONG THE

671
00:22:39,440 --> 00:22:40,680
RESIDENTS AND WHEN WE MEASURED

672
00:22:40,680 --> 00:22:43,760
WAS THE CLABSI RATING IN THE

673
00:22:43,760 --> 00:22:46,320
HOSPITAL, DRAMATIC LOAMACYY

674
00:22:46,320 --> 00:22:49,240
IMPROVED, ALMOST REACHED 0 HERE

675
00:22:49,240 --> 00:22:50,640
IN SEVERAL CASES WHICH WAS NOT

676
00:22:50,640 --> 00:22:52,760
ALWAYS THE CASE IN THE

677
00:22:52,760 --> 00:22:54,080
PREINTERVENTION ERA AND OTHER

678
00:22:54,080 --> 00:22:55,360
RESIDENTS CAME IN THE FOLLOWING

679
00:22:55,360 --> 00:22:57,040
YEAR WHO DIDN'T GET TRAINED FOR

680
00:22:57,040 --> 00:22:58,440
WHATEVER REASON AND SEE THE RATE

681
00:22:58,440 --> 00:23:00,240
WENT BACK UP BUT ONCE THEY WERE

682
00:23:00,240 --> 00:23:01,520
TRAINED WENT BACK DOWN AGAIN.

683
00:23:01,520 --> 00:23:03,680
SO THIS LOOKS VERY IMPRESSIVE AS

684
00:23:03,680 --> 00:23:06,400
SORT OF T2 KIND OF PATIENT CARE

685
00:23:06,400 --> 00:23:08,840
OUTCOMES IMPACTED BY SIMULATION

686
00:23:08,840 --> 00:23:09,640
TRAINING EMPLOY BUT I WILL TELL

687
00:23:09,640 --> 00:23:11,200
YOU THERE'S A PROBLEM.

688
00:23:11,200 --> 00:23:13,880
IT'S NOT OFTEN POSSIBLE TO DRAW

689
00:23:13,880 --> 00:23:17,400
A DIRECT LINE FROM PATIENT

690
00:23:17,400 --> 00:23:19,120
OUTCOMES BACK TO SIMULATION,

691
00:23:19,120 --> 00:23:19,480
WHY?

692
00:23:19,480 --> 00:23:20,560
PATIENT OUTCOMES AS YOU

693
00:23:20,560 --> 00:23:22,680
ULTIMATELY KNOW ARE VERY

694
00:23:22,680 --> 00:23:23,920
COMPLICATED OUTCOMES, AND

695
00:23:23,920 --> 00:23:25,240
PROBABLY THERE ARE MANY

696
00:23:25,240 --> 00:23:27,520
VARIABLES THAT IMPACT PATIENT

697
00:23:27,520 --> 00:23:29,360
OUTCOMES, IN THIS CASE, THERE

698
00:23:29,360 --> 00:23:31,640
WERE PROBABLY OTHER VARIABLES

699
00:23:31,640 --> 00:23:34,600
THAT COULD HAVE INFLUENCED THE

700
00:23:34,600 --> 00:23:37,080
CLABSI RATE ONCE THE SIMULATOR

701
00:23:37,080 --> 00:23:38,440
TRAINED RESIDENTS WERE RELEASED

702
00:23:38,440 --> 00:23:40,040
INTO THE REAL WORLD, THINGS LIKE

703
00:23:40,040 --> 00:23:41,680
NOW WE'RE PAYING ATTENTION TO

704
00:23:41,680 --> 00:23:44,040
CENTRAL LINE INSERTION SO MAYBE

705
00:23:44,040 --> 00:23:46,160
EVERYBODY WAS MORE AWARE OR HER

706
00:23:46,160 --> 00:23:47,760
HAPPENS NURSES WERE INVOLVED IN

707
00:23:47,760 --> 00:23:49,880
THIS TRAINING AND THEY SAW THE

708
00:23:49,880 --> 00:23:51,560
RESIDENTS DOING SOMETHING

709
00:23:51,560 --> 00:23:52,720
DIFFERENT AND I THAT DID A

710
00:23:52,720 --> 00:23:54,120
BETTER JOB OF MAINTAINING

711
00:23:54,120 --> 00:23:55,720
CENTRAL LINES OR MAYBE THERE WAS

712
00:23:55,720 --> 00:23:57,240
A HOSPITAL WIDE EFFORT

713
00:23:57,240 --> 00:23:58,200
INDEPENDENT OF SIMULATION TO

714
00:23:58,200 --> 00:23:59,920
FOCUS ON THE CARE OF CENTRAL

715
00:23:59,920 --> 00:24:02,440
LINES ONCE THEY WERE PLACED.

716
00:24:02,440 --> 00:24:04,360
ALL THESE THINGS PROBE IMPACTED

717
00:24:04,360 --> 00:24:06,000
PATIENT OUTCOMES SO DRAWING A

718
00:24:06,000 --> 00:24:07,040
LINE DIRECTLY BACK TO THE SIM

719
00:24:07,040 --> 00:24:09,360
LAB IS NOT EASY AND OFTEN THERE

720
00:24:09,360 --> 00:24:11,120
ARE CO VARIABLES THAT HAVE TO BE

721
00:24:11,120 --> 00:24:14,040
TAKEN INTO ACCOUNT.

722
00:24:14,040 --> 00:24:16,720
AND BECAUSE OF THAT T2 RESEARCH

723
00:24:16,720 --> 00:24:17,720
IS HARD.

724
00:24:17,720 --> 00:24:19,040
CONTROLLING THESE OTHER

725
00:24:19,040 --> 00:24:20,080
VARIABLES IS NOT EASY BUT IT IS

726
00:24:20,080 --> 00:24:23,440
THE GOAL WE ALL LOOK FOR IN

727
00:24:23,440 --> 00:24:25,480
HEALTHCARE SIMULATION, SO WHAT

728
00:24:25,480 --> 00:24:27,720
IS MY TAKE HOME POINTS FOR YOU

729
00:24:27,720 --> 00:24:28,200
TODAY?

730
00:24:28,200 --> 00:24:29,800
ONE, SIMULATION BASED MEDICAL

731
00:24:29,800 --> 00:24:31,560
EDUCATION DOES WORK, IT'S CALLED

732
00:24:31,560 --> 00:24:34,040
THE EFAS CASSIE DATA I

733
00:24:34,040 --> 00:24:35,600
PRESENTED, BUT IT TAKES TIME AND

734
00:24:35,600 --> 00:24:37,000
RESOURCES AND IT TAKES MONEY.

735
00:24:37,000 --> 00:24:40,680
AND ALL OF THESE ARE ALL QUS BUT

736
00:24:40,680 --> 00:24:43,640
WE IN THE SIMULATION COMMUNITY

737
00:24:43,640 --> 00:24:46,000
BELIEVE IT IS FIRMLY WORTH THIS

738
00:24:46,000 --> 00:24:46,600
INVESTMENT.

739
00:24:46,600 --> 00:24:48,000
PEASHT OUTCOMES YOU JUST SAW IS

740
00:24:48,000 --> 00:24:49,280
THE GOLD STANDARD, WE ARE TRYING

741
00:24:49,280 --> 00:24:51,040
TO,A CHIEF WITH HELT CARE

742
00:24:51,040 --> 00:24:52,520
SIMULATION, BUT IT'S NOT EASY

743
00:24:52,520 --> 00:24:54,040
BECAUSE THE CORRELATION IS

744
00:24:54,040 --> 00:24:55,680
FRAUGHT WITH A LOT OF OTHER CO

745
00:24:55,680 --> 00:24:57,520
VARIABLES THAT HAVE TO BE

746
00:24:57,520 --> 00:25:00,280
ACCOUNTED FOR AND LASTLY WE NEED

747
00:25:00,280 --> 00:25:02,520
MORE T2 AND T3 RESEARCH, WE WERE

748
00:25:02,520 --> 00:25:03,680
PRETTY MUCH DONE WITH, I CAN

749
00:25:03,680 --> 00:25:05,360
SHOW YOU I DO BETTER IN THE SIM

750
00:25:05,360 --> 00:25:07,000
LAB, LET'S FOCUS MORE ON PATIENT

751
00:25:07,000 --> 00:25:08,360
OUTCOMES AND POPULATION

752
00:25:08,360 --> 00:25:10,400
OUTCOMES, AND THAT IS SORELY

753
00:25:10,400 --> 00:25:12,640
NEEDED AND HOPEFULLY WILL BE

754
00:25:12,640 --> 00:25:14,440
MORE AS THIS FIELD MATURES AND

755
00:25:14,440 --> 00:25:15,440
AS WE GO FORWARD.

756
00:25:15,440 --> 00:25:17,320
SO I WANT TO STOP HERE AND ALLOW

757
00:25:17,320 --> 00:25:18,720
TIME FOR MY OTHER PRESENTERS TO

758
00:25:18,720 --> 00:25:21,440
MAKE THERAPIST PRESENTATIONS, WE

759
00:25:21,440 --> 00:25:22,640
WILL PROBABLY TAKE QUESTIONS

760
00:25:22,640 --> 00:25:23,600
AFTERWARDS BUT THANK YOU AGAIN

761
00:25:23,600 --> 00:25:24,640
FOR THE TIME AND STANDING BY FOR

762
00:25:24,640 --> 00:25:28,120
YOUR QUESTIONS LATER ON IN THIS

763
00:25:28,120 --> 00:25:28,640
PRESENTATION.

764
00:25:28,640 --> 00:25:38,800
THANK YOU.

765
00:25:41,880 --> 00:25:44,520
IT'S REALLY MY GREAT PLEASURE TO

766
00:25:44,520 --> 00:25:46,400
BE PARTICIPATING IN THIS NIH

767
00:25:46,400 --> 00:25:47,680
GRAND ROUNDS.

768
00:25:47,680 --> 00:25:50,520
I'M SO GLAD WE ARE FOCUSED

769
00:25:50,520 --> 00:25:51,560
DURING HEALTHCARE SIMULATION

770
00:25:51,560 --> 00:25:54,440
WEEK ON TALKING ABOUT SIMULATION

771
00:25:54,440 --> 00:25:56,200
AND I'M HERE TO DISCUSS

772
00:25:56,200 --> 00:25:57,360
SIMULATION BASED EDUCATION AS IT

773
00:25:57,360 --> 00:25:59,520
RELATES TO HIGH RISK LOW VOLUME

774
00:25:59,520 --> 00:26:01,960
CARE, WHICH IS PARTICULARLY

775
00:26:01,960 --> 00:26:03,560
RELEVANT TO THE PATIENTS WE CARE

776
00:26:03,560 --> 00:26:05,280
FOR HERE AT NIH.

777
00:26:05,280 --> 00:26:06,520
SO I THINK WE SHOULD ALWAYS

778
00:26:06,520 --> 00:26:08,320
START WITH A DEFINITION, THERE

779
00:26:08,320 --> 00:26:10,000
ARE SEVERAL DEFINITIONS BUT A

780
00:26:10,000 --> 00:26:12,280
WIDELY ACCEPTED 1 FOR HIGH RISK

781
00:26:12,280 --> 00:26:13,320
LOW VOLUME THERAPY, IS THAT

782
00:26:13,320 --> 00:26:15,240
THESE ARE THERAPIES THAT ARE

783
00:26:15,240 --> 00:26:16,000
PRACTICED INFETAL COMPARTMENT

784
00:26:16,000 --> 00:26:17,280
QUENTLY AND YET CARRY AN

785
00:26:17,280 --> 00:26:18,240
INCREASED RISK TO PATIENTS

786
00:26:18,240 --> 00:26:22,400
BECAUSE OF THEIR COMPLEXITY.

787
00:26:22,400 --> 00:26:26,400
HOWEVER, EVEN DEFINITION OF HIGH

788
00:26:26,400 --> 00:26:29,240
RISK LOW VOLUME AS IT CREATES

789
00:26:29,240 --> 00:26:35,760
CONTROVERSY AND HAS LIMITATIONS,

790
00:26:35,760 --> 00:26:37,320
AND HOW DO WE PROCEED?

791
00:26:37,320 --> 00:26:39,120
WE THINK OF THE PROCEDURE ITSELF

792
00:26:39,120 --> 00:26:40,960
AND WE THINK OF THE SKILL OF THE

793
00:26:40,960 --> 00:26:42,480
PERSON DOING THE PROCEDURE, IT'S

794
00:26:42,480 --> 00:26:44,560
MUCH MORE COMPLICATED THAN THAT,

795
00:26:44,560 --> 00:26:45,800
THE SAME OPERATION WOULD HAVE

796
00:26:45,800 --> 00:26:47,280
DIFFERENT RISKS BEPENDING ON THE

797
00:26:47,280 --> 00:26:49,240
PATIENT'S CLINICAL STATUS, A

798
00:26:49,240 --> 00:26:51,160
HEALTHY OUTPATIENT COMPARED TO A

799
00:26:51,160 --> 00:26:52,640
CRITICALLY ILL PATIENT AND

800
00:26:52,640 --> 00:26:53,800
MULTIORGAN FAILURE IN THE ICU,

801
00:26:53,800 --> 00:26:56,200
WE WILL HAVE DIFFERENT

802
00:26:56,200 --> 00:26:57,960
PROCEDURAL RISKS.

803
00:26:57,960 --> 00:26:59,520
AND THE RISKS ALSO RELATES TO

804
00:26:59,520 --> 00:27:02,400
HOW WELL THE TEAM THAT'S

805
00:27:02,400 --> 00:27:03,520
PROVIDING SUPPORTIVE CARE,

806
00:27:03,520 --> 00:27:04,960
WHETHER THAT'S IN AN OPERATING

807
00:27:04,960 --> 00:27:07,000
ROOM OR IN AN ICU OR ON A

808
00:27:07,000 --> 00:27:10,200
MEDICAL FLOOR FOR EXAMPLE, ARE

809
00:27:10,200 --> 00:27:11,720
PROVIDING SUPPORTIVE CARE AND

810
00:27:11,720 --> 00:27:14,960
DOING THEIR BEST TO PREVENT

811
00:27:14,960 --> 00:27:15,360
COMPLICATIONS.

812
00:27:15,360 --> 00:27:17,000
SO IT IS--THERE ARE CLEAR

813
00:27:17,000 --> 00:27:19,560
LIMITATIONS TO THIS DEFINITION,

814
00:27:19,560 --> 00:27:21,360
HERE I'M SHOWING YOU THAT THE

815
00:27:21,360 --> 00:27:23,080
NIH CLINICAL CENTER MISSION

816
00:27:23,080 --> 00:27:25,360
STATEMENT AND I SHOW YOU THIS

817
00:27:25,360 --> 00:27:27,000
BECAUSE, THE TYPE OF CARE WE

818
00:27:27,000 --> 00:27:28,080
PROVIDE HERE REALLY IS WHAT

819
00:27:28,080 --> 00:27:31,040
WE'RE TALKING ABOUT, WHEN WE

820
00:27:31,040 --> 00:27:32,480
TALK ABOUT HIGH RISK LOW VOLUME

821
00:27:32,480 --> 00:27:35,440
AND IT'S ACTUALLY ALLUDED TO IN

822
00:27:35,440 --> 00:27:36,080
OUR MISSION STATEMENT.

823
00:27:36,080 --> 00:27:37,640
I WILL POP UP THE RELEVANT

824
00:27:37,640 --> 00:27:39,760
PORTION HERE SO CAN YOU SEE IT

825
00:27:39,760 --> 00:27:41,280
BETTER, INNOVATIVE THERAPY AND

826
00:27:41,280 --> 00:27:42,680
HIGH QUALITY CARE TREATING

827
00:27:42,680 --> 00:27:44,560
PATIENTS WITH RARE AND SEVERE

828
00:27:44,560 --> 00:27:44,960
DISEASES.

829
00:27:44,960 --> 00:27:49,200
THIS CLEARLY REFERS TO HIGH RISK

830
00:27:49,200 --> 00:27:52,160
LOW VOLUME CARE, SO NOT ONLY IS

831
00:27:52,160 --> 00:27:54,320
THIS PART OF OUR MISSION

832
00:27:54,320 --> 00:27:55,760
STATEMENT, HIGH RISK LOW VOLUME

833
00:27:55,760 --> 00:27:58,720
CARE IS A PRIORITY OF STAFF AND

834
00:27:58,720 --> 00:28:00,600
A FOCUS, SO THERE HAVE BEEN

835
00:28:00,600 --> 00:28:02,080
INDEPENDENT SURVEYS THAT HAVE

836
00:28:02,080 --> 00:28:03,720
BEEN DONE THAT HAVE BEEN

837
00:28:03,720 --> 00:28:05,320
CONDUCTED BY BOTH THE CLINICAL

838
00:28:05,320 --> 00:28:07,080
CENTER PATIENT SAFETY CLINICAL

839
00:28:07,080 --> 00:28:08,320
PRACTICING QUALITY COMMITTEE AS

840
00:28:08,320 --> 00:28:13,760
WELL AS THE NURSING DEPARTMENT

841
00:28:13,760 --> 00:28:14,960
LEADERSHIP, WITH THOSE REACHING

842
00:28:14,960 --> 00:28:17,040
OUT TO NURSES AND BEDSIDE

843
00:28:17,040 --> 00:28:17,960
PATIENTS RESPECTIVELY.

844
00:28:17,960 --> 00:28:19,560
AND LOW RISK HIGH VOLUME CARE

845
00:28:19,560 --> 00:28:21,240
HAS BEEN IDENTIFIED BY BOTH

846
00:28:21,240 --> 00:28:24,800
GROAPS AS A POTENTIAL

847
00:28:24,800 --> 00:28:27,840
VOWELLERRENERRABILITY.

848
00:28:27,840 --> 00:28:29,080
VOWELLERRENERRABILITY--VULNERABI

849
00:28:29,080 --> 00:28:29,280
LITY.

850
00:28:29,280 --> 00:28:31,960
WHEN WE DIG DEEPER INTO THESE

851
00:28:31,960 --> 00:28:33,160
SURVEYS, THEY WANT TO ASSURE

852
00:28:33,160 --> 00:28:35,080
THAT ALL MEMBERS OF THE TREATING

853
00:28:35,080 --> 00:28:36,760
TEAM ARE PREPARED TO MANAGE

854
00:28:36,760 --> 00:28:40,720
THESE COMPLEX PATIENTS.

855
00:28:40,720 --> 00:28:42,160
AND BOTH GROUPS INDEPENDENTLY

856
00:28:42,160 --> 00:28:44,200
REPORT THAT FURTHER TRAINING OF

857
00:28:44,200 --> 00:28:45,920
THOSE TEAMS WOULD BE HELPFUL AND

858
00:28:45,920 --> 00:28:48,400
I THINK THAT'S CLEARLY AN AREA

859
00:28:48,400 --> 00:28:55,200
WHERE SIMULATION IS AN EXCELLENT

860
00:28:55,200 --> 00:28:56,440
PLATFORM FOR US TO PROVIDE THAT

861
00:28:56,440 --> 00:28:58,560
SORT OF EDUCATION SO NOW I WILL

862
00:28:58,560 --> 00:28:59,840
DESCRIBE, GO ON TO DISCUSS WHAT

863
00:28:59,840 --> 00:29:02,400
TYPE OF TRAINING IS MOST USEFUL.

864
00:29:02,400 --> 00:29:03,400
WHEN WE'RE TALKING ABOUT MAKING

865
00:29:03,400 --> 00:29:05,880
SURE THE WHOLE TEAM IS ON THE

866
00:29:05,880 --> 00:29:09,280
SAME PAGE FOR TREATING THESE

867
00:29:09,280 --> 00:29:14,080
COMPLEX PATIENTS.

868
00:29:14,080 --> 00:29:18,680
SO,--HERE--YEAH.

869
00:29:18,680 --> 00:29:23,880
SO WE HAVE HERE IS--I WANT TO

870
00:29:23,880 --> 00:29:26,040
TART WITH A CASE PRESENTATION.

871
00:29:26,040 --> 00:29:27,560
THIS PICTURE IS A DEPICTION HERE

872
00:29:27,560 --> 00:29:30,560
OF AN EXAMPLE OF A CASE THAT WAS

873
00:29:30,560 --> 00:29:32,400
PRESENTED AT AN M& M
CONFERENCE

874
00:29:32,400 --> 00:29:33,240
AT ANOTHER HOSPITAL.

875
00:29:33,240 --> 00:29:35,280
THIS IS A TRAUMA PATIENT WHO

876
00:29:35,280 --> 00:29:38,760
PRESENTED TO THE E. R. AFTER A

877
00:29:38,760 --> 00:29:39,800
MOTOR VEHICLE ACCIDENT

878
00:29:39,800 --> 00:29:42,400
COMPLAINING OF ABDOMINAL PAIN.

879
00:29:42,400 --> 00:29:44,440
CAN YOU SEE EACH OF THE MEMBERS

880
00:29:44,440 --> 00:29:45,520
OF THE PROFESSIONAL TEAM

881
00:29:45,520 --> 00:29:47,000
PERFORMING RESPECTIVE ROLES AS A

882
00:29:47,000 --> 00:29:48,880
PATIENT A CLINICAL STATUS

883
00:29:48,880 --> 00:29:52,120
WORSENS, CAN YOU SEE HERE THE

884
00:29:52,120 --> 00:29:54,040
ANESTHESIOLOGIST AND RESPIRATORY

885
00:29:54,040 --> 00:29:55,360
THERAPIST AT THE HEAD OF THE

886
00:29:55,360 --> 00:29:56,080
BED, THEY'RE WORKING TO

887
00:29:56,080 --> 00:29:56,920
INTERNATIONAL

888
00:29:56,920 --> 00:29:58,440
INTERNATIINTERNATIONAL CLASSIFIN

889
00:29:58,440 --> 00:30:01,880
PATIENT, SECURE THE ENDOTRACHEAL

890
00:30:01,880 --> 00:30:03,840
TUBE, SECURE OXYGEN WHILE

891
00:30:03,840 --> 00:30:05,560
BAGGING THROUGH THE ENDOTRACHEAL

892
00:30:05,560 --> 00:30:06,920
TUBE, CAN YOU SEE NURSES ON BOTH

893
00:30:06,920 --> 00:30:09,920
SIDES WORKING TO GET IV ACCESS,

894
00:30:09,920 --> 00:30:12,240
DRAWING BLOOD FOR LABS,

895
00:30:12,240 --> 00:30:13,880
ADMINISTERING FLUIDS AND

896
00:30:13,880 --> 00:30:15,320
MEDICATIONS FOR RESUSCITATION.

897
00:30:15,320 --> 00:30:16,920
WE SEE A RESIDENT HERE TRYING TO

898
00:30:16,920 --> 00:30:21,400
DO A RAPID--CALLED A FAST

899
00:30:21,400 --> 00:30:23,120
ULTRASOUND TO LOOK AT HEART

900
00:30:23,120 --> 00:30:25,480
FUNCTION, TO LOOK FOR EVIDENCE

901
00:30:25,480 --> 00:30:27,520
OF ANY BLEEDING, OBVIOUSLY THIS

902
00:30:27,520 --> 00:30:30,120
PATIENT HAD ABDOMINAL TRAUMA AND

903
00:30:30,120 --> 00:30:33,760
THEN AT THE SAME TIME YOU SEE A

904
00:30:33,760 --> 00:30:35,880
SURGEON EXAMINING THE PATIENT

905
00:30:35,880 --> 00:30:41,680
DECIDING IF THIS REQUIRES--IF

906
00:30:41,680 --> 00:30:43,880
THIS CASE REQUIRES GOING TO THE

907
00:30:43,880 --> 00:30:46,800
O. R. URGENTLY @ FOOT OF THE BED

908
00:30:46,800 --> 00:30:49,280
YOU SEE THE TEAM LEADER GUIDING

909
00:30:49,280 --> 00:30:49,600
RESUSCITATION.

910
00:30:49,600 --> 00:30:51,080
SADLY IN THE CASE THAT WAS

911
00:30:51,080 --> 00:30:52,920
REVIEWED AT THE M& M, THE

912
00:30:52,920 --> 00:30:54,160
PATIENT LATER DIED AND 1 OF THE

913
00:30:54,160 --> 00:30:56,720
CONCERNS RAISED IN THE

914
00:30:56,720 --> 00:30:58,280
CONFERENCE WAS WHETHER WAS THERE

915
00:30:58,280 --> 00:31:00,680
DELAYED ACTIVATION OF A MASSIVE

916
00:31:00,680 --> 00:31:02,280
TRANSFUSION PROTE PROTOCOL THATD

917
00:31:02,280 --> 00:31:04,560
BE IMPLEMENTED IN PERSISTENT

918
00:31:04,560 --> 00:31:06,600
HYPOTENSION IF PRESUMED

919
00:31:06,600 --> 00:31:09,800
ABDOMINAL BLEEDING WERE THE

920
00:31:09,800 --> 00:31:11,040
CAUSE OF HYPERTENSION.

921
00:31:11,040 --> 00:31:12,680
SO WHEN WE TALK ABOUT THIS, THE

922
00:31:12,680 --> 00:31:13,640
IMPORTANT QUESTION WE ASK IS HOW

923
00:31:13,640 --> 00:31:16,160
DO WE IMPROVE TEAM CARE FOR THE

924
00:31:16,160 --> 00:31:18,840
NEXT PATIENT WITH SIMILAR--WITH

925
00:31:18,840 --> 00:31:21,040
A SIMILAR PRESENTATION.

926
00:31:21,040 --> 00:31:23,280
I THINK 1 OF THE CHALLENGES WE

927
00:31:23,280 --> 00:31:25,520
HAVE IN HEALTH PROFESSIONS

928
00:31:25,520 --> 00:31:26,680
EDUCATION IS WE TRADITIONALLY

929
00:31:26,680 --> 00:31:28,480
LEARNED IN SILOS BASED ON OUR

930
00:31:28,480 --> 00:31:32,040
PEER GROUP, PHYSICIANS LEARN

931
00:31:32,040 --> 00:31:33,520
TOGETHER, RESPIRATORY THERAPY

932
00:31:33,520 --> 00:31:34,800
AND UPONNISTS COME OUT, NURSES,

933
00:31:34,800 --> 00:31:37,680
FORM CYST, PTOT, ALL ARE GROUPS

934
00:31:37,680 --> 00:31:41,480
OF PROVIDERS WE LEARN IN OUR

935
00:31:41,480 --> 00:31:45,520
SEPARATE SILOS BUT WE CARE FOR

936
00:31:45,520 --> 00:31:48,360
IN THOSE PATIENTS IN THE EXAMPLE

937
00:31:48,360 --> 00:31:50,120
IS WITH PROFESSIONAL TEAMS SO

938
00:31:50,120 --> 00:31:51,920
WHEN WE TALK ABOUT CONCEPT, WE

939
00:31:51,920 --> 00:31:55,560
WILL TALK ABOUT IN MORE RETAIL

940
00:31:55,560 --> 00:31:57,920
PRACTICE WE CAN'T DO THAT OF ANY

941
00:31:57,920 --> 00:31:59,840
SILOS WE MUST BREAK OUT OF THEM

942
00:31:59,840 --> 00:32:03,920
TO REALLY IMPROVE TEAM

943
00:32:03,920 --> 00:32:04,240
PERFORMANCE.

944
00:32:04,240 --> 00:32:08,040
WHEN WE WANT TO DO NOW IS REFER

945
00:32:08,040 --> 00:32:09,480
TO A COUPLE DIFFERENT WAYS TO GO

946
00:32:09,480 --> 00:32:11,600
ABOUT THIS WHEN WE TALK ABOUT

947
00:32:11,600 --> 00:32:13,400
HIGH RISK FOR TRAINING, 1 IS

948
00:32:13,400 --> 00:32:15,480
PROFESSIONAL EDUCATION I WILL

949
00:32:15,480 --> 00:32:17,240
TALK A FAIR AMOUNT ABOUT THAT,

950
00:32:17,240 --> 00:32:19,560
THAT OCCURS WHEN 2 OR MORE

951
00:32:19,560 --> 00:32:20,480
PROFESSIONALS LEARN ABOUT FROM

952
00:32:20,480 --> 00:32:22,240
AND WITH EACH OTHER TO ENABLE

953
00:32:22,240 --> 00:32:24,400
EFFECTIVE COLLABORATION AND

954
00:32:24,400 --> 00:32:25,920
IMPROVE HEALTH OUTCOMES, CAN YOU

955
00:32:25,920 --> 00:32:28,200
SEE FOR EXAMPLE AN IRPT

956
00:32:28,200 --> 00:32:29,160
PROFESSIONAL TEAM LIKE I SHOWED

957
00:32:29,160 --> 00:32:30,720
IN THE CLINICAL EXAMPLE WOULD BE

958
00:32:30,720 --> 00:32:37,040
1 IF THEY TOGETHER IN A

959
00:32:37,040 --> 00:32:40,280
GROUP FOR A TEACHING, THAT WOULD

960
00:32:40,280 --> 00:32:42,920
BE AN INTERPROFESSIONAL

961
00:32:42,920 --> 00:32:43,760
EDUCATION, THIS IS FOR THE

962
00:32:43,760 --> 00:32:46,280
PROGRAM HERE IS JUST IN TIME.

963
00:32:46,280 --> 00:32:49,640
JUST IN TIME TRAINING IS A

964
00:32:49,640 --> 00:32:51,480
PRACTICE OF A SKILL IMMEDIATELY

965
00:32:51,480 --> 00:32:52,800
PRIOR TO A ROUGH ATOM SEEDURE, 1

966
00:32:52,800 --> 00:32:56,800
CAN IMAGINE 1 OF THESE COMPLEX

967
00:32:56,800 --> 00:32:58,080
SURGERIES FOR HIGH RISK LOW

968
00:32:58,080 --> 00:32:59,680
VOLUME TREATMENTS WE DO HERE.

969
00:32:59,680 --> 00:33:01,720
IF WE KNOW WE HAVE A SCHEDULED

970
00:33:01,720 --> 00:33:03,560
ADMISSION FOR A PATIENT THAT WE

971
00:33:03,560 --> 00:33:05,160
COULD GATHER THE TEAM TOGETHER

972
00:33:05,160 --> 00:33:07,400
IN ADVANCE OF THAT SCHEDULED

973
00:33:07,400 --> 00:33:09,520
ADMISSION AND PRACTICE WITH

974
00:33:09,520 --> 00:33:12,800
PREDICTABLE POTENTIAL

975
00:33:12,800 --> 00:33:13,680
COMPLICATIONS MIGHT BE.

976
00:33:13,680 --> 00:33:15,400
SO NOW THAT YOU UNDERSTAND THESE

977
00:33:15,400 --> 00:33:17,240
TERMS, LET'S TALK A LITTLE BIT

978
00:33:17,240 --> 00:33:18,920
MORE ABOUT REFLECTIVE PRACTICE.

979
00:33:18,920 --> 00:33:20,960
SO THIS A WELL KNOWN CONCEPT

980
00:33:20,960 --> 00:33:22,600
OUTSIDE OF MEDICINE FOR A

981
00:33:22,600 --> 00:33:23,800
PROFESSIONALS TO IMPROVE

982
00:33:23,800 --> 00:33:26,200
PERFORMANCE IN A COLLABORATIVE

983
00:33:26,200 --> 00:33:26,440
SETTING.

984
00:33:26,440 --> 00:33:28,040
I THINK THE QUESTION BECOMES IF

985
00:33:28,040 --> 00:33:30,080
WE'RE GOING TO IMPROVE FUTURE

986
00:33:30,080 --> 00:33:32,360
CLINICAL OUTS, HOW DO WE

987
00:33:32,360 --> 00:33:33,800
UNDERSTAND WHY WE PERFORM

988
00:33:33,800 --> 00:33:36,480
CERTAIN ACTIONS THAT IMPACTED

989
00:33:36,480 --> 00:33:38,680
THE RESULTS OF CLINICAL

990
00:33:38,680 --> 00:33:40,080
OUTCOMES, RIGHT?

991
00:33:40,080 --> 00:33:44,120
SO THE WHY HERES ARE FRAMED.

992
00:33:44,120 --> 00:33:46,680
OR A MENTAL MODEL MAY BE ANOTHER

993
00:33:46,680 --> 00:33:48,480
WORD YOU HEARD SO IN MEDICAL

994
00:33:48,480 --> 00:33:50,360
EDUCATION, WHEN WE TALK ABOUT

995
00:33:50,360 --> 00:33:52,760
FRAMES OUR PRIMARY EMPHASIS IS

996
00:33:52,760 --> 00:33:53,960
HISTORICALLY BEEN ABOUT YOUR

997
00:33:53,960 --> 00:33:55,200
KNOWLEDGE BASE, INCREASE IN

998
00:33:55,200 --> 00:33:57,440
KNOWLEDGE BASE, TEACH PEOPLE,

999
00:33:57,440 --> 00:34:00,320
JOE ALLUDED TO THAT IN HIS

1000
00:34:00,320 --> 00:34:01,520
PRESENTATION BUT THERE'S SO MANY

1001
00:34:01,520 --> 00:34:03,720
OTHER CONTRIBUTORS TO 1 FRAME

1002
00:34:03,720 --> 00:34:05,800
AND 1'S FRAME AGAIN INFLUENCES

1003
00:34:05,800 --> 00:34:06,520
PATIENT OUTCOMES.

1004
00:34:06,520 --> 00:34:08,400
SO THE EXAMPLE I SHOWED EARLIER

1005
00:34:08,400 --> 00:34:12,280
OF THE TRAUMA PATIENT WHY DIDN'T

1006
00:34:12,280 --> 00:34:15,520
TEAM MEMBERS SPEAK UP ABOUT

1007
00:34:15,520 --> 00:34:16,320
PERSISTENT HYPOATTENTION AND

1008
00:34:16,320 --> 00:34:18,120
ACTIVATE THE MASSIVE TRANSFUSION

1009
00:34:18,120 --> 00:34:19,040
PROTOCOL EARLIER?

1010
00:34:19,040 --> 00:34:20,480
THEY WERE DEFERRING TO THE TEAM

1011
00:34:20,480 --> 00:34:21,760
LEADER, RIGHT?

1012
00:34:21,760 --> 00:34:24,080
THAT RELATES TO WE GET TO

1013
00:34:24,080 --> 00:34:25,440
ASSUMPTIONS, WELL I WON'T SAY

1014
00:34:25,440 --> 00:34:26,560
ANYTHING BECAUSE I ASSUME THAT

1015
00:34:26,560 --> 00:34:27,960
THE TEAM LEADER RECOGNIZES THIS

1016
00:34:27,960 --> 00:34:30,600
AND RULES, HIERARCHY, THE NURSE,

1017
00:34:30,600 --> 00:34:32,640
OR MAYBE THE THERAPIST DOESN'T

1018
00:34:32,640 --> 00:34:35,320
FEEL EMPOWERED TO SPEAK ABOUT

1019
00:34:35,320 --> 00:34:36,840
ACTIVATING SOMETHING BECAUSE

1020
00:34:36,840 --> 00:34:38,560
THAT'S REALLY THE JOB OF THE

1021
00:34:38,560 --> 00:34:39,040
PHYSICIAN.

1022
00:34:39,040 --> 00:34:40,920
AND THEN MAYBE IN MANY OF THESE

1023
00:34:40,920 --> 00:34:42,840
CASES, THERE'S SO MUCH COGNITIVE

1024
00:34:42,840 --> 00:34:44,280
LOAD, THESE ARE HIGH STRESS

1025
00:34:44,280 --> 00:34:45,560
SITUATIONS THE TEAM LEADER MAY

1026
00:34:45,560 --> 00:34:47,480
HAVE LOST SITUATIONAL AWARENESS,

1027
00:34:47,480 --> 00:34:48,120
RIGHT?

1028
00:34:48,120 --> 00:34:49,000
BECAUSE THEY WERE TRYING TO HELP

1029
00:34:49,000 --> 00:34:50,680
WITH THE ULTRASOUND TO SEE IF

1030
00:34:50,680 --> 00:34:52,520
THERE WAS BLEEDING AND A

1031
00:34:52,520 --> 00:34:53,480
DIFFICULT EXAMINATION AND AGAIN

1032
00:34:53,480 --> 00:34:56,400
WE ARE NOT WORKING IN A VARMIS

1033
00:34:56,400 --> 00:34:57,920
VACUUM THAT TEAM LEADER HAD JUST

1034
00:34:57,920 --> 00:34:59,640
COME OUT FROM SEEING A PATIENT

1035
00:34:59,640 --> 00:35:01,880
WITHIN AN ACUTE MI AND WAITING

1036
00:35:01,880 --> 00:35:04,280
FOR THE CATH LAB TO CALL BACK

1037
00:35:04,280 --> 00:35:06,960
AND WORRY BODY THAT PATIENT SO

1038
00:35:06,960 --> 00:35:09,040
REALLY EXPLORING THESE FRAMES SO

1039
00:35:09,040 --> 00:35:10,400
WE CAN CHANGE ACTIONS AND

1040
00:35:10,400 --> 00:35:12,360
RESULTS IS VERYICAL CHALLENGING

1041
00:35:12,360 --> 00:35:14,240
IN MEDICINE BUT REALLY THE BEST

1042
00:35:14,240 --> 00:35:15,640
VENUE WE HAVE IS THE DEBRIEFING

1043
00:35:15,640 --> 00:35:16,760
AND SIMULATION AND OUR HOPE HERE

1044
00:35:16,760 --> 00:35:18,920
IS THAT ONCE WE IDENTIFY THESE

1045
00:35:18,920 --> 00:35:20,120
FRAMES AND AGAIN CAN BE MAYBE IN

1046
00:35:20,120 --> 00:35:22,560
THIS CASE RELATED TO HIERARCHY

1047
00:35:22,560 --> 00:35:25,480
AND ASSUMPTIONS THAT WE CAN

1048
00:35:25,480 --> 00:35:27,320
EFFECTIVELY DEBRIEF THEM TO

1049
00:35:27,320 --> 00:35:28,960
IDENTIFY IT AND THEN WE EMPOWER

1050
00:35:28,960 --> 00:35:31,480
TEAM MEMBERS TO SPEAK UP AND

1051
00:35:31,480 --> 00:35:33,200
HOPEFULLY FLATTEN HIERARCHYS AND

1052
00:35:33,200 --> 00:35:36,560
CHANGE THE FRAME SO WE CAN

1053
00:35:36,560 --> 00:35:41,360
IMPACT FUTURE ACTIONS.

1054
00:35:41,360 --> 00:35:42,720
AND SO HERE I SHOW YOU A SLIDE

1055
00:35:42,720 --> 00:35:45,000
OF A PICTURE FROM THE STANFORD

1056
00:35:45,000 --> 00:35:47,080
GROUP SHOWING AN EXAMPLE OF A

1057
00:35:47,080 --> 00:35:49,520
DEBRIEFING AND YOU CAN SEE THE

1058
00:35:49,520 --> 00:35:50,560
DEBRIEFER HERE IS LEADING A

1059
00:35:50,560 --> 00:35:53,000
GROUP OF PARTICIPANTS WHO ARE IN

1060
00:35:53,000 --> 00:35:55,640
A CODE BLUE SCENARIO AND THE

1061
00:35:55,640 --> 00:35:56,600
PROFESSIONAL TEAM TOOK PART ON

1062
00:35:56,600 --> 00:35:59,000
THAT AND ARE REVIEWING THE VIDEO

1063
00:35:59,000 --> 00:36:02,920
OF THE RESUSCITATION THE GOAL

1064
00:36:02,920 --> 00:36:04,800
HERE, GOING BACK TO WHAT WE WERE

1065
00:36:04,800 --> 00:36:05,920
TALKING ABOUT THE LAST SLIDE IS

1066
00:36:05,920 --> 00:36:09,200
TO UNDERSTAND THE GROUP MEMBER

1067
00:36:09,200 --> 00:36:11,720
SETTINGS, PARTICULARLY IN THE

1068
00:36:11,720 --> 00:36:13,480
SCENARIO WHERE THE ACTIONS WERE

1069
00:36:13,480 --> 00:36:14,440
SUBOPTIMAL AND THE GOAL IS TO

1070
00:36:14,440 --> 00:36:16,040
WORK THROUGH THAT SO THAT WE CAN

1071
00:36:16,040 --> 00:36:19,320
AN IMPROVEMENT IN DECISION

1072
00:36:19,320 --> 00:36:22,520
MAKING FOR THE NEXT TIME OR ALSO

1073
00:36:22,520 --> 00:36:23,880
IDENTIFY AND FIX UP SOME

1074
00:36:23,880 --> 00:36:25,560
PROCESSES THAT MIGHT BE IMPACTS

1075
00:36:25,560 --> 00:36:30,120
TEAM PERFORMANCE.

1076
00:36:30,120 --> 00:36:31,920
SO YOU CAN SEE ON THE LEFT SIDE

1077
00:36:31,920 --> 00:36:33,560
OF THE SCREEN, HERE THAT

1078
00:36:33,560 --> 00:36:35,440
THERE--YOU KNOW THERE'S A HUGE,

1079
00:36:35,440 --> 00:36:38,160
VERY ASPIRATIONAL QUADRUPLE AIM

1080
00:36:38,160 --> 00:36:39,680
OF INTERPROFESSIONAL EDUCATION,

1081
00:36:39,680 --> 00:36:39,880
RIGHT?

1082
00:36:39,880 --> 00:36:41,280
IF WE CAN WORK TOGETHER, WE

1083
00:36:41,280 --> 00:36:44,200
IMPROVE AND WE WORK EFFECTIVELY,

1084
00:36:44,200 --> 00:36:45,240
AND COLLABORATIVELY WE CAN

1085
00:36:45,240 --> 00:36:46,400
IMPROVE OUR PROVIDER EXPERIENCE

1086
00:36:46,400 --> 00:36:49,760
AND THAT TRANSLATES TO AN

1087
00:36:49,760 --> 00:36:51,680
IMPROVED PATIENT EXPERIENCE, AND

1088
00:36:51,680 --> 00:36:52,400
HOPEFULLY AGAIN, CHANGING

1089
00:36:52,400 --> 00:36:54,560
ACTIONS AND RESULTS, WE IMPROVE

1090
00:36:54,560 --> 00:36:56,440
PATIENT OUTCOMES AND HOPEFULLY

1091
00:36:56,440 --> 00:36:57,840
THE EFFICIENCY ALLOWS FOR A

1092
00:36:57,840 --> 00:36:58,720
LOWER COST OF CARE.

1093
00:36:58,720 --> 00:37:00,920
YOU KNOW UNFORTUNATELY IF IT

1094
00:37:00,920 --> 00:37:03,320
WERE ONLY THAT EASY, RIGHT?

1095
00:37:03,320 --> 00:37:05,040
THERE ARE SIGNIFICANT OBSTACLES

1096
00:37:05,040 --> 00:37:06,120
TO GETTING GROUPS TO TRAIN AND

1097
00:37:06,120 --> 00:37:10,560
LEARN TOGETHER AND THEY MUST BE

1098
00:37:10,560 --> 00:37:12,680
OVERCOME AND THAT'S WHY, FRANKLY

1099
00:37:12,680 --> 00:37:14,000
INTERPROFESSIONAL EDUCATION

1100
00:37:14,000 --> 00:37:15,840
STILL IS A COMMON PLACE.

1101
00:37:15,840 --> 00:37:17,160
WHY IT'S DIFFICULT ENOUGH TO

1102
00:37:17,160 --> 00:37:18,760
ORGANIZE A SINGLE GROUP OF

1103
00:37:18,760 --> 00:37:22,080
PEOPLE IN A SILO TO SCHEDULE FOR

1104
00:37:22,080 --> 00:37:25,720
JOINT TRAINING ORGANIZING ACROSS

1105
00:37:25,720 --> 00:37:28,240
POSITIONS, NURSES, THERAPISTS,

1106
00:37:28,240 --> 00:37:30,760
AND SO FORTH, IT'S QUITE

1107
00:37:30,760 --> 00:37:31,280
CHALLENGING.

1108
00:37:31,280 --> 00:37:33,240
BECAUSE WE'VE ALSO--BECAUSE

1109
00:37:33,240 --> 00:37:34,880
WE'RE USED TO LEARNING IN OUR

1110
00:37:34,880 --> 00:37:36,120
SILOED PEER GROUPS, THERE'S A

1111
00:37:36,120 --> 00:37:37,400
GREAT FEAR OF LEARNING OUTSIDE

1112
00:37:37,400 --> 00:37:39,320
OF THAT AND SO, YOU REALLY NEED

1113
00:37:39,320 --> 00:37:43,560
A SKILLED EDUCATOR WHO CREATES A

1114
00:37:43,560 --> 00:37:45,960
SAFE SPACE SO ALL LEARNERS FEEL

1115
00:37:45,960 --> 00:37:47,280
SAFE LEARNING THERE, BUT THEY

1116
00:37:47,280 --> 00:37:50,400
HAVE TO PUSH ENOUGH TO THE EDGE

1117
00:37:50,400 --> 00:37:52,320
OF THAT COMFORT ZONE TO REALLY

1118
00:37:52,320 --> 00:37:53,680
LEARN TO FIGURE OUT THESE FRAMES

1119
00:37:53,680 --> 00:37:58,480
AND TO IMPACT FUTURE

1120
00:37:58,480 --> 00:37:58,800
PERFORMANCE.

1121
00:37:58,800 --> 00:38:00,320
SO, YOU KNOW I THINK JOE ALLUDED

1122
00:38:00,320 --> 00:38:01,320
TO THIS AND I'M TALKING ABOUT

1123
00:38:01,320 --> 00:38:04,960
THE BARRIERS IN MY PRIOR SLIDE,

1124
00:38:04,960 --> 00:38:07,440
THERE'S A LOT OF TIME, EFFORT,

1125
00:38:07,440 --> 00:38:08,520
EXPENSE, STAKEHOLDER ENGAGEMENT

1126
00:38:08,520 --> 00:38:11,800
TO BE ABLE TO PROVIDE

1127
00:38:11,800 --> 00:38:12,440
PROFESSIONAL SIMULATION SO I

1128
00:38:12,440 --> 00:38:13,920
THINK WE'RE VERY COMMONLY HERE,

1129
00:38:13,920 --> 00:38:14,240
RIGHT?

1130
00:38:14,240 --> 00:38:19,960
WHAT IS THE EVIDENCE FOR

1131
00:38:19,960 --> 00:38:21,000
SIMULATION TRAINING AND

1132
00:38:21,000 --> 00:38:22,560
IMPROVING OUTCOMES AND I THINK

1133
00:38:22,560 --> 00:38:23,760
JOE TALKED ABOUT THE LIMITATIONS

1134
00:38:23,760 --> 00:38:25,400
AND THE CHALLENGES AND HOPEFULLY

1135
00:38:25,400 --> 00:38:27,600
THE GOALS FOR MORE PATIENT

1136
00:38:27,600 --> 00:38:28,320
CENTERED OUTCOMES BUT CERTAINLY

1137
00:38:28,320 --> 00:38:29,240
IT'S NOT THAT EASY.

1138
00:38:29,240 --> 00:38:31,040
I WILL TALK A BIT ABOUT THAT

1139
00:38:31,040 --> 00:38:32,920
GOING FORWARD, BUT I WANT TO

1140
00:38:32,920 --> 00:38:35,520
TALK ABOUT FLIGHT SIMULATION,

1141
00:38:35,520 --> 00:38:35,840
RIGHT?

1142
00:38:35,840 --> 00:38:37,440
AND THE EXAMPLE OF FLIGHT

1143
00:38:37,440 --> 00:38:39,200
TRAINING, SIMULATION IS REQUIRED

1144
00:38:39,200 --> 00:38:41,040
FOR PILOTS, BUT THERE IS NO

1145
00:38:41,040 --> 00:38:42,120
RANDOMIZED STUDY SHOWING A

1146
00:38:42,120 --> 00:38:45,280
REDUCED MORTALITY OF PASSENGERS

1147
00:38:45,280 --> 00:38:47,520
IN PLANES FLOWN BY I PILOTS WHO

1148
00:38:47,520 --> 00:38:49,160
ARE TRAINED ON SIMULATORS

1149
00:38:49,160 --> 00:38:50,560
COMPARED TO THOSE WHO DID NOT

1150
00:38:50,560 --> 00:38:52,680
RECEIVE ANY SIMULATION TRAINING,

1151
00:38:52,680 --> 00:38:53,200
RIGHT?

1152
00:38:53,200 --> 00:38:54,760
SIMULATION IS DONE IN FLIGHT

1153
00:38:54,760 --> 00:38:56,840
TRAINING BECAUSE IT MAKES SENSE.

1154
00:38:56,840 --> 00:38:58,440
IN THE EARLY DAYS OF FLYING,

1155
00:38:58,440 --> 00:39:00,880
THERE WAS NO SIMULATOR OPTION.

1156
00:39:00,880 --> 00:39:03,360
I WILL SHOW YOU A VIDEO CLIP AND

1157
00:39:03,360 --> 00:39:05,680
THIS PERSON WAS FINE, I FOUND A

1158
00:39:05,680 --> 00:39:07,040
CLIP THAT THE PERSON WAS

1159
00:39:07,040 --> 00:39:08,240
UNHARMED BUT THIS IS A VIDEO

1160
00:39:08,240 --> 00:39:09,760
CLIP OF A PILOT ATTEMPTING TO

1161
00:39:09,760 --> 00:39:15,120
FLY ON THE SIDE OF A MOUNTAIN

1162
00:39:15,120 --> 00:39:18,680
OBVIOUSLY AND THE COMPLEXITY AND

1163
00:39:18,680 --> 00:39:20,480
THE TEAM WORK REQUIRED IN CARING

1164
00:39:20,480 --> 00:39:23,280
FOR PATIENTS GOING BACK TO HIGH

1165
00:39:23,280 --> 00:39:27,160
RISK LOW VOLUME AND USED TO

1166
00:39:27,160 --> 00:39:28,600
PRACTICE AS A TEAM WITH

1167
00:39:28,600 --> 00:39:29,400
SIMULATION BEFORE WE'RE DOING

1168
00:39:29,400 --> 00:39:32,120
THAT IN A DECOMSAITING PATIENT

1169
00:39:32,120 --> 00:39:34,280
AND THAT'S AGAIN DESPITE THE

1170
00:39:34,280 --> 00:39:38,800
LIMITATIONS OF THE EVIDENCE

1171
00:39:38,800 --> 00:39:39,560
BASE.

1172
00:39:39,560 --> 00:39:41,640
SO NOW I DO WANT TO GO THROUGH A

1173
00:39:41,640 --> 00:39:43,520
COUPLE OF STUDIES THAT THEY TALK

1174
00:39:43,520 --> 00:39:45,000
ABOUT THE EVIDENCE BASE OF

1175
00:39:45,000 --> 00:39:48,080
IMPROVED OUTCOMES, WITH

1176
00:39:48,080 --> 00:39:49,000
INTERPROFESSIONAL SIMULATION,

1177
00:39:49,000 --> 00:39:50,720
AGAIN, I TRIED TO PULL A COUPLE

1178
00:39:50,720 --> 00:39:53,480
OF PAPERS THAT DIDN'T JUST HAVE

1179
00:39:53,480 --> 00:39:56,480
INCREASED CONFIDENCE AT THE

1180
00:39:56,480 --> 00:39:58,480
LOWER LEVELS OF THE PYRAMID THAT

1181
00:39:58,480 --> 00:40:01,240
JOE DESCRIBED.

1182
00:40:01,240 --> 00:40:03,720
SO HERE'S A STUDY THAT ASKS AN

1183
00:40:03,720 --> 00:40:04,920
INTERESTING QUESTION, IN TRAUMA

1184
00:40:04,920 --> 00:40:07,600
CENTERS IS THE USE OF TRAUMA

1185
00:40:07,600 --> 00:40:09,320
SIMULATIONS, THESE ARE PEDIATRIC

1186
00:40:09,320 --> 00:40:10,560
TRAUMA CENTERS,A ASSOCIATED WITH

1187
00:40:10,560 --> 00:40:12,480
THE CHANGE IN CLINICAL OUTCOME

1188
00:40:12,480 --> 00:40:14,640
AND SO THE AUTHORS OF THESE

1189
00:40:14,640 --> 00:40:16,440
PAPER AT JENSEN AND COLLEAGUES

1190
00:40:16,440 --> 00:40:18,280
THEY SERVE A PROGRAM LEADERSHIP

1191
00:40:18,280 --> 00:40:19,800
OF 124 CENTERS THAT PARTICIPATE

1192
00:40:19,800 --> 00:40:21,200
INDEED THE AMERICAN COLLEGE OF

1193
00:40:21,200 --> 00:40:22,320
SURGEONS PEDIATRIC TRAUMA

1194
00:40:22,320 --> 00:40:23,880
QUALITY IMPROVEMENT PROGRAM.

1195
00:40:23,880 --> 00:40:25,640
AND THESE CENTERS HAVE OUTCOME

1196
00:40:25,640 --> 00:40:28,520
DATA OVER THE TIME STUDIES FROM

1197
00:40:28,520 --> 00:40:33,080
ALMOST 58,000 PATIENTS.

1198
00:40:33,080 --> 00:40:34,760
IF YOU LOOK AT TABLE 2 FROM THE

1199
00:40:34,760 --> 00:40:38,000
PAPER HERE, WHAT YOU CAN SEE, IS

1200
00:40:38,000 --> 00:40:40,600
THE FIRST LOOKING AT UNADJUSTED

1201
00:40:40,600 --> 00:40:43,080
THE AVERAGE CENTER UNADJUSTED

1202
00:40:43,080 --> 00:40:44,880
MORTALITY WAS LOWEST IN CENTERS

1203
00:40:44,880 --> 00:40:46,760
WITH THE HIGH VOLUME OF

1204
00:40:46,760 --> 00:40:48,200
SIMULATION BASED TRAININGS, SO

1205
00:40:48,200 --> 00:40:49,960
LET ME ORIENT YOU TO THIS, SO

1206
00:40:49,960 --> 00:40:51,920
LET ME SEE THE UNADJUSTED

1207
00:40:51,920 --> 00:40:54,680
CENTERS SPECIFIC MORTALITY, AND

1208
00:40:54,680 --> 00:40:57,800
.88% IN THE CENTERS THAT DID NO

1209
00:40:57,800 --> 00:40:58,960
SIMULATION, OUT OF 40 CENTERS

1210
00:40:58,960 --> 00:41:00,080
INITIATIVES THE CENTERS THAT DID

1211
00:41:00,080 --> 00:41:03,360
1 TO 10 PEDIATRIC TRAUMA

1212
00:41:03,360 --> 00:41:05,040
SIMULATIONS, THE 19 CENTERS, THE

1213
00:41:05,040 --> 00:41:08,280
MORTALITY IS 1.59% AND THE 1S

1214
00:41:08,280 --> 00:41:11,000
THAT DID 11 + SIMULATIONS IN

1215
00:41:11,000 --> 00:41:13,680
THAT TIME PERIOD, AND OF 35

1216
00:41:13,680 --> 00:41:16,840
CENTERS, MORTALITY WAS EVEN

1217
00:41:16,840 --> 00:41:18,720
LOWER OF .03%.

1218
00:41:18,720 --> 00:41:20,880
NOW THE QUESTION IS THERE ARE SO

1219
00:41:20,880 --> 00:41:23,400
MANY FACTORS RIGHT, THAT

1220
00:41:23,400 --> 00:41:24,720
COULDN'T AFFECT MORTALITY AND WE

1221
00:41:24,720 --> 00:41:26,800
HAVE TO BE VERY CAREFUL ABOUT

1222
00:41:26,800 --> 00:41:29,280
THIS AND SO THE GROUP DID A

1223
00:41:29,280 --> 00:41:31,320
RISK--THEY DID A RISK ADJUSTED

1224
00:41:31,320 --> 00:41:34,440
MORTALITY, BASED ON A VALIDATED

1225
00:41:34,440 --> 00:41:36,360
TRAUMA QI PROGRAM MODEL, AND

1226
00:41:36,360 --> 00:41:43,720
THAT INCORPORATES AGE, SEX,

1227
00:41:43,720 --> 00:41:44,640
PRESENTATION, MECHANISM OF THE

1228
00:41:44,640 --> 00:41:46,080
INJURY OF THE TRAUMA AND YOU CAN

1229
00:41:46,080 --> 00:41:48,040
SEE HERE THE RISK OF THE

1230
00:41:48,040 --> 00:41:50,040
ADJUSTED MORTALITY IS STILL, WE

1231
00:41:50,040 --> 00:41:52,960
LOOK AT ODDS RATIO OF 0.55 AND

1232
00:41:52,960 --> 00:41:55,080
THE CONFIDENCE FOR BOTH, FOR THE

1233
00:41:55,080 --> 00:41:57,480
CENTERS THAT DID 1 TO 10

1234
00:41:57,480 --> 00:41:58,960
SIMULATIONS AND THOSE THAT DID

1235
00:41:58,960 --> 00:42:01,080
11 + COMPARED TO THE REFERENCE

1236
00:42:01,080 --> 00:42:02,360
OF NO SIMULATION, SO I DON'T

1237
00:42:02,360 --> 00:42:05,720
WANT TO OVERHYPE THAT SORT OF

1238
00:42:05,720 --> 00:42:06,920
PAPER, ASSOCIATION, CERTAINLY

1239
00:42:06,920 --> 00:42:10,840
DOES NOT IMPLY CAUSATION.

1240
00:42:10,840 --> 00:42:12,560
BUT, THIS IS CLEARLY AN

1241
00:42:12,560 --> 00:42:15,640
INTERESTING FINDING AND

1242
00:42:15,640 --> 00:42:17,280
THAT--AND OF BETTER OUTCOMES,

1243
00:42:17,280 --> 00:42:21,400
AND CENTERS THAT DO MORE

1244
00:42:21,400 --> 00:42:21,880
SIMULATION.

1245
00:42:21,880 --> 00:42:22,840
THE NEXT PAPER IS ABOUT AN

1246
00:42:22,840 --> 00:42:26,360
INTERESTING AREA THAT'S CALLED

1247
00:42:26,360 --> 00:42:29,120
KRA [INDISCERNIBLE] CPR, SO IT'S

1248
00:42:29,120 --> 00:42:32,840
INCREASED USE OF [INDISCERNIBLE]

1249
00:42:32,840 --> 00:42:36,520
CPR AND YOU MAY HAVE HEARD OF IT

1250
00:42:36,520 --> 00:42:39,480
AS ECNO, SO YOU HAVE TO

1251
00:42:39,480 --> 00:42:41,520
KAN--KANAULATE LARGE VESSELS TO

1252
00:42:41,520 --> 00:42:43,280
PUT THEM ON THE ECMOW CIRCUIT

1253
00:42:43,280 --> 00:42:44,960
AND THAT REQUIRES SKILLED

1254
00:42:44,960 --> 00:42:46,560
SURGEONS WITH AN ENTIRE TEAM AND

1255
00:42:46,560 --> 00:42:48,040
THEN TRYING TO DO THAT IN 1 OF

1256
00:42:48,040 --> 00:42:50,040
THE PATIENTS BEING RESUSCITATED

1257
00:42:50,040 --> 00:42:51,800
DURING CARDIAC ARREST IS MORE

1258
00:42:51,800 --> 00:42:52,880
COMPLEX, SO CAN YOU SEE HERE IN

1259
00:42:52,880 --> 00:42:53,520
THE PATIENTS IN THE CLINIC UPPER

1260
00:42:53,520 --> 00:42:55,440
THIS IS A MANIKIN, AND THIS WAS

1261
00:42:55,440 --> 00:42:57,520
IN A PEDIATRIC CENTER AS YOU SEE

1262
00:42:57,520 --> 00:43:00,520
THE SMALL MANNEQUINS RIGHT WITH

1263
00:43:00,520 --> 00:43:06,880
SPECIALLY DESIGNED EC ECMOW NECK

1264
00:43:06,880 --> 00:43:09,720
PATCH THAT ALLOW FOR CPR

1265
00:43:09,720 --> 00:43:10,960
SIMULATION, YOU CANY BELOW THAT

1266
00:43:10,960 --> 00:43:13,520
THE SURGICAL TEAM CAN PERFORM A

1267
00:43:13,520 --> 00:43:18,120
LIFE LIKE ECMO KAN--KANAULATION

1268
00:43:18,120 --> 00:43:22,080
DURING CPR, SO THERE'S A STUDY

1269
00:43:22,080 --> 00:43:24,480
OF THE TRAINING OF THESE CPR AND

1270
00:43:24,480 --> 00:43:25,760
THEY LOOK AT THIS LARGE

1271
00:43:25,760 --> 00:43:27,600
CHILDREN'S HOSPITAL IN SEATTLE

1272
00:43:27,600 --> 00:43:32,240
AND THEY COMPARED ECPROUTCOMES

1273
00:43:32,240 --> 00:43:34,240
IN PATIENTS BEFORE AND AFTER THE

1274
00:43:34,240 --> 00:43:35,320
SIMULATION I'M DESCRIBING WERE

1275
00:43:35,320 --> 00:43:36,840
START AND SO THESE SIMULATIONS

1276
00:43:36,840 --> 00:43:40,000
WERE HELD 1-2 TIMES PER MONTH IN

1277
00:43:40,000 --> 00:43:43,280
THE 3 PEDIATRIC ICOWS AND THE 29

1278
00:43:43,280 --> 00:43:46,560
SIMULATION SESSIONS, AND THEY

1279
00:43:46,560 --> 00:43:47,520
INCLUDED OVER 300 HEALTHCARE

1280
00:43:47,520 --> 00:43:53,040
PROFESSIONALS IN THESE SESSIONS.

1281
00:43:53,040 --> 00:43:54,800
THIS TABLE HERE SHOWS THE

1282
00:43:54,800 --> 00:43:57,240
CLINICAL OUTCOMES FROM THE EPC R

1283
00:43:57,240 --> 00:43:59,880
EEIVETS THAT OCCURRED AND IN THE

1284
00:43:59,880 --> 00:44:01,320
LEFT COLUMN IT'S FORCING

1285
00:44:01,320 --> 00:44:04,080
SIMULATION SO THE PC R AND THE

1286
00:44:04,080 --> 00:44:05,720
SIMULATION SESSIONS AND THEN IN

1287
00:44:05,720 --> 00:44:08,080
THE 16 AFTER THE SIMULATION

1288
00:44:08,080 --> 00:44:08,440
SESSIONS.

1289
00:44:08,440 --> 00:44:10,240
SO AGAIN, THAT'S A LOW END AND

1290
00:44:10,240 --> 00:44:11,880
THAT'S VERY COMMON IN HIGH RISK

1291
00:44:11,880 --> 00:44:13,040
LOW VOLUME STUDIES SO IT'S VERY

1292
00:44:13,040 --> 00:44:15,200
HARD TO ACHIEVE STATISTICAL

1293
00:44:15,200 --> 00:44:18,000
SIGNIFICANCE AND THAT'S CRUST A

1294
00:44:18,000 --> 00:44:20,520
FACT IN SOME AGAIN HIGH RISK LOW

1295
00:44:20,520 --> 00:44:21,120
VOLUME.

1296
00:44:21,120 --> 00:44:23,400
BY DEFINITION THE END WILL BE

1297
00:44:23,400 --> 00:44:26,160
LOW AND THANKFULLY, NEED FOR

1298
00:44:26,160 --> 00:44:27,160
CARDIAC ARREST IN CHILDREN

1299
00:44:27,160 --> 00:44:30,520
PUTTING THISEM ON ECPR IS A LOW

1300
00:44:30,520 --> 00:44:31,720
VOLUME EVENT.

1301
00:44:31,720 --> 00:44:35,240
BUT SO, WHAT WE SEE HERE IS A

1302
00:44:35,240 --> 00:44:36,840
STATISTICALLY SIGNIFICANT AND

1303
00:44:36,840 --> 00:44:39,120
SEEMS MEANINGFULLY SIGNIFICANT 5

1304
00:44:39,120 --> 00:44:40,240
MINUTE REDUCTION IN ACTIVATION

1305
00:44:40,240 --> 00:44:42,920
OF THE ECRP TEAM AFTER THE

1306
00:44:42,920 --> 00:44:44,000
SIMULATION SESSION SO CERTAINLY

1307
00:44:44,000 --> 00:44:45,760
YOU THINK 5 MINUTES IN CARDIAC

1308
00:44:45,760 --> 00:44:47,440
ARREST CAN BE THE DIFFERENCE

1309
00:44:47,440 --> 00:44:48,360
BETWEEN LIFE AND DEATH.

1310
00:44:48,360 --> 00:44:50,320
SO AGAIN, THAT'S AN INTERESTING

1311
00:44:50,320 --> 00:44:53,360
PAPER AND FINDING AND THESE ARE

1312
00:44:53,360 --> 00:44:55,760
2 PAPERS THAT SHOW IMPROVEMENTS

1313
00:44:55,760 --> 00:44:59,520
WITH SIMULATION BASED CARE.

1314
00:44:59,520 --> 00:45:00,760
SO I WANT TO TALK A LITTLE BIT

1315
00:45:00,760 --> 00:45:02,280
IN THE LAST FEW MINUTES ABOUT

1316
00:45:02,280 --> 00:45:05,000
WHAT WE'RE DOING HERE AT THE NIH

1317
00:45:05,000 --> 00:45:06,840
CLINICAL CENTER AND WE'RE REALLY

1318
00:45:06,840 --> 00:45:08,160
AGAIN FOCUSED ON TEAM TRAINING

1319
00:45:08,160 --> 00:45:09,280
WHEN WE'RE TALKING ABOUT HIGH

1320
00:45:09,280 --> 00:45:12,560
RISK LOW VOLUME HERE.

1321
00:45:12,560 --> 00:45:14,480
SO IN OUR CRITICAL CARE GROUP,

1322
00:45:14,480 --> 00:45:17,280
WE DO WEEKLY INTERPROFESSIONAL

1323
00:45:17,280 --> 00:45:18,400
CRITICAL CARE SESSIONS AND WHEN

1324
00:45:18,400 --> 00:45:21,280
I TALKED EARLIER ABOUT

1325
00:45:21,280 --> 00:45:22,320
REFLECTIVE PRACTICE WE REALLY

1326
00:45:22,320 --> 00:45:24,680
HAVE AN EMPHASIS IN CRISIS

1327
00:45:24,680 --> 00:45:25,880
RECOURSE MANAGEMENT WHICH IS A

1328
00:45:25,880 --> 00:45:28,120
TERM THAT COMES UP A LOT IN

1329
00:45:28,120 --> 00:45:29,560
EMERGENCY AND CRITICAL CARE

1330
00:45:29,560 --> 00:45:29,840
MANAGEMENT.

1331
00:45:29,840 --> 00:45:31,560
WE'RE WORKING WITH PINS PELS

1332
00:45:31,560 --> 00:45:33,160
DEALING WITH COGNITIVE AND

1333
00:45:33,160 --> 00:45:35,000
INTERPERSONAL BEHAVIORS AND

1334
00:45:35,000 --> 00:45:38,240
THOSE THAT CONTRIBUTE TO OPTIMAL

1335
00:45:38,240 --> 00:45:39,680
TEAM PERFORMANCE AND IT GOES

1336
00:45:39,680 --> 00:45:40,760
BACK SIMILAR TO WHAT WE'RE

1337
00:45:40,760 --> 00:45:41,800
TALKING ABOUT IN UNDERSTANDING

1338
00:45:41,800 --> 00:45:44,040
PEOPLE'S FRAMES IN OPTIMIZING

1339
00:45:44,040 --> 00:45:44,440
PERFORMANCE.

1340
00:45:44,440 --> 00:45:46,680
AND EVERY WEEK WE HAVE A

1341
00:45:46,680 --> 00:45:48,400
SIMULATION THAT'S AN

1342
00:45:48,400 --> 00:45:49,680
INTERPROFESSIONAL SIMULATION,

1343
00:45:49,680 --> 00:45:51,200
PHYSICIAN, NURSES AND

1344
00:45:51,200 --> 00:45:52,320
RESPIRATORY THERAPISTS.

1345
00:45:52,320 --> 00:45:54,280
CAN YOU SEE AN EXAMPLEOT RIGHT

1346
00:45:54,280 --> 00:45:56,960
OF A PATIENT, THE MANNEQUIN OF

1347
00:45:56,960 --> 00:46:00,400
COURSE BUT A SIMULATED PATIENT

1348
00:46:00,400 --> 00:46:02,080
DECOMPENSATING ON A VENTILATOR

1349
00:46:02,080 --> 00:46:05,680
AND THE PROFESSIONAL, THE TEAM

1350
00:46:05,680 --> 00:46:06,480
RESUSCITATING THE PATIENT.

1351
00:46:06,480 --> 00:46:08,560
SO THE OTHER THING WE DO IS WE

1352
00:46:08,560 --> 00:46:12,120
DEBRIEF BY EDUCATORS OF VARIED

1353
00:46:12,120 --> 00:46:15,080
EDUCATIONAL BACKGROUNDS SO WE

1354
00:46:15,080 --> 00:46:16,640
HAVE RESPIRAT TORTHERAPISTSES

1355
00:46:16,640 --> 00:46:17,880
ARE PHYSICIANS AND NURSES TO

1356
00:46:17,880 --> 00:46:19,520
PROVIDE A SAFE SPACE FOR

1357
00:46:19,520 --> 00:46:21,320
LEARNING FOR ALL MEMBERS OF THE

1358
00:46:21,320 --> 00:46:23,440
TEAM.

1359
00:46:23,440 --> 00:46:26,080
SO ANOTHER INITIATIVE,

1360
00:46:26,080 --> 00:46:28,440
SIMULATION INITIATIVE THAT,

1361
00:46:28,440 --> 00:46:29,960
RELATES TO ACUTE ILLNESS RELATES

1362
00:46:29,960 --> 00:46:34,120
TO NEUROLOGIC EMERGENCIES AT

1363
00:46:34,120 --> 00:46:34,280
NIH.

1364
00:46:34,280 --> 00:46:35,200
WE SEE HERE ON THE RIGHT A

1365
00:46:35,200 --> 00:46:37,440
PATIENT WITH A DILATED PUPIL AND

1366
00:46:37,440 --> 00:46:40,960
THAT CAN BE A SIGN OF INCREASED

1367
00:46:40,960 --> 00:46:42,720
INTERCRANIAL PRESSURE, AT NIH,

1368
00:46:42,720 --> 00:46:45,840
WE CARE PER MANY PATIENTS AT

1369
00:46:45,840 --> 00:46:47,680
COMPLEX DISEASES AND RISK FOR

1370
00:46:47,680 --> 00:46:49,840
ACUTE NEUROLOGIC DECOMPENSATION

1371
00:46:49,840 --> 00:46:52,240
AND SO HAVING A TEAM THAT CAN

1372
00:46:52,240 --> 00:46:55,480
QUICKLY AND EFFECTIVELY RESPOND

1373
00:46:55,480 --> 00:46:57,040
TO NEUROLOGICAL EMERGENCIES IS

1374
00:46:57,040 --> 00:46:57,760
VERY IMPORTANT.

1375
00:46:57,760 --> 00:46:59,600
SO BECAUSE OF IT, THE CLINICAL

1376
00:46:59,600 --> 00:47:01,040
CENTER LEADERSHIP DECIDED TO

1377
00:47:01,040 --> 00:47:02,560
IMPLEMENT A BRAIN CO SHORT

1378
00:47:02,560 --> 00:47:03,920
HOTTER THAT WOULD ALLOW

1379
00:47:03,920 --> 00:47:06,440
IMMEDIATE MOBILIZATION OF THE

1380
00:47:06,440 --> 00:47:09,000
RESOURCES AND PROVIDERS LIKE

1381
00:47:09,000 --> 00:47:11,160
CODE BLUE TEAM, ICU TEAM,

1382
00:47:11,160 --> 00:47:12,440
NEUROLOGY, AND THE ABILITY TO

1383
00:47:12,440 --> 00:47:16,400
GET A STAT HEAD CT TO RESPOND TO

1384
00:47:16,400 --> 00:47:19,000
A NEUROLOGICAL EMERGENCY.

1385
00:47:19,000 --> 00:47:23,440
FORTUNATELY WE WERE ALLOWED AND

1386
00:47:23,440 --> 00:47:25,080
ABLE, WE WERE ABLE TO DEVELOP A

1387
00:47:25,080 --> 00:47:26,200
SIMULATION TO PRACTICE THIS

1388
00:47:26,200 --> 00:47:29,280
BEFORE WE ROLLED OUT PATIENT

1389
00:47:29,280 --> 00:47:31,000
CARE RM.

1390
00:47:31,000 --> 00:47:33,720
SO YOU CAN SEE HERE IT'S AN

1391
00:47:33,720 --> 00:47:35,600
INSITU SIMULATION MEANING IT WAS

1392
00:47:35,600 --> 00:47:37,720
DONE ON A HOSPITAL BED, WE DID

1393
00:47:37,720 --> 00:47:39,680
THIS ON THE FLOOR OF THE

1394
00:47:39,680 --> 00:47:40,880
NEUROLOGY FLOOR AND TESTED OUT

1395
00:47:40,880 --> 00:47:42,080
THE BRAIN CODE WITH THE

1396
00:47:42,080 --> 00:47:44,560
MANNEQUIN HAVING AN ACUTE

1397
00:47:44,560 --> 00:47:45,560
NEUROLOGIC DECOMMIZATION AND

1398
00:47:45,560 --> 00:47:48,840
HERE THE MANNEQUIN HAS BEEN

1399
00:47:48,840 --> 00:47:50,360
RESUSCITATED INTUBATED AND THE

1400
00:47:50,360 --> 00:47:52,000
REZONING PIRATTORY THERAPIST IS

1401
00:47:52,000 --> 00:47:53,040
BAGGING THE MANNEQUIN AND

1402
00:47:53,040 --> 00:47:54,120
THEY'RE GOING DOWN FROM THE

1403
00:47:54,120 --> 00:47:55,440
SEVENTH FLOOR, YOU SEE THE

1404
00:47:55,440 --> 00:47:56,360
ELVITTOR THERE TO THE FIRST

1405
00:47:56,360 --> 00:48:01,800
FLOOR FOR A STAT HEAD CT.

1406
00:48:01,800 --> 00:48:03,680
IN THIS SIMULATION WAS EXTREMELY

1407
00:48:03,680 --> 00:48:05,880
USEFUL BECAUSE IT WAS HELPFUL IN

1408
00:48:05,880 --> 00:48:07,160
IDENTIFYING SEVERAL ISSUES THAT

1409
00:48:07,160 --> 00:48:08,720
WERE ADDRESSED BEFORE THE

1410
00:48:08,720 --> 00:48:11,520
PROGRAM WAS ROLLED OUT IN ACTUAL

1411
00:48:11,520 --> 00:48:12,520
PATIENT CARE.

1412
00:48:12,520 --> 00:48:16,600
YOU SEE ON THE LEFT COLUMN,

1413
00:48:16,600 --> 00:48:17,960
IDENTIFY INDEED THE SOLUTION

1414
00:48:17,960 --> 00:48:19,400
THAT WAS IN THE RIGHT COLUMN

1415
00:48:19,400 --> 00:48:21,680
THAT WAS IMPLEMENTED PRIOR TO

1416
00:48:21,680 --> 00:48:23,200
THE PATIENT CARE ROLL OUT.

1417
00:48:23,200 --> 00:48:25,120
SO FIRST FOR CONFUSION ABOUT

1418
00:48:25,120 --> 00:48:26,560
WHICH TEAM MEMBERS COULD CALL A

1419
00:48:26,560 --> 00:48:28,440
BRAIN CODE AND WOULD RESPOND AND

1420
00:48:28,440 --> 00:48:30,080
THEN THERE WAS EDUCATION ACROSS

1421
00:48:30,080 --> 00:48:32,440
THE DIFFERENT TEAMS TO CLARIFY

1422
00:48:32,440 --> 00:48:33,560
THAT.

1423
00:48:33,560 --> 00:48:35,400
THE SECOND ISSUE THAT THE CT

1424
00:48:35,400 --> 00:48:36,840
SCANNER WAS NOTIFIED BY CALLING

1425
00:48:36,840 --> 00:48:38,680
THE FRONT DESK OF CT, BUT

1426
00:48:38,680 --> 00:48:39,760
OBVIOUSLY THAT WOULD NOT BE

1427
00:48:39,760 --> 00:48:41,280
USEFUL AT NIGHT, SO THE PROCESS

1428
00:48:41,280 --> 00:48:46,120
WAS CHANGED TO PAGING THE

1429
00:48:46,120 --> 00:48:47,520
RADIOLOGY TECH ONCALL SO SOMEONE

1430
00:48:47,520 --> 00:48:48,720
WILL ALWAYS BE ABLE TO RESPOND

1431
00:48:48,720 --> 00:48:50,640
AND MOBILIZE THE CT SCANNER.

1432
00:48:50,640 --> 00:48:51,960
ANOTHER THING IS OBVIOUSLY

1433
00:48:51,960 --> 00:48:53,920
TREATMENT OF INCREASED

1434
00:48:53,920 --> 00:48:54,720
INTERCRANIAL PRESSURE IS VERY

1435
00:48:54,720 --> 00:48:56,480
IMPORTANT IN A NEUROLOGICAL

1436
00:48:56,480 --> 00:48:59,160
EMERGENCY, IT WAS NOTED DURING

1437
00:48:59,160 --> 00:49:02,840
THAT INSITU SIMULATION THAT

1438
00:49:02,840 --> 00:49:08,320
THERE WERE LACKS OF SPACE SO THE

1439
00:49:08,320 --> 00:49:10,680
CODE CAT WAS ARRANGED TO PROVIDE

1440
00:49:10,680 --> 00:49:11,080
FOR THAT.

1441
00:49:11,080 --> 00:49:12,480
SO IN THE END A LOT OF BEEN FIT

1442
00:49:12,480 --> 00:49:12,800
THERE.

1443
00:49:12,800 --> 00:49:14,560
SO IN CONCLUSION, HIGH RISK, LOW

1444
00:49:14,560 --> 00:49:16,120
VOLUME CARE REQUIRES EFFECTIVE

1445
00:49:16,120 --> 00:49:17,840
TEAM BASED CARE, SIMULATION

1446
00:49:17,840 --> 00:49:18,800
BASED PROFESSIONAL EDUCATION

1447
00:49:18,800 --> 00:49:20,680
ALLOWS FOR TEAM PRACTICE,

1448
00:49:20,680 --> 00:49:21,960
TREATING PREDICTED EMERGENCYING

1449
00:49:21,960 --> 00:49:22,920
AND THEIR OPPORTUNITIES FOR

1450
00:49:22,920 --> 00:49:25,360
FUTURE JUST IN TIME TRAINING OF

1451
00:49:25,360 --> 00:49:26,880
TEAMS FOR SCHEDULED ADMISSIONS

1452
00:49:26,880 --> 00:49:28,880
OF HIGH RISK LOW VOLUME CASES,

1453
00:49:28,880 --> 00:49:29,880
REALLY EXCITE FEDERAL WE CAN DO

1454
00:49:29,880 --> 00:49:31,880
THAT AND I WANT TO ACKNOWLEDGE

1455
00:49:31,880 --> 00:49:34,240
OUR AMAZING CRITICAL CARE

1456
00:49:34,240 --> 00:49:35,800
SIMULATION TEAM DEVELOPED

1457
00:49:35,800 --> 00:49:36,480
SCENARIOS AND DEBRIEFED TOGETHER

1458
00:49:36,480 --> 00:49:37,960
AND NOW WE HAVE RON GILL

1459
00:49:37,960 --> 00:49:39,080
SUPPORTING US WITH OPERATIONS,

1460
00:49:39,080 --> 00:49:40,560
NOW I WANT TO STOP AND PASS IT

1461
00:49:40,560 --> 00:49:43,080
ON TO DR. GOMEZ WHO WILL TALK

1462
00:49:43,080 --> 00:49:44,280
ABOUT SOME OF THE OTHER

1463
00:49:44,280 --> 00:49:46,000
IMPORTANT SIMULATION WORK GOING

1464
00:49:46,000 --> 00:49:46,600
ON AT THE CENTER.

1465
00:49:46,600 --> 00:49:47,560
>> THANK YOU DR. SEAM AND
THE

1466
00:49:47,560 --> 00:49:49,080
LAST PART OF THIS PRESENTATION

1467
00:49:49,080 --> 00:49:51,160
IS ABOUT THE SIMULATION

1468
00:49:51,160 --> 00:49:52,080
INITIATIVES BUT BEFORE TALKING

1469
00:49:52,080 --> 00:49:53,360
ABOUT THOSE INITIATIVES I WOULD

1470
00:49:53,360 --> 00:49:57,040
LIKE TO SHARE WITH YOU THE

1471
00:49:57,040 --> 00:49:58,520
PROGRAM'S INITIATIVE WHICH IS

1472
00:49:58,520 --> 00:50:01,200
ADVANCE PATIENT CARE AT THE NIH

1473
00:50:01,200 --> 00:50:02,600
CLINICAL CENTER ESPECIALLY WITH

1474
00:50:02,600 --> 00:50:04,800
REGARDS TO ITS UNIQUE HIGH RISK,

1475
00:50:04,800 --> 00:50:07,360
LOW VOLUME CASE MAKES TO THE

1476
00:50:07,360 --> 00:50:09,560
INTEGRATION OF A

1477
00:50:09,560 --> 00:50:10,840
STATE-OF-THE-ART SIMULATION INTO

1478
00:50:10,840 --> 00:50:12,360
THE CONTINUUM OF TRAINING AND

1479
00:50:12,360 --> 00:50:14,200
EDUCATION FOR CLINICAL AND

1480
00:50:14,200 --> 00:50:16,440
ADMINISTRATIVE PROFESSIONALS.

1481
00:50:16,440 --> 00:50:20,200
OUR MISSION INCLUDES 1

1482
00:50:20,200 --> 00:50:21,440
CULMINATED CENTER AND PROGRAM

1483
00:50:21,440 --> 00:50:23,360
AVAILABLE AND ACCESSIBLE TO

1484
00:50:23,360 --> 00:50:25,880
EVERYONE, SUPPORT PROFESSIONAL

1485
00:50:25,880 --> 00:50:27,800
DEVELOPMENT, IMPROVE SYSTEMS AND

1486
00:50:27,800 --> 00:50:29,480
TEAM PERFORMANCE AND OF COURSE

1487
00:50:29,480 --> 00:50:34,320
SUPPORT A SAFER ENVIRONMENT FOR

1488
00:50:34,320 --> 00:50:35,560
FURTHER ENHANCING PATIENT

1489
00:50:35,560 --> 00:50:35,920
OUTCOMES.

1490
00:50:35,920 --> 00:50:38,520
SO WE HAVE 4 WORK STREAMS IN OUR

1491
00:50:38,520 --> 00:50:40,160
PROGRAM, THE TRANSLATIONAL

1492
00:50:40,160 --> 00:50:41,720
SIMULATION WORK STREAM WHICH

1493
00:50:41,720 --> 00:50:43,760
ESSENTIALLY TRAININGS ARE

1494
00:50:43,760 --> 00:50:46,000
DIRECTLY FOCUSED ON IMPROVING

1495
00:50:46,000 --> 00:50:46,880
HEALTHCARE PROCESSES ON

1496
00:50:46,880 --> 00:50:52,080
OUTCOMES, WE DO SYSTEM TESTING

1497
00:50:52,080 --> 00:50:53,040
PROCESS IMPROVEMENT AND SAFETY

1498
00:50:53,040 --> 00:50:53,640
ATHAT WILL SIS.

1499
00:50:53,640 --> 00:50:55,840
IN OUR CLINICAL WORK STREAM, WE

1500
00:50:55,840 --> 00:50:59,480
USE HEALTHCARE SIMULATION AS AN

1501
00:50:59,480 --> 00:51:01,880
EDUCATIONAL TOOL WHERE THE

1502
00:51:01,880 --> 00:51:03,160
PARTICIPANTS CAN PRACTICE

1503
00:51:03,160 --> 00:51:05,800
CLINICAL AND NONCLINICAL SKILLS

1504
00:51:05,800 --> 00:51:07,240
CREATING A SAFE ENVIRONMENT.

1505
00:51:07,240 --> 00:51:11,160
WE OFFER CENTER-BASED AND INSITU

1506
00:51:11,160 --> 00:51:12,520
SIMULATION, WE HAVE EDUCATION

1507
00:51:12,520 --> 00:51:15,040
AND FACULTY DEVELOPMENT PURPOSES

1508
00:51:15,040 --> 00:51:16,240
WITH EMPHASIS ON

1509
00:51:16,240 --> 00:51:18,000
INTERPROFESSIONAL COLLABORATION.

1510
00:51:18,000 --> 00:51:21,920
IN OUR--OUR INNOVATION WORK

1511
00:51:21,920 --> 00:51:24,000
STREAM, WE WORK WITH OTHER

1512
00:51:24,000 --> 00:51:27,280
DEPARTMENTS AND INSTITUTES TO

1513
00:51:27,280 --> 00:51:31,600
CREATE DIFFERENT SIMULATION

1514
00:51:31,600 --> 00:51:32,800
REALITIES THAT SERVE AS

1515
00:51:32,800 --> 00:51:34,440
EDUCATIONAL TOOLS FOR OUR

1516
00:51:34,440 --> 00:51:35,080
LEARNERS.

1517
00:51:35,080 --> 00:51:39,400
AND IN RESEARCH, WE HAVE FOCUSED

1518
00:51:39,400 --> 00:51:42,080
OUR ENERGY ON CREATING A STRONG

1519
00:51:42,080 --> 00:51:43,720
SIM DATABASE AND DEVELOPING OUR

1520
00:51:43,720 --> 00:51:45,120
METRICS AND ASSESSMENT TOOLS

1521
00:51:45,120 --> 00:51:48,600
THAT HELP US TO BUILD EVIDENCE.

1522
00:51:48,600 --> 00:51:50,640
SO LET ME SHOW SOME OF THOSE

1523
00:51:50,640 --> 00:51:57,000
EXAMPLES WITH YOU.

1524
00:51:57,000 --> 00:51:58,880
FOR TRANSLATIONAL SIMULATION,

1525
00:51:58,880 --> 00:52:01,000
THE GENE 1 PROMG ECTOMYOSINNINGS

1526
00:52:01,000 --> 00:52:02,440
SERVED FOR THE SIMULATION

1527
00:52:02,440 --> 00:52:04,200
PROGRAM IF YOU REMEMBER AS PART

1528
00:52:04,200 --> 00:52:06,480
OF THE NIH CLINICAL CENTER IN

1529
00:52:06,480 --> 00:52:09,920
2019, THE CEO DR. GILMAN INCLUDE

1530
00:52:09,920 --> 00:52:11,680
TD GENE THERAPY AS 1 RESEARCH

1531
00:52:11,680 --> 00:52:13,120
PRIORITY FOR THE HOSPITAL AND

1532
00:52:13,120 --> 00:52:14,720
THE AMBITIOUS PROJECT CAME WITH

1533
00:52:14,720 --> 00:52:16,320
MANY CHALLENGES LIKE TAKING CARE

1534
00:52:16,320 --> 00:52:19,400
OF YOUNGER AND SMALLER PEDIATRIC

1535
00:52:19,400 --> 00:52:21,800
PATIENTS SO IT HAS BEEN WORKING

1536
00:52:21,800 --> 00:52:23,720
ON THE CAPABILITIES NEEDED TO

1537
00:52:23,720 --> 00:52:25,160
RELIEVE THE JEEP THERAPY AT

1538
00:52:25,160 --> 00:52:30,040
TREATMENT AND ALSO KEEPING OUR

1539
00:52:30,040 --> 00:52:31,440
PATIENTS SAFE.

1540
00:52:31,440 --> 00:52:33,480
GENE THERAPY HAS PROVIDED

1541
00:52:33,480 --> 00:52:35,720
TREATMENT FOR UNTREATABLE

1542
00:52:35,720 --> 00:52:38,680
DISEASES LIKE THE TYPE 1

1543
00:52:38,680 --> 00:52:40,640
[INDISCERNIBLE] WHICH HAS RARE

1544
00:52:40,640 --> 00:52:43,160
RAPIDLY FATAL CANNED WHAT

1545
00:52:43,160 --> 00:52:45,400
DISORDER WITH LIFE EXPECTANCY OF

1546
00:52:45,400 --> 00:52:48,000
LESS THAN 3 YEARS OF AGE.

1547
00:52:48,000 --> 00:52:50,680
SO IN 2021 THE CLINICAL CENTER

1548
00:52:50,680 --> 00:52:54,000
RECEIVED 2 PATIENTS WITH THIS

1549
00:52:54,000 --> 00:52:55,400
MEDICAL CONDITION AND IN ORDER

1550
00:52:55,400 --> 00:52:57,000
TO BE READY FOR THEM WE DEVELOP

1551
00:52:57,000 --> 00:52:59,160
A SIMULATION BASED TRAINING TO

1552
00:52:59,160 --> 00:53:02,160
BE PREPARED FOR ANY

1553
00:53:02,160 --> 00:53:04,040
COMPLICATIONS RELATED TO GENE

1554
00:53:04,040 --> 00:53:07,920
THERAPY LIKE CARDIAC ARRHYTHMIA,

1555
00:53:07,920 --> 00:53:10,240
ANAFLACKSIS AND SEIZURES.

1556
00:53:10,240 --> 00:53:12,160
IN OUR SIMULATION INITIATIVES WE

1557
00:53:12,160 --> 00:53:15,240
HAVE THE NEW SCIENCE NURSING

1558
00:53:15,240 --> 00:53:16,480
EDUCATION, HERE'S 1 FOR 0 EMPLOY

1559
00:53:16,480 --> 00:53:18,960
AS YOU KNOW NEUROLOGICAL

1560
00:53:18,960 --> 00:53:19,960
EMERGENCIES REQUIRE IMMEDIATE

1561
00:53:19,960 --> 00:53:21,520
RECOGNITION AND TREATMENT TO

1562
00:53:21,520 --> 00:53:23,920
PREVENT LONG-TERM DISABILITY AND

1563
00:53:23,920 --> 00:53:24,880
DEATH.

1564
00:53:24,880 --> 00:53:26,680
TREATMENT IS TIME SENSITIVE AND

1565
00:53:26,680 --> 00:53:28,800
THE INITIAL MANAGEMENT INVOLVES

1566
00:53:28,800 --> 00:53:31,320
RAPID ASSESSMENT AND SUPPORTIVE

1567
00:53:31,320 --> 00:53:35,760
TREATMENT, HOWEVER, EVERY

1568
00:53:35,760 --> 00:53:37,040
ASSESSMENT CAN BE INTIMIDATING

1569
00:53:37,040 --> 00:53:38,320
AND SOMETIMES CLINICIANS DON'T

1570
00:53:38,320 --> 00:53:40,440
HAVE TIME TO COMPLETE A

1571
00:53:40,440 --> 00:53:41,200
NEUROLOGICAL ASSESSMENT.

1572
00:53:41,200 --> 00:53:43,680
SO WITH THE HELP OF A CRITICAL

1573
00:53:43,680 --> 00:53:44,760
DECISION AID TOOL DEVELOPED HERE

1574
00:53:44,760 --> 00:53:52,320
AT THE CLINICAL CENTER, WE

1575
00:53:52,320 --> 00:53:53,320
CREATED SIMULATION BASED

1576
00:53:53,320 --> 00:53:54,520
TRAINING WHERE THE PARTICIPANTS

1577
00:53:54,520 --> 00:53:56,480
HAVE THE OPPORTUNITY TO CONDUCT

1578
00:53:56,480 --> 00:54:00,760
THEIR ASSESSMENTS AND GAIN

1579
00:54:00,760 --> 00:54:02,520
CONFIDENCE IN CONDUCTING THEIR

1580
00:54:02,520 --> 00:54:03,920
ASSESSMENT AND IMPROVE PRACTICE

1581
00:54:03,920 --> 00:54:06,560
IN THE PROFESSIONAL

1582
00:54:06,560 --> 00:54:06,880
COLLABORATION.

1583
00:54:06,880 --> 00:54:11,000
SINCE MARCH WE HAVE TRAINED 177

1584
00:54:11,000 --> 00:54:12,920
PARTICIPANTS IN NEUROLOGICAL

1585
00:54:12,920 --> 00:54:18,840
EVENTS.

1586
00:54:18,840 --> 00:54:20,440
[INDISCERNIBLE] IS NOT A RARE

1587
00:54:20,440 --> 00:54:22,800
EVENT, YOU WILL FIND MULTIPLE

1588
00:54:22,800 --> 00:54:24,200
REPORTS OF THESE EVENTS ON THE

1589
00:54:24,200 --> 00:54:26,320
INTERNET AS CAN YOU SEE HERE.

1590
00:54:26,320 --> 00:54:29,200
AND THE FEDERAL AVIATION

1591
00:54:29,200 --> 00:54:30,360
ADMINISTRATION REGULATES THE

1592
00:54:30,360 --> 00:54:32,040
CONTENT OF THE EMERGENCY MEDICAL

1593
00:54:32,040 --> 00:54:33,640
EQUIPMENT, CAN YOU SEE THE LIST

1594
00:54:33,640 --> 00:54:37,320
HERE AND YOU CAN ALSO APPRECIATE

1595
00:54:37,320 --> 00:54:39,360
THAT EPINEPHRINE INJECTORS ARE

1596
00:54:39,360 --> 00:54:42,040
NOT PART OF THAT EMERGENCY

1597
00:54:42,040 --> 00:54:47,880
MEDICAL EQUIPMENT, SO WE HAD AN

1598
00:54:47,880 --> 00:54:49,880
IMMUNOLOGY AND IMAGING PROGRAM.

1599
00:54:49,880 --> 00:54:51,760
SOPHISTICATEDY WE CREATED

1600
00:54:51,760 --> 00:54:55,960
SCENARIOS FOR THE FELLOWS LIKE

1601
00:54:55,960 --> 00:54:57,760
AN ANAPHYLAXIS UNIT OR CBO

1602
00:54:57,760 --> 00:54:58,880
CHALLENGE AND REACTION TO

1603
00:54:58,880 --> 00:55:01,480
MEDICATIONS BUT WE ALSO CREATED

1604
00:55:01,480 --> 00:55:04,600
AN AIRPLANE ANAPHYLAXIS FOR THE

1605
00:55:04,600 --> 00:55:07,280
MOST OBJECTIVE IN THIS CASE,

1606
00:55:07,280 --> 00:55:09,360
BASICALLY THAT THE FELLOWS COULD

1607
00:55:09,360 --> 00:55:11,920
PRACTICE OUTSIDE OF CLINICAL

1608
00:55:11,920 --> 00:55:14,000
SETTINGS, WITH RESOURCES OR

1609
00:55:14,000 --> 00:55:16,520
LIMITED RESOURCES, AND ALSO FOR

1610
00:55:16,520 --> 00:55:18,160
EXAMPLE, USE TECHNOLOGY LIKE

1611
00:55:18,160 --> 00:55:20,240
CELL PHONES AND APPLICATIONS TO

1612
00:55:20,240 --> 00:55:21,840
CREATE OR TO TRANSLATE THOSE

1613
00:55:21,840 --> 00:55:27,480
CELL PHONES INTO MONITORS.

1614
00:55:27,480 --> 00:55:30,280
RADIOLOGY AND IMAGING SCIENCES

1615
00:55:30,280 --> 00:55:32,320
SIMULATION BASED TRAINING AS YOU

1616
00:55:32,320 --> 00:55:33,200
KNOW LIFE THREATENING

1617
00:55:33,200 --> 00:55:34,560
EMERGENCIES ARE RELATIVELY

1618
00:55:34,560 --> 00:55:36,520
INCOMMON IN THE RADIOLOGY

1619
00:55:36,520 --> 00:55:39,280
DEPARTMENT BUT WHEN ENCOUNTERED

1620
00:55:39,280 --> 00:55:44,160
REQUIRE TIMELY INTERVENTION, SO

1621
00:55:44,160 --> 00:55:47,240
RADIS IS SUPPORTED BY THE ICU

1622
00:55:47,240 --> 00:55:48,960
CODE BLUE AND RAPID RESPONSE

1623
00:55:48,960 --> 00:55:50,600
TEAM HOWEVER THERE IS A CRITICAL

1624
00:55:50,600 --> 00:55:51,960
PERIOD BETWEEN CARDIAC ARREST

1625
00:55:51,960 --> 00:55:53,080
CURING AND THE SUBSIDIARY QUEBT

1626
00:55:53,080 --> 00:55:54,760
IEE, AUDIENCE RIVAL OF

1627
00:55:54,760 --> 00:55:55,760
RESUSCITATION TEAM.

1628
00:55:55,760 --> 00:55:58,880
FOR THAT REASON WE DEVISED A

1629
00:55:58,880 --> 00:56:03,480
TEAM THAT INCLUDES RADIOLOGY IV

1630
00:56:03,480 --> 00:56:04,960
THERAPY, ADMINISTRATIVE PERSONAL

1631
00:56:04,960 --> 00:56:06,800
AND CARDIOLOGISTS AND WE CREATE

1632
00:56:06,800 --> 00:56:08,480
A SIMULATION BASED TRAINING

1633
00:56:08,480 --> 00:56:10,600
WHERE THEY HAVE THE OPPORTUNITY

1634
00:56:10,600 --> 00:56:12,040
TO PRACTICE ASSERTIVE

1635
00:56:12,040 --> 00:56:12,960
COMMUNICATION AND

1636
00:56:12,960 --> 00:56:14,160
INTERPROFESSIONAL COLLABORATION.

1637
00:56:14,160 --> 00:56:17,440
OF COURSE, THE CASE SCENARIOS

1638
00:56:17,440 --> 00:56:18,560
ARE COMMON MEDICAL EMERGENCIES

1639
00:56:18,560 --> 00:56:21,400
WITHIN THE RADIOLOGY DEPARTMENT

1640
00:56:21,400 --> 00:56:24,920
LIKE ANAPHYLAXIS IV

1641
00:56:24,920 --> 00:56:26,920
ADMINISTRATION AND VASAL

1642
00:56:26,920 --> 00:56:27,280
[INDISCERNIBLE].

1643
00:56:27,280 --> 00:56:29,840
IN THE INNOVATION AS YOU KNOW

1644
00:56:29,840 --> 00:56:33,480
ELECTRONIC HEALTH RECORDS

1645
00:56:33,480 --> 00:56:35,280
IMPROVE THE [INDISCERNIBLE] IN

1646
00:56:35,280 --> 00:56:36,600
SIMULATION BASED TRAININGS BUT

1647
00:56:36,600 --> 00:56:38,200
ALSO INCREASE THE ABILITY TO

1648
00:56:38,200 --> 00:56:40,040
RECOGNIZE AND COMMUNICATE

1649
00:56:40,040 --> 00:56:41,920
CRITICAL PATIENT SAFETY ISSUES,

1650
00:56:41,920 --> 00:56:44,760
BUILD INTO THE SIMULATED MEDICAL

1651
00:56:44,760 --> 00:56:47,960
RECORD SO WITH THE HELP OF THE

1652
00:56:47,960 --> 00:56:50,320
DEPARTMENT OF CLINICAL RESEARCH

1653
00:56:50,320 --> 00:56:51,560
INFORMATICS HERE AT THE CLINICAL

1654
00:56:51,560 --> 00:56:53,760
CENTER, WE CREATED ELECTRONIC

1655
00:56:53,760 --> 00:56:55,920
MEDICAL RECORDS FOR EVERY SINGLE

1656
00:56:55,920 --> 00:56:56,640
SIMULATED PATIENT.

1657
00:56:56,640 --> 00:57:00,800
SO THAT MEANS DURING THE

1658
00:57:00,800 --> 00:57:02,480
INTERPROFESSIONAL OR

1659
00:57:02,480 --> 00:57:05,160
PROFESSIONAL SIMULATIONS,

1660
00:57:05,160 --> 00:57:06,080
PARTICIPANTS HAVE OPPORTUNITY TO

1661
00:57:06,080 --> 00:57:09,120
SEE, OTHERS, RESULTS, X-RAYS AND

1662
00:57:09,120 --> 00:57:10,760
EKGs TO IMPROVE THE DECISION

1663
00:57:10,760 --> 00:57:16,160
MAKING PROCESS.

1664
00:57:16,160 --> 00:57:18,320
EMPATHY IT'S REALLY DIFFICULT TO

1665
00:57:18,320 --> 00:57:19,640
DEFINE AND HARD TO MEASURE BUT

1666
00:57:19,640 --> 00:57:24,320
WE ALL KNOW THAT EMPTHATETTIC

1667
00:57:24,320 --> 00:57:26,280
CARE IS FUNDAMENTAL IN HELT CARE

1668
00:57:26,280 --> 00:57:28,400
SETTINGS AND ASSOCIATED TO

1669
00:57:28,400 --> 00:57:29,400
POSITIVE OUTCOMES FOR CARE

1670
00:57:29,400 --> 00:57:31,320
WORKERS AND PATIENTS.

1671
00:57:31,320 --> 00:57:34,160
NO STANDARD CURRICULUM FOR

1672
00:57:34,160 --> 00:57:35,520
HEALTHCARE TRAINING CURRENTLY

1673
00:57:35,520 --> 00:57:37,640
EXISTS IN HEALTHCARE EDUCATION

1674
00:57:37,640 --> 00:57:42,840
AND BUILDING EVIDENCE IN EMPATHY

1675
00:57:42,840 --> 00:57:44,680
TRAINING HAS BEEN ELUSIVE FOR

1676
00:57:44,680 --> 00:57:45,400
MANY REASONS.

1677
00:57:45,400 --> 00:57:47,360
SO THE EVIDENCE OR THE BEST

1678
00:57:47,360 --> 00:57:52,880
EVIDENCE AVAILABLE SAYS THAT THE

1679
00:57:52,880 --> 00:57:55,320
LEARNERS SHOULD BE IN THE

1680
00:57:55,320 --> 00:57:56,360
PATIENT'S SHOES, SO WE NEED TO

1681
00:57:56,360 --> 00:57:57,880
ASK THE LEARNER TO ACT IN THE

1682
00:57:57,880 --> 00:57:59,600
ROLE OF THE PATIENT.

1683
00:57:59,600 --> 00:58:00,680
WITH THIS EVIDENCE AVAILABLE AND

1684
00:58:00,680 --> 00:58:05,400
WITH THE HELP OF THE PAIN AND

1685
00:58:05,400 --> 00:58:06,200
PALLIATIVE CARE SERVICE WE

1686
00:58:06,200 --> 00:58:09,400
CREATED A HUMAN AVATAR, THIS

1687
00:58:09,400 --> 00:58:11,440
HUMAN AVATAR INTERACTING IN A

1688
00:58:11,440 --> 00:58:13,120
REAL WORLD WITH REAL HUMANS SO

1689
00:58:13,120 --> 00:58:16,760
THAT GIVES THE FELLOWS THE

1690
00:58:16,760 --> 00:58:20,360
OPPORTUNITY TO EXPERIENCE A

1691
00:58:20,360 --> 00:58:21,560
PATIENT'S JOURNEY FROM THEIR

1692
00:58:21,560 --> 00:58:23,520
ARRIVAL THE AT NIH CENTER FOLLOW

1693
00:58:23,520 --> 00:58:28,600
THE END OF LIFE CONVERSATIONS.

1694
00:58:28,600 --> 00:58:30,000
IN SUMMARY THE SIMULATION

1695
00:58:30,000 --> 00:58:31,960
PROGRAM IS PREVING TO BE

1696
00:58:31,960 --> 00:58:35,400
ANENTIOUS SENTIAL TRAINING TOOL

1697
00:58:35,400 --> 00:58:37,440
THAT PREPARES CLINICAL SKILLS,

1698
00:58:37,440 --> 00:58:39,600
PREPARES TEAMS FOR MORE COMPLEX

1699
00:58:39,600 --> 00:58:41,120
CARE AND IMPROVES TEAM WORK AND

1700
00:58:41,120 --> 00:58:42,480
COMMUNICATION AND FUTURE

1701
00:58:42,480 --> 00:58:43,640
INITIATIVES WILL LOOK AT

1702
00:58:43,640 --> 00:58:44,600
OPPORTUNITIES BEYOND THE

1703
00:58:44,600 --> 00:58:46,880
TRADITIONAL SIMULATION TO

1704
00:58:46,880 --> 00:58:48,400
INCLUDE HEALTH SYSTEM

1705
00:58:48,400 --> 00:58:50,000
ADMINISTRATIVE SIMULATION,

1706
00:58:50,000 --> 00:58:54,040
OPERATIONAL TASKS, AND

1707
00:58:54,040 --> 00:58:54,400
COMMUNICATIONS.

1708
00:58:54,400 --> 00:58:56,280
A SPECIAL THANKS TO ALL THE NIH

1709
00:58:56,280 --> 00:58:58,360
CLINICIANS THAT HAVE BECOME

1710
00:58:58,360 --> 00:58:59,760
SIMULATION CHAMPIONS AND HELP US

1711
00:58:59,760 --> 00:59:02,360
TO ADVANCE THE PROGRAM WITHOUT

1712
00:59:02,360 --> 00:59:06,560
THEM THIS WOULD NOT BE POSSIBLE.

1713
00:59:06,560 --> 00:59:07,440
WHERE TO START?

1714
00:59:07,440 --> 00:59:11,120
IF YOU DON'T KNOW HOW TO DO

1715
00:59:11,120 --> 00:59:12,400
THESE TRAININGS, JUST REACH OUT

1716
00:59:12,400 --> 00:59:15,320
AND WE ARE IN THE INTERNET AND

1717
00:59:15,320 --> 00:59:19,240
WE WILL SUPPORT YOU TO DEVELOP

1718
00:59:19,240 --> 00:59:19,680
YOUR INITIATIVES.

1719
00:59:19,680 --> 00:59:26,080
THANK YOU.

1720
00:59:26,080 --> 00:59:27,280
>> FIRST OF ALL I WANT TO
THANK

1721
00:59:27,280 --> 00:59:34,560
OW SPEAKERS DR. LOPRIEATO, AND

1722
00:59:34,560 --> 00:59:36,280
SEAMS AND GOMEZ, THANK YOU FOR

1723
00:59:36,280 --> 00:59:37,360
PROVIDING THE INFORMATION FOR

1724
00:59:37,360 --> 00:59:38,640
TRAINING, UNFORTUNATELY WE'RE AT

1725
00:59:38,640 --> 00:59:40,040
THE HOUR SO WE WILL NOT BE ABLE

1726
00:59:40,040 --> 00:59:42,520
TO TAKE ANY WRITTEN

1727
00:59:42,520 --> 00:59:43,400
QUESTIONS--TAKE ANY QUESTIONS

1728
00:59:43,400 --> 00:59:45,680
BUT IF ANY OF VIEWERS WOULD LIKE

1729
00:59:45,680 --> 00:59:46,960
TO SUBMIT QUESTIONS I WILL MAKE

1730
00:59:46,960 --> 00:59:48,640
SURE THEY GET SENT TO THE

1731
00:59:48,640 --> 00:59:49,640
APPROPRIATE SPEAKER.

1732
00:59:49,640 --> 00:59:51,080
THANKS FOR THIS OVERVIEW.

1733
00:59:51,080 --> 00:59:52,880
I THINK IT'S VERY IMPORTANT

1734
00:59:52,880 --> 00:59:54,240
ESPECIALLY WITH REGARDS TO THE

1735
00:59:54,240 --> 00:59:55,520
EVIDENCE OF HOW SIMULATION

1736
00:59:55,520 --> 00:59:57,680
TRAINING CAN IMPROVE ON OUTCOMES

1737
00:59:57,680 --> 00:59:59,080
AND TRAINING AND COMMUNICATION

1738
00:59:59,080 --> 01:00:02,440
AS WELL AS THE PROGRAMS THAT

1739
01:00:02,440 --> 01:00:03,800
HAVE BEEN IMPLEMENTED TO DATE

1740
01:00:03,800 --> 01:00:05,360
HERE AT THE CLINICAL CENTER, I

1741
01:00:05,360 --> 01:00:08,000
WANT TO THANK THE LEADERSHIP OF

1742
01:00:08,000 --> 01:00:09,200
DR. GOMEZ AND DR. SEAM FOR US,

1743
01:00:09,200 --> 01:00:10,160
THIS IS FOR THAT.

1744
01:00:10,160 --> 01:00:12,800
SO AGAIN, THANK YOU VERY MUCH

1745
01:00:12,800 --> 01:00:14,520
AND TO OUR VIEWING AUDIENCE,

1746
01:00:14,520 --> 01:00:15,720
THANK YOU FOR JOINING US AND WE

1747
01:00:15,720 --> 01:00:18,560
WILL SEE YOU NEXT WEEK AND I

1748
01:00:18,560 --> 01:00:19,800
WISH EVERYONE A GREAT AFTERNOON.

1749
01:00:19,800 --> 01:00:22,120
THANK YOU.

1750
01:00:22,120 --> 00:00:00,000
>> KD--SALLY THANK YOU.