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 --> 00:00:46,160 Learn more by visiting us online at http://clinicalcenter.nih.gov 11 00:00:46,160 --> 00:00:48,600 TODAY WE'RE HONORED TO HAVE 12 00:00:48,600 --> 00:00:51,680 DR. MARY FEY. 13 00:00:51,680 --> 00:00:55,040 SHE'S A PRINCIPLE FACT MEMBER 14 00:00:55,040 --> 00:00:56,640 FOR MEDICAL SIMULATION HARVARD 15 00:00:56,640 --> 00:00:58,560 AND MANAGING PARTNER AT 16 00:00:58,560 --> 00:01:01,960 TRANSFORMATIVE TEACHING LLC. 17 00:01:01,960 --> 00:01:06,240 SHE RECEIVED HER BACHELOR'S IN 18 00:01:06,240 --> 00:01:09,760 NURSING AND MASTER'S IN 19 00:01:09,760 --> 00:01:10,640 ADMINISTRATION FROM UNIVERSITY 20 00:01:10,640 --> 00:01:12,320 BALTIMORE AND HER RESEARCH 21 00:01:12,320 --> 00:01:15,160 THESIS FOCUSSED ON 22 00:01:15,160 --> 00:01:16,240 SIMULATION-BASED TRAINING 23 00:01:16,240 --> 00:01:16,560 EXPERIENCES. 24 00:01:16,560 --> 00:01:18,160 SHE SERVED AS THE DIRECTOR OF 25 00:01:18,160 --> 00:01:23,240 THE DEBORAH L. CLINICAL 26 00:01:23,240 --> 00:01:23,920 SIMULATION LABORATORY UNIVERSITY 27 00:01:23,920 --> 00:01:26,920 OF MARYLAND SCHOOL OF NURSING 28 00:01:26,920 --> 00:01:28,320 ONE OF THE LARGEST NURSING 29 00:01:28,320 --> 00:01:28,960 SIMULATION TRAINING PROGRAMS IN 30 00:01:28,960 --> 00:01:31,960 THE COUNTRY. 31 00:01:31,960 --> 00:01:35,040 SHE THEN JOINED THE NATIONAL 32 00:01:35,040 --> 00:01:35,680 LEAGUE FOR NURSING FOR THE 33 00:01:35,680 --> 00:01:38,480 CENTER FOR ACADEMIC AND CLINICAL 34 00:01:38,480 --> 00:01:40,200 TRANSITIONS WHERE SHE 35 00:01:40,200 --> 00:01:41,320 CO-AUTHORED THE NLV VISION FOR 36 00:01:41,320 --> 00:01:44,880 TEACHING AND SIMULATION AND THE 37 00:01:44,880 --> 00:01:45,920 NLV VISION FOR DEBRIEFING ACROSS 38 00:01:45,920 --> 00:01:50,200 THE CURRICULUM. 39 00:01:50,200 --> 00:01:52,280 THESE TWO PAPERS HAVE BEEN 40 00:01:52,280 --> 00:01:54,080 DOWNLOADED IN THE SERIES. 41 00:01:54,080 --> 00:01:56,120 AFTERWARDS DR. FEY COMPLETED HER 42 00:01:56,120 --> 00:02:01,840 POST-DOCTORAL FELLOWSHIP AND 43 00:02:01,840 --> 00:02:06,560 JOINED AS A LECTURER, 44 00:02:06,560 --> 00:02:07,880 SPECIALIZING FACULTY DEVELOPMENT 45 00:02:07,880 --> 00:02:10,560 AND HER WORK HAS FOCUSSED ON 46 00:02:10,560 --> 00:02:12,240 FACULTY DEVELOPMENT AND 47 00:02:12,240 --> 00:02:12,920 DEBRIEFING AND SIMULATION 48 00:02:12,920 --> 00:02:15,800 EDUCATION AND TEACHER-LEARNER 49 00:02:15,800 --> 00:02:16,960 RELATIONSHIP. 50 00:02:16,960 --> 00:02:19,640 FROM 1920 TO 2021 SERVED AS THE 51 00:02:19,640 --> 00:02:21,840 CENTER DIRECTOR FOR TEACHING AND 52 00:02:21,840 --> 00:02:22,480 LEARNING. 53 00:02:22,480 --> 00:02:25,840 CURRENTLY SHE TEACHES AS AT THE 54 00:02:25,840 --> 00:02:27,160 CENTER AND IS CONSULTANT 55 00:02:27,160 --> 00:02:32,240 FOCUSSING ON NURSING EDUCATORS 56 00:02:32,240 --> 00:02:36,840 AND ADJUNCT FACULTY AT DREXEL. 57 00:02:36,840 --> 00:02:39,240 SHE'S INTERNATIONALLY RECOGNIZED 58 00:02:39,240 --> 00:02:42,080 FOR HER EXPERTISE IN SIMULATION 59 00:02:42,080 --> 00:02:43,080 TRAINING FROM CONCEPT TO DESIGN 60 00:02:43,080 --> 00:02:44,000 AND IMPLEMENTATION. 61 00:02:44,000 --> 00:02:46,600 SHE'S A FELLOW IN THE NATIONAL 62 00:02:46,600 --> 00:02:48,920 LEAGUE FOR NURSING ACADEMY OF 63 00:02:48,920 --> 00:02:50,720 NURSE EDUCATORS AND FELLOW IN 64 00:02:50,720 --> 00:02:52,840 THE AMERICAN ACADEMY OF NURSING. 65 00:02:52,840 --> 00:02:55,320 SHE'S ACTIVELY INVOLVED IN THE 66 00:02:55,320 --> 00:02:56,040 SOCIETY FOR SIMULATION HEALTH 67 00:02:56,040 --> 00:02:57,760 CARE AS A RESEARCH MENTOR 68 00:02:57,760 --> 00:03:00,360 LEADING THE DEVELOPMENT OF 69 00:03:00,360 --> 00:03:02,160 CERTIFIED HEALTH CARE 70 00:03:02,160 --> 00:03:07,440 STIMULATION ADVANCE D 71 00:03:07,440 --> 00:03:09,640 CERTIFICATION PROGRAM AND HER 72 00:03:09,640 --> 00:03:12,200 TALK IS GREAT MINDS DON'T ALWAYS 73 00:03:12,200 --> 00:03:14,000 THINK A LOT. 74 00:03:14,000 --> 00:03:14,640 SIMULATION'S ROLE IN BUILDING 75 00:03:14,640 --> 00:03:24,920 TEAM COGNITION. 76 00:03:37,400 --> 00:03:38,680 AND BECOME MORE COORDINATED 77 00:03:38,680 --> 00:03:41,640 TEAMS FOR THE BENEFIT OF PATIENT 78 00:03:41,640 --> 00:03:42,240 OUTCOMES. 79 00:03:42,240 --> 00:03:46,000 AS I TALK ABOUT THIS I WANT TO 80 00:03:46,000 --> 00:03:47,640 START TALKING ABOUT A MODEL FOR 81 00:03:47,640 --> 00:03:50,160 TEAM WORK THAT'S BEEN AROUND 20 82 00:03:50,160 --> 00:03:52,080 MILLION YEARS. 83 00:03:52,080 --> 00:03:56,120 JUST LIKE US WHO COME TO WORK 84 00:03:56,120 --> 00:03:58,880 EVERY DAY WE USUALLY FUNCTION AS 85 00:03:58,880 --> 00:03:59,720 HIGHLY SPECIALIZED INDIVIDUALS 86 00:03:59,720 --> 00:04:04,240 THAT ARE INTEGRATED INTO A 87 00:04:04,240 --> 00:04:05,440 LARGER TEAM. 88 00:04:05,440 --> 00:04:07,520 SO THE FIRST MODEL I WANT TO 89 00:04:07,520 --> 00:04:08,680 TALK ABOUT FOR TEAM WORK IS THE 90 00:04:08,680 --> 00:04:09,720 HONEY BEE. 91 00:04:09,720 --> 00:04:12,240 AS I SAID, HONEY BEES HAVE BEEN 92 00:04:12,240 --> 00:04:14,960 AROUND FUNCTIONING IN THEIR 93 00:04:14,960 --> 00:04:17,080 COLONIES, WE HAVE FOSSIL 94 00:04:17,080 --> 00:04:17,920 EVIDENCE FROM ABOUT 20 MILLION 95 00:04:17,920 --> 00:04:18,840 YEARS AGO. 96 00:04:18,840 --> 00:04:21,240 I'M A BEEKEEPER AND LEARNED SO 97 00:04:21,240 --> 00:04:23,000 MUCH FROM MY BEES ABOUT HOW 98 00:04:23,000 --> 00:04:24,240 INDIVIDUALS WITH HIGHLY 99 00:04:24,240 --> 00:04:26,600 SPECIALIZED ROLES BECOME 100 00:04:26,600 --> 00:04:28,400 INTEGRATED INTO A LARGER 101 00:04:28,400 --> 00:04:30,080 ORGANISM AND HOW THAT ORGANISM 102 00:04:30,080 --> 00:04:30,840 PRODUCES SOMETHING GREATER THAN 103 00:04:30,840 --> 00:04:36,560 THE SUM OF THE INDIVIDUAL PARTS. 104 00:04:36,560 --> 00:04:37,920 WARNING, I'LL BE SHOWING HONEY 105 00:04:37,920 --> 00:04:39,760 BEE VIDEOS DURING THE TALK AND 106 00:04:39,760 --> 00:04:44,720 WHEN I SEE ONE MY HEART IS 107 00:04:44,720 --> 00:04:47,360 FILLED WITH BEES BUT IF YOU 108 00:04:47,360 --> 00:04:50,440 DON'T WANT TO SEE THEM PLEASE 109 00:04:50,440 --> 00:04:52,640 LOOK AWAY AND I'LL WARN YOU 110 00:04:52,640 --> 00:04:54,280 BEFORE I SEE THE VIDEOS. 111 00:04:54,280 --> 00:04:55,880 THIS IS THE HONEY BEE HIVE. 112 00:04:55,880 --> 00:04:57,600 THE HIVE IS THE STRUCTURE THEY 113 00:04:57,600 --> 00:04:58,080 LIVE IN. 114 00:04:58,080 --> 00:05:00,240 AS YOU LOOK AT THIS VIDEO IT 115 00:05:00,240 --> 00:05:04,240 KIND OF LOOKS LIKE RANDOM FLIGHT 116 00:05:04,240 --> 00:05:06,880 OF A BUNCH OF BUGS BUT THERE'S A 117 00:05:06,880 --> 00:05:08,880 LOT GOING ON BEHIND THE SCENES. 118 00:05:08,880 --> 00:05:11,160 EACH BEE IN THE COLONY HAS A 119 00:05:11,160 --> 00:05:12,960 HIGHLY SPECIALIZED JOB YET 120 00:05:12,960 --> 00:05:14,000 THEY'RE ALL INTERDEPENDENT ON 121 00:05:14,000 --> 00:05:15,640 EACH OTHER TO ACHIEVE THEIR 122 00:05:15,640 --> 00:05:17,480 ULTIMATE GOAL WHICH IS SURVIVAL 123 00:05:17,480 --> 00:05:17,960 OF THE HIVE. 124 00:05:17,960 --> 00:05:20,680 SO THESE BEES YOU SEE ON THE 125 00:05:20,680 --> 00:05:22,360 OUTSIDE ARE PRETTY OBVIOUS 126 00:05:22,360 --> 00:05:25,920 THERE'S BEES PLAYING A LOT OF 127 00:05:25,920 --> 00:05:27,520 DIFFERENT ROLES. 128 00:05:27,520 --> 00:05:36,480 EACH FEMALE BEE THE FEMALE BEE 129 00:05:36,480 --> 00:05:38,440 PASSES THROUGH SPECIALIZATION. 130 00:05:38,440 --> 00:05:40,000 THE FIRST JOB THE BEE HAS IS 131 00:05:40,000 --> 00:05:41,360 BECOME A CLEANER. 132 00:05:41,360 --> 00:05:43,240 THEY CLEAN THEY CELL THEY WERE 133 00:05:43,240 --> 00:05:46,320 IN AND ANY ADJACENT CELLS SO THE 134 00:05:46,320 --> 00:05:48,800 CELLS ARE READY FOR THE QUEEN 135 00:05:48,800 --> 00:05:51,520 COMES PAST AND WANTS TO DEPOSIT 136 00:05:51,520 --> 00:05:52,400 AN EGG. 137 00:05:52,400 --> 00:05:54,000 THEN THEY BECOME NURSE BEES. 138 00:05:54,000 --> 00:05:57,240 THE NURSE BEES ARE THE BEE FEED 139 00:05:57,240 --> 00:05:59,200 THE LARVAE DEVELOPING FROM THE 140 00:05:59,200 --> 00:06:00,680 STORES IN THE HIVE FROM THE 141 00:06:00,680 --> 00:06:03,080 HONEY AND POLLEN. 142 00:06:03,080 --> 00:06:03,600 THEY'RE UNDERTAKER BEE. 143 00:06:03,600 --> 00:06:06,480 THE INSIDE OF A BEE HIVE IS VERY 144 00:06:06,480 --> 00:06:06,880 CLEAN. 145 00:06:06,880 --> 00:06:09,760 BEES DO NOT ELIMINATE OR ALLOW 146 00:06:09,760 --> 00:06:13,080 DEAD BODIES TO ACCUMULATE SO THE 147 00:06:13,080 --> 00:06:15,680 UNDERTAKER BEES' JOB IS TO PICK 148 00:06:15,680 --> 00:06:17,720 UP THE BODIES AND LET THEM GO 149 00:06:17,720 --> 00:06:18,840 OUTSIDE THE HIVE. 150 00:06:18,840 --> 00:06:21,000 THERE'S ARCHITECT BEES OR THE 151 00:06:21,000 --> 00:06:21,840 BUILDER BEES. 152 00:06:21,840 --> 00:06:25,560 THEY MONITOR THE AVAILABILITY OF 153 00:06:25,560 --> 00:06:28,160 EMPTY HONEYCOMB AND MAKE SURE 154 00:06:28,160 --> 00:06:29,840 THERE'S ENOUGH FOR THE QUEEN TO 155 00:06:29,840 --> 00:06:32,440 LAY HER EGG AND FOR THE BEES TO 156 00:06:32,440 --> 00:06:35,960 MAKE NECTAR UP TO MAKE HONEY IN 157 00:06:35,960 --> 00:06:41,080 AND STORE POLLEN FOR FOOD FOR 158 00:06:41,080 --> 00:06:42,440 THE WIN TER. 159 00:06:42,440 --> 00:06:44,240 THERE'S TWO THINGS ON THE 160 00:06:44,240 --> 00:06:46,000 OUTSIDE OF THE HIVE. 161 00:06:46,000 --> 00:06:48,960 MOST BEE THE FORAGER BEE. 162 00:06:48,960 --> 00:06:50,360 THAT'S THE LAST JOB ANY BEE WILL 163 00:06:50,360 --> 00:06:52,160 HAVE IN HER LIFE AND THEY BRING 164 00:06:52,160 --> 00:06:54,520 THE POLLEN AND HONEY BACK TO THE 165 00:06:54,520 --> 00:06:54,720 HIVE. 166 00:06:54,720 --> 00:06:55,960 WHAT YOU CAN'T SEE THAT'S ALSO 167 00:06:55,960 --> 00:06:58,120 GOING ON THE ENTRANCE OF THE 168 00:06:58,120 --> 00:07:00,000 HIVE IS GUARD BEES AND BEES DO 169 00:07:00,000 --> 00:07:04,240 NOT ALLOW BEE THAT DON'T LIVE IN 170 00:07:04,240 --> 00:07:06,240 THAT HIVE TO COME IN AND IT'S 171 00:07:06,240 --> 00:07:08,280 THE GUARD BEES HIVE SMELL EVERY 172 00:07:08,280 --> 00:07:12,040 BEE OR SOMETIMES INVASIVE WASPS 173 00:07:12,040 --> 00:07:14,480 THAT PREY ON BEES TRY TO GET IN 174 00:07:14,480 --> 00:07:16,520 THE HIVES AND THE GUARD BEES 175 00:07:16,520 --> 00:07:18,360 WILL ATTACK THEM AND DRIVE THEM 176 00:07:18,360 --> 00:07:19,240 AWAY FROM THE HIVE. 177 00:07:19,240 --> 00:07:25,960 I'LL SHOW YOU ONE MORE VIDEO. 178 00:07:25,960 --> 00:07:28,360 THESE GUYS ARE THE VENTILATOR 179 00:07:28,360 --> 00:07:28,800 BEES. 180 00:07:28,800 --> 00:07:31,320 THEY ARE BEATING THEIR WINGS IN 181 00:07:31,320 --> 00:07:31,680 THIS DIRECTION. 182 00:07:31,680 --> 00:07:33,520 THEY'RE BRINGING FRESH AIR INTO 183 00:07:33,520 --> 00:07:35,640 THE HIVE SO THEIR MANAGING THE 184 00:07:35,640 --> 00:07:38,600 OXYGEN AND CARBON DIOXIDE LEVELS 185 00:07:38,600 --> 00:07:40,640 INSIDE THE HIVE AND THEY'RE 186 00:07:40,640 --> 00:07:41,480 MAINTAINING THE TEMPERATURE OF 187 00:07:41,480 --> 00:07:42,880 THE HIVE. 188 00:07:42,880 --> 00:07:44,440 THE INSIDE OF A BEE HIVE STAYING 189 00:07:44,440 --> 00:07:48,840 BETWEEN 93 AND 96 DEGREES 190 00:07:48,840 --> 00:07:52,080 FAHRENHEIT AT ALL THESE TIMES. 191 00:07:52,080 --> 00:07:53,880 WE SOMEWHERE ALL THESE BEES WITH 192 00:07:53,880 --> 00:07:54,800 SPECIALIZED ROLLED AND ALL 193 00:07:54,800 --> 00:07:55,640 DEPENDENT ON EACH OTHER TO STAY 194 00:07:55,640 --> 00:07:58,280 IN THEIR ROLE AND DO THE JOB AND 195 00:07:58,280 --> 00:08:01,880 THE VENTILATOR BEES DON'T WORRY 196 00:08:01,880 --> 00:08:03,880 ABOUT WHETHER THE UNDERTAKER 197 00:08:03,880 --> 00:08:04,600 BEES DO THEIR JOB BECAUSE THEY 198 00:08:04,600 --> 00:08:06,480 HAVE THEIR JOB. 199 00:08:06,480 --> 00:08:09,240 SO INSIDE THE BEE HIVE ABOUT 95% 200 00:08:09,240 --> 00:08:10,800 OF THE BEE FEMALE. 201 00:08:10,800 --> 00:08:13,640 AND ABOUT 5% ARE THE BOY BEES. 202 00:08:13,640 --> 00:08:16,280 AND THEN WITHIN EACH BEE HIVE 203 00:08:16,280 --> 00:08:17,280 THERE'S ONE QUEEN. 204 00:08:17,280 --> 00:08:18,880 SO LET'S TALK ABOUT THE OTHER 205 00:08:18,880 --> 00:08:20,040 SPECIALIZED ROLES. 206 00:08:20,040 --> 00:08:23,480 FIRST WE'VE GOT THE BOYS. 207 00:08:23,480 --> 00:08:24,920 THE BOYS SADLY CONTRIBUTE VERY 208 00:08:24,920 --> 00:08:26,920 LITTLE TO THE DAILY WORKING OF 209 00:08:26,920 --> 00:08:27,680 THE HIVES. 210 00:08:27,680 --> 00:08:29,080 BUT THEY HAVE ONE VERY 211 00:08:29,080 --> 00:08:30,480 APPRECIATION RESOURCE AND THAT 212 00:08:30,480 --> 00:08:32,960 IS THEY HAVE THE SPERM THAT IN 213 00:08:32,960 --> 00:08:35,400 THE EVENT THE PRESENT QUEEN DIES 214 00:08:35,400 --> 00:08:40,920 AND A NEW QUEEN EMERGES THE BOY 215 00:08:40,920 --> 00:08:42,840 BEE THERE TO CONTRIBUTE SPERM 216 00:08:42,840 --> 00:08:44,840 FOR THAT PURPOSE. 217 00:08:44,840 --> 00:08:47,120 WHEN A NEW QUEEN IS FORMED SHE 218 00:08:47,120 --> 00:08:50,800 GOES ON HER NUPTIAL FLIGHT AND 219 00:08:50,800 --> 00:08:52,480 MATE BETWEEN 12 AND 40 DRONE 220 00:08:52,480 --> 00:08:55,720 BEES AND COLLECTS ALL THE SPERM 221 00:08:55,720 --> 00:08:59,480 SHE'LL NEED FOR THE REST OF HER 222 00:08:59,480 --> 00:09:02,000 LIFE AND NEVER LEAVE THE HIVE 223 00:09:02,000 --> 00:09:04,000 AGAIN AND LAYS BETWEEN 1,000 AND 224 00:09:04,000 --> 00:09:05,960 1500 EGGS EVERY DAY OF HER LIFE 225 00:09:05,960 --> 00:09:08,720 FOR HER WHOLE LIFE SPAN WHICH 226 00:09:08,720 --> 00:09:10,000 USUALLY LAST BETWEEN TWO AND 227 00:09:10,000 --> 00:09:10,520 THREE YEARS. 228 00:09:10,520 --> 00:09:13,640 SO EACH OF THESE BEES HAD A 229 00:09:13,640 --> 00:09:14,240 HIGHLY SPECIALIZED ROLE. 230 00:09:14,240 --> 00:09:16,160 THEY ALL HAVE TO WORK DWEJ AND 231 00:09:16,160 --> 00:09:17,080 ALL HAVE ONE COMMON GOAL WHICH 232 00:09:17,080 --> 00:09:19,440 IS SURVIVAL OF THE HIVE. 233 00:09:19,440 --> 00:09:22,240 AND I THINK IT'S PRETTY EASY FOR 234 00:09:22,240 --> 00:09:23,880 PEOPLE TO LOOK AT THE QUEEN BEE 235 00:09:23,880 --> 00:09:25,400 AND THINK SHE'S THE MOST 236 00:09:25,400 --> 00:09:26,480 IMPORTANT FOR THE LEADER BUT 237 00:09:26,480 --> 00:09:28,760 SHE'S REALLY JUST ANOTHER BUG 238 00:09:28,760 --> 00:09:30,440 WITH A JOB. 239 00:09:30,440 --> 00:09:33,720 BUT EVERY DAY AS THE BEES ARE 240 00:09:33,720 --> 00:09:35,480 GOING THROUGH THEIR ROLES, 241 00:09:35,480 --> 00:09:37,480 THINGS DON'T USUALLY GO TO 242 00:09:37,480 --> 00:09:38,240 DISRUPTIVE AND THINGS GO ALONG 243 00:09:38,240 --> 00:09:41,000 PRETTY WELL AND EASILY BUT EVERY 244 00:09:41,000 --> 00:09:42,080 ONCE IN A WHILE IT'S NOT 245 00:09:42,080 --> 00:09:43,280 BUSINESS AS USUAL. 246 00:09:43,280 --> 00:09:43,960 YOU'VE PROBABLY ALL SEEN 247 00:09:43,960 --> 00:09:46,000 PICTURES OF SOMETHING THAT LOOKS 248 00:09:46,000 --> 00:09:47,440 LIKE THIS WHEN THIS IS CALLED 249 00:09:47,440 --> 00:09:49,800 THE SWARM WHEN A SWARM ENDS UP 250 00:09:49,800 --> 00:09:51,000 IN THE DUGOUT OF A BASELINE 251 00:09:51,000 --> 00:09:52,840 FIELD WE SEE IT ON THE NEWS OR 252 00:09:52,840 --> 00:09:55,920 SOMETIMES YOU'LL SEE IT ON THE 253 00:09:55,920 --> 00:09:59,280 NEWS IF THEY ARE IN A PUBLIC 254 00:09:59,280 --> 00:09:59,480 PLACE. 255 00:09:59,480 --> 00:10:01,720 I WANT TO TALK ABOUT WHAT'S 256 00:10:01,720 --> 00:10:03,440 GOING ON WITH A SWARM BECAUSE 257 00:10:03,440 --> 00:10:06,120 THIS IS WHEN THINGS OUT OF THE 258 00:10:06,120 --> 00:10:07,400 ORDINARY THINGS HAPPEN AND JUST 259 00:10:07,400 --> 00:10:10,360 LIKE US COMING TO WORK EVERY DAY 260 00:10:10,360 --> 00:10:11,720 MOST DAYS IT'S KIND OF BUSINESS 261 00:10:11,720 --> 00:10:12,560 AS USUAL. 262 00:10:12,560 --> 00:10:13,600 WE DO OUR VERY IMPORTANT JOBS 263 00:10:13,600 --> 00:10:17,480 AND DO THEM PRETTY WELL BUT ONCE 264 00:10:17,480 --> 00:10:19,600 IN A WHILE MORE CHALLENGING 265 00:10:19,600 --> 00:10:21,920 THINGS COMES UP AND WHAT'S 266 00:10:21,920 --> 00:10:25,400 HAPPENING TO THE BEE COLONY WHEN 267 00:10:25,400 --> 00:10:32,240 THERE'S A WARM AND THIS IS A 268 00:10:32,240 --> 00:10:34,800 NATURAL LIFE SICKLE AND THE BEE 269 00:10:34,800 --> 00:10:37,920 HIVE GROWS AND THE POPULATION 270 00:10:37,920 --> 00:10:40,360 GROWS AND IT'S NOT THAT GOOD FOR 271 00:10:40,360 --> 00:10:42,960 THE BEES TO STAY BECAUSE THERE'S 272 00:10:42,960 --> 00:10:46,440 TOO MANY BEES AND THEY KNOW HALF 273 00:10:46,440 --> 00:10:48,760 THE HIVE HAS TO LEAVE. 274 00:10:48,760 --> 00:10:50,760 I HAVE NO IDEA HOW THEY DECIDE 275 00:10:50,760 --> 00:10:52,000 WHO'S GOING AND STAYING. 276 00:10:52,000 --> 00:10:53,400 IN THE DAYS AND WEEKS LEADING UP 277 00:10:53,400 --> 00:10:58,800 TO WHEN HALF THE HIVE IS GOING 278 00:10:58,800 --> 00:11:02,640 TO BE LEAVING THE FORAGER BEES 279 00:11:02,640 --> 00:11:09,400 START TO GORGE ON HONEY AND PROD 280 00:11:09,400 --> 00:11:11,480 THE QUEEN AND START TO PUSH HER 281 00:11:11,480 --> 00:11:15,720 AROUND SO SHE HAS TO MOVE MORE 282 00:11:15,720 --> 00:11:17,240 SO SHE LOSES A LITTLE BIT OF 283 00:11:17,240 --> 00:11:18,560 WEIGHT TO MAKE IT EASIER TO FLY 284 00:11:18,560 --> 00:11:19,520 AND THEY DO THINGS IN 285 00:11:19,520 --> 00:11:22,040 PREPARATION FOR THE BIG MOMENT. 286 00:11:22,040 --> 00:11:23,480 ONCE THE QUEEN REALIZES 287 00:11:23,480 --> 00:11:25,400 EVERYBODY IS READY TO GO SHE 288 00:11:25,400 --> 00:11:27,800 SETS OFF A SERIES OF CHIRPING 289 00:11:27,800 --> 00:11:28,960 NOISES THAT TELLS THE BEES WE'RE 290 00:11:28,960 --> 00:11:32,240 READY TO GO AND SHE LEAVES THE 291 00:11:32,240 --> 00:11:36,240 HIVE AND HALF THE HIVE LEAVES 292 00:11:36,240 --> 00:11:39,080 WITH HER ABOUT 20,000 BEES AND 293 00:11:39,080 --> 00:11:40,120 SHE'S IN THE MIDDLE AND THEY'RE 294 00:11:40,120 --> 00:11:41,200 ALL AROUND HER TRYING TO KEEP 295 00:11:41,200 --> 00:11:42,120 HER WARM. 296 00:11:42,120 --> 00:11:44,800 NOW WE HAVE REALLY SOMETHING OUT 297 00:11:44,800 --> 00:11:46,520 OF THE ORDINARY GOING ON AND 298 00:11:46,520 --> 00:11:47,880 THEY HAVE TO SWITCH THEIR ROLES 299 00:11:47,880 --> 00:11:50,000 IN THE SAME WAY AS IF I'M A 300 00:11:50,000 --> 00:11:53,120 NURSE ON THE WARD TAKING CARE OF 301 00:11:53,120 --> 00:11:54,920 MY PATIENT BUT THEY HAVE CARDIAC 302 00:11:54,920 --> 00:11:57,840 ARREST NOW I BECOME THE PERSON 303 00:11:57,840 --> 00:12:00,440 AT THE MEDICATION CART DRAWING 304 00:12:00,440 --> 00:12:01,960 UP THE EMERGENCY DRUGS OR MAYBE 305 00:12:01,960 --> 00:12:03,680 I BECOME THE NURSE RECORDING AND 306 00:12:03,680 --> 00:12:04,760 KEEPING TRACK AND MAKING SURE 307 00:12:04,760 --> 00:12:06,480 THE TEAM IS ALL ON THE SAME 308 00:12:06,480 --> 00:12:06,720 PAGE. 309 00:12:06,720 --> 00:12:08,160 SAME WITH BEES. 310 00:12:08,160 --> 00:12:14,320 SO THE FORAGERS SWITCH ROLES AND 311 00:12:14,320 --> 00:12:15,160 BECOME SCOUT BEES. 312 00:12:15,160 --> 00:12:16,800 THEY START TO LOOK FOR NEW PLACE 313 00:12:16,800 --> 00:12:17,720 TO LIVE. 314 00:12:17,720 --> 00:12:21,360 THE SCOUT BEES WILL ALMOST 315 00:12:21,360 --> 00:12:23,040 INVARIABLY PICK A CAVITY THAT 316 00:12:23,040 --> 00:12:25,920 HOLDS ABOUT TWO LITERS ABOUT 22 317 00:12:25,920 --> 00:12:27,800 FEET OFF THE GROUND AND FACE THE 318 00:12:27,800 --> 00:12:28,040 SOUTHEAST. 319 00:12:28,040 --> 00:12:31,400 THEY KNOW WHAT THEY'RE LOOK FOR. 320 00:12:31,400 --> 00:12:34,240 HOLLOWED OUT TREE, EMPTY 321 00:12:34,240 --> 00:12:35,040 BUILDING. 322 00:12:35,040 --> 00:12:38,400 AS THE SCOUT BEES FIND A GOOD 323 00:12:38,400 --> 00:12:39,920 ONE THEY COME BACK AND TELL THE 324 00:12:39,920 --> 00:12:42,360 HIVE WHERE THE NEW HOMES ARE AND 325 00:12:42,360 --> 00:12:43,760 THERE'S SEVERAL SCOUT BEES WITH 326 00:12:43,760 --> 00:12:44,920 MULTIPLE OPTIONS. 327 00:12:44,920 --> 00:12:48,000 AND SO CERTAIN BEES START TO FLY 328 00:12:48,000 --> 00:12:50,560 OUT TO THESE TWO HOMES AND CHECK 329 00:12:50,560 --> 00:12:53,280 OUT WHAT THE SCOUT BEES ARE 330 00:12:53,280 --> 00:12:54,480 TELLING THEM TO DO UNTIL 331 00:12:54,480 --> 00:12:55,840 EVENTUALLY ALL THE BEES START TO 332 00:12:55,840 --> 00:12:57,840 GO TO ONE PLACE. 333 00:12:57,840 --> 00:13:01,840 THEY'VE ENGAGED IN A DECISION 334 00:13:01,840 --> 00:13:03,400 MAKING PROCESS WHERE THEY'VE ALL 335 00:13:03,400 --> 00:13:04,720 HAD TO PROCESS INFORMATION, 336 00:13:04,720 --> 00:13:06,800 COMMUNICATE WITH EACH OTHER WHAT 337 00:13:06,800 --> 00:13:08,640 THE OPTIONS ARE, UNDER A LOT OF 338 00:13:08,640 --> 00:13:11,640 TIME PRESSURE AND UNDER A LOT OF 339 00:13:11,640 --> 00:13:12,360 ENVIRONMENTAL THREATS. 340 00:13:12,360 --> 00:13:16,040 IF THE TEMPERATURE DROPS, IF 341 00:13:16,040 --> 00:13:17,480 THERE'S A COLD RAIN IT ALL GOES 342 00:13:17,480 --> 00:13:19,640 TO THE SURVIVAL OF THE HIVE AND 343 00:13:19,640 --> 00:13:23,920 IN CLINICAL CARE WHEN WE'RE 344 00:13:23,920 --> 00:13:26,800 EXPECTED WITH LIFE AND DEATH 345 00:13:26,800 --> 00:13:27,960 SITUATIONS WE HAVE TO MAKE 346 00:13:27,960 --> 00:13:29,280 DECISIONS AN SHORT PERIOD OF 347 00:13:29,280 --> 00:13:31,960 TIME OR WE HAVE A RESEARCH 348 00:13:31,960 --> 00:13:33,720 PROTOCOL WE WILL GO THIS WAY, 349 00:13:33,720 --> 00:13:37,360 STEP ONE, TWO, THREE, FOUR AND 350 00:13:37,360 --> 00:13:40,240 BECAUSE HUMANS ARE HUMANS WE GET 351 00:13:40,240 --> 00:13:41,400 THROWN QUICK BALLS AND HAVE TO 352 00:13:41,400 --> 00:13:42,560 ASSESS AND CHANGE OUR ROLES TO 353 00:13:42,560 --> 00:13:44,800 MEET THE DEMANDS OF THE 354 00:13:44,800 --> 00:13:47,240 SITUATION. 355 00:13:47,240 --> 00:13:47,600 SAME WITH BEAUS. 356 00:13:47,600 --> 00:13:48,200 -- BEES. 357 00:13:48,200 --> 00:13:50,480 ONCE THE BEES HAVE PROCESSED 358 00:13:50,480 --> 00:13:51,720 THEIR INFORMATION TOGETHER AND 359 00:13:51,720 --> 00:13:54,080 MADE A NEW PLAN NOW FOR WHAT 360 00:13:54,080 --> 00:13:55,400 WE'RE GOING TO DO IN THE 361 00:13:55,400 --> 00:13:56,240 IMMEDIATE FUTURE THAT GETS 362 00:13:56,240 --> 00:13:58,720 COMMUNICATED TO THE QUEEN AND 363 00:13:58,720 --> 00:14:00,240 AGAIN SHE MAKES A SERIES OF 364 00:14:00,240 --> 00:14:03,520 CHIRPING NOISES AND AT THAT 365 00:14:03,520 --> 00:14:05,000 MOMENT THE ENTIRE SWARM LEAVES 366 00:14:05,000 --> 00:14:07,600 AND THE INTERESTING PART, ONLY 367 00:14:07,600 --> 00:14:08,720 20% OF THE BEES IN THE SWARM 368 00:14:08,720 --> 00:14:12,000 HAVE EVER BEEN TO THE NEW HOUSE 369 00:14:12,000 --> 00:14:14,520 AND YET AT THE SAME MOMENT THEY 370 00:14:14,520 --> 00:14:17,680 ALL LEAVE THE BRANCH, FLY EN 371 00:14:17,680 --> 00:14:19,040 MASSE TO THE NEW HOME AND ARRIE 372 00:14:19,040 --> 00:14:20,640 TO THE NEW HOME TOGETHER. 373 00:14:20,640 --> 00:14:22,480 IN ORDER FOR THAT TO HAPPEN 374 00:14:22,480 --> 00:14:24,240 THERE HAS TO BE SOME SORT OF 375 00:14:24,240 --> 00:14:27,600 AMAZING COMMUNICATION STRUCTURE. 376 00:14:27,600 --> 00:14:29,160 NOW THEY'RE GOING IN THE 377 00:14:29,160 --> 00:14:31,440 UNKNOWN, HOPING FOR THE BEST, 378 00:14:31,440 --> 00:14:32,080 COMMUNICATING WITH EACH OTHER 379 00:14:32,080 --> 00:14:33,920 ALONG THE WAY TO MAKE SURE 380 00:14:33,920 --> 00:14:35,480 EVERYBODY STAYS SAFE AND WE 381 00:14:35,480 --> 00:14:36,240 ACHIEVE OUR GOAL. 382 00:14:36,240 --> 00:14:38,040 SOMETHING ELSE HAPPENS IN THE 383 00:14:38,040 --> 00:14:39,840 SWARM. 384 00:14:39,840 --> 00:14:41,840 YOU BASICALLY HAVE A BUNCH OF 385 00:14:41,840 --> 00:14:43,360 BUGS THAT HAVE A CENTRAL 386 00:14:43,360 --> 00:14:45,720 ANNIVERSARY SYSTEM BUT WHEN THEY 387 00:14:45,720 --> 00:14:46,800 ALL CONNECT AROUND A SHARED GOAL 388 00:14:46,800 --> 00:14:48,960 SOMETHING NEW EMERGES FROM THE 389 00:14:48,960 --> 00:14:53,000 LITTLE BUGS AND IT'S A FORM OF 390 00:14:53,000 --> 00:14:53,440 INTELLIGENCE. 391 00:14:53,440 --> 00:14:57,760 AND DR. TOM SELEY AT CORNELL 392 00:14:57,760 --> 00:14:58,800 TERMED IT SWARM INTELLIGENCE. 393 00:14:58,800 --> 00:15:03,320 IN MY MIND WHAT WE DO AS WE FORM 394 00:15:03,320 --> 00:15:07,600 AND REFORM AROUND OUR PATIENT 395 00:15:07,600 --> 00:15:10,800 CARE AND INTELLIGENCE IS MORE 396 00:15:10,800 --> 00:15:11,360 THAN EACH INDIVIDUAL 397 00:15:11,360 --> 00:15:12,400 INTELLIGENCE EACH INDIVIDUAL 398 00:15:12,400 --> 00:15:13,280 BROUGHT TO THE PATIENT CARE 399 00:15:13,280 --> 00:15:13,680 SITUATION. 400 00:15:13,680 --> 00:15:18,760 FOR US WE CALL IT TEAM 401 00:15:18,760 --> 00:15:19,120 COGNITION. 402 00:15:19,120 --> 00:15:20,840 FOR BEES IT'S SWARM 403 00:15:20,840 --> 00:15:21,200 INTELLIGENCE. 404 00:15:21,200 --> 00:15:24,240 THE KEY PART IN ACHIEVING OUR 405 00:15:24,240 --> 00:15:26,160 GOAL IS COMMUNICATE EACH OTHER 406 00:15:26,160 --> 00:15:28,400 IN A WAY WE UNDERSTAND AND 407 00:15:28,400 --> 00:15:28,600 VALUE. 408 00:15:28,600 --> 00:15:30,880 LET'S LOOK AT BEE COMMUNICATION. 409 00:15:30,880 --> 00:15:41,200 BEE VIDEO COMING UP. 410 00:15:53,480 --> 00:15:54,240 >>THERE'S MOVEMENTS AND SOUNDS 411 00:15:54,240 --> 00:16:03,520 SHE PRODUCES. 412 00:16:03,520 --> 00:16:06,440 THE WAGGLE DANCE IS THE ONLY 413 00:16:06,440 --> 00:16:07,440 KNOWN SYMBOLIC LANGUAGE THAT 414 00:16:07,440 --> 00:16:10,080 EXISTS OUTSIDE THE REALM OF 415 00:16:10,080 --> 00:16:12,320 HUMANS AND NON PRIMATES. 416 00:16:12,320 --> 00:16:13,840 THERE'S NOTHING THAT COMPARES TO 417 00:16:13,840 --> 00:16:16,040 THE DANCE LANGUAGE OF THE MONEY 418 00:16:16,040 --> 00:16:16,200 BEE. 419 00:16:16,200 --> 00:16:17,680 >>THIS IS THE PART OF THE 420 00:16:17,680 --> 00:16:19,760 PRESENTATION WHERE I TEACH YOU 421 00:16:19,760 --> 00:16:20,360 ALL HOW TO DANCE. 422 00:16:20,360 --> 00:16:28,680 NO. 423 00:16:28,680 --> 00:16:29,440 BUT THE COMMUNICATION STRUCTURE 424 00:16:29,440 --> 00:16:32,040 THAT EXISTS IN MY MIND PARALLEL 425 00:16:32,040 --> 00:16:34,360 THE COMMUNICATION WE NEED TO 426 00:16:34,360 --> 00:16:35,920 HAVE ON OUR HEALTH CARE TEAMS IF 427 00:16:35,920 --> 00:16:37,360 WE'RE TO REACH OUR SHARED GOAL 428 00:16:37,360 --> 00:16:38,920 OF DELIVERING THE BEST PATIENT 429 00:16:38,920 --> 00:16:39,880 CARE WE CAN WHATEVER THE CONTEXT 430 00:16:39,880 --> 00:16:42,320 MIGHT BE. 431 00:16:42,320 --> 00:16:44,240 SO NOW TO PEOPLE THAT DON'T KNOW 432 00:16:44,240 --> 00:16:45,200 HEALTH CARE THEY MIGHT LOOK AT 433 00:16:45,200 --> 00:16:48,120 THIS PICTURE AND IT LOOKS LIKE A 434 00:16:48,120 --> 00:16:49,560 BUNCH OF PEOPLE DRESSED IN BLUE 435 00:16:49,560 --> 00:16:51,560 SWARMING AROUND ENGAGING IN 436 00:16:51,560 --> 00:16:51,800 ACTIVITY. 437 00:16:51,800 --> 00:16:52,880 TO OUR TRAINED EYE WE KNOW THIS 438 00:16:52,880 --> 00:16:56,040 IS A PICTURE OF PEOPLE THAT 439 00:16:56,040 --> 00:17:01,720 PROBABLY HAVE SPECIALIZED ROLES. 440 00:17:01,720 --> 00:17:04,240 I'M GOING TO GUESS THE PERSON AT 441 00:17:04,240 --> 00:17:07,080 THE HEAD OF THE BED PROBABLY 442 00:17:07,080 --> 00:17:09,280 COMES FROM THE ANESTHESIA 443 00:17:09,280 --> 00:17:10,800 DEPARTMENT AND AT THE BOTTOM IS 444 00:17:10,800 --> 00:17:13,480 PROBABLY THE TEAM LEADER AND 445 00:17:13,480 --> 00:17:16,240 RESPIRATORY SPECIALISTS AND 446 00:17:16,240 --> 00:17:17,720 MAYBE NURSES AND MAYBE 447 00:17:17,720 --> 00:17:18,040 PHARMACIST. 448 00:17:18,040 --> 00:17:19,400 WE'RE VERY MUCH LIKE THE BEES IN 449 00:17:19,400 --> 00:17:21,360 THAT WE HAVE HIGHLY SPECIALIZED 450 00:17:21,360 --> 00:17:23,120 ROLES AND WE'RE INTERDEPENDENT 451 00:17:23,120 --> 00:17:25,320 ON EACH OTHER IF WE ARE GOING TO 452 00:17:25,320 --> 00:17:26,360 EXECUTE OUR TASKS. 453 00:17:26,360 --> 00:17:30,040 AND JUST LIKE THE BEES, THOUGH 454 00:17:30,040 --> 00:17:32,000 WE BRING INDIVIDUAL PERSPECTIVES 455 00:17:32,000 --> 00:17:33,520 AND INDIVIDUAL INTELLIGENCE IN 456 00:17:33,520 --> 00:17:35,440 THE ROOM AS WE COME TOGETHER 457 00:17:35,440 --> 00:17:38,120 AROUND A SHARED GOAL, SOMETHING 458 00:17:38,120 --> 00:17:39,520 LARGER EMERGES AND THE LARGER 459 00:17:39,520 --> 00:17:40,880 THING THAT EMERGES IS TEAM 460 00:17:40,880 --> 00:17:43,360 COGNITION. 461 00:17:43,360 --> 00:17:46,080 NOW, THE GOOD THING ABOUT TEAM 462 00:17:46,080 --> 00:17:48,120 COGNITION IS THERE'S COMPONENTS 463 00:17:48,120 --> 00:17:50,120 THAT ARE MEASURABLE AND 464 00:17:50,120 --> 00:17:51,720 OBSERVABLE AND REPEATABLE AND 465 00:17:51,720 --> 00:17:55,320 ALSO AMENABLE TO TRAINING. 466 00:17:55,320 --> 00:17:56,720 WHAT I WANT TO TALK ABOUT NEXT 467 00:17:56,720 --> 00:17:58,640 IS WHAT ARE THOSE ELEMENTS OF 468 00:17:58,640 --> 00:18:00,080 TEAM COGNITION WE CAN OBSERVE 469 00:18:00,080 --> 00:18:00,760 AND MEASURE AND WE CAN ALSO 470 00:18:00,760 --> 00:18:04,120 TRAIN. 471 00:18:04,120 --> 00:18:06,920 THEN I'M GOING IT LINK THAT TO A 472 00:18:06,920 --> 00:18:09,440 NUMBER OF STUDIES THAT SHOW WHEN 473 00:18:09,440 --> 00:18:11,440 OUR TEAM COGNITION IS STRONGER, 474 00:18:11,440 --> 00:18:14,280 OUR PATIENTS DO BETTER. 475 00:18:14,280 --> 00:18:15,680 THERE IS NO QUESTION IN THE 476 00:18:15,680 --> 00:18:17,520 LITERATURE WHEN WE TRAIN OUR 477 00:18:17,520 --> 00:18:20,480 TEAMS TO COMMUNICATE BETTER AND 478 00:18:20,480 --> 00:18:21,920 CONNECT BETTER AND TO RELATE TO 479 00:18:21,920 --> 00:18:23,520 EACH OTHER PATIENTS DO BETTER. 480 00:18:23,520 --> 00:18:25,480 LET'S TALK FIRST ABOUT WHAT 481 00:18:25,480 --> 00:18:27,920 THOSE COMPONENTS ARE OF TEAM 482 00:18:27,920 --> 00:18:28,960 COGNITION. 483 00:18:28,960 --> 00:18:30,160 THERE'S TWO MAINLY I WANT TO 484 00:18:30,160 --> 00:18:30,600 CONCENTRATE ON. 485 00:18:30,600 --> 00:18:32,960 THE FIRST IS THE IDEA OF HAVING 486 00:18:32,960 --> 00:18:34,360 A TEAM MENTAL MODEL. 487 00:18:34,360 --> 00:18:37,080 AND TEAM MENTAL MODELS 488 00:18:37,080 --> 00:18:39,280 ENCOMPASSES BOTH THE TASK AND 489 00:18:39,280 --> 00:18:41,200 THE TEAM-RELATED KNOWLEDGE HELD 490 00:18:41,200 --> 00:18:42,680 BY THE TEAM AS A UNIT. 491 00:18:42,680 --> 00:18:45,160 THE NURSE HAS A PIECE OF THE 492 00:18:45,160 --> 00:18:46,280 PUZZLE, THE PHYSICIAN HAS A 493 00:18:46,280 --> 00:18:48,360 PIECE OF THE PUZZLE. 494 00:18:48,360 --> 00:18:50,280 THE RESPIRATORY THERAPIST AND 495 00:18:50,280 --> 00:18:50,600 PHARMACIST. 496 00:18:50,600 --> 00:18:51,680 WE ALL KNOW THE PATIENT BUT IN A 497 00:18:51,680 --> 00:18:54,680 DIFFERENT WAY. 498 00:18:54,680 --> 00:18:56,920 AS WE COME TOGETHER AND AS WE 499 00:18:56,920 --> 00:18:58,680 CREATE THIS SHARED MENTAL MODEL 500 00:18:58,680 --> 00:19:00,240 ABOUT WHAT WE'RE DOING HERE IT 501 00:19:00,240 --> 00:19:02,560 ALLOWS US TO DO A COUPLE THINGS. 502 00:19:02,560 --> 00:19:05,480 IT ALLOWS US TO DESCRIBE WHAT'S 503 00:19:05,480 --> 00:19:07,000 GOING ON BECAUSE WE'RE ABLE TO 504 00:19:07,000 --> 00:19:08,200 INTERPRET INFORMATION IN THE 505 00:19:08,200 --> 00:19:09,000 SAME WAY. 506 00:19:09,000 --> 00:19:12,000 AS WE'RE LOOKING AT LAB DATA AND 507 00:19:12,000 --> 00:19:13,600 THE PHYSICAL EXAM FINDINGS OF 508 00:19:13,600 --> 00:19:14,520 THE PATIENT WE CAN ALL DESCRIBE 509 00:19:14,520 --> 00:19:17,280 THEM IN THE SAME WAY. 510 00:19:17,280 --> 00:19:18,720 IMPORTANTLY, IT ALLOWS US TO 511 00:19:18,720 --> 00:19:20,240 ANTICIPATE WHERE WE'RE GOING. 512 00:19:20,240 --> 00:19:21,960 IT ALLOWS US TO PREDICT AND THE 513 00:19:21,960 --> 00:19:25,240 BEAUTIFUL THING ABOUT THIS IF 514 00:19:25,240 --> 00:19:29,000 YOU THINK ABOUT COMPLEX 515 00:19:29,000 --> 00:19:31,680 DISCHARGE I CAN MANY PATIENTS 516 00:19:31,680 --> 00:19:33,760 HAVE COMPLEX DISCHARGE NEEDS AND 517 00:19:33,760 --> 00:19:35,880 IF WE HAVE A SOCIAL WORKER WHO 518 00:19:35,880 --> 00:19:38,880 KNOWS WHAT THE PATIENT WILL NEED 519 00:19:38,880 --> 00:19:41,680 WE CKCAN ANTICIPATE THE RESOURC 520 00:19:41,680 --> 00:19:46,280 IN IN NEED FOR THE PATIENT. 521 00:19:46,280 --> 00:19:49,440 AND A NURSE MAY KNOW I HAVE TO 522 00:19:49,440 --> 00:19:52,760 HAVE A DEFIBRILLATOR READY TO GO 523 00:19:52,760 --> 00:19:54,880 AND ALLOWS US TO PREDICT AND 524 00:19:54,880 --> 00:19:56,480 HAVE AN UNDERSTANDING HOW WE GOT 525 00:19:56,480 --> 00:19:59,160 IN THE SITUATION TO BEGIN AND 526 00:19:59,160 --> 00:20:00,960 ALL IDENTIFY CAUSAL EVENTS. 527 00:20:00,960 --> 00:20:02,920 EACH MEMBER OF THE TEAM MAY HAVE 528 00:20:02,920 --> 00:20:03,960 A SLIGHTLY DIFFERENT 529 00:20:03,960 --> 00:20:05,480 CONTRIBUTION TO THIS. 530 00:20:05,480 --> 00:20:09,760 ESPECIALLY WHEN I THINK OF 531 00:20:09,760 --> 00:20:13,560 CAUSAL EVENTS OFTEN, I WAS A 532 00:20:13,560 --> 00:20:20,400 CARDIAC NURSE OFTEN THERE WAS ED 533 00:20:20,400 --> 00:20:25,320 CHEST PAIN OR SOMETHING AND THE 534 00:20:25,320 --> 00:20:26,440 CARDIOLOGIST WILL LOOK AT HOW 535 00:20:26,440 --> 00:20:27,560 BAD IS THE SITUATION. 536 00:20:27,560 --> 00:20:29,480 WHAT DO WE NEED TO ACHIEVE? 537 00:20:29,480 --> 00:20:32,280 WHERE DO WE NEED TO GO HERE? 538 00:20:32,280 --> 00:20:34,080 THAT'S HAVING A STRONG TEAM 539 00:20:34,080 --> 00:20:34,800 MENTAL MODEL. 540 00:20:34,800 --> 00:20:35,960 THERE'S TWO QUALITIES THAT WORK 541 00:20:35,960 --> 00:20:36,520 IN OUR FAVOR. 542 00:20:36,520 --> 00:20:41,080 ONE IS WE HAVE TO HAVE SIMILAR 543 00:20:41,080 --> 00:20:42,840 MEN MODELS. 544 00:20:42,840 --> 00:20:44,720 EVERYBODY ON THE TEAM SHOULD BE 545 00:20:44,720 --> 00:20:46,120 SEEING THIS IN THE SAME WAY. 546 00:20:46,120 --> 00:20:48,960 THE OTHER THING ABOUT THE TEAM 547 00:20:48,960 --> 00:20:55,840 MENTAL MODELS IS IT'S GOT TO BE 548 00:20:55,840 --> 00:21:06,000 ACCURATE. 549 00:21:09,680 --> 00:21:11,440 ONE PERSON IN THE ROOM IS 550 00:21:11,440 --> 00:21:13,760 THINKING ABOUT ONE THING AND 551 00:21:13,760 --> 00:21:15,680 OTHERS ABOUT THAT AND THAT'S 552 00:21:15,680 --> 00:21:16,760 WHERE SIMULATION CAN HELP US. 553 00:21:16,760 --> 00:21:19,160 IT PUTS OUR TEAM IN A PLACE 554 00:21:19,160 --> 00:21:22,400 WHERE WE KNOW WHO'S ON THE TEAM, 555 00:21:22,400 --> 00:21:24,600 WE KNOW WHAT THEY'RE CAPABLE OF 556 00:21:24,600 --> 00:21:26,240 AND RESPECT WHAT EVERYBODY 557 00:21:26,240 --> 00:21:27,000 BRINGS TO THE ROOM WHICH MAKES 558 00:21:27,000 --> 00:21:29,520 IT EASIER FOR THE ONE PERSON TO 559 00:21:29,520 --> 00:21:33,320 SPEAK UP AND SAY, HANG ON, GUYS 560 00:21:33,320 --> 00:21:35,520 HAVE YOU CONSIDERED -- HOLD ON 561 00:21:35,520 --> 00:21:38,200 ONE SECOND, DID YOU NOTICE? 562 00:21:38,200 --> 00:21:40,080 THAT'S HOW TRAINING AND TEAM 563 00:21:40,080 --> 00:21:42,000 MENTAL MODELS CAN HELP TEAMS 564 00:21:42,000 --> 00:21:42,520 FUNCTION BETTER. 565 00:21:42,520 --> 00:21:47,440 THAT'S ONE WAY THE OTHER 566 00:21:47,440 --> 00:21:52,240 IMPORTANT COMPONENT IS TRANS 567 00:21:52,240 --> 00:21:53,920 TRANSACTIVE MEMORY SYSTEMS. 568 00:21:53,920 --> 00:21:54,560 WE KNOW WHO KNOWS WHAT ON THE 569 00:21:54,560 --> 00:21:57,840 TEAM. 570 00:21:57,840 --> 00:22:01,680 AS I THINK OF BRINGING TOGETHER 571 00:22:01,680 --> 00:22:04,920 A GROUP PEOPLE TO START A NEW 572 00:22:04,920 --> 00:22:06,840 RESEARCH PROTOCOL WE NEED TO 573 00:22:06,840 --> 00:22:07,600 UNDERSTAND THE SKILLS EVERYBODY 574 00:22:07,600 --> 00:22:08,720 BRINGS TO THE TEAM. 575 00:22:08,720 --> 00:22:10,360 WHAT'S THE PHARMACIST KNOW ABOUT 576 00:22:10,360 --> 00:22:11,480 THIS PARTICULAR DRUG? 577 00:22:11,480 --> 00:22:13,800 WHAT DOES THE NURSE KNOW ABOUT 578 00:22:13,800 --> 00:22:14,680 THIS PATIENT? 579 00:22:14,680 --> 00:22:16,280 WHAT THE PHYSICIAN UNDERSTAND 580 00:22:16,280 --> 00:22:19,520 ABOUT THE DIAGNOSIS? 581 00:22:19,520 --> 00:22:22,160 THAT'S ALL IMPORTANT. 582 00:22:22,160 --> 00:22:24,400 IN TRANS ACTIVE MEMORY SYSTEMS 583 00:22:24,400 --> 00:22:29,520 WE OFTEN HAVE A STRONG 584 00:22:29,520 --> 00:22:30,680 TRANSACTIVE MEMORY SYSTEM AND 585 00:22:30,680 --> 00:22:33,600 WHERE PEOPLE ARE SUDDENLY THROWN 586 00:22:33,600 --> 00:22:35,840 TOGETHER TO MAKE CRITICALS CAN 587 00:22:35,840 --> 00:22:37,520 BE UNDER TIME PRESSURE WITH 588 00:22:37,520 --> 00:22:39,040 ENVIRONMENTAL STRESSORS IT CAN 589 00:22:39,040 --> 00:22:40,120 BE MORE DIFFICULT. 590 00:22:40,120 --> 00:22:42,760 THERE ARE THINGS WE CAN TRAIN IN 591 00:22:42,760 --> 00:22:45,480 SIMULATION TO IMPROVE OUR 592 00:22:45,480 --> 00:22:46,680 TRANSACTIVE MEMORY SYSTEMS BY 593 00:22:46,680 --> 00:22:48,240 COMING UP WITH QUICK AND EASY 594 00:22:48,240 --> 00:22:50,560 WAYS TO ELICIT THAT INFORMATION 595 00:22:50,560 --> 00:22:53,360 FROM THE TEAM AND TRANSACTIVE 596 00:22:53,360 --> 00:22:55,280 MEMORY SYSTEMS THERE'S OTHER 597 00:22:55,280 --> 00:22:55,560 PROPERTIES. 598 00:22:55,560 --> 00:22:57,400 THERE'S THE SIMPLE KNOWLEDGE 599 00:22:57,400 --> 00:22:59,560 PROPERTY, WHO DO I KNOW AND DO I 600 00:22:59,560 --> 00:23:01,960 KNOW HOW TO DO WHAT THEY DO AND 601 00:23:01,960 --> 00:23:03,880 THERE'S A HUGE CREDIBILITY ISSUE 602 00:23:03,880 --> 00:23:05,920 WITH THIS SYSTEM AND THAT BY 603 00:23:05,920 --> 00:23:09,040 KNOWING I WORKED WITH DR. GOMES. 604 00:23:09,040 --> 00:23:10,040 I KNOW I CAN DEPEND ON HER FOR 605 00:23:10,040 --> 00:23:13,720 THIS. 606 00:23:13,720 --> 00:23:15,800 THERE BECOMES A CREDIBILITY AND 607 00:23:15,800 --> 00:23:17,120 TRUST ISSUE ON OUR TEAMS WHICH 608 00:23:17,120 --> 00:23:18,520 CANNOT BE DISCOUNTED. 609 00:23:18,520 --> 00:23:21,040 I THINK ONE OF THE IMPORTANT 610 00:23:21,040 --> 00:23:22,480 THINGS ABOUT TRANSACTIVE MEMORY 611 00:23:22,480 --> 00:23:25,800 SYSTEMS IT ALLOWS US TO 612 00:23:25,800 --> 00:23:26,840 DISTRIBUTE THE COGNITIVE LOAD 613 00:23:26,840 --> 00:23:28,880 AMONG THE TEAM. 614 00:23:28,880 --> 00:23:32,000 I OFTEN AS A WASH A NURSE 615 00:23:32,000 --> 00:23:33,040 PRACTITIONER OR PHYSICIAN SAY 616 00:23:33,040 --> 00:23:35,400 RUN A CODE, I OFTEN THINK THE 617 00:23:35,400 --> 00:23:37,760 DECISIONS THEY HAVE TO MAKE, THE 618 00:23:37,760 --> 00:23:39,400 COGNITIVE LOAD THAT PERSON 619 00:23:39,400 --> 00:23:40,800 CARRIES AND HOW NICE IS IT THAT 620 00:23:40,800 --> 00:23:43,840 PERSON CAN JUST SAY, OKAY, 621 00:23:43,840 --> 00:23:45,120 MARY'S AT THE CART. 622 00:23:45,120 --> 00:23:46,760 I KNOW SHE'LL GET THE DRUG READY 623 00:23:46,760 --> 00:23:48,680 AND SUSAN'S RECORDING EVERYTHING 624 00:23:48,680 --> 00:23:51,520 AND LET ME KNOW WHEN THE NEXT 625 00:23:51,520 --> 00:23:54,680 EPI-IS READY TO GO SO THE PERSON 626 00:23:54,680 --> 00:23:55,600 DOESN'T HAVE TO THINK OF 627 00:23:55,600 --> 00:23:57,080 EVERYTHING BECAUSE WE CAN 628 00:23:57,080 --> 00:23:57,920 DISTRIBUTE OUR KNOWLEDGE AROUND 629 00:23:57,920 --> 00:24:00,240 THE TEAM AND HAVE FAITH THE 630 00:24:00,240 --> 00:24:01,400 PEOPLE ON THE TEAM WILL DO THE 631 00:24:01,400 --> 00:24:05,280 RIGHT THING AT THE RIGHT TIME. 632 00:24:05,280 --> 00:24:07,840 THERE'S A DYNAMIC SHIFTING OF 633 00:24:07,840 --> 00:24:09,360 TEAM MENTAL MODELS WHERE 634 00:24:09,360 --> 00:24:12,240 EVERYBODY HAS TO KNOW THE SAME 635 00:24:12,240 --> 00:24:16,400 WAYNE AND TRANSACTIVE MEMORY 636 00:24:16,400 --> 00:24:18,360 SYSTEM WHERE YOU SEE 637 00:24:18,360 --> 00:24:19,720 SPECIALIZATION AND 638 00:24:19,720 --> 00:24:20,080 GENERALIZATION. 639 00:24:20,080 --> 00:24:21,680 IF WE THINK WHAT IT TAKES TO 640 00:24:21,680 --> 00:24:24,240 SEND A PATIENT TO AN OPERATING 641 00:24:24,240 --> 00:24:24,440 ROOM. 642 00:24:24,440 --> 00:24:25,240 IN THE OPERATING ROOM EVERYBODY 643 00:24:25,240 --> 00:24:27,240 IN THE ROOM HAS TO HAVE THE SAME 644 00:24:27,240 --> 00:24:29,880 SHARED MENTAL MODEL ABOUT THE 645 00:24:29,880 --> 00:24:30,920 PROCEDURE WE'RE DOING, THE 646 00:24:30,920 --> 00:24:34,720 CONDITION THE PATIENT IS AT THE 647 00:24:34,720 --> 00:24:36,040 START TO THINK ABOUT THE 648 00:24:36,040 --> 00:24:37,360 COMPLICATIONS THAT MIGHT ARISE 649 00:24:37,360 --> 00:24:40,160 AND BE READY FOR THE 650 00:24:40,160 --> 00:24:40,520 COMPLICATIONS. 651 00:24:40,520 --> 00:24:42,400 THAT'S HAVING A SHARED MENTAL 652 00:24:42,400 --> 00:24:42,960 MODEL. 653 00:24:42,960 --> 00:24:44,920 WHEN WE THINK OF THE TRANS 654 00:24:44,920 --> 00:24:48,360 ACTIVE MEDICAL SYSTEM WE KNOW IF 655 00:24:48,360 --> 00:24:51,520 THERE'S ANESTHESIOLOGIST HAS 656 00:24:51,520 --> 00:24:52,240 THIS. 657 00:24:52,240 --> 00:24:54,640 IF THERE'S A DECISION ABOUT 658 00:24:54,640 --> 00:24:55,480 CHANGING THE APPROACH THE 659 00:24:55,480 --> 00:24:57,680 SURGEON WILL TAKE CARE OF THAT 660 00:24:57,680 --> 00:25:00,280 SO THE ANESTHESIOLOGIST DOESN'T 661 00:25:00,280 --> 00:25:03,120 HAVE TO WORRY ABOUT OUT AND IF 662 00:25:03,120 --> 00:25:09,000 THERE'S SUDDENLY A NEED MORE 663 00:25:09,000 --> 00:25:10,360 RESOURCES THE NURSES HAVE THAT 664 00:25:10,360 --> 00:25:13,560 AND THE ABILITY TO ANTICIPATE. 665 00:25:13,560 --> 00:25:15,600 THAT'S HOW TRANSACTIVE MEMORY 666 00:25:15,600 --> 00:25:16,360 SYSTEMS AND TEAM MENTAL MODELS 667 00:25:16,360 --> 00:25:21,880 WORK TOGETHER. 668 00:25:21,880 --> 00:25:24,000 THESE ARE THE TWO COMPONENTS 669 00:25:24,000 --> 00:25:24,880 THAT ARE AMENABLE TO TRAINING 670 00:25:24,880 --> 00:25:32,080 AND SIMULATION. 671 00:25:32,080 --> 00:25:35,160 AS WE THINK OF SIMULATION IT'S 672 00:25:35,160 --> 00:25:37,400 SO MUCH MORE THAT WHAT HAPPENS 673 00:25:37,400 --> 00:25:39,360 IN THE 15 MINUTE PERIOD. 674 00:25:39,360 --> 00:25:42,440 IT'S NOT MUCH WITHOUT THE 675 00:25:42,440 --> 00:25:42,920 DEBROFING AFTERWARDS. 676 00:25:42,920 --> 00:25:45,360 THAT DEBRIEFING IS THE TIME 677 00:25:45,360 --> 00:25:46,840 WHERE WE CAN DISCUSS CHAPPED IN 678 00:25:46,840 --> 00:25:50,400 THE SIMULATION BE A RESPECTFUL 679 00:25:50,400 --> 00:25:52,040 AND OPEN WAY. 680 00:25:52,040 --> 00:25:56,440 THAT'S NOT EASY WITH 681 00:25:56,440 --> 00:25:57,040 HIGH-ACHIEVING HEALTH CARE 682 00:25:57,040 --> 00:25:58,080 PROFESSIONALS WHO ALL WANT TO 683 00:25:58,080 --> 00:25:59,760 LOOK GOOD IN FRONT OF EACH OTHER 684 00:25:59,760 --> 00:26:00,920 BUT WE ALWAYS DO. 685 00:26:00,920 --> 00:26:03,360 WE ALL ENGAGE IN IMAGE 686 00:26:03,360 --> 00:26:08,240 MANAGEMENT ALL THE TIME. 687 00:26:08,240 --> 00:26:12,240 I GOT UP AND DID MY HAIR AND 688 00:26:12,240 --> 00:26:13,720 PICKED MY OUTFIT BECAUSE I CARE 689 00:26:13,720 --> 00:26:16,240 WHAT YOU THINK ABOUT ME AND IT'S 690 00:26:16,240 --> 00:26:17,240 DIFFICULT TO MAKE YOURSELF 691 00:26:17,240 --> 00:26:20,160 VULNERABLE AND SAY I MADE A 692 00:26:20,160 --> 00:26:20,360 MISTAKE. 693 00:26:20,360 --> 00:26:22,400 I MISSED THAT POSE OF 694 00:26:22,400 --> 00:26:22,680 INFORMATION. 695 00:26:22,680 --> 00:26:24,720 I DIDN'T HEAR HER SAY THAT OR 696 00:26:24,720 --> 00:26:26,200 WHATEVER THE PROBLEM MIGHT BE 697 00:26:26,200 --> 00:26:29,040 THAT HAPPENED IN SIMULATION. 698 00:26:29,040 --> 00:26:30,680 WITH SIMULATION AND THE 699 00:26:30,680 --> 00:26:32,160 DEBRIEFING IT'S CRITICALLY 700 00:26:32,160 --> 00:26:35,280 IMPORTANT WE CREATE A 701 00:26:35,280 --> 00:26:36,240 PSYCHOLOGICALLY SAFE LEARNING 702 00:26:36,240 --> 00:26:37,960 ENVIRONMENT AND DR. GOMES KNOWS 703 00:26:37,960 --> 00:26:39,360 THIS WELL BECAUSE WE BOTH 704 00:26:39,360 --> 00:26:45,120 TRAINED AT THE SAME PLACE. 705 00:26:45,120 --> 00:26:47,280 PSYCHOLOGICAL SAFETY IS THE 706 00:26:47,280 --> 00:26:48,760 ENVIRONMENT IN WHICH THIS HAS TO 707 00:26:48,760 --> 00:26:49,000 HAPPEN. 708 00:26:49,000 --> 00:26:53,520 I'M REFERRING TO THE WORK DONE 709 00:26:53,520 --> 00:26:59,400 BY A HARVARD BUSINESS SCHOLAR 710 00:26:59,400 --> 00:27:01,640 AND STUDIED OPEN HEART SURGERY 711 00:27:01,640 --> 00:27:03,800 TEAMS AT MASSACHUSETTS GENERAL 712 00:27:03,800 --> 00:27:09,480 HOST IN 1999 SHE WAS ABLE TO TIE 713 00:27:09,480 --> 00:27:11,040 PSYCHOLOGICAL SAFETY TO BETTER 714 00:27:11,040 --> 00:27:11,280 OUTCOMES. 715 00:27:11,280 --> 00:27:13,320 IN A PSYCHOLOGICALLY SAFE 716 00:27:13,320 --> 00:27:15,480 LEARNING ENVIRONMENT WE ARE ALL 717 00:27:15,480 --> 00:27:17,520 WILLING TO BE VUL VERBAL IN 718 00:27:17,520 --> 00:27:20,240 FRONT OF EACH OWNER. 719 00:27:20,240 --> 00:27:23,080 -- VULNERABLE AND THE ONE 720 00:27:23,080 --> 00:27:25,080 QUALITY SHE SAWS WAS LEADER 721 00:27:25,080 --> 00:27:26,440 INCLUSIVENESS WHERE THE SURGEON 722 00:27:26,440 --> 00:27:27,560 AT THE BEGINNING WOULD SAY 723 00:27:27,560 --> 00:27:30,240 CLEARLY I'M IN CHARGE HERE, I'M 724 00:27:30,240 --> 00:27:32,680 GOING IT MAKE DECISIONS HOW THE 725 00:27:32,680 --> 00:27:33,920 SURGERY GOES BUT I NEED ALL OF 726 00:27:33,920 --> 00:27:37,200 YOU TO HELP ME. 727 00:27:37,200 --> 00:27:39,400 IF YOU SEE ANYTHING UNUSUAL OR 728 00:27:39,400 --> 00:27:40,680 DON'T SEE ANYTHING RIGHT LET ME 729 00:27:40,680 --> 00:27:41,320 KNOW RIGHT AWAY. 730 00:27:41,320 --> 00:27:43,480 IT'S THE LEADER INVITING PEOPLE 731 00:27:43,480 --> 00:27:46,680 TO SPEAK UP ENCOURAGING 732 00:27:46,680 --> 00:27:49,720 EVERYBODY TO BE RESPECTFUL WHEN 733 00:27:49,720 --> 00:27:52,000 PEOPLE BRINGS TO THE TABLE AND 734 00:27:52,000 --> 00:27:54,960 THAT'S WHAT THEY DO IN A 735 00:27:54,960 --> 00:27:57,920 PSYCHOLOGICALLY SAFE LEARNING 736 00:27:57,920 --> 00:27:59,800 ENVIRONMENT AND RECOGNIZE 737 00:27:59,800 --> 00:28:01,600 EVERYTHING DOESN'T GO PERFECTLY 738 00:28:01,600 --> 00:28:03,440 IN SIMULATION AND IN REAL LIFE 739 00:28:03,440 --> 00:28:05,960 BUT IN SIMULATION WE TAKE THE 740 00:28:05,960 --> 00:28:08,280 TIME TO EXPLORE AND DISCUSS AND 741 00:28:08,280 --> 00:28:08,840 TO QUESTION. 742 00:28:08,840 --> 00:28:11,160 SOMETIMES WE TAKE THE TIME TO 743 00:28:11,160 --> 00:28:12,720 PUSHBACK AND SAY LOOK THIS IS 744 00:28:12,720 --> 00:28:14,840 THE WAY WE'VE ALWAYS DONE IT BUT 745 00:28:14,840 --> 00:28:16,240 I'M NOT SURE THAT'S THE BEST WAY 746 00:28:16,240 --> 00:28:17,480 TO DO IT. 747 00:28:17,480 --> 00:28:20,080 SIMULATION AND DEBRIEFING CAN 748 00:28:20,080 --> 00:28:24,400 TRAIN US IN GIVING LEADERS TO 749 00:28:24,400 --> 00:28:30,920 QUICKLY CREATE MENTAL MODELS. 750 00:28:30,920 --> 00:28:34,360 IT CAN HELP TRANSACTIVE SYSTEMS 751 00:28:34,360 --> 00:28:35,600 WITH ABLE AD HOC TEAM. 752 00:28:35,600 --> 00:28:38,240 WHO IS EVERYBODY HERE IN THE 753 00:28:38,240 --> 00:28:38,640 ROOM. 754 00:28:38,640 --> 00:28:40,160 I'M A NURSE AND I'M A 755 00:28:40,160 --> 00:28:41,520 RESPIRATORY THERAPIST. 756 00:28:41,520 --> 00:28:43,440 NOW THE TEAM LEADER KNOWS WHO IS 757 00:28:43,440 --> 00:28:45,120 IN THE ROOM AND THESE ARE THE 758 00:28:45,120 --> 00:28:47,480 KINDS OF THINGS AMENABLE TO 759 00:28:47,480 --> 00:28:49,680 SIMULATION TRAINING. 760 00:28:49,680 --> 00:28:51,960 WHEN WE BRING TEAMS TOGETHER IN 761 00:28:51,960 --> 00:28:53,680 SIMULATION, WE ARE NOT USUALLY 762 00:28:53,680 --> 00:28:54,800 BRINGING THOSE TEAMS TOGETHER TO 763 00:28:54,800 --> 00:28:56,720 WORK ON THEIR TECHNICAL SKILLS. 764 00:28:56,720 --> 00:29:00,560 WE DON'T BRING THE TEAM TOGETHER 765 00:29:00,560 --> 00:29:02,960 TO SEE IF DR. SMITH KNOWS HOW TO 766 00:29:02,960 --> 00:29:04,720 APPROPRIATELY DIAGNOSE SOMETHING 767 00:29:04,720 --> 00:29:07,640 OR NURSE SMITH KNOWS HOW TO GIVE 768 00:29:07,640 --> 00:29:10,080 X, Y, Z DRUG. 769 00:29:10,080 --> 00:29:12,200 WE BRING THEM TO WORK ON TEAM 770 00:29:12,200 --> 00:29:12,720 WORK PROCESSES. 771 00:29:12,720 --> 00:29:13,760 THERE'S A LOT OF FRAMEWORKS OUT 772 00:29:13,760 --> 00:29:15,400 THERE TO DO THIS. 773 00:29:15,400 --> 00:29:16,000 I THINK TEAM STEPS SAY WELL 774 00:29:16,000 --> 00:29:19,800 KNOWN ONE. 775 00:29:19,800 --> 00:29:21,040 -- IS A WELL KNOWN ONE THE 776 00:29:21,040 --> 00:29:22,120 GOVERNMENT HAS. 777 00:29:22,120 --> 00:29:24,640 TONS OF FREE RESOURCES ON THEIR 778 00:29:24,640 --> 00:29:26,240 WEBSITE TO TEACH AND MEASURE 779 00:29:26,240 --> 00:29:27,120 TEAM WORK. 780 00:29:27,120 --> 00:29:28,240 THE IMPORTANT THING WITH TEAMS 781 00:29:28,240 --> 00:29:32,680 IS WE DON'T BRING PEOPLE IN 782 00:29:32,680 --> 00:29:35,280 PEOPLE SAY LOOK WE DO 783 00:29:35,280 --> 00:29:35,920 INTERPROFESSIONAL SIMULATION AND 784 00:29:35,920 --> 00:29:37,280 AFTER SHOULD THE NURSES BE 785 00:29:37,280 --> 00:29:40,280 DEBRIEFED BY A NURSE AND THE 786 00:29:40,280 --> 00:29:45,200 DOCTOR BY A DOCTOR AND, NO, YOU 787 00:29:45,200 --> 00:29:47,520 MISSED THE POINT IF YOU SEPARATE 788 00:29:47,520 --> 00:29:51,040 THE PROFESSIONS IN THE 789 00:29:51,040 --> 00:29:53,480 DEBRIEFING BECAUSE THAT'S WHERE 790 00:29:53,480 --> 00:29:58,440 LEARNING GETS CONSOLIDATED. 791 00:29:58,440 --> 00:29:59,720 WHEN WE LOOK AT TEAM BASED 792 00:29:59,720 --> 00:30:00,920 DEVELOPMENT THERE'S A COUPLE 793 00:30:00,920 --> 00:30:03,320 PRINCIPLES I'D LIKE TO SHARE. 794 00:30:03,320 --> 00:30:04,520 WE SHOULD BE USING THE 795 00:30:04,520 --> 00:30:06,720 SIMULATION TO TARGET INFORMATION 796 00:30:06,720 --> 00:30:08,240 SHARING BEHAVIORS. 797 00:30:08,240 --> 00:30:13,560 ASKING QUESTIONS, SEEKING IN PUT 798 00:30:13,560 --> 00:30:14,880 CLOSED LOOP COMMUNICATION. 799 00:30:14,880 --> 00:30:16,560 AND WHEN I USE SIMULATION I'M 800 00:30:16,560 --> 00:30:20,200 NOT TALKING ABOUT TRAINING 801 00:30:20,200 --> 00:30:25,440 PEOPLE IN SKILLS AND WE MAY ADD 802 00:30:25,440 --> 00:30:27,720 A NEW RESEARCH PLAN OR PROTOCOL 803 00:30:27,720 --> 00:30:29,920 OR MEDICAL EMERGENCY. 804 00:30:29,920 --> 00:30:32,240 DESIGN YOUR SIMULATIONS SO THEY 805 00:30:32,240 --> 00:30:34,520 HELP YOU INFLUENCE THOSE MENTAL 806 00:30:34,520 --> 00:30:37,920 MODELS IN THE TRANSACTIVE MEMORY 807 00:30:37,920 --> 00:30:39,040 SYSTEMS AND THE STIMULATIONS 808 00:30:39,040 --> 00:30:41,120 THAT ARE GREAT ARE WHERE THE 809 00:30:41,120 --> 00:30:43,200 TEAM HAS TO ENGAGE IN PLANNING 810 00:30:43,200 --> 00:30:43,480 BEHAVIORS. 811 00:30:43,480 --> 00:30:47,160 ONE OF THE SIMULATIONS WE DO IN 812 00:30:47,160 --> 00:30:49,000 OUR COURSE -- DON'T ANYBODY COME 813 00:30:49,000 --> 00:30:49,920 TO THE COURSE BECAUSE I'M ABOUT 814 00:30:49,920 --> 00:30:51,640 TO TELL YOU WHAT THE SIMULATION 815 00:30:51,640 --> 00:30:52,000 IS. 816 00:30:52,000 --> 00:30:54,920 ONE WE DO AT HARVARD IS WE HAVE 817 00:30:54,920 --> 00:30:56,440 OUR INTERPROFESSIONAL TEAM OF 818 00:30:56,440 --> 00:30:57,560 CLINICIANS AND HAVE THEM IN THE 819 00:30:57,560 --> 00:31:01,040 ROOM AND TELL THEM THEY'RE THE 820 00:31:01,040 --> 00:31:04,520 EMERGENCY ROOM DEPARTMENT STAFF 821 00:31:04,520 --> 00:31:06,080 FOR THAT DAY AND IT'S FULL AND 822 00:31:06,080 --> 00:31:10,600 WE TELL THE PATIENT AND THE 823 00:31:10,600 --> 00:31:11,720 DIAGNOSIS AND TELL THEM THERE'S 824 00:31:11,720 --> 00:31:14,080 A CRASH AND THEY'LL GET TRAUMA 825 00:31:14,080 --> 00:31:14,520 PATIENTS. 826 00:31:14,520 --> 00:31:20,200 THEY HAVE TO DECIDE HOW TO GET 827 00:31:20,200 --> 00:31:25,760 THE E.R. READY AND STARTS WITH 828 00:31:25,760 --> 00:31:27,040 WHO'S ON THE TEAM AND WHAT DO 829 00:31:27,040 --> 00:31:29,280 YOU KNOW AND WHAT DO YOU DO AND 830 00:31:29,280 --> 00:31:30,760 WE HAVE TO GATHER INFORMATION 831 00:31:30,760 --> 00:31:32,240 ABOUT THE ORGANIZATION AND THEN 832 00:31:32,240 --> 00:31:32,440 PLAN. 833 00:31:32,440 --> 00:31:34,800 WE'LL MOVE THIS PATIENT AT THIS 834 00:31:34,800 --> 00:31:37,240 TIME AND PATIENT ON THIS TIME 835 00:31:37,240 --> 00:31:38,320 AND THEY FIND THEY DON'T HAVE 836 00:31:38,320 --> 00:31:40,200 TIME TO GET ALL THE PATIENTS OUT 837 00:31:40,200 --> 00:31:42,920 FOR ALL THE PATIENTS COMING IN 838 00:31:42,920 --> 00:31:44,720 AND HAVE TO AD HOC SET UP SPACES 839 00:31:44,720 --> 00:31:47,000 TO TAKE CARE OF THE PATIENTS. 840 00:31:47,000 --> 00:31:49,520 THOSE KINDS OF SIMULATIONS 841 00:31:49,520 --> 00:31:50,800 REQUIRE US TO ASK QUESTIONS OF 842 00:31:50,800 --> 00:31:53,960 EACH OTHER AND LISTEN TO EACH 843 00:31:53,960 --> 00:31:56,200 OTHER AND THAT CAN HELP BUILD 844 00:31:56,200 --> 00:31:57,560 THE TRANSACTIVE MODELS AND 845 00:31:57,560 --> 00:32:00,200 MEMORY SYSTEMS. 846 00:32:00,200 --> 00:32:03,120 I TALKED ABOUT STIMULATIONS TO 847 00:32:03,120 --> 00:32:07,960 EQUIP TEAM LED -- LEADERS AND 848 00:32:07,960 --> 00:32:10,400 THERE'S A FRAMEWORK WE DEVELOPED 849 00:32:10,400 --> 00:32:14,080 AT THE CENTER FOR MEDICAL 850 00:32:14,080 --> 00:32:16,640 SIMULATION THAT'S A QUICK CLAIM 851 00:32:16,640 --> 00:32:17,520 CLAIM AIM. 852 00:32:17,520 --> 00:32:19,040 THAT'S THE CONSEQUENCE WE USE 853 00:32:19,040 --> 00:32:20,440 WHICH IS THE TEAM LEADER COMES 854 00:32:20,440 --> 00:32:22,760 IN THE ROOM, NAMES WHAT'S GOING 855 00:32:22,760 --> 00:32:24,440 ON, SAYS THEY'LL BE THE TEAM 856 00:32:24,440 --> 00:32:27,680 LEADER AND THEN SAID TO THE OF 857 00:32:27,680 --> 00:32:29,520 THE TEAM, I'LL TAKE CHARGE BUT I 858 00:32:29,520 --> 00:32:30,520 NEED HELP. 859 00:32:30,520 --> 00:32:34,560 QUICKLY CAN YOU TELL ME WHO'S IN 860 00:32:34,560 --> 00:32:36,880 THE ROOM? 861 00:32:36,880 --> 00:32:39,840 THIS TEAM LEADER CALLS OUT WHAT 862 00:32:39,840 --> 00:32:45,960 THEY THINK THEY SEE AND ASKED 863 00:32:45,960 --> 00:32:47,040 OTHERS AND KNOWING WHAT THEY'RE 864 00:32:47,040 --> 00:32:50,600 GOOD AT CAN BUILD THE 865 00:32:50,600 --> 00:32:52,240 TRANSACTIVE MEMORY SYSTEM IF 866 00:32:52,240 --> 00:32:54,520 IT'S AN AD HOC TEAM. 867 00:32:54,520 --> 00:32:55,880 AND REALLY IMPORTANTLY 868 00:32:55,880 --> 00:32:57,840 STRUCTURING THE DEBRIEFINGS SO 869 00:32:57,840 --> 00:33:00,200 WHAT WE'RE TALKING ABOUT ARE ALL 870 00:33:00,200 --> 00:33:00,880 THOSE THINGS THAT INFLUENCE TEAM 871 00:33:00,880 --> 00:33:03,960 COGNITION. 872 00:33:03,960 --> 00:33:05,880 IT'S SO IMPORTANT FOR ALL OF US 873 00:33:05,880 --> 00:33:07,760 TO REMEMBER THAT WHEN WE COME IN 874 00:33:07,760 --> 00:33:09,440 OUR DAILY WORK AND SIMULATION 875 00:33:09,440 --> 00:33:12,040 AND DEBRIEFING, I BRING MY WHOLE 876 00:33:12,040 --> 00:33:15,200 SELF WITH ME AND THAT MEANS ALL 877 00:33:15,200 --> 00:33:17,320 MY EXPERIENCES AND EDUCATION AND 878 00:33:17,320 --> 00:33:19,800 VALUES AND WHAT MY MOM AND DAD 879 00:33:19,800 --> 00:33:21,960 TAUGHT ME, WHAT I LEARNED IN 15 880 00:33:21,960 --> 00:33:23,720 YEARS OF BEING A NURSE. 881 00:33:23,720 --> 00:33:29,520 THAT INFLUENCES OUR BEHAVIOR AND 882 00:33:29,520 --> 00:33:34,760 THE LEVEL WE NEED TO GET TO THIS 883 00:33:34,760 --> 00:33:41,120 WE NEED TO HAVE REFLECTIVE 884 00:33:41,120 --> 00:33:42,840 CONVERSATIONS OF WHAT YOU KNEW 885 00:33:42,840 --> 00:33:44,440 AND NOT KNOW. 886 00:33:44,440 --> 00:33:45,040 PSYCHOLOGICAL SAFETY IS SO 887 00:33:45,040 --> 00:33:46,240 IMPORTANT AND ONE THING WE KNOW 888 00:33:46,240 --> 00:33:50,920 IS THAT WHEN PEOPLE HAVE A 889 00:33:50,920 --> 00:33:52,720 PERCEPTION THEY'RE PSYCHOLOGICAL 890 00:33:52,720 --> 00:33:55,320 SAFE THEY'RE WILLING TO TAKE 891 00:33:55,320 --> 00:33:57,320 INTERPERSONAL RISKS AND THEY'RE 892 00:33:57,320 --> 00:33:58,360 ADMITTING THEY DON'T KNOW 893 00:33:58,360 --> 00:34:02,960 SOMETHING, ASKING FOR HELP, 894 00:34:02,960 --> 00:34:04,160 ASKING QUESTIONS. 895 00:34:04,160 --> 00:34:05,280 IN ESSENCE THEY'RE WILLING TO BE 896 00:34:05,280 --> 00:34:07,800 VULNERABLE IN FRONT OF EACH 897 00:34:07,800 --> 00:34:08,160 OTHER. 898 00:34:08,160 --> 00:34:11,520 FOR THE LONG TERM GAIN OF 899 00:34:11,520 --> 00:34:12,560 IMPROVED COGNITION DOWN THE 900 00:34:12,560 --> 00:34:12,760 ROAD. 901 00:34:12,760 --> 00:34:15,840 ONE THING WE TEND TO DO IN 902 00:34:15,840 --> 00:34:17,880 DEBRIEFING IS TEND TO DO THE 903 00:34:17,880 --> 00:34:21,160 SIMULATION AND BRING PEOPLE INTO 904 00:34:21,160 --> 00:34:22,680 DEBRIEFING AND SPEND TIME ON THE 905 00:34:22,680 --> 00:34:24,280 MISTAKES THEY MADE. 906 00:34:24,280 --> 00:34:28,240 I WANT TO ENCOURAGE EVERYONE TO 907 00:34:28,240 --> 00:34:30,520 START DEBRIEFING THE GOOD STUFF. 908 00:34:30,520 --> 00:34:31,960 THERE WAS AN IMPORTANT WHITE 909 00:34:31,960 --> 00:34:33,680 PAPER ABOUT PATIENT SAFETY A 910 00:34:33,680 --> 00:34:36,360 NUMBER OF YEARS AGO GOING FROM 911 00:34:36,360 --> 00:34:41,360 SAFETY 1 TO SAFETY 2. 912 00:34:41,360 --> 00:34:43,880 THE CONCEPT IS OR QUESTION THEY 913 00:34:43,880 --> 00:34:45,560 ASKED WAS WHEN WE'RE TRYING TO 914 00:34:45,560 --> 00:34:47,240 UNDERSTAND PATIENT SAFETY AND 915 00:34:47,240 --> 00:34:49,680 ERRORS WHY DO WE SPEND ALL OUR 916 00:34:49,680 --> 00:34:55,040 TIME STUDYING THE 2% OF THE TIME 917 00:34:55,040 --> 00:34:59,880 THINGS GO WRONG BUT STUDY THE 918 00:34:59,880 --> 00:35:01,520 98% OF THE TIME THAT THINGS GO 919 00:35:01,520 --> 00:35:01,720 WELL. 920 00:35:01,720 --> 00:35:03,120 UNDERSTAND THERE'S GREATER VALUE 921 00:35:03,120 --> 00:35:05,000 IN TALKING ABOUT WHEN THINGS GO 922 00:35:05,000 --> 00:35:05,520 WELL. 923 00:35:05,520 --> 00:35:11,520 WHEN WE CREATE A SIMULATION WE 924 00:35:11,520 --> 00:35:12,200 KNOW WHERE PEOPLE ARE GOING TO 925 00:35:12,200 --> 00:35:18,120 BE CHALLENGED. 926 00:35:18,120 --> 00:35:22,920 IF A GROUP COMES IN AND KNOCKS 927 00:35:22,920 --> 00:35:24,760 IT OUT OF THE PARK WE NEED TO 928 00:35:24,760 --> 00:35:26,480 DEBRIEF THAT AND WE NEED TO 929 00:35:26,480 --> 00:35:28,440 FIGURE OUT WHAT WAS AT PLAY. 930 00:35:28,440 --> 00:35:30,720 WHAT WERE THE COMMUNICATION 931 00:35:30,720 --> 00:35:31,040 STRUCTURES? 932 00:35:31,040 --> 00:35:32,200 WHAT WAS THE RELATIONSHIP AMONG 933 00:35:32,200 --> 00:35:35,480 THE TEAM THAT ALLOWED THAT TEAM 934 00:35:35,480 --> 00:35:38,040 TO DO SO WELL. 935 00:35:38,040 --> 00:35:40,520 I PUBLISHED A PAPER A COUPLE 936 00:35:40,520 --> 00:35:44,160 MONTHS AGO USING A PSYCHOLOGICAL 937 00:35:44,160 --> 00:35:47,720 APPROACH USING A COGNITIVE TASK 938 00:35:47,720 --> 00:35:53,200 ANALYSIS TO DEBRIEF GOOD 939 00:35:53,200 --> 00:35:54,480 PERFORMANCE AND IT ELEVATES THE 940 00:35:54,480 --> 00:35:56,760 TEAM UP THEIR OWN MIND AND GIVES 941 00:35:56,760 --> 00:35:59,000 THEM CONFIDENCE THEY'RE DOING 942 00:35:59,000 --> 00:36:01,080 GREAT THINGS AND LOTS OF 943 00:36:01,080 --> 00:36:02,920 POSITIVE REINFORCEMENT FOR THAT. 944 00:36:02,920 --> 00:36:07,680 SO WE TRAIN OUR TEAMS TO DO 945 00:36:07,680 --> 00:36:10,000 THESE THINGS AND THERE'S ALSO 946 00:36:10,000 --> 00:36:12,240 BRUSHING UP OF TECHNICAL SKILLS 947 00:36:12,240 --> 00:36:13,400 BUT THERE'S INTERESTING RESEARCH 948 00:36:13,400 --> 00:36:17,120 FROM AUSTRALIA NOW. 949 00:36:17,120 --> 00:36:20,120 TWO COLLEAGUES AN EMERGENCY ROOM 950 00:36:20,120 --> 00:36:22,960 PHYSICIAN AND AN ANTHROPOLOGIST 951 00:36:22,960 --> 00:36:23,920 TURNED EMERGENCY ROOM PHYSICIAN 952 00:36:23,920 --> 00:36:26,120 HAVE AN ACTIVE SIM PROGRAM IN 953 00:36:26,120 --> 00:36:28,200 THEIR EMERGENCY DEPARTMENT AND 954 00:36:28,200 --> 00:36:29,600 STARTED TO NOTICE THEY'RE TEAMS 955 00:36:29,600 --> 00:36:32,800 WERE RELATING TO EACH OTHER 956 00:36:32,800 --> 00:36:34,040 DIFFERENTLY OUTSIDE OF 957 00:36:34,040 --> 00:36:34,440 SIMULATION. 958 00:36:34,440 --> 00:36:39,240 THERE WAS MORE DISCUSSION GOING 959 00:36:39,240 --> 00:36:40,920 ON MORE FEEDBACK GIVEN AND 960 00:36:40,920 --> 00:36:41,720 QUESTIONS ASKED. 961 00:36:41,720 --> 00:36:44,080 PEOPLE WERE FINDING IT EASIER TO 962 00:36:44,080 --> 00:36:44,520 SPEAK UP. 963 00:36:44,520 --> 00:36:47,520 VICK AND EVE DECIDED TO DO 964 00:36:47,520 --> 00:36:49,040 QUALITATIVE STUDIES ABOUT THE 965 00:36:49,040 --> 00:36:52,080 PHENOMENON THEY WERE OBSERVING. 966 00:36:52,080 --> 00:36:55,360 THE FIRST PAPER TALKS ABOUT 967 00:36:55,360 --> 00:36:56,360 TAKING SIMULATION OUT OF THE 968 00:36:56,360 --> 00:36:57,320 SAFE CONTAINER. 969 00:36:57,320 --> 00:37:00,240 THAT'S A METAPHOR THAT 970 00:37:00,240 --> 00:37:03,160 SIMULATION TO TALK ABOUT THE 971 00:37:03,160 --> 00:37:05,040 PSYCHOLOGICALLY SAFE LEARNING 972 00:37:05,040 --> 00:37:07,400 ENVIRONMENT AND WHAT VICK AND 973 00:37:07,400 --> 00:37:09,680 EVE SAY IS IT LEAKS AND LEAKS 974 00:37:09,680 --> 00:37:12,280 INTO REAL CLINICAL AREA. 975 00:37:12,280 --> 00:37:14,000 SO THE PSYCHOLOGICAL SAFETY THAT 976 00:37:14,000 --> 00:37:15,440 ALLOWS US TO BE VULNERABLE IN 977 00:37:15,440 --> 00:37:17,960 FRONT OF EACH OTHER, TO ASK FOR 978 00:37:17,960 --> 00:37:19,920 HELP AND ADMIT WHEN WE'RE 979 00:37:19,920 --> 00:37:22,640 STRUGGLING AND TO SAY WHEN WE 980 00:37:22,640 --> 00:37:23,840 DON'T KNOW SOMETHING STARTS TO 981 00:37:23,840 --> 00:37:25,080 TRANSFER TO THE REAL CLINICAL 982 00:37:25,080 --> 00:37:25,440 ENVIRONMENT. 983 00:37:25,440 --> 00:37:26,800 I THINK THAT'S ONE OF THE 984 00:37:26,800 --> 00:37:27,920 REASONS PATIENTS DO BETTER WHEN 985 00:37:27,920 --> 00:37:32,160 WE TRAIN OUR TEAMS. 986 00:37:32,160 --> 00:37:34,200 AND THEN ANOTHER STUDY IS EVE 987 00:37:34,200 --> 00:37:36,040 LOOKED AT THE RELATIONSHIP 988 00:37:36,040 --> 00:37:37,880 ASPECTS, HOW WE RELATE TO EACH 989 00:37:37,880 --> 00:37:39,880 OTHER AND ITS AFFECT ON TRAUMA 990 00:37:39,880 --> 00:37:40,320 PATIENTS. 991 00:37:40,320 --> 00:37:43,240 I REALIZE I'M AT THE NATIONAL 992 00:37:43,240 --> 00:37:45,200 INSTITUTES OF HEALTH, OUR 993 00:37:45,200 --> 00:37:46,240 PREMIER HEALTH SCIENCE CENTER IN 994 00:37:46,240 --> 00:37:47,880 THE UNITED STATES AND KNOW I 995 00:37:47,880 --> 00:37:49,000 BETTER HAVE EVIDENCE TO BACK UP 996 00:37:49,000 --> 00:37:49,760 ALL I'M SAYING. 997 00:37:49,760 --> 00:37:54,720 I WANT TO SHARE WITH YOU SOME 998 00:37:54,720 --> 00:37:54,920 STUDIES. 999 00:37:54,920 --> 00:37:58,000 THEY TIED SIMULATION TRAINING TO 1000 00:37:58,000 --> 00:38:00,640 BETTER OUTCOMES AND DR. GOMES 1001 00:38:00,640 --> 00:38:01,960 HAS THE REFERENCE LIST IF ANYONE 1002 00:38:01,960 --> 00:38:03,200 IS INTERESTED FURTHER IN THE 1003 00:38:03,200 --> 00:38:03,400 STUDIES. 1004 00:38:03,400 --> 00:38:05,080 LET'S LOOK AT SOME OF THIS. 1005 00:38:05,080 --> 00:38:11,400 IN A HOSPITAL THAT DID OB 1006 00:38:11,400 --> 00:38:17,280 EMERGENCY SIMS THEY'RE FOUND THE 1007 00:38:17,280 --> 00:38:19,560 APGAR SCORES DECREASED PER 1008 00:38:19,560 --> 00:38:20,120 10,000 LIVE BIRTHS AND THE 1009 00:38:20,120 --> 00:38:30,640 INCIDENCE OF HYPOXIC ISCHEMIC 1010 00:38:33,320 --> 00:38:33,840 ENCEPHALOPATHY DECREASED. 1011 00:38:33,840 --> 00:38:36,560 IN AN EMERGENCY DEPARTMENT THE 1012 00:38:36,560 --> 00:38:38,600 TRAINED PEOPLE AROUND TRAUMA 1013 00:38:38,600 --> 00:38:41,840 CARE THEY WERE STUDYING THE TEAM 1014 00:38:41,840 --> 00:38:44,520 WORK MEASURES AND SITUATIONAL 1015 00:38:44,520 --> 00:38:46,200 AWARENESS, CROSS-MONITORING. 1016 00:38:46,200 --> 00:38:49,040 THEY IMPROVED BUT WHAT THEY ALSO 1017 00:38:49,040 --> 00:38:55,040 FOUND WAS PATIENTS GOT TO SCAT 1018 00:38:55,040 --> 00:38:55,920 SCAN FASTER. 1019 00:38:55,920 --> 00:39:04,960 TIME TO INTUBATION DECREASED. 1020 00:39:04,960 --> 00:39:10,120 I THINK A FOUR MINUTE REDUCTION 1021 00:39:10,120 --> 00:39:16,240 IN TIME TO INTUBATION IS 1022 00:39:16,240 --> 00:39:18,640 PROBABLY CLINICALLY SIGNIFICANT. 1023 00:39:18,640 --> 00:39:20,240 ANOTHER HOSPITAL TRAINED THEIR 1024 00:39:20,240 --> 00:39:23,560 TEAMS AROUND APPROACHES TO 1025 00:39:23,560 --> 00:39:26,200 ISCHEMIC STROKE. 1026 00:39:26,200 --> 00:39:32,200 THE DOOR TO THROMBOLOSIS WAS CUT 1027 00:39:32,200 --> 00:39:36,360 IN HALF AFTER TEAM TRAINING. 1028 00:39:36,360 --> 00:39:37,520 ANOTHER SYSTEM HOSPITAL PROGRAMS 1029 00:39:37,520 --> 00:39:39,360 SOME HAD ACTIVE SIMULATION 1030 00:39:39,360 --> 00:39:41,560 PROGRAMS AND SOME NOT SO ACTIVE. 1031 00:39:41,560 --> 00:39:44,440 THEY FOUND IN THEIR HOSPITALS 1032 00:39:44,440 --> 00:39:46,320 VERY VERY ACTIVE SIMULATIONS THE 1033 00:39:46,320 --> 00:39:52,480 ARD -- CARDIAC ARREST SURVIVAL 1034 00:39:52,480 --> 00:39:54,600 RATE WAS HIGHER THAN THE 1035 00:39:54,600 --> 00:39:55,720 HOSPITAL WITHOUT A SIMULATION 1036 00:39:55,720 --> 00:39:59,120 PROGRAM AND THERE WERE REDUCED 1037 00:39:59,120 --> 00:40:09,600 ODDS RATIO FORWARD -- FOR 1038 00:40:11,600 --> 00:40:17,000 CARDIAC ARREST AND SIM CENTERS 1039 00:40:17,000 --> 00:40:19,800 YOU SEE ALL THE OUTCOMES THE 1040 00:40:19,800 --> 00:40:23,240 SYSTEMIC REVIEW HIGHLIGHTED. 1041 00:40:23,240 --> 00:40:25,960 INCREASED SURVIVAL RATES, LOWER 1042 00:40:25,960 --> 00:40:28,640 RATES OF SEPSIS AND RESPIRATORY 1043 00:40:28,640 --> 00:40:29,040 FAILURE. 1044 00:40:29,040 --> 00:40:31,720 ONE HOSPITAL THAT WASN'T REALLY 1045 00:40:31,720 --> 00:40:33,360 DO SIMS ABOUT HOSPITAL-WIDE 1046 00:40:33,360 --> 00:40:34,120 DEATHS BUT AFTER THE SIM PROGRAM 1047 00:40:34,120 --> 00:40:40,120 WAS UP AND RUNNING THEY FOUND A 1048 00:40:40,120 --> 00:40:40,960 STATISTICALLY SIGNIFICANT 1049 00:40:40,960 --> 00:40:42,680 DIFFERENCE IN HOSPITAL-WIDE 1050 00:40:42,680 --> 00:40:42,920 DEATHS. 1051 00:40:42,920 --> 00:40:46,960 THERE'S A LOT OF REASONS FOR US 1052 00:40:46,960 --> 00:40:49,360 TO DO SIMULATION. 1053 00:40:49,360 --> 00:40:53,560 I'LL NEVER SAY WE SHOULDN'T DO 1054 00:40:53,560 --> 00:40:56,160 INDIVIDUAL PROFESSION 1055 00:40:56,160 --> 00:40:56,560 SIMULATIONS. 1056 00:40:56,560 --> 00:40:56,880 WE SHOULD. 1057 00:40:56,880 --> 00:40:58,640 SOMETIMES NURSES NEED TO DO 1058 00:40:58,640 --> 00:41:00,080 THINGS ON THEIR OWN AND DOCTORS 1059 00:41:00,080 --> 00:41:03,080 NEED TO DO THINGS ON THEIR OWN 1060 00:41:03,080 --> 00:41:06,680 AND RESPIRATORY SPECIALISTS NEED 1061 00:41:06,680 --> 00:41:09,320 TO DO THINGS ON THEIR OWN AND 1062 00:41:09,320 --> 00:41:10,720 WHEN WE'RE A TEAM IF WE CAN 1063 00:41:10,720 --> 00:41:13,120 BRING THAT TO BEING IN A SIM LAB 1064 00:41:13,120 --> 00:41:15,400 AND FINE TUNE IT SO WE'RE MORE 1065 00:41:15,400 --> 00:41:17,200 ON THE SAME PAGE SO WE RELATE TO 1066 00:41:17,200 --> 00:41:19,280 EACH OTHER IN HEALTHY WAYS THEN 1067 00:41:19,280 --> 00:41:27,560 WE IMPROVE OUR TEAM COGNITION. 1068 00:41:27,560 --> 00:41:29,440 IF WE CAN IMPROVE OUR TEAM 1069 00:41:29,440 --> 00:41:30,600 COGNITION, WE CAN IMPROVE OUR 1070 00:41:30,600 --> 00:41:32,200 PATIENT OUTCOME AND IN THE END 1071 00:41:32,200 --> 00:41:33,720 THAT'S WHAT WE'RE ALL HERE FOR. 1072 00:41:33,720 --> 00:41:35,760 WITH THAT THANK YOU FOR YOUR 1073 00:41:35,760 --> 00:41:37,360 KIND ATTENTION AND OPEN UP THE 1074 00:41:37,360 --> 00:41:47,720 FLOOR TO QUESTIONS. 1075 00:41:54,280 --> 00:41:57,560 >>THANK YOU FOR THE 1076 00:41:57,560 --> 00:41:59,000 PRESENTATION AND DR. GOMES' 1077 00:41:59,000 --> 00:42:01,120 FOCUS ON DEVELOPING THE 1078 00:42:01,120 --> 00:42:01,720 SIMULATION TRAINING PROGRAM 1079 00:42:01,720 --> 00:42:04,240 SINCE WE HAVE A SMALL NUMBER OF 1080 00:42:04,240 --> 00:42:06,880 TRAINEES WORKING WITH FULLY 1081 00:42:06,880 --> 00:42:09,280 TRAINED CREDENTIALED PRIVILEGED 1082 00:42:09,280 --> 00:42:09,920 STAFF AT PROVIDER LEVELS AS WELL 1083 00:42:09,920 --> 00:42:12,240 AS NURSING. 1084 00:42:12,240 --> 00:42:14,160 IT'S NICE TO KNOW WE'RE ON THE 1085 00:42:14,160 --> 00:42:17,000 RIGHT PATH WHEN WE'RE FOCUSSED 1086 00:42:17,000 --> 00:42:19,320 ON TEAM TRAINING EDUCATION AND 1087 00:42:19,320 --> 00:42:23,080 NOT PROCEDURAL SKILLS. 1088 00:42:23,080 --> 00:42:23,680 WITH THAT. 1089 00:42:23,680 --> 00:42:31,320 >>THAT WAS INTRIGUED WITH THE 1090 00:42:31,320 --> 00:42:33,360 RELATION AND WONDERING IF THEY 1091 00:42:33,360 --> 00:42:37,880 DID THE STUDY THE RELATION OF 1092 00:42:37,880 --> 00:42:39,080 THE QUEEN BEES. 1093 00:42:39,080 --> 00:42:41,240 >>THAT'S A REALLY GOOD QUESTION 1094 00:42:41,240 --> 00:42:46,000 AND DOCTOR TOM SELEY IS THE GUY 1095 00:42:46,000 --> 00:42:46,720 AT CORNELL UNIVERSITY THAT 1096 00:42:46,720 --> 00:42:48,240 STUDIES ALL THAT STUFF. 1097 00:42:48,240 --> 00:42:51,160 I'M NOT AN EXPERT ON HONEY BEE 1098 00:42:51,160 --> 00:42:51,880 PHYSIOLOGY SO MUCH. 1099 00:42:51,880 --> 00:42:54,200 >>SECOND QUESTION, THOUGH I 1100 00:42:54,200 --> 00:42:58,960 HAVE A Ph.D. IN NUCLEAR PHYSICS 1101 00:42:58,960 --> 00:43:00,760 I ENDED STUDYING COMPLICATION 1102 00:43:00,760 --> 00:43:04,720 SOFTWARE AND LOOKING AT SOME OF 1103 00:43:04,720 --> 00:43:08,360 THE COMPLICATIONS AND AT THE 1104 00:43:08,360 --> 00:43:16,000 MAYO CLINIC AND FOR NIH TO OPEN 1105 00:43:16,000 --> 00:43:19,600 SURGERY I FOUND OUT A RESIDENT 1106 00:43:19,600 --> 00:43:25,640 WILL HELP ME IN MY STUDY PHASE. 1107 00:43:25,640 --> 00:43:27,360 IT HELPED ME LOOK AT THE ISSUES. 1108 00:43:27,360 --> 00:43:30,880 FROM THE CLINICAL STUDIES, ALSO, 1109 00:43:30,880 --> 00:43:33,200 WE HAD ANOTHER SESSION, 1110 00:43:33,200 --> 00:43:43,760 DR. MAGOON AT MAYO CLINIC IS IN 1111 00:43:47,640 --> 00:43:51,480 CARDIO VASCULAR STUDY AND SHOWED 1112 00:43:51,480 --> 00:43:55,840 UP AT 7:30 WITH DONUTS AND 1113 00:43:55,840 --> 00:43:59,040 COFFEE AND THE CARDIOLOGIST AND 1114 00:43:59,040 --> 00:44:00,800 RADIOLOGIST WHO GAVE WRONG 1115 00:44:00,800 --> 00:44:02,840 INFORMATION TO THE SURGEON, THIS 1116 00:44:02,840 --> 00:44:06,760 IS THE TIME TO TELL ME, HEY, YOU 1117 00:44:06,760 --> 00:44:09,360 GAVE ME THE WRONG INFORMATION 1118 00:44:09,360 --> 00:44:10,960 AND IT WAS DIFFERENT THAN WHAT I 1119 00:44:10,960 --> 00:44:11,840 WAS THINKING. 1120 00:44:11,840 --> 00:44:16,600 ALL THIS FEEDBACK AND EVERYTHING 1121 00:44:16,600 --> 00:44:18,080 ELSE WORKS NICELY. 1122 00:44:18,080 --> 00:44:20,120 IT REMINDS ME OF SOMETHING I DID 1123 00:44:20,120 --> 00:44:24,080 IN A WAY AND WE HAD A LOT OF 1124 00:44:24,080 --> 00:44:24,760 FUN. 1125 00:44:24,760 --> 00:44:27,480 THIS IS WHAT WE HAVE TO LEARN 1126 00:44:27,480 --> 00:44:31,080 NOT ONLY ACADEMIC LEVEL BECAUSE 1127 00:44:31,080 --> 00:44:34,520 WE HAVE SIMILAR THE WAY THEY 1128 00:44:34,520 --> 00:44:35,560 ORGANIZE THE SYSTEM. 1129 00:44:35,560 --> 00:44:37,240 THIS IS WHAT THE POLITICIANS 1130 00:44:37,240 --> 00:44:38,240 NEED TO LEARN HOW TO MAKE THINGS 1131 00:44:38,240 --> 00:44:44,000 WORK AS A TEAM. 1132 00:44:44,000 --> 00:44:48,160 >>I THINK AS THINGS GET MORE 1133 00:44:48,160 --> 00:44:49,200 COMPLEX THERE'S SO MUCH MORE 1134 00:44:49,200 --> 00:44:51,240 INFORMATION TO MANAGE WE CAN'T 1135 00:44:51,240 --> 00:44:52,640 KNOW EVERYTHING AND HAVE TO 1136 00:44:52,640 --> 00:44:53,400 DISTRIBUTE THAT KNOWLEDGE AROUND 1137 00:44:53,400 --> 00:44:53,920 OUR TEAMS AND SHARE THAT 1138 00:44:53,920 --> 00:45:01,000 KNOWLEDGE. 1139 00:45:01,000 --> 00:45:11,160 [OFF-MIC] 1140 00:45:11,600 --> 00:45:21,800 >>INTERESTING. 1141 00:45:43,360 --> 00:45:53,480 [OFF-MIC] 1142 00:45:58,440 --> 00:45:59,440 >>THANK YOU VERY MUCH. 1143 00:45:59,440 --> 00:46:04,640 >>THANK YOU FOR AN EXCELLENT 1144 00:46:04,640 --> 00:46:04,840 TALK. 1145 00:46:04,840 --> 00:46:06,680 ONE COMMENT OR A QUESTION YOU 1146 00:46:06,680 --> 00:46:08,720 HIGHLIGHTED ABOUT TEAM COGNITION 1147 00:46:08,720 --> 00:46:10,960 AND TEAM TRAINING BEING 1148 00:46:10,960 --> 00:46:12,240 SOMETHING THAT POTENTIALLY 1149 00:46:12,240 --> 00:46:13,080 IMPROVES PATIENT OUTCOMES. 1150 00:46:13,080 --> 00:46:17,120 ONE THING WE STRUGGLE IN ALL WE 1151 00:46:17,120 --> 00:46:20,720 TEACH IS THAT'S THE HOLEY GRAIL 1152 00:46:20,720 --> 00:46:21,760 AND THERE'S A REAL OPPORTUNITY 1153 00:46:21,760 --> 00:46:23,320 AND THERE'S SOME DATA AS YOU 1154 00:46:23,320 --> 00:46:24,000 POINT OUT. 1155 00:46:24,000 --> 00:46:25,880 I THINK THE QUESTION WHICH IS 1156 00:46:25,880 --> 00:46:29,320 MAYBE A MORE DIFFICULT ONE I 1157 00:46:29,320 --> 00:46:31,040 THINK AT MORE JUNIOR LEVELS 1158 00:46:31,040 --> 00:46:34,200 STUDENTS, RESIDENTS, FELLOWS AND 1159 00:46:34,200 --> 00:46:37,600 NURSING STUDENTS AND PHARMACY 1160 00:46:37,600 --> 00:46:39,800 AND THERE'S A CULTURE OF GOING 1161 00:46:39,800 --> 00:46:40,760 THROUGH SIMULATION-BASED 1162 00:46:40,760 --> 00:46:42,280 TRAINING AND WORKING TOGETHER IN 1163 00:46:42,280 --> 00:46:44,240 THE TEAM-BASED THERAPY. 1164 00:46:44,240 --> 00:46:47,520 TO ME THE BIGGEST CHALLENGE AND 1165 00:46:47,520 --> 00:46:51,200 THE LARGEST WHERE THERE'S A 1166 00:46:51,200 --> 00:46:54,080 VULNERABILITY IS FACULTY. 1167 00:46:54,080 --> 00:46:55,640 WE HAVE A HARD TIME GETTING 1168 00:46:55,640 --> 00:46:58,160 PEOPLE IN THE SIM, FACULTY WISE. 1169 00:46:58,160 --> 00:47:00,760 THAT'S THE GROUP I THINK WE CAN 1170 00:47:00,760 --> 00:47:03,880 MAKE TREMENDOUS STRIDES IN IN 1171 00:47:03,880 --> 00:47:04,920 IMPROVING OUTCOME. 1172 00:47:04,920 --> 00:47:07,360 I DON'T KNOW IF YOU HAVE TIPS OR 1173 00:47:07,360 --> 00:47:09,880 CONSIDERATIONS OF HOW DO YOU GET 1174 00:47:09,880 --> 00:47:12,040 THAT GROUP IN THERE TO GO 1175 00:47:12,040 --> 00:47:13,000 THROUGH THIS TRAINING? 1176 00:47:13,000 --> 00:47:14,680 >>I THINK IT'S A GREAT 1177 00:47:14,680 --> 00:47:16,240 CHALLENGE AND GREAT QUESTION AND 1178 00:47:16,240 --> 00:47:19,200 A CHALLENGE THAT WE ALL HAD TO 1179 00:47:19,200 --> 00:47:21,040 DEAL WITH. 1180 00:47:21,040 --> 00:47:22,120 I THINK TO SOME DEGREE IT HAS TO 1181 00:47:22,120 --> 00:47:24,800 BE A CULTURE CHANGE IN MEDICINE. 1182 00:47:24,800 --> 00:47:27,520 WE TEND TO THINK SIMULATION 1183 00:47:27,520 --> 00:47:29,240 TRAINING IS ONLY FOR BEGINNERS. 1184 00:47:29,240 --> 00:47:33,160 BUT IF YOU GET OUTSIDE OF HEALTH 1185 00:47:33,160 --> 00:47:35,080 CARE AND THIS IS AN IMPORTANT 1186 00:47:35,080 --> 00:47:37,680 MESSAGE TO CARRY TO THE MORE 1187 00:47:37,680 --> 00:47:39,960 SENIOR FOLKS IT'S NOT ONE 1188 00:47:39,960 --> 00:47:40,640 PROFESSIONAL, IT'S ALL THE 1189 00:47:40,640 --> 00:47:41,520 SENIOR FOLKS. 1190 00:47:41,520 --> 00:47:43,440 I GOT THIS, I DON'T NEED ANYBODY 1191 00:47:43,440 --> 00:47:47,040 TO TELL ME HOW TO DO MY JOB BUT 1192 00:47:47,040 --> 00:47:48,480 IF WE THINK OF THINGS LIKE THE 1193 00:47:48,480 --> 00:47:50,720 MILITARY, THEY SIMULATE A LOT OF 1194 00:47:50,720 --> 00:47:52,120 THEIR COMMAND AND CONTROL 1195 00:47:52,120 --> 00:47:52,480 EXERCISES. 1196 00:47:52,480 --> 00:47:54,280 IF WE THINK OF AVIATION, THE 1197 00:47:54,280 --> 00:47:57,360 FIRST TIME A PILOT FLIES A PLANE 1198 00:47:57,360 --> 00:48:00,240 WITH PEOPLE IS THE FIRST TIME 1199 00:48:00,240 --> 00:48:02,000 HE'S FLYING THAT PLANE. 1200 00:48:02,000 --> 00:48:03,640 EVERYTHING ELSE ASSIMILATION AND 1201 00:48:03,640 --> 00:48:05,040 THEY'RE REQUIRED TO HAVE 1202 00:48:05,040 --> 00:48:08,000 SIMULATION TRAINING EVERY YEAR. 1203 00:48:08,000 --> 00:48:10,800 AND PEOPLE WHO OPERATE POWER 1204 00:48:10,800 --> 00:48:12,240 PLANT, THE SAME. 1205 00:48:12,240 --> 00:48:14,280 NASA SIMULATES EVERYTHING. 1206 00:48:14,280 --> 00:48:16,640 AN EXAMPLE OF SENIOR PEOPLE WHO 1207 00:48:16,640 --> 00:48:19,440 GOT BETTER BECAUSE OF SIMULATION 1208 00:48:19,440 --> 00:48:21,480 IS AT CHILDREN'S HOSPITAL THEY 1209 00:48:21,480 --> 00:48:23,520 WERE GOING TO BE DOING A 1210 00:48:23,520 --> 00:48:26,320 COMPLICATED NEUROSURGERY ON THE 1211 00:48:26,320 --> 00:48:28,960 CHILD AND 3-D PRINT THE KID'S 1212 00:48:28,960 --> 00:48:30,320 CENTRAL NERVOUS SYSTEM AND 1213 00:48:30,320 --> 00:48:31,960 SIMULATED THE ENTIRE SURGERY AND 1214 00:48:31,960 --> 00:48:37,120 THEY WERE ABLE TO SAVE 25 1215 00:48:37,120 --> 00:48:42,440 MINUTES OF TIME THE CHILD 1216 00:48:42,440 --> 00:48:47,920 DIDN'T HAVE TO BE UNDER A 1217 00:48:47,920 --> 00:48:48,440 ANESTHESIA. 1218 00:48:48,440 --> 00:48:49,640 THE BALTIMORE ORIOLES, WHAT'S 1219 00:48:49,640 --> 00:48:54,960 THEIR RATIO OF PRACTICE TO PLAY? 1220 00:48:54,960 --> 00:48:56,760 THEY PRACTICE FOR FIVE DAYS FOR 1221 00:48:56,760 --> 00:48:59,520 ONE GAME AND WE SHOW UP EVERY 1222 00:48:59,520 --> 00:49:01,720 DAY IS GAME DAY AND WE TEAM 1223 00:49:01,720 --> 00:49:03,280 PEOPLE WHO ARE ALREADY EXCELLENT 1224 00:49:03,280 --> 00:49:08,160 HOW TO BE 1% BETTER. 1225 00:49:08,160 --> 00:49:11,080 WHEN I TALK THE IDEA OF HOW DO 1226 00:49:11,080 --> 00:49:13,000 WE CONVINCE SENIOR PEOPLE THIS 1227 00:49:13,000 --> 00:49:14,960 COULD BE HELPFUL IS BECAUSE 1228 00:49:14,960 --> 00:49:16,240 THERE'S ALWAYS ROOM TO BE 1% 1229 00:49:16,240 --> 00:49:19,840 BETTER AND OFTEN A SLOW CULTURE 1230 00:49:19,840 --> 00:49:21,040 CHANGE IN AN ORGANIZATION. 1231 00:49:21,040 --> 00:49:23,280 WHEN WE START TO SEE BETTER 1232 00:49:23,280 --> 00:49:24,520 OUTCOMES IT HELPS PEOPLE GO 1233 00:49:24,520 --> 00:49:27,240 UNDER THE BUS BUT IT'S A CULTURE 1234 00:49:27,240 --> 00:49:29,920 CHANGE THAT TAKES TIME. 1235 00:49:29,920 --> 00:49:30,920 >>THANK YOU. 1236 00:49:30,920 --> 00:49:32,240 A QUESTION AND COMMENT THAT 1237 00:49:32,240 --> 00:49:34,880 RELATE TO WHAT YOU'RE SAYING IS 1238 00:49:34,880 --> 00:49:36,800 THE FACT TO WHAT YOU TOUCHED ON 1239 00:49:36,800 --> 00:49:37,560 WAS THE ISSUE OF PSYCHOLOGICAL 1240 00:49:37,560 --> 00:49:41,560 SAFETY. 1241 00:49:41,560 --> 00:49:42,880 WHEN YOU GET MORE SEASONED I'LL 1242 00:49:42,880 --> 00:49:46,960 SAY YOU DON'T WANT TO SEEM 1243 00:49:46,960 --> 00:49:47,720 VULNERABLE TO NOT HAVE KNOWLEDGE 1244 00:49:47,720 --> 00:49:54,480 AND SKILLS OR WHATEVER. 1245 00:49:54,480 --> 00:49:58,080 WHEN WE TALK TO GROUPS OF 1246 00:49:58,080 --> 00:49:59,520 PARTICIPANTS WHAT HAPPENS IN SIM 1247 00:49:59,520 --> 00:50:00,880 STAYS IN SIM. 1248 00:50:00,880 --> 00:50:03,840 BEYOND THAT HOW DO YOU CONVEY 1249 00:50:03,840 --> 00:50:04,240 THAT? 1250 00:50:04,240 --> 00:50:06,840 IS THERE A STRATEGY HOW DO YOU 1251 00:50:06,840 --> 00:50:09,000 MAKE PEOPLE TRULY FEEL 1252 00:50:09,000 --> 00:50:10,360 COMFORTABLE WITH THE 1253 00:50:10,360 --> 00:50:10,800 PSYCHOLOGICAL SAFETY? 1254 00:50:10,800 --> 00:50:12,120 >>THERE'S AN IMPORTANT TIME 1255 00:50:12,120 --> 00:50:14,200 BEFORE PEOPLE GO INTO SIMULATION 1256 00:50:14,200 --> 00:50:15,800 WE CALL THE PREBRIEFING OR THE 1257 00:50:15,800 --> 00:50:17,200 BRIEFING BEFORE AND THIS IS THE 1258 00:50:17,200 --> 00:50:20,000 TIME WE SET THE SAFE CONTAINER 1259 00:50:20,000 --> 00:50:23,480 AS WE SAY IN SIMULATION. 1260 00:50:23,480 --> 00:50:25,720 IF I'M A NURSE AND KNOW I GOT 1261 00:50:25,720 --> 00:50:27,160 THE CHIEF OF CARDIAC SURGERY 1262 00:50:27,160 --> 00:50:28,920 COMING TO MY SIMULATION I DON'T 1263 00:50:28,920 --> 00:50:32,240 PRETEND THEY'RE NOT THERE. 1264 00:50:32,240 --> 00:50:35,520 I DON'T PRETEND THEY'RE LIKE 1265 00:50:35,520 --> 00:50:39,560 EVERYBODY ELSE AND I'LL DO MY 1266 00:50:39,560 --> 00:50:42,000 TALK ABOUT WE ALL CAN BE 1% 1267 00:50:42,000 --> 00:50:44,160 BETTER AND WE HAVE DR. GOMES THE 1268 00:50:44,160 --> 00:50:47,200 HEAD OF CARDIAC SURGERY AND SO 1269 00:50:47,200 --> 00:50:52,200 GLAD YOU'RE HERE AND SURE YOU'RE 1270 00:50:52,200 --> 00:50:53,320 EXPERTISE AT DEBRIEFING. 1271 00:50:53,320 --> 00:50:54,640 THE BEST THING YOU CAN 1272 00:50:54,640 --> 00:50:55,760 ACKNOWLEDGE THE EXPERTISE IN THE 1273 00:50:55,760 --> 00:50:57,440 ROOM AND TELL THEM HOW MUCH YOU 1274 00:50:57,440 --> 00:50:59,400 VALUE THEM BEING THERE AND 1275 00:50:59,400 --> 00:51:00,800 REITERATE THE MESSAGE WE'RE ALL 1276 00:51:00,800 --> 00:51:03,880 HERE TO BE 1% BETTER AND I TELL 1277 00:51:03,880 --> 00:51:08,680 PEOPLE WHEN I'M DOING PRE 1278 00:51:08,680 --> 00:51:09,360 BRIEFING I'VE NEVER HAD A 1279 00:51:09,360 --> 00:51:11,960 PERFECT DAY IN MY LIFE BUT 1280 00:51:11,960 --> 00:51:13,120 THERE'S SO MUCH TO BE LEARNED 1281 00:51:13,120 --> 00:51:14,320 WHEN WE'RE NOT PERFECT. 1282 00:51:14,320 --> 00:51:15,920 WHEN I THINK OF PSYCHOLOGICAL 1283 00:51:15,920 --> 00:51:18,160 SAFETY AND WHAT IT COMES DOWN TO 1284 00:51:18,160 --> 00:51:19,680 IS EVERYBODY BEING TRANSPARENT 1285 00:51:19,680 --> 00:51:21,120 ABOUT WHAT THEY'RE THINKING. 1286 00:51:21,120 --> 00:51:25,400 >>ONE THING WE'RE SEEING TOO IS 1287 00:51:25,400 --> 00:51:27,920 MANY OF OUR NURSES IN THE EARLY 1288 00:51:27,920 --> 00:51:29,960 PART OF CAREERS AND FELLOWS AND 1289 00:51:29,960 --> 00:51:32,000 RESIDENTS PARTICIPATED IN 1290 00:51:32,000 --> 00:51:34,800 SIMULATION IN THEIR SCHOOLING. 1291 00:51:34,800 --> 00:51:39,400 IF WE START TO ROLL THIS OUT IT 1292 00:51:39,400 --> 00:51:40,360 BECOMES A MORE COMFORTABLE 1293 00:51:40,360 --> 00:51:43,640 SETTING IT'S THE OLD FOLKS LIKE 1294 00:51:43,640 --> 00:51:45,040 MYSELF THAT THINK YOU'RE GOING 1295 00:51:45,040 --> 00:51:47,560 TO TELL ME HOW TO DO YOUR JOB. 1296 00:51:47,560 --> 00:51:50,040 >>WE ARE HERE TO WORK ON TEAM 1297 00:51:50,040 --> 00:51:52,240 COGNITION NOT TO TELL YOU HOW TO 1298 00:51:52,240 --> 00:51:52,800 DO YOUR JOB. 1299 00:51:52,800 --> 00:51:57,400 >>EXCELLENT TALK AS ALWAYS. 1300 00:51:57,400 --> 00:51:59,560 SOMETIMES SIMULATION REQUIRES 1301 00:51:59,560 --> 00:52:01,720 ASSESSMENT. 1302 00:52:01,720 --> 00:52:04,280 HOW DO COMBINE THE SAFE 1303 00:52:04,280 --> 00:52:05,600 CONTAINER WITH INFORMATIVE 1304 00:52:05,600 --> 00:52:05,880 ASSESSMENTS. 1305 00:52:05,880 --> 00:52:07,040 >>GREAT QUESTION. 1306 00:52:07,040 --> 00:52:09,480 WHEN I BRING PEOPLE TO THE SIM 1307 00:52:09,480 --> 00:52:11,960 LAB I'M ALWAYS DOING SOME SORT 1308 00:52:11,960 --> 00:52:13,480 OF ASSESSMENT. 1309 00:52:13,480 --> 00:52:16,560 MY FORMATIVE ASSESSMENT IS HOW 1310 00:52:16,560 --> 00:52:18,480 ARE THEY DOING WITH 1311 00:52:18,480 --> 00:52:19,360 CLOSED-LOOPED COMMUNICATION. 1312 00:52:19,360 --> 00:52:20,520 THAT'S MY FORMATIVE ASSESSMENT 1313 00:52:20,520 --> 00:52:27,560 AND WHAT A TALK ABOUT IN 1314 00:52:27,560 --> 00:52:28,760 DEBRIEFING. 1315 00:52:28,760 --> 00:52:30,600 WHEN I THINK OF PSYCHOLOGICAL 1316 00:52:30,600 --> 00:52:32,560 SAFETY A SURE WAY IS THERE'S NO 1317 00:52:32,560 --> 00:52:35,120 CONSEQUENCES IF I MAKE A 1318 00:52:35,120 --> 00:52:35,560 MISTAKE. 1319 00:52:35,560 --> 00:52:37,160 IF THERE'S A SUMMATIVE 1320 00:52:37,160 --> 00:52:38,640 ASSESSMENT I'M SEEING IF I CAN 1321 00:52:38,640 --> 00:52:42,840 ALLOW THEM TO INTUBATE A REAL 1322 00:52:42,840 --> 00:52:44,520 HUMAN BEING OR A PROCEDURE A 1323 00:52:44,520 --> 00:52:44,920 REAL HUMAN BEING. 1324 00:52:44,920 --> 00:52:48,280 IT'S DIFFERENT BUT THERE'S A WAY 1325 00:52:48,280 --> 00:52:50,160 TO SET UP A TRUSTING ENVIRONMENT 1326 00:52:50,160 --> 00:52:53,720 AND WE'RE WORKING ON THIS ON 1327 00:52:53,720 --> 00:52:55,560 COMPETENCY BASED EDUCATION IN 1328 00:52:55,560 --> 00:53:00,040 NURSING THE PEOPLE BEING 1329 00:53:00,040 --> 00:53:01,280 SUMMATIVELY ASSESSED NEED TO BE 1330 00:53:01,280 --> 00:53:02,440 INFORMED ON WHAT THEY'RE BEING 1331 00:53:02,440 --> 00:53:03,120 ASSESSED ABOUT. 1332 00:53:03,120 --> 00:53:06,320 IF I'M BRINGING IN SOMEONE WHO 1333 00:53:06,320 --> 00:53:07,560 WILL BE A CODE TEAM LEADER AND 1334 00:53:07,560 --> 00:53:09,840 THEY'RE JUST LEARNING IT THE 1335 00:53:09,840 --> 00:53:12,480 OTHER PEOPLE IN THE SIMULATION 1336 00:53:12,480 --> 00:53:13,720 WOULD NOT BE PEOPLE ALSO 1337 00:53:13,720 --> 00:53:15,240 LEARNING BUT MAYBE ACTORS SO 1338 00:53:15,240 --> 00:53:16,600 THIS PERSON IS THE ONLY PERSON I 1339 00:53:16,600 --> 00:53:19,480 HAVE TO WATCH AND I WOULD LET 1340 00:53:19,480 --> 00:53:21,120 THIS PERSON KNOW HERE'S WHAT 1341 00:53:21,120 --> 00:53:22,800 WE'LL BE ASSESSING YOU ON, YOUR 1342 00:53:22,800 --> 00:53:24,920 ABILITY TO CREATE A SHARED 1343 00:53:24,920 --> 00:53:26,720 MENTAL MODEL AND INVITE OTHER 1344 00:53:26,720 --> 00:53:28,080 PEOPLE INTO DECISION MAKING ON 1345 00:53:28,080 --> 00:53:29,800 THE TEAM AND HAVE MY ACTORS HAVE 1346 00:53:29,800 --> 00:53:31,040 DIFFERENT BITS OF INFORMATION 1347 00:53:31,040 --> 00:53:32,240 THE TEAM LEADER DOESN'T HAVE AND 1348 00:53:32,240 --> 00:53:33,240 NEEDS. 1349 00:53:33,240 --> 00:53:36,600 AND THAT'S HOW I WOULD DO THAT. 1350 00:53:36,600 --> 00:53:39,680 THE KEY WITH SUMMATIVE IS TO BE 1351 00:53:39,680 --> 00:53:40,760 SUPER CLEAR WHAT THE ASSESSMENT 1352 00:53:40,760 --> 00:53:45,640 POINTS ARE GOING TO BE. 1353 00:53:45,640 --> 00:53:47,560 NOT EXACTLY. 1354 00:53:47,560 --> 00:53:49,120 SO THEY NEED TO BE WELL INFORMED 1355 00:53:49,120 --> 00:53:50,640 WHAT THEY'RE GOING INTO AND HAVE 1356 00:53:50,640 --> 00:53:52,120 HAD MULTIPLE TIMES TO PRACTICE 1357 00:53:52,120 --> 00:53:57,520 IN SIMULATION IN A FORMATIVE WAY 1358 00:53:57,520 --> 00:54:00,600 BEFORE THEY'RE SUMMATIVELY 1359 00:54:00,600 --> 00:54:00,800 EXIST. 1360 00:54:00,800 --> 00:54:01,560 YOUR COMMITTEE CHAIRS SHOULD 1361 00:54:01,560 --> 00:54:03,800 NEVER LET YOU DO YOUR DEFENSE 1362 00:54:03,800 --> 00:54:05,560 UNTIL THEY'RE SURE YOU'RE GOING 1363 00:54:05,560 --> 00:54:10,720 TO PASS AND I WOULD SAY THE SAME 1364 00:54:10,720 --> 00:54:12,080 IN SIMULATION. 1365 00:54:12,080 --> 00:54:13,960 SO WHEN IT SEEMS LIKE SUMMATIVE 1366 00:54:13,960 --> 00:54:19,760 IT SEEMS LIKE ANOTHER DAY IN THE 1367 00:54:19,760 --> 00:54:21,520 SIMULATION LAB. 1368 00:54:21,520 --> 00:54:26,880 >>WHEN OUR CEO ESTABLISHED THE 1369 00:54:26,880 --> 00:54:30,000 PROGRAM HERE WITH THE MISSION 1370 00:54:30,000 --> 00:54:31,160 STATEMENT IT APPLIES TO EVERYONE 1371 00:54:31,160 --> 00:54:33,720 IN A CLINICAL CENTER NOT JUST 1372 00:54:33,720 --> 00:54:35,720 PROVIDERS OR NURSES OR 1373 00:54:35,720 --> 00:54:38,160 TECHNOLOGISTS BUT EVERYONE. 1374 00:54:38,160 --> 00:54:39,720 I DIDN'T -- HAVE YOU EXPLORED 1375 00:54:39,720 --> 00:54:42,240 DOING SIMULATIONS AT OTHER 1376 00:54:42,240 --> 00:54:44,400 ARENAS WITHIN THE ENVIRONMENT 1377 00:54:44,400 --> 00:54:49,480 BUT OUTSIDE PROVIDERS LIKE 1378 00:54:49,480 --> 00:54:50,160 HOUSEKEEPING AND ADMINISTRATION 1379 00:54:50,160 --> 00:54:58,200 AND WHAT THOSE LOOK LIKE? 1380 00:54:58,200 --> 00:55:02,920 AND THE WARD ADMINISTRATIVE 1381 00:55:02,920 --> 00:55:13,440 SESSION AND I'VE WORKED WITH 1382 00:55:13,880 --> 00:55:16,200 PLACES ESPECIALLY IN EMERGENCY 1383 00:55:16,200 --> 00:55:16,800 DEPARTMENTS WHERE EVERYONE 1384 00:55:16,800 --> 00:55:19,400 INVOLVED IN THE SIMULATION AND 1385 00:55:19,400 --> 00:55:20,240 SOMETIMES IT'S TURNING THE ROOM 1386 00:55:20,240 --> 00:55:30,480 OVER QUICKLY. 1387 00:55:42,240 --> 00:55:44,240 >>A COMMENT IN SOUTHERN 1388 00:55:44,240 --> 00:55:46,760 CALIFORNIA, EXCELLENT INFO INTO 1389 00:55:46,760 --> 00:55:47,600 TEAM MODELS AND LEARNED A LOT 1390 00:55:47,600 --> 00:55:52,240 ABOUT BEES. 1391 00:55:52,240 --> 00:55:54,200 I'M CONTEMPLATING MY OWN ROLE 1392 00:55:54,200 --> 00:55:55,600 HERE ABOUT MALE BEES BUT THAT'S 1393 00:55:55,600 --> 00:55:57,320 A DIFFERENT THING. 1394 00:55:57,320 --> 00:55:58,640 WITH THAT I WANT TO SAY THANK 1395 00:55:58,640 --> 00:56:00,720 YOU FOR YOUR TIME AND SHARING 1396 00:56:00,720 --> 00:56:01,960 YOUR EXPERTISE AND WE GREATLY 1397 00:56:01,960 --> 00:56:03,320 APPRECIATE YOUR COMING. 1398 00:56:03,320 --> 00:56:13,840 >>THANK YOU FOR INVITING ME.