 Ministry of Health
http://newzealand.govt.nz/
©Copyright
Published:
28/11/2011
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Simulation for Non Technical Skills Training
Lara Hopley
Outline Simulation for non-technical skills training
Lara Hopley
Department of Anaesthesia
Auckland City Hospital
Simulation for "non-technical" skills training
Conclusion #1
The separation of tasks into "technical skills" and "behavioural skills" is an arbitrary and potentially damaging dichotomy.
Simulation for non-technical skills training
Lara Hopley
Department of Anaesthesia
Auckland City Hospital
train vb*
* "to guide or teach (to do something) as by subjecting to various exercises or experiences
* to control or guide towards a specific goal
* to do exercises and prepare for a specific purpose
* to improve or curb by subjecting to discipline"
Training concepts
* "to guide or teach (to do something) as by subjecting to various exercises or
experiences
* to control or guide towards a specific goal
* to do exercises and prepare for a specific purpose
* to improve or curb by subjecting to discipline"
Conclusion #2
In complex, non-linear environments like Medicine there are substantial limits
to our ability to "train" individuals to particular goals.
There may even be a downside...
"Six sigma"
What is our target?
What is our target?
Doing better
"Yet every time the average moved up, Matthews and a few others somehow managed
to stay ahead of the pack"*
How can we do better?
"Even doctors with great knowledge and technical skill can have mediocre
results, more nebulous factors like aggressiveness and diligence and ingenuity
can matter enormously"*
Two questions
* Can we teach such skills?
* Can we learn such skills?
Simulation for integrated skills training
Lara Hopley
Department of Anaesthesia
Auckland City Hospital
skill n
* "special ability in a sport, etc., esp. ability acquired by training
* something, esp. a trade or technique, requiring special training or manual
proficiency."*
* "the ability to use one's knowledge effectively and readily in execution or
performance"+
Error recovery
The hero
"... I have to confess that I find the heroic recoveries of much greater
interest and - in the long run, I believe - potentially more beneficial to the
pursuit of improved safety in dangerous operations."*
Conclusion #3
In a fairly well-defended system, we neglect the skillful 'hero' at our peril.
"The ingredients of heroic recovery"
* Coping with
* Coping with unlikely but possible hazards
* Generic qualities
1. Coping with expected hazards
* identify & assess the hazard
* develop countermeasures, test these, and rehearse them
* deploy the countermeasures effectively and in a timely fashion
"situational awareness"
2. Coping with unlikely hazards
United Air Flight 232
3. Generic qualities
In addition to situational awareness, Reason identifies the following as of
value:
* "Realistic optimism, the opposite of despair"
* "Finding the right balance between old and new"
Simulation for integrated learning of skills
Lara Hopley
Department of Anaesthesia
Auckland City Hospital
simulate vb*
* "to make a pretence of
* to reproduce the conditions of a situation, etc.
* to have the appearance of"*
* "to give or assume the appearance or effect of often with the intent to
deceive"+
My Goals
* Reflection: regular, structured review of how we are doing
* Communication: transfer of relevant, structured information within and between
teams that do similar things
* Proactive measures: continual innovation based on the above, using simple,
robust measures
Integrated learning of optimism, balance and situational awareness through
everyday practice
Lara Hopley
Department of Anaesthesia
Auckland City Hospital
"The black box in theatre"
Conclusion #3
In a fairly well-defended system, we neglect the skillful 'hero' at our peril.
"The ingredients of heroic recovery"
* Coping with expected hazards
* Coping with unlikely but possible hazards
* Generic qualities
1. Coping with expected hazards
* identify & assess the hazard
* develop countermeasures, test these, and train
* deploy the countermeasures effectively and in a timely fashion
"situational awareness"
2. Coping with unlikely hazards
"Irreplaceable people"
(How Gordon Vette rescued Jay Prochnow)
"A unique set of qualities:
* tenacity
* ingenuity
* very considerable intelligence."
3. Generic qualities
In addition to situational awareness, Reason identifies the following as of
value:
* "Realistic optimism, the opposite of despair"
* "Finding the right balance between old and new"
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