"I saw it once on TV..."

[Carlos Danger]

It comes down to how you use them.

As I said before, we used a Sim-man a lot when I was a new-ish flight paramedic. For scenario-based training, I think it was very useful. Perhaps we could have replicated the essential parts of the experience by just doing verbal scenarios, I don't know.

Cost? I think my employer paid about $50k for the whole setup. Not chump change, for sure. But for that amount of money, they had 15 flight paramedics and 15 flight nurses frequently practicing challenging clinical scenarios in ways that they probably wouldn't have before. Was it worth the money? Did it actually improve the care that I provided? I can't say for sure, but it did mean that we spent a lot more time practicing skills and talking about clinical scenarios than we probably would have otherwise. We also used it for pre-employment testing, which was always fun.

We use them in the program I'm in now, too. Not a whole lot. But it seems pretty valuable for introduction to basic airway skills, practicing induction and extubation sequences, practicing mask-ventilating and using the anesthesia machine and ventilator, etc. I don't think of it as "clinical education", but rather as a good "orientation" to what we do before we get into the clinical area. And the cost, well, I'm sure it works out to a pretty small percentage of what they charge students in tuition over the service life the simulator.

Ficus, you seem to be equating potential problems with simulation over-use to the larger problem of poor overall education for EMS providers. The problem of poor EMS education is with us, with or without simulation. Simulation may be an expensive and not very effective band-aid for the problem, but I would definitely not discount it completely. I think it has it's place.

 

[Veneficus]

Ficus, you seem to be equating potential problems with simulation over-use to the larger problem of poor overall education for EMS providers. The problem of poor EMS education is with us, with or without simulation. Simulation may be an expensive and not very effective band-aid for the problem, but I would definitely not discount it completely. I think it has it's place.

I wouldn't limit it only to EMS education.

I think you summed it up perfectly. It is becomming a very expensive band-aid for a lack of effective clinical education (I would add) at all levels.

 

[ThadeusJ]

I wouldn't limit it only to EMS education.

I think you summed it up perfectly. It is becoming a very expensive band-aid for a lack of effective clinical education (I would add) at all levels.

An essential component of simulation training is the ability to compress the frequency of exposure normally seen in clinical practice (as long as you can do it in a sim situation). Clinical times are set in an effort to have the student be exposed to a "normal day in the life", where we hope that they will be exposed to all, if not most scenarios. Its those things that make us say, "ya know, you're gonna see this, maybe not today, maybe not tomorrow, but someday and you'll be glad that you were exposed to it". When I had rotating students during their hospital rotations, some days we had vents running and some days were eerily quiet.

Solid simulation evens that exposure out for all students (in an objective way as well; to remove evaluator bias) while making available as many scenarios as possible.

 

[Rialaigh]

An aweful lot of money to spend on an industry that works "sometimes."

another industry comes to mind...the healthcare industry...but that is another topic all together...

There is no alternative to patient contact - however -

I think sim mans are an excellent way to compress thousands of hours of required patient time to see that one thing happen one time. Into seeing that one thing happen 50 times in two days. At some point you have to weight cost/benefit. Is the benefit as great doing it on a dummy, no it is not, but the cost is much much less.

 

[Carlos Danger]

I think sim mans are an excellent way to compress thousands of hours of required patient time to see that one thing happen one time. Into seeing that one thing happen 50 times in two days. At some point you have to weight cost/benefit. Is the benefit as great doing it on a dummy, no it is not, but the cost is much much less.

Exactly.

 

[Summit]

I think sim mans are an excellent way to compress thousands of hours of required patient time to see that one thing happen one time. Into seeing that one thing happen 50 times in two days. At some point you have to weight cost/benefit. Is the benefit as great doing it on a dummy, no it is not, but the cost is much much less.

Indeed

However...

For most scenarios outside of select situations I'm not convinced a sim-man is better than a student rotating through the rolls of scenario actor. By select situations, I mean critical care and skills practice. I'd have speculated surgery fell under this exception, but I defer to Vene.

 

[Rialaigh]

Indeed

However...

For most scenarios outside of select situations I'm not convinced a sim-man is better than a student rotating through the rolls of scenario actor. By select situations, I mean critical care and skills practice. I'd have speculated surgery fell under this exception, but I defer to Vene.

I'm good with that. I would agree that a scenario actor is better or equal to a sim man in most situations.

However I think sim mans will be primarily used (hours spent) by critical care and skills practice. I know we (in P-school) don't use sim-mans to practice putting bandages on or splinting. We use them to identify cardiac rhythms, hang drips, see reactions, pace, shock, and evaluate breath sounds and treatment reactions.

 

[BSE]

I've used both Sim-mans and trained actors to train my guys.

This is purely my opinion.

The sim-mans are good for medicine based scenarios that focus on procedural steps....ACLS for example. I do not use them for anything involving trauma. The guys I train are PJ's, so it isn't very realistic to throw a $40K sim-man down a manhole for a technical rescue....never-mind water work.

In trauma/rescue scenarios I like to use actors...trained if I can get them (rare) or I coach volunteers to act a specific way, I try to use folks that are fellow medics...that way they should know how to mimic a specific injury. As far as moulage, I am a minimalist. Lots of blood tends to get the point across....though I am a fan of tubing connected to a bag to produce bleeders.

With all the fancy training aids that are available, I think simple is better in most cases. I don't encourage my folks to go out and buy the high dollar stuff when there are just as effective/cheaper alternatives.

 

[BSE]

Now address the original topic....youtube or something similar for learning.

I am not a fan of distance learning...especially having just completed an online genetics course that I took for a little prep for a program I am about to start. I hated it. This is just me, but the complete lack of interaction really bothered me, especially for a subject that has potential to be complex. I don't feel I got as much as I could of out of it. This is purely anecdotal.

That said, there is a place for video style learning. As another example, I have been watching a series of lectures on youtube by a guy named Dr. Najeeb (sp?). I am using his lectures as a refresher for BioChem/physiology as it has been a while since I was last exposed to it. It has been great. I can skip around to the points that I need work on, and he is easy to follow. That said....it is working out because I already have a grasp of the overall topic. Maybe that is the key.:unsure:

Using youtube for procedural stuff could be beneficial with simply covering the steps and basic mechanics of a task, but should never replace the real thing unless there is no other option; this is where training simulators (dolls and such) come in handy'ish.

 

[DrParasite]

I loooooove you tube!!!

lets see, I have used youtube to give me directions ot unclog my drain in my dishwater, to replace a leaking shower head/tub faucet in my bathroom, replace a leaking kitchen sink, and probably a bunch of other DIY fixes around the house. it's awesome, and I absolutely recommend anyone who has something break around their home check youtube for step by step directions before they call a repair main, as it's sometimes an easier fix than they thought.

would I use youtube to learn a new technique in EMS? sure, why not? am I going to ONLY use youtube? no no no. but it can be part of the learning process, included with formal education, hands on practice under simulated enviornments, and then, hands on practice under controlled enviornment under the direct supervision of a more experienced person, and then try it out in the field.

I also recently tubed fred the head in class. first time in, right into the esophgas. second time in, once I actually realized what I thought was the vocal cords weren't, and found the vocal cords, right in the lungs. does that mean I am going to start tubing every patient I see? absolutely not. but some of the techniques I learned on fred the head could probably be practices and used on real people. it's an early step using a sim person, but you still need practice on real people under the guidance of someone more edcuated and experienced.

 

[ExpatMedic0]

What do you think of this Vene? http://www.nmetc.com/online-paramedic-program.html

 

[Veneficus]

it looks like a very overpriced distance learning program?

 

[ExpatMedic0]

it looks like a very overpriced distance learning program?

Well ya.... However, I was expecting an explosive and detailed rant. I guess Ill settle for your response though.

 

[Veneficus]

Believe it or not,

Well ya.... However, I was expecting an explosive and detailed rant. I guess Ill settle for your response though.

There are only 2 things that set off an explosive detailed rant. The rest is simply introspective, but sometimes it doesn't seem so.

One is people who are not physicians claiming they are as able/effective as physicians and the other is people who advocate the excellence of mediocrity.

But I think I should clarify why I wrote this post.

It isn't really a rant against modern or distance learning. In fact I am quite sold on the problem based learning method some US medical schools are using. I wouldn't call it ideal for everyone, certainly it would have been easier for somebody like me, but I have benefitted greatly from traditional education many ways I didn't realize and faught against until much later when I finally saw the value for myself, mostly because of outstanding teachers. But not everyone gets outstanding teachers, and I have had my fill of A**hole teachers too.

Whether you are watching a lecture in class or on video, somebody is still standing there talking at you. The medium is really inconsequential. What is important is the quality of the lecturer.

Because I am terribly bored by people droning on at me in lecture, I try to take a different approach and make it more like a discussion. I would say it has many benefits, some people would claim it just raises anxiety.

I am not too keen on skills bootcamps, because what is lost is is the learning and reflection that comes with skill practice over time. But the bootcamp method can meet the minimum requirement. If being the minimum works for (collective) you then ok I guess. Somebody has to be at the bottom.

What does drive me to rant threshold from introspection though is when people use things like simulation and distance learning in place of and not adjunctive to clinical practice.

Back when ships were wood and men were iron when i first started, most of the simulators were, basic. there wasn't really a focus on the "situation" or environment. The idea was a bare bones skill instruction. (not to be confused with practice) Once you could make a laryngoscope light come on, discover how to sync a monitor, or stab an orange with a needle, skill instruction was basically over.

You practiced these skills in clinical. (recall I went to an EMT program that required hours of clinical before any EMT clinical was mandated) Under the guidance of experienced clinicians. In addition to far more practice, a host of non curriculum skills, like dealing with various personalities and difficulties were learned.People went to the field after graduation with a fair amount of experience and usually far more comfortable with their skills.

From my perspective, there is nothing in EMS that isn't done so routinely that there is any need for "simulation." Now some people may chime in with "we never do crics" but that doesn't mean they are not done or can't be. Going back to my experience in the US as a medic. I learned how to cric in the OR. Taught by an extremely respected and accomplished surgeon. I didn't happen to be there when the pt needed an emergent cric. I went in knowing that was what I was there to learn. Many people still require a trach, and a cric is easily converted, so many students, medic and medical were taught by doing the cric part prior to the surgeon converting it to a trach. We practiced a skill, under expert guidance, on a real person, and also learned some other interesting stuff while we were there.

All of the expensive simulators also don't compare to a more realistic experience that can be had from a trip to the butcher shop for the price of gratitude. Where you can tube, cric, iv, and see real tissue in action for hundreds less than fred the head and thousands less than sim man.

For those of you who have not had a pop, on the spot, anatomy interrogation by a surgeon it is a bit intimidating. Especially since the more correct answers you get, the more that gets asked and the more difficult the questions become. Sooner or later you learn there is no level of satisfactory answer and there is always something more you need to learn.

The aforementioned simulation labs when used in place of this clinical education eliminate all of that.

As I mentioned in another thread. We live in modern times in the information age, there is no information that is not readily accessable anywhere at any time. But information is not knowledge, and should not be confused as such.

If you want to pass with the minimum, you need information. If you want to understand and excel, you need knowledge.

Remember the time you had to explain to the simulator that even though you already missed the IV twice she really needed it and you would have to try again, and she got more anxious and so did you, and she was complaining and screaming, all the while threatening to sue you and call your boss?

Exactly.

 

[mycrofft]

Do they have manikins which present with the distractors, false leads and subtle clues live patients present? Do they scream, defecate, vomit, get handsy with/on you?

Uh, all I was looking for was a "No"....

 

[Veneficus]

Uh, all I was looking for was a "No"....

They probably do. If they didn't give them a few months.

 

[mycrofft]

Not-cheap dates. But I bet you can use the commuter express lane on the freeway with one.