Over ten years ago, the Macy Foundation supported the Center for Medical Simulation with grant funding over three years to develop a program for training instructors to effectively use simulation. That funding catalyzed what has become the world’s largest program for using simulation to develop health professions educators. It’s often said (partly in jest) that simulation is an excuse to do a debriefing. But, simulation is also a vehicle for faculty development; an opportunity for healthcare educators to get some formal education to become better teachers. It’s those teachers who have the power to change the world for the better, through changing the attitudes, behaviors and clinical performance of their students, from pre-licensure to practicing clinician.
CMS (the real CMS, not the one with two “M’s” in its name) was one of the world’s first simulation programs; we’re in our 23rd year. We started out doing simulation-based training for crisis management in anesthesia and expanded into other domains. The focus of our training for medical professionals is on using simulation for training in teamwork, particularly through courses in crisis management. We do that through highly realistic scenarios, conducted in a “virtual hospital”—a physical facility that seems like a real medical environment. Everything is real, except the patients, which are life-size, computer-controlled mannequins that do many of things real patients do, e.g., breathe, have a heartbeat and pulses, eyes that open and close and that even can have conversations with their healthcare providers through the projected voice of an actor. Such facilities are now commonplace throughout almost the entire world. Many or most focus on teaching clinical, technical skills required for delivering healthcare. The primary rationale is that it’s safer and better to practice via simulation first and thus not expose patients to risks during the process of training clinicians. But, training for teamwork and crisis management is equally important and there are other applications for healthcare simulation as well.
It is during debriefing of simulation scenarios, by discussing with their instructors and peers what they have just experienced, that students really learn. We at CMS realized long ago that the way to positive changes in healthcare, to make it safer, more compassionate, patient-centered and effective is through the teachers. We thus concentrate our efforts on using simulation as a catalyst for instructor training We don’t teach how to operate the mannequins, but rather how to use simulation to become a better educator.
Instructor training via simulation
Partnering with our colleagues at the Stanford Palo Alto VA, led by Dr. David Gaba, we started our first instructor program in 1996. But it wasn’t until the Macy Foundation grant that CMS created its Institute for Medical Simulation (IMS) program. The IMS started in 2004 and, to date has taught more than 3,000 clinical educators from around the world. This year, the IMS will conduct a total of 26, 4- and 5-day instructor-training courses at CMS’ Boston facility and at host sites around the world.
The focus of the training isn’t the technology; it’s on helping HPE educators connect with their students using simulation-based scenarios. Those scenarios are the material for the participants to explore their personal strengths and weaknesses and to identify how health professions can work better together in interprofessional teams.
My life’s work and passion has been around patient safety; simulation is my instrument. To leverage that instrument in ways that will foster safer care, providers need to learn how to develop open, honest working relationships. By having frank, respectful conversations about what went well and what didn’t go well – and why—in a simulation, healthcare providers learn how to have those same kinds of conversations in the real world.
What is it that simulation instructors need to learn?
The objective of CMS instructor course is not primarily to inform but to transform. IMS courses use simulation to teach simulation. The teacher-student gets to feel what it’s like to be a student in simulation, building their own scenarios and practicing debriefings on each other – all with the expert guidance and feedback from CMS faculty. Doing effective debriefing is challenging. It requires new perspectives about the teacher student relationship and introspection and self-reflection of the teacher. It requires motivation and commitment for the teacher to become learner-centered, to push him/herself first to understand their own teaching behaviors and to develop skills that can change their learners’ behaviors.
This transformation and mastering the skill of debriefing is not easy stuff. Instructor courses are intense. They are not a collection of lectures but a carefully crafted set of modules that build on one other. The curriculum has been honed over the years and continues to evolve as we hone our message guided by feedback from participants. In addition to the basic instructor course, the advanced courses further develop advanced debriefing skills and help others to develop their own in-house instructor programs.
Are we making a difference?
It’s hard for any education program to measure what difference it’s making in the world. We do know that dozens of the graduates of IMS programs have become leaders nationally, internationally and in their own local programs. What they tell us is that doing the kind of debriefing taught at CMS is challenging. They don’t get it right immediately and need continuing practice and feedback to refine and enhance their skills.
From the great number of anecdotes and the blessing we receive from continuing connection of IMS grads to our faculty and their colleagues, we know that there has been a wrinkle and perhaps a little positive shift in the energy of the world. There is a growing cadre of committed simulation leaders and educators who are making a difference in their local, regional and national healthcare and education communities. Teachers are our collective leverage for change. We’re really appreciative of the Macy Foundation for having provided the critical funding that made it possible to get this growing community of change agents on this path.
Jeffrey B. Cooper, PhD, is is founder and Executive Director of the Center for Medical Simulation and Professor of Anaesthesia at Harvard Medical School and Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medicine. His landmark research in medical errors in the 1970’s is one of the roots of the patient safety movement. Among his awards are the 2003 John Eisenberg Award for Lifetime Achievement in Patient Safety from National Quality Forum and the Joint Commission. He is the only non-physician awarded the Distinguished Service Award of the American Society of Anesthesiologists. Learn more about CMS.