How to Implement Psychological Safety in Simulation

How to Implement Psychological Safety in Simulation

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How To Implement Psychological Safety In Simulation

Psychological safety is a crucial concept in the context of education, particularly in simulation-based training, as it plays a vital role in creating an environment where learners feel safe to take risks, make mistakes, and learn from their experiences. Some people have trouble learning how to implement psychological safety in simulation, and Simulation Nation is here to help!

Simulations are particularly conducive to establishing psychological safety. They provide a controlled and realistic environment where learners can practice their skills and decision-making without real-world consequences. In such simulations, errors are not failures but opportunities for growth and improvement. Instructors play a significant role in setting the tone for a psychologically safe environment by fostering an atmosphere of trust and respect.

Amy Cowperthwait CEO, RN, MSN, CNS, CHSE-A and Megan Weldon sit down with Simulation Nation this week to talk about how to implement psychological safety in simulation.


Be Psychologically Safe

If you enjoyed our guide to Implementing Psychological Safety, check out more episodes of Simulation Nation below, and subscribe to our podcast and Youtube so you never miss an episode!

Full Transcript:

00;00;00;00 – 00;00;17;16
Nate
This episode of Simulation Nation is brought to you by Avkin Inc.. Your one stop shop for wearable simulators and everything. Standardized patient.

00;00;17;18 – 00;00;21;25
Megan
Hello, everybody, and welcome to Simulation Nation.

00;00;22;01 – 00;00;22;28
Amy
One day.

00;00;22;28 – 00;00;26;04
Megan
We are going to be talking about all things psychological.

00;00;26;04 – 00;00;26;26
Amy
Safety.

00;00;26;29 – 00;00;37;05
Megan
So this is a topic that well, let’s let’s be clear in simulation. Psychological safety. In simulation, yeah. We’re not sure about external things here. We got to keep it limited. If we.

00;00;37;05 – 00;00;38;18
Amy
Can’t cover all those topics, in.

00;00;38;19 – 00;01;00;17
Megan
Part, we’ll go to five. They’ll be like nine, 9 hours. So I think the important thing that we talk a lot about with psychological safety is that we’re going to kind of go through a checklist here. But I think the important part is psychological Safety is not a checklist. It’s not just to go through and check the boxes, but it really is a culture that needs to be created inside of your simulation center.

00;01;00;20 – 00;01;26;00
Megan
It needs to be the director of simulation being the one to really kind of forefront that or, you know, whoever is your main simulation person needs to be the one leading that charge, but it needs to be carried out through students tyrannized, nice patients, faculty members. But really anyone who’s going to be a part of it needs to all kind of come together to understand the importance to make sure that simulation is safe for students to participate in.

00;01;26;02 – 00;01;51;20
Amy
Yeah, and I think that there is a within the Association of Standardized Patient Educators, there is one of their domains is safety. Right. But I don’t it’s domain. Yes, but but it’s not specific in the health care standards to best practice. It is woven throughout. So it’s kind of the same idea of your SIM center needs to have psychological safety woven throughout.

00;01;51;23 – 00;02;17;09
Amy
But really, you know, if you think of kind of like one of its pillars or one of its main focus is if you guys are writing for accreditation, psychological safety could be one of the main pillars that you’re really trying to, you know, enforce or uphold. And again, if you don’t have psychological safety, at the end of the day, you’ve just you’re either undoing any learning that they’ve done or they aren’t learning at all.

00;02;17;09 – 00;02;26;26
Amy
Like, I mean, best case scenario is that they’re not learning. But yeah, but even worse is that you are potentially undoing things or creating false frames.

00;02;26;28 – 00;02;58;25
Megan
Well, and also creating further trauma for being able to participate then in psychologically shape simulation. And I’ve heard that a lot from hospital educators where they will have people coming in that are just absolutely terrified of simulation because some of the noxious experiences that they’ve had in their undergrad programs, which then makes them hesitant to really open up and participate in their graduate programs, to be able to fully immerse themselves because simulation wasn’t done well or it wasn’t done correctly.

00;02;58;28 – 00;03;08;14
Megan
And so not only is it undoing learning, but then it’s starting to prohibit future simulation learning because there’s a fear or stigma around it.

00;03;08;16 – 00;03;33;15
Amy
Yeah, and I I’ve shared this story before. It it took me many years to talk about this. And it’s not something that happened in simulation because they didn’t have simulation where I was in a nursing school. But one time I was I made a critical error with a pediatric patient. And it wasn’t it didn’t hurt the patient. But I basically left the side rail halfway down and went to the sink, which was about five feet away.

00;03;33;17 – 00;03;53;07
Amy
And my instructor walked in the room and saw that I hadn’t put the side rails all the way up and I knew I was supposed to, I was being lazy and it was wrong and I got reprimanded for it. But what happened in post conference with all of the other nursing students there is that he knocked on my head and asked if anything was in there in front of all of my all of my peers.

00;03;53;07 – 00;04;22;28
Amy
And I was so embarrassed by that. And it was something that that I like. I’m getting tearful about it, but it was something that brought trauma forward, even as to whether I was going to be a good nurse. And I think that it can if you are if you’re not careful and if you’re not very intentional with how you enact, you know, your policies, procedures, your culture, your simulations, your debriefing processes, all of those things, if you’re not thinking about that, you actually could be doing more harm than good.

00;04;23;00 – 00;04;41;02
Amy
And it is something I think a lot of us have those stories and get a lot of us from, you know, back in the day, I guess, and maybe even today. But we don’t. We don’t that is not helping anybody be a better nurse. Yeah. And and I think that it’s just really important that we spend time on this and that we have the discussion.

00;04;41;04 – 00;05;01;08
Amy
It is something that we talk about quite frequently and is very near and dear to our hearts. We’re really kind of going to go in two pieces with this. So there’s the psychological safety that we all, as simulation is, are very aware of as far as learners, psychological safety. But then there is another aspect which I mentioned a little bit, but the standardized patient psychological safety.

00;05;01;08 – 00;05;18;06
Amy
So when you have standardized patients and again, that’s that’s our specialty, that’s our expertise, that’s our wheelhouse. We also want to speak to that. So this is going to be kind of in two parts. The other piece of this that I want to put a kind of as a disclaimer is we’re not going to cover every single aspect.

00;05;18;06 – 00;05;52;20
Amy
What we’re trying to really do here is point out some things that are not super clear in the literature. So your debriefing style, your pre briefing pieces, we’ll go over that a little bit. But there is a lot of really good literature about about what to do for that, but really almost trying to kind of think about things that we’ve heard along the way as we’ve done consulting or as we have interacted with other simulation, is that they struggle with to point out some things that maybe are happening that you’re not even aware that could be contributing to either negative culture or some other psychologically safe pieces.

00;05;52;20 – 00;06;16;07
Megan
Yeah, And I think the unique part here is, you know, from my perspective as someone who is a serious patient for many, many years, I saw the full gamut. And most of the time I’d say 95% of the time no one is intentionally trying to create an unsafe, psychologically environment. Right? They’re trying to create an environment that is learning and things like that.

00;06;16;12 – 00;06;45;16
Megan
But I think just personalities and things that come up, it leads to these comments or situations that they’re not aware how formative these are for students. And being that kind of third party watching, you know, being there but not really being observed or notice that I’m there, I’ve seen the gamut of what can happen with small comments, small decisions that can then lead to environments and again, being able to kind of share some of those.

00;06;45;18 – 00;07;04;22
Megan
But I think some of this can be there’s two portions here where you can look at it in terms of comments that are made or situations that arise. But then there’s another component that Suzy touched on Ricci recently, Suzy Card, and again, she posted on LinkedIn basically in all caps and just put do not scare your students in simulation.

00;07;04;25 – 00;07;29;26
Megan
And I think that this is a mindset or culture that has to be reprogramed. I think when we started in simulation, there was this mindset of Let’s throw the book at them. They got to learn everything. We got to put everything out there. We got to give them all of the worst patients that could have possibly happened. And I hear that more frequently from other facilities haters, that when you have other faculty members come in to play the role of the patient.

00;07;30;02 – 00;07;51;07
Megan
So not your typical standardized patient, but when you have another faculty member come in, they want to then portray the worst, all of the worst patients that they’ve ever had. They want to combine all of them into 1 – 30 minute segment to kind of see and test the students and kind of, I’ll throw out this test and see how they bite that image throughout this test and see what happens here.

00;07;51;09 – 00;08;12;24
Megan
But the going off the rails happens much more frequently. Frequently with having other faculty members play the role of the patient because they are trying to, you know, show them all of the possibilities. And I hear that more frequently than I do with standardized patients going off the rails. I feel like that’s the more common thread that I hear in simulation.

00;08;12;24 – 00;08;26;13
Amy
Yeah, I think Suzy being at Harvard, you know, that’s really kind of the hotbed of psychological safety and simulation and, you know, the idea or the concept of don’t scare your students in simulation. It’s kind of like that’s just a fundamental. Yeah. So I love.

00;08;26;13 – 00;08;30;21
Megan
We want it to be fundamental, right? Because I still even hear people who will be like,

00;08;30;21 – 00;08;41;10
Megan
you know, I’m ready to do this really hard them. And those are the conversations that scare me in terms of like, that shouldn’t be the exciting part of simulation that we are getting under student’s skin.

00;08;41;13 – 00;08;47;18
Amy
Yeah, but I think I think fundamentally, like what you said at the beginning, is that nobody’s doing this with the intention to hurt the students.

00;08;47;18 – 00;08;52;05
Megan
I think the mindset is it’s fun. I think it’s kind of this like, well, it’s a fun situation.

00;08;52;06 – 00;09;02;05
Amy
From a from an educators perspective, you feel the weight of the responsibility of preparing the next generations of learners. And one of the things that I teach in

00;09;02;05 – 00;09;20;18
Amy
that to the to the standardized patients when we teach their patients is you have to think of learners as a as a as a sculpture and that you’re working on pieces or bits of their time, but you’re not going to go and start taking the chisel and hammer to the middle of the piece and start, you know, not being carrying huge shells fall off.

00;09;20;18 – 00;09;44;22
Amy
So it is one of those things to almost give the facilitators or the simulation educators permission not to complete their education in one course. Yeah. To, you know, help them understand. And and I think by and large, most educators understand it, but because there’s such a limited time in simulation, the idea is, let me get as much out of this as possible.

00;09;44;25 – 00;10;00;12
Amy
But what ends up happening is it does overwhelm them. But let’s get some let’s get back to some of the fundamentals of this. So I want to make sure we mention it. And it is like I said, there’s plenty out there in the literature, especially if you go to Google Scholar and you type something in and there’s a link off to the right,

00;10;00;12 – 00;10;02;19
Amy
it’s a free article, it’s an open access article.

00;10;02;19 – 00;10;05;22
Amy
So if you don’t have a great library of

00;10;05;22 – 00;10;20;15
Amy
books or if you’re not a member of some of the associations that have journals, there are still plenty of resources. The health care standards at best practice are free resources and free access that you can get at any point in time. I think So to get let’s start with the

00;10;20;15 – 00;10;20;27
Amy
top.

00;10;20;27 – 00;10;28;09
Amy
Okay. So in simulation planning, the very beginning of this. So if you think of the the context in the background,

00;10;28;09 – 00;10;41;20
Amy
what are the needs, Where does it what what need? And I’m not saying needs as in multiples. I’m saying what is the where are the gaps in education? And it could be something there that nclex scores aren’t scoring high enough or it could be something where

00;10;41;20 – 00;10;44;29
Amy
employers are reporting back that there’s a deficit.

00;10;45;02 – 00;10;53;07
Amy
It could be that there’s been a new addition to the curriculum or there’s been something identified by an accrediting body. So where are the needs?

00;10;53;07 – 00;11;15;10
Amy
Clinical faculty are coming back and saying that students are struggling in a particular area, whatever it is, where are the needs? And then the objectives you need to limit the. There are more often than not when we’re working with faculty that don’t have a large experience in simulations, they want to put five, six, seven objectives in the simulation because again, they’re trying to, you know, accomplish a lot.

00;11;15;12 – 00;11;17;17
Amy
But think about the idea of

00;11;17;17 – 00;11;35;13
Amy
limiting it to three. And really what happens is if you can kind of separate those objectives and actually improves learning because now they’re able to draw on prior knowledge that they’ve had from their classroom or maybe clinical experiences. They’re drawing on that knowledge and then they’re adding to it.

00;11;35;13 – 00;11;43;21
Amy
And so limiting those objectives and creating a simulation that is focused on one thing, you’re going to get much more bang for your buck.

00;11;43;24 – 00;11;59;22
Amy
A lot of times you think of simulation as Let me do the extraordinary right. I can’t go into the hospital and have somebody have an acute MRI on the unit that day so my students can see it. So let me let me bring that out in simulation, which is great,

00;11;59;22 – 00;12;07;26
Amy
but not for a fundamental student. Right? So thinking about your level of learner and what is it that at the end of this course.

00;12;07;26 – 00;12;33;29
Amy
So go back to your course of objectives. What is at the end of this experience, at the end of this semester? Do we do we want these students to be able to accomplish? But maybe it’s a little bit more challenging or a little bit more difficult in a clinical setting or maybe we’re augmenting. So I can remember early on this goes back to the don’t scare your students, but we I’m not a psychiatric nurse, but we did three psychiatric simulations.

00;12;33;29 – 00;12;52;08
Amy
One was depression assessment where the patient was suicidal and had run their car into a brick wall at a high rate of speed. And the students had to go in and do a depression assessment and safety assessment. The other one was a psych psychotic break where they actually had to put the patient in four point restraints

00;12;52;08 – 00;12;52;27
Amy
safely.

00;12;52;27 – 00;12;56;24
Amy
And again, we had a lot of you know, a lot of

00;12;56;24 – 00;12;58;05
Amy
safety regulations in there.

00;12;58;05 – 00;13;19;07
Amy
We’ll talk about the pieces of that. And then the third one was a patient who was borderline alcoholic, and they had to go through motivational interviewing techniques. And what came back to us from the psych psychiatric clinical instructors, what was it? The students were scared to go into clinical because they thought that they were going to get at one of those three particular interactions.

00;13;19;09 – 00;13;39;16
Amy
And so this so we did our simulations before they went into clinical. So we added at the beginning of the semester just a psych intake where a patient had a little anxiety or a little depression, but it wasn’t as challenging of a patient portrayal, and that was to give them an idea of what they’re probably going to see.

00;13;39;16 – 00;14;01;21
Amy
So rather than just the most challenging psych mental health cases that they may have, we also added in some other. So they had a point of reference and it wasn’t anxiety, it wasn’t reducing anxiety for them. So that was something that we learned along the way. And obviously, you know, I feel like I started not with the dinosaurs, but at least with the alligators, maybe the early start.

00;14;01;24 – 00;14;03;10
Amy
They’re really reptiles. I don’t know.

00;14;03;15 – 00;14;31;16
Megan
And I think the important thing there to highlight is why we’re talking about objectives in terms of psychological safety, is because when you approach the simulation to be more challenging than what the learner can handle, it creates an improper power dynamic where you are basically setting them up where they will not be successful. If you are including seven objectives with a fundamental student with something that is well beyond what they would be expected to know at that time.

00;14;31;21 – 00;14;37;12
Megan
And that’s what creates that psychologically unsafe environment when you’re trying to put too much into the simulation.

00;14;37;13 – 00;15;04;28
Amy
Well, it’s actually it goes into the idea of cognitive load theory. So if you think about being overloaded, is that the gap in knowledge is too great? So if you think about we used to do all of our simulations before we did clinical and then we had to move our curriculum change. So we had to move to a model where basically we were doing the same simulations we won with the students that were in the course as we were doing in week 12.

00;15;05;04 – 00;15;23;06
Amy
So the people that were doing the simulations in week one, they hadn’t gotten the content and they were doing two or three different simulations. So we had to be very intentional about our prep work for that. And also to help them understand that this is going to be a challenging this is going to be a challenging simulation for them.

00;15;23;06 – 00;15;43;11
Amy
And I don’t necessarily condone that that style, but it was something that we didn’t have a choice based off of the way that the curriculum moved. So to think about putting things in context, the psychological safety of this is making sure that your students understand that the simulations have been created to stretch them to the edges of their ability.

00;15;43;11 – 00;15;47;22
Amy
So you’re almost saying this is going to feel a little uncomfortable for you.

00;15;47;22 – 00;16;05;25
Amy
And you’re also saying, hey, if you feel as though at any point in time you’re overwhelmed or overloaded, that’s where that whole safe container concept comes in that that they’ve introduced at Harvard, where, you know, there’s almost a blue square on the floor or there’s somewhere that they can go just for a minute to think.

00;16;05;25 – 00;16;07;14
Amy
And it’s kind of like a timeout.

00;16;07;14 – 00;16;17;19
Amy
And I think that’s more applicable in a CSP simulation than it actually is in a mannequin simulation, because the if the ESP can see them in that safe container, they know they just need a minute

00;16;17;19 – 00;16;18;03
Amy
again,

00;16;18;03 – 00;16;30;11
Amy
from the idea of creating that simulation with the right objectives, you’re putting some of these things in place to make sure before the simulation even starts that they know that we’ve created.

00;16;30;11 – 00;16;51;02
Amy
This is a stretching ability. Harvard also comes out with that the you know that the mantra and it’s I say it as a mantra, but it is not something that you should just have your facilitators read in pre we think that it is something that you need they need to believe and embrace is the idea that everybody that’s entering to do these simulations is intelligent, capable and cares about doing their best.

00;16;51;09 – 00;16;56;29
Amy
And I think again, what I always say to the students when they’re struggling with,

00;16;56;29 – 00;16;57;29
Amy
you know, particular,

00;16;57;29 – 00;16;59;03
Amy
you know, concept

00;16;59;03 – 00;17;10;20
Amy
or doing something and they don’t know what to say to the patient is to to remind themselves and to remind the patient I’m here to help. Right. Because there’s times where you’re not you’re you’re you’re stuck. Well, it’s the same idea.

00;17;10;20 – 00;17;34;29
Amy
You want the facilitators to be reminded. This is this is what we believe. And you also want them to embrace that. Yeah. At the same time. So that’s that culture building policies and procedures go a long way. So thinking about having pre briefing scripts with help to help new facilitators, peer evaluations, peer to peer evaluations to make sure that everyone is running the simulation

00;17;34;29 – 00;17;40;25
Amy
the same way and facilitating the simulation in a way that is going to be beneficial for the students.

00;17;40;28 – 00;18;01;11
Megan
And I think making sure that there is an environment that students can come forward and be able to share feedback about the simulation or the facilitation that they got, because I’ve heard that several times that people will, you know, have conversations with me, whether it be through consulting or whatever, but they’ll say, the students just don’t like to go into difficult sets.

00;18;01;12 – 00;18;25;00
Megan
They just they just don’t like that. And I think that there’s an element that, yes, being uncomfortable in simulation doesn’t feel great, but I do think that it does call for at least looking at the simulation to see are we jumping the gun here? Are we putting too much in this simulation that they haven’t actually gotten necessarily in class or things along those lines or looking at the facilitation?

00;18;25;02 – 00;18;46;14
Megan
You know, as a serious patient, I had experiences where I’ve seen facilitators run through one of our psych sims that we had done for seven years. It’s all done the same way over and over and over again. And then we went through a new training process and we brought in three new facilitators for that one SIM and I got to see all three of them on their own.

00;18;46;14 – 00;19;09;04
Megan
I saw them in training and then I saw them when they did it themselves. And when I saw it, there was a very big difference to how they were approaching it. And one in particular was very aggressive, very aggressive in the debriefing process when other people were in the room. That is not how she presented herself. But in the debriefing it was very, you know, why would you choose to do that?

00;19;09;04 – 00;19;32;15
Megan
What was the thinking behind that? You know, pretty much again, is there anyone in there without necessarily saying is anyone in there? And I remember that two students had come forward saying something and they came to me because I was a part of the SIM and basically saying like, did you notice anything? Did you see anything? And I was like, It is a very different style than other facilitators at that point.

00;19;32;23 – 00;19;50;19
Megan
That led to additional conversation. But I think that in that peer review, a lot of times it is the mindset of I’m going integrate a friend or someone that I work with. I don’t necessarily want to be critical, but it is the checks and balances, and I think it’s the very rare situation that someone’s coming in observing you, right?

00;19;50;19 – 00;20;13;07
Megan
It doesn’t feel always great to have that. But having that sterilized patient or listening to those learners, I do think that it at least can bring up the conversation that you’re acknowledging it and not just brushing it off kind of with an eye roll or something along those lines that they don’t want to be stretched. I think that there are elements that that can be the case, but there’s also situations where there is something different that might be happening that you’re not fully aware of.

00;20;13;07 – 00;20;17;23
Amy
And that’s where you’re, you know, again, anonymous evaluations

00;20;17;23 – 00;20;39;10
Amy
and not just for the whole SIM, but that you are finding out what date and time that simulation was happening. And, you know, you’re making sure that there isn’t any inconsistencies and things along those lines. There’s a lot to be said for having that checks and balances, right? So ASPs are evaluating the learners as far as giving feedback.

00;20;39;16 – 00;21;02;01
Amy
ASPs are, you know, maybe even giving feedback about the facilitator. Facilitator is giving feedback about the you know, I mean, if you think about it, if you if you think about Pam Jeffries theory, there’s these dynamic interactions. And when I wrote the article on adding standardized patients to that theory, you have other people now in the room, and so they’re really should be checks and balances all the way around.

00;21;02;01 – 00;21;08;12
Amy
I think as far as the simulation, we’ve talked a lot about making sure that that simulation is stretching students, but it is not

00;21;08;12 – 00;21;10;17
Amy
it is not pushing them.

00;21;10;19 – 00;21;12;01
Megan
Over the edge. Yeah.

00;21;12;04 – 00;21;24;26
Amy
And I’ll say that over the years there’s it’s not even if you have 100 students that are in the same class and in the same cohort and go all through this, you’re going to have a bell curve of students. So students that are struggling

00;21;24;26 – 00;21;30;21
Amy
and students that that perform and get to the objectives in a much shorter time frame.

00;21;30;23 – 00;21;54;16
Amy
And what I would always say to my students and on camera, you’ll be able to see this. But but if you’re just listening to it on a podcast, I’ll try to describe it. But what I would always say to the students, especially the ones that maybe weren’t as prepared as the others or struggled a little bit more, is if you can if you come into simulation with this much knowledge and I would put my hand about about a foot of my knee and I can get you to this much knowledge.

00;21;54;16 – 00;22;11;21
Amy
And I would raise my hand about six inches. But then I would say my other hand about six inches over top. But if you come in to simulation with this much knowledge and I would put my hand up now to there where they’re even so in other words, they came into the simulation with more knowledge, I can help you get to this much knowledge.

00;22;11;23 – 00;22;40;01
Amy
So if students are struggling with just basic knowledge and I commonly it was a pathophysiology where they struggled or even anatomy and physiology where they would struggle if they they struggled in some of these foundational courses. It was really hard to get them to understand how different medications would interact or, you know, how how some type of chronic condition would impact the physiology of a patient.

00;22;40;03 – 00;23;00;03
Amy
So so the idea is you can’t necessarily get someone who’s at the lower end of that bell curve to meet even the middle of the bell curve. You can get them up and get them farther a bit long and also work with them to try to do some remediation. Right. But you cannot necessarily stretch them farther.

00;23;00;07 – 00;23;00;19
Megan
Yeah.

00;23;00;24 – 00;23;01;15
Amy
And so back.

00;23;01;15 – 00;23;25;10
Megan
Down and get them from a two to an eight in one simulation. It’s what you were talking about earlier with being able to mold and do kind of the the sculpture and things like that. It’s like you’ve got to take little pieces at a time. This is not the goal. Should not be that you’re going to get them from that to to that eight by just telling them everything that they’re doing incorrectly, that all of a sudden they’re just going to magically understand and then be able to be at that top of the bell curve.

00;23;25;12 – 00;23;38;01
Amy
Or that you can have that expectation. You really need to meet learners where they are. And that’s and that’s the sign of a really good educator as well as a facilitator. But I think in simulation, because the groups are smaller, you just have more opportunity to

00;23;38;01 – 00;23;45;20
Amy
see where each student is individually. So rather than a test grade, it’s really how are they able to critically think, how are they able to

00;23;45;20 – 00;23;54;17
Amy
take what they’ve learned in there with their knowledge, you know, with the with the contextual knowledge that they have and now put it into actual action.

00;23;54;17 – 00;24;12;14
Amy
And then I think what you were kind of talking about with the debriefing piece of this right, you were alluding to that. But we have seen, you know, there’s tons of different debriefing styles. There’s tons. But I think it’s very, very important that when we are considering all the different debriefing styles

00;24;12;14 – 00;24;19;18
Amy
that you have some consistency, that when you’re educating new faculty that there is some standard of

00;24;19;18 – 00;24;31;14
Amy
that and that you are even providing them an outline or what we had was an index card honoring and for each simulation they would have some pointed questions

00;24;31;14 – 00;24;34;05
Amy
and that followed the style of debriefing.

00;24;34;07 – 00;24;53;05
Amy
And where were appropriate for the objectives that were set. And I think that it’s really important that you are helping a lot of times when we talk to in our consulting, there’s multiple different campuses and not every campus does it the same way.

00;24;53;05 – 00;25;04;17
Amy
Whoever is your SIM champion, if there’s one sym champion at one campus, that is really kind of leading that for all of them, that same champion then needs to help those other campuses,

00;25;04;17 – 00;25;08;11
Amy
whether they have the power or the ability to do that, I can’t say.

00;25;08;13 – 00;25;12;24
Amy
But what I will say is that there is not a dean or director

00;25;12;24 – 00;25;30;03
Amy
that I have ever met that would not say that it is important to them that we are following best practice standards, that I will say I don’t think that anyone has ever said, Hey, it’s not that important. It’s best practice. Isn’t that great? Because we are health care providers and best practices.

00;25;30;03 – 00;25;38;08
Amy
So incredibly important. So from my perspective, the idea of pointing it back to best practice standards,

00;25;38;08 – 00;25;43;14
Amy
advocating for a full time swim champion that is

00;25;43;14 – 00;25;45;04
Amy
helping to reinforce

00;25;45;04 – 00;25;46;27
Amy
the standards of best practice.

00;25;46;27 – 00;26;01;05
Amy
It may not happen tomorrow, may not happen next week, but I will say that rather than just saying they’re doing it wrong or the student students hate simulation, but to say we are not following best practice standards is really the best approach.

00;26;01;05 – 00;26;02;17
Amy
In my mind, it’s the best approach.

00;26;02;17 – 00;26;07;05
Megan
So how would you say that having different debriefing styles ties back to psychological safety?

00;26;07;05 – 00;26;07;18
Amy
So

00;26;07;18 – 00;26;32;00
Amy
as far as that, again, thinking about how if a lot a lot of places that I’m referring to, they have adjunct faculty. So an adjunct faculty member is someone who is a bedside clinician that agrees to come and take a clinical group for a semester into the clinical setting. But a lot of times associated with that is a day or two of simulation.

00;26;32;02 – 00;26;49;24
Amy
And that clinical or adjunct faculty member is expected not just to be a clinical instructor, but to be a simulation instructor. And they’re not the same thing. So if the clinical instructor runs that debriefing session as if it’s a post conference in,

00;26;49;24 – 00;26;52;01
Amy
in the hospital, you,

00;26;52;01 – 00;27;01;11
Amy
you have a they’re not following a debriefing style. It’s a different it’s just a very different way of communicating and they also

00;27;01;11 – 00;27;07;17
Amy
become a bit I mean, and I’m not I’m generalizing and stereotyping here, but they become a bit concerned about the state.

00;27;07;20 – 00;27;37;18
Amy
They are these students going to make a mistake in the hospital with the patients? Because as a clinical instructor you have eight or nine or ten students. You can’t possibly be in all rooms at all times. So they want to fix the learners in the debriefing process. And the way that learners learn in debriefing is by self-reflection and by peer discussion rather than the instructor saying, You did this right, you did this wrong, you don’t do that.

00;27;37;18 – 00;27;39;10
Amy
You could kill your patient, right?

00;27;39;10 – 00;27;42;15
Megan
Or you just did. You just didn’t kill your patient right there.

00;27;42;16 – 00;27;44;25
Amy
Yeah. So so what happens is

00;27;44;25 – 00;27;45;22
Amy
it’s just it

00;27;45;22 – 00;27;55;12
Amy
what makes a good clinical instructor, even if they are a psych clinical instructor, does not necessarily mean that they are a good simulation. Debris for or instructor.

00;27;55;12 – 00;28;12;03
Megan
Well, and especially with that practice, I think that’s the key part that is always missing is that when you’re bringing someone in as adjunct faculty to fill in for simulation for a semester or for a month or whatever it may be, simulation and debriefing is a learned skill that comes with time. I think it’s a love that grows.

00;28;12;11 – 00;28;31;12
Megan
I don’t think that there’s a lot of people who are like, I love simulation. That’s why I got the job. I think a lot of people were like, I just volunteered for this job and then eventually ended up falling in love with it. I think that’s the more normal whole track that a lot of people took or they didn’t know what they were getting into when they signed up for simulation and that eventually, like, really, this is awesome, I love this, but that seems to be the normal track.

00;28;31;17 – 00;28;49;28
Megan
So when you have people who are coming in who don’t necessarily love simulation, you then don’t have policy and procedure for what your standards are in terms of how you do debriefing, what your debriefing style is. You don’t have a training process for training them on how to debrief and then you put them into simulations. They will just do your best, right?

00;28;49;28 – 00;29;07;04
Megan
I think that’s the normal situation that ends up happening and from there I think there is expectation that you’re just going to magically know what’s in my head and that’s just going to magically, you know, through osmosis. You’re just going to know and be able to run into that debriefing room and be able to run that the way I would.

00;29;07;11 – 00;29;23;01
Megan
And I think that that’s not a fair expectation. But when you can go from a top down situation, because I think a lot of times we go bottom up and look at it as like they’re the problem, it’s the issue. We can’t have this. But if you look it from a top down situation, you say, I can’t control who’s going to come in, because again, a lot of us.

00;29;23;01 – 00;29;27;15
Megan
And so we don’t have control over hires. We don’t have control over getting the help we need.

00;29;27;18 – 00;29;29;14
Amy
Probably the people that are listening to this do.

00;29;29;14 – 00;29;32;26
Megan
But yes, well, we want to advocate for being able to get help. We need.

00;29;32;26 – 00;29;33;11
Amy
Definitely.

00;29;33;11 – 00;29;59;21
Megan
But I’ve seen a lot of changes and a lot of turns over the last few years, honestly, since COVID. But a lot of times I think people are just feeling powerless. What we can do inside of simulation as simulation champions is work on developing policy and procedure that goes back to best practices, like you said, because then you can say, I’ve developed a policy and procedure manual on simulation that follows all of an actual SSA to best practices director.

00;29;59;23 – 00;30;23;27
Megan
Please feel free to review. Right. And like you’ve said, they’re not going to look at that and go, We don’t need stared as best practice here, right? For the most part, there will always be exceptions. For the most part, they will accept that as best practice once you have that is policy and procedure for your simulation lab, you now have a leg to stand on when bringing in adjunct faculty to say Our policy is we need three days of training.

00;30;24;02 – 00;30;44;10
Megan
We need, you know, all of these things. They need to have remediation, they need to be followed, they need to shadow, they need, you know, all of these pieces. And what will come out, I’m sure, is, wow, that’s a lot of investment for simulation faculty to be involved. Right. And then you say, yes, it is. It is a big investment because we have to stick to sense the best practice.

00;30;44;10 – 00;30;53;14
Megan
Here we go. And if you are an accredited sim center, that kind of argument just goes out the window because then you’re accredited. So to keep up your accreditation, well, this is just what it has to be. But I.

00;30;53;14 – 00;30;56;09
Amy
But my experience is that you still have to fight for.

00;30;56;09 – 00;31;02;03
Megan
It. I think it’s always a fight. I don’t think anyone in simulation ever goes, yeah, everything is so easy.

00;31;02;07 – 00;31;03;00
Amy
Full budget.

00;31;03;01 – 00;31;08;22
Megan
They love it. Everyone adopts it, right? I think it’s always feels like a fight, but you at least have.

00;31;08;22 – 00;31;10;28
Amy
Some should say, advocate, advocate.

00;31;10;28 – 00;31;30;23
Megan
Advocate, Advocate is the right word, but at least you have some sort of backing because I feel like without that policy and procedure, without that training manual, you don’t have a place where everyone can come and agree because then you just have, you know, well, Susie says this and Sarah says this, right. It’s just it’s two different things that it’s two different opinions.

00;31;30;28 – 00;31;47;21
Megan
But when you now have policy and procedure to back what you’re saying, yeah, it’s a different conversation. So that is what I always encourage people when they come to me about, you know, changes coming in and who’s coming into this lab to do briefings and skills lab and all of these things. I always say to them, What does your policy procedure look like?

00;31;47;21 – 00;31;55;00
Megan
Because that’s the easiest way to start. To create a framework you have to be able to get by from leadership, but it creates a framework.

00;31;55;00 – 00;32;05;27
Amy
And I will say that I did we definitely did that backwards. I yeah, I didn’t have strong leadership training or really understand the importance of policy in procedure. It took us a long time to get to policy and procedure.

00;32;05;27 – 00;32;08;19
Megan
It was a highly west. It’s just the Wild West. For a long time.

00;32;08;21 – 00;32;17;11
Amy
It probably should’ve been the first thing we talk about because I think that that actually even goes in before you’re setting the objectives or doing your needs. Assessment is what is your policies and procedures behind this?

00;32;17;11 – 00;32;23;29
Amy
There are great there are so many same centers. Again, simulation is share. So simulation is help, Simulation is guys.

00;32;23;29 – 00;32;26;19
Amy
There are lots of people that are willing to share their policies and procedures.

00;32;26;19 – 00;32;34;21
Amy
You don’t have to start with nothing. Yeah, chappy is another option, but just know that there is a lot of people out there that are willing to share theirs.

00;32;34;21 – 00;32;34;26
Amy
And

00;32;34;26 – 00;32;44;21
Amy
so don’t be afraid to ask, you know, look at three, four or five. See what is integrated. You talked about the idea of accreditation. The other idea is endorsement through an axel.

00;32;44;21 – 00;33;12;06
Amy
So, you know, an actual will endorse you to say that you’re doing good. Sam, If you are endorsed, there’s going to be some standards. Yeah. There is also some good reinforcement through the National League for Nursing. So there are options out there. But I think the easiest, the path of least resistance is to start with that policy and procedure and have that be your foundation for everything else that you do and your decision making and your advocacy.

00;33;12;06 – 00;33;40;11
Amy
So if, you know, again, we had to change our curriculum, now all of a sudden they wanted to include clinical instructors and it just because we had policies and procedures that required training and required all of those things and things got to the point where we had identified simulation champions and simulation faculty. One of the things that Sam Houston does is they have specific faculty that are trained to do all of the pediatric simulations.

00;33;40;11 – 00;33;59;26
Amy
So that subject matter expert is the facilitator for all of the simulations in pediatrics, which I think is really cool, right? So they’ve invested in a few more simulation faculty members, but they they’ve invested in people that are SIM champions within each of the different specialty areas that they have simulations in, which I think is a great.

00;34;00;02 – 00;34;08;17
Megan
my God idea. I completely agree. It really helps with especially including standardized patients. It really helps with creating that standard. Yeah.

00;34;08;20 – 00;34;08;29
Amy
Yeah.

00;34;08;29 – 00;34;27;20
Megan
All right. So let’s talk a little bit more about these heroes patients side of things, because there is similar to what you were talking about with Pam Jefferies simulation model and then you going in and adapting it, including to your nice patients. It really does change the conversation because there is a whole nother component that comes along with this.

00;34;27;23 – 00;34;44;00
Megan
So whether it just be serious patients or also a serious patient educator, but both of those people are now a new member inside of it. It’s kind of like I don’t know how to think of in terms of like family realms, but it’s like if you just had you and your kids and like, that’s how you guys operate.

00;34;44;00 – 00;34;52;06
Megan
And then now there’s a new step mom and, and you stepped out of what, like, I don’t know how to say it, but it changes the family dynamics. Everything just changes inside.

00;34;52;06 – 00;34;53;20
Amy
That’s exactly how Pam describes.

00;34;53;20 – 00;35;07;08
Megan
Yeah, we got to rethink it all. We got to rethink the way that life was before, because now we have these two new people and they just assume, no, you guys are just going to blend in the way that we do with our mannequins and basically, like this is all just going to flow the same way it did before.

00;35;07;09 – 00;35;08;24
Amy
Retract, mannequin insert.

00;35;08;24 – 00;35;31;13
Megan
ESP exactly as if it’s just that easy that you’re going to start to face some challenges. So being able to just first address the fact that there will be changes if you do start with your nice patients and then eventually add a serious patient educator. When you’re adding that educator in, it’s the same thing. You’ve got to go back through your dynamics and rethink how this is going to work, even just from basic communication.

00;35;31;13 – 00;35;54;17
Megan
I’m going to start with what you’re looking for, though. In a standardized patient that creates psychological safety, because we were talking earlier about the culture of creating that in the center, you’re seeing your nice patients are also a crucial member to make sure that they are also psychologically creating a psychologically safe environment. So we are looking for theirs, but we also want to make sure that they are exuding that.

00;35;54;19 – 00;36;09;29
Megan
So one of the key things you’re going to look for is when you’re bringing in a standardized patient, always start with interviews and auditions. And one of the things you’re looking for is if someone says that they want to fix health care or they want to fix the health care providers, that should always or if they’re.

00;36;09;29 – 00;36;12;07
Amy
Describing noxious experiences with.

00;36;12;09 – 00;36;35;22
Megan
Bad, yes, those should all be red flags, because when that happens, what the road down, what’s going to happen down the road is that they will start to take over the debriefings. They will come into simulations with a chip on their shoulder or an agenda that they’re ready to talk about. They will also feel like because they maybe had those experiences, they know better, that they know what it’s really like to be the patient.

00;36;35;28 – 00;36;51;27
Megan
So they’re not going to necessarily only stick to the objectives they might add in their own objectives that they want to add in to get points across. That is not a person that should be a serious patient. They might be an amazing patient advocate. And I say this a lot. Patient advocates say drives patients not to say.

00;36;51;27 – 00;37;02;15
Amy
So I’m going to talk a little bit about the characteristics of what you’re looking for with a C or an ICE patient to make sure that they are creating a psychologically safe and culture for simulation. So the.

00;37;02;15 – 00;37;03;02
Megan
Learners.

00;37;03;05 – 00;37;25;20
Amy
For the learners. So again, not just looking out for their psychological safety, but also that they are exuding psychologic safety. So part of that would be doing an interview in an audition you want to catch in the interview. If someone is there to try to fix health care providers, we want to make sure that when they’re coming in, they’re coming in with a mindset of, look, maybe they want to volunteer and that’s fine.

00;37;25;26 – 00;37;31;08
Amy
But we also just want to make sure they’re not coming in with a chip on their shoulder to try to fix anybody. I think that’s the big thing.

00;37;31;13 – 00;37;42;27
Megan
Like, if they’ve had noxious experiences with health care or they have some type of chronic health condition or a family member does, and they haven’t necessarily had great experiences, that’s not necessarily the person that you would select. Yeah.

00;37;42;28 – 00;38;02;11
Amy
For you. And I think you can usually read that you don’t need to get too far into anything. You can normally tell through basic conversation is this someone who has a chip on their shoulder or not, but just know that kind of through the conversation you can usually determine that the next part would be in the audition phase looking for anyone who leans towards a hyper emotion.

00;38;02;18 – 00;38;19;26
Amy
So anything you obviously want there to be some emotion and some baseline things. But anyone who’s going to go from a 0 to 10, which is not appropriate for the simulation or for the scenario that they’re portraying, you want to coach them and say, okay, that was a ten. Let me see you out of four, Let me see you at a five.

00;38;19;28 – 00;38;47;27
Amy
And if they’re coachable, you can work with that. That makes sense that you have the ability to work through that. But just someone who’s not coachable, who is leaning to the highest level of those emotions, that can now very negatively translate into simulation that’s going to affect sterilization, which you don’t want, but it’s also going to really, again, could be a very noxious experience for those learners if they go into that same and then that serious patient is overly emotional and that what you want the last piece

00;38;47;27 – 00;38;52;06
Amy
similar to the coaching notes in terms of their performance, but also in their feedback.

00;38;52;10 – 00;39;13;20
Megan
Well, before we get into that, I just want to say something because as a simulation educator, I hear every I can hear everybody that’s listening to say, I don’t have time for interviews and auditions and we don’t have time for the mannequins to break down either. Right? But if you take the time in the beginning and lay that foundation, you end up with such a better result at the end.

00;39;13;26 – 00;39;30;18
Megan
So just just so you know, we did a 15 minute interview and a 15 minute audition. Yeah. And we would stack them. We had certain times and we would do one right after the other, and we had you. It was basically at that point Meghan was working as a SEM

00;39;30;18 – 00;39;32;03
Megan
intern, I guess would be,

00;39;32;03 – 00;39;38;01
Megan
and Rob in doing the interviews and then my myself, sometimes I would be there.

00;39;38;01 – 00;40;04;08
Megan
But typically Allen, we had our educator as champion doing the auditions. So it’s not you don’t need, you know, ten people there. No, you don’t need gobs of time. I think we spent probably a total of 7 hours at the end of every semester. So the way that we hours was an actual course. So the students that were enrolled in the course had to go through an interview and audition before they would be accepted into the course.

00;40;04;10 – 00;40;06;22
Megan
So we did it before enrollment. So

00;40;06;22 – 00;40;23;23
Megan
we knew one, we knew how many students were probably going to sign up and two, they knew that they could sign up for the course. Yeah. So it was about a month before this the semester ended that we would do that and it was a grind, but it was worth every bit of time that we did that.

00;40;23;23 – 00;40;39;15
Amy
Yeah. My other recommendation would be if you are looking for how to conduct it, because we’ve heard that several times, they don’t know how to conduct an interview and audition. We do a lot of webinars on it, so just be on the lookout for when Avkin’s going to be putting out a webinar on interviews and auditions because it’s something we’re very comfortable with.

00;40;39;15 – 00;40;55;17
Amy
And I think that a lot of people get very intimidated by the thought of it. It’s very simple. I feel like every time we do, it’s like it’s so easy, you know, it’s very basic, but it is nice to have a framework going into it if you’ve never done it before. Yeah, yeah, great. So the other piece would be with the feedback.

00;40;55;17 – 00;41;19;28
Amy
So thinking about that same concept of coaching, you want them to be coachable in their feedback. Feedback is a skill that needs to be learned from your nice patients. It is not the opportunity of just, okay, start talking and let’s see what happens over the next, you know, 5 minutes of you speaking. It is a very structured way of approaching it and we do the same watch technique just because it’s easier with steer nice patients being able to teach them the same technique.

00;41;19;28 – 00;41;27;09
Amy
We don’t teach them the debriefing techniques and things along those lines we go through and we teach them feedback skills there. That’s where they do.

00;41;27;09 – 00;41;30;24
Megan
We do teach them what when they will be asked for their feedback.

00;41;30;26 – 00;41;52;13
Amy
As a part of the debriefing. Right? But inside of their own debriefing, we coach them on what are the appropriate feelings of the patient. We don’t want them to say things that are very harsh, especially when it’s not appropriate for the level of what’s actually taking place. So if they were to say, the patient felt violated when you touched my arm to give a blood pressure.

00;41;52;18 – 00;42;20;22
Amy
Right. That’s not appropriate. That’s an extreme word for what actually happened. So we really make sure that we are coaching them and that they know the weight of their words for the people that are coming in. And that’s something that we really, really focus on. And a next piece is that in the characters, Gretchen, they always know the level of learner and during dress rehearsal we really make sure that they are aware that they are not there to expect a fundamental student to be the same as the nurse that they see in the hospital.

00;42;20;22 – 00;42;38;10
Amy
It is not going to be the same and they need to have appropriate expectations of what those learners are going to be. Sometimes that comes with coaching, sometimes it’s hard to get that across and they may not be the right person, but it is important to know that they need to know the level of learner and that their expectations are appropriate in regards to feedback as well.

00;42;38;13 – 00;42;57;02
Amy
So sure, the next component is thinking about the psychological safety of the series patient. So not only what they’re bringing to the table in terms of being able to make it psychologically safe for the learners, but also making sure that that other live person in that simulation is also safe. So ask me the Association of Standardized Patient Educators.

00;42;57;08 – 00;43;14;11
Amy
They’re very first domain is safety. So discussing the safety of the series patient. So that can be physical as well as psychological. The very first component when it comes to psychological safety is we allow any serialized patient to opt out of simulation at any point.

00;43;14;11 – 00;43;20;29
Amy
There is no expectation that they have to be a part of the given simulation that they were assigned to.

00;43;21;02 – 00;43;28;00
Amy
Even if they agree to it, they sign up for it and then later on find out that there’s a component or a piece they don’t want to be a part of.

00;43;28;00 – 00;43;39;17
Amy
It is a no harm, no foul situation. They can at any point opt out of that simulation because we don’t want them to ever feel pushed or pressured to go into a simulation with something that they’re not comfortable with.

00;43;39;23 – 00;44;01;18
Amy
So really, at any point, right up until this time, even in this room, they have the option to opt out of that simulation. And because of that, we try to do extensive training, making sure that they are fully aware of it. So part of that is during the dress rehearsal, they do act out that role. And again, at that point they are able to opt out of the set because now they actually get the full understanding and are able to act out that patient.

00;44;01;21 – 00;44;26;20
Amy
The next component is just the physical safety. When you are thinking of doing a SEM, I always want people to think about themselves doing that simulation. So if that means that, these three students are now going to move this patient from this bed to, you know, a chair lift or something along those lines. Right. Think about are you comfortable with that level of learner putting you in a lift and moving?

00;44;26;22 – 00;44;50;04
Amy
Does that feel safe? If it does feel free, if you’re like, absolutely not. There’s no part of me that would be doing that. Do not ask another person to do it. Do it themselves. That also goes back to thinking about masks, thinking about other clothing items, asking people to rewear things. Just think about if you would be comfortable doing it.

00;44;50;10 – 00;44;56;11
Amy
Ask your standardized patients. If you’re not comfortable doing it, you shouldn’t be asking someone else to do that thing.

00;44;56;11 – 00;44;58;16
Megan
So I have a funny story with that one. And

00;44;58;16 – 00;45;18;17
Megan
one is the idea or the concept that there is obesity suits that are out there and they I believe they were made for the mannequins. Yes. But there are times where, again, some well-meaning instructors think I want to do an obesity SEM. Let’s have our standardized patients wear this.

00;45;18;19 – 00;45;33;29
Megan
And I had one particular instructor and I was trying to explain to them, Hey, this isn’t an appropriate ask because they’re going to have to wear there’s no way to clean it and wipe it off. So, you know, the wearable simulators are that can makes all of them wipeable, They’re clean.

00;45;34;05 – 00;45;39;04
Amy
You wear because I knew I was going to wear it after people. So I made sure that they were easy to clean.

00;45;39;04 – 00;45;41;15
Megan
Sure. And that’s the important part. But

00;45;41;15 – 00;45;57;24
Megan
what I said to that instructor was, if you’ll wear it at the end of the semester after everybody else has worn it and you’ll wear it, then, then we can do it. And she’s like, Absolutely not. And they said, That’s exactly what you’re asking faculty. So that’s just one way to advocate.

00;45;57;24 – 00;45;59;14
Megan
Again, it’s it.

00;45;59;16 – 00;46;05;25
Amy
It all sounds great. And then it’s the realities that really start to change that concept.

00;46;05;28 – 00;46;27;04
Megan
And I think think that they are human beings. They are real people with real emotions. They may have had. You know, you talk about that they could opt out in the midst of a simulation or they could they may have had no experiences with anybody with breast cancer prior to the semester and be fine. And then all of a sudden a close loved one gets diagnosed and then it’s too close to home.

00;46;27;04 – 00;46;38;25
Megan
Yeah. So again, think about it from the perspective. And because we taught a course, there was still a power dynamic. We really had to be very clear that it was okay that you could opt out.

00;46;38;25 – 00;46;59;06
Amy
Yeah, and there was Anonymous opt out opting out and things along those lines. But I think the other component with opting out is remembering to, like you said, things change. I was the person that prided myself that I could do anything, I could do anything, I could do it anywhere. You know, I remember me in another escudos, which was like shave my head, put me in the bath.

00;46;59;06 – 00;47;12;04
Amy
No, I don’t care. I’ll do whatever it takes. And I was the same way. I was like, Whatever it is, I’m down for the same. It’s super fun. I want to do it. And then I had a baby. And when that happened, all of the sudden, any type of pediatric

00;47;12;04 – 00;47;21;04
Amy
like again, fatal, anything that was even just like a bad injury, anything like that all of a sudden was just a no go.

00;47;21;06 – 00;47;45;16
Amy
I could not. I can’t I can’t do it. It just every time I think of my own child. And so all of the sudden, someone who prided themselves on being able to do anything and everything now had this huge okay, this whole catalog is now off limits. I can’t do any of that anymore for the time being. And maybe it will change once my child gets older and they’re no longer in that age group of 18 months and things like that.

00;47;45;23 – 00;48;09;03
Amy
But it was a huge shift and it was even harder as we speak because it was something that I like to do. And I in my head I’m like, No, it’s fun. And then I’m like, No, but you won’t have fun doing it anymore. Like you got to remember that. But it is this challenge of us. Yep. So having that from the educator and also other faculty members being able to say like it’s okay to not do it for an hour, it’s okay to opt out, it’s okay to change your mind.

00;48;09;05 – 00;48;19;19
Amy
And being very open to that, I think also helps that serious patient because sometimes they don’t even really know what those limits are until they’re actually in the bed. And then it it really changes things.

00;48;19;19 – 00;48;30;08
Megan
And it’s also, you know, telling them if you get a spidey sense in the midst of trying to read this character description or maybe they’re watching a video in preparation, if there’s just something that feels off.

00;48;30;08 – 00;48;44;02
Megan
Yeah, but again, it’s very rare that it happens. Yeah, but it is something that you do want to give them permission. They are human beings, they have emotions and we should not be doing further emotional psychological harm to anybody.

00;48;44;02 – 00;48;50;07
Megan
So yeah, it’s just something that again, as we covers it, but we want to make sure that we’re talking about that.

00;48;50;07 – 00;49;11;00
Amy
We don’t want to do any harm to any live people in simulation ever. And then just the last part is just considering, again, going back to the physical safety, not only the movements and the changing them from beds and things like that, but also what’s in the room. I heard a very scary story once. I was not a part of this is a different institution, but they had a defibrillator in the room.

00;49;11;03 – 00;49;17;23
Amy
A live defibrillator? Yes. Something that worked. And when they they just had it there because it was just it makes them look like they.

00;49;17;23 – 00;49;19;19
Megan
Had done a different sim earlier that.

00;49;19;19 – 00;49;37;12
Amy
Day. But they were like, it’s who cares? It’s just in the room, right in the room. So this them with a live person and nothing to do with needing the defibrillator. And when the student walked in the room with the stair nice patient when they saw it, they assumed that they were supposed to use it in some way.

00;49;37;12 – 00;49;38;24
Megan
As a proper form. Yeah.

00;49;38;27 – 00;49;44;21
Amy
So it got to the point that this defibrillator that ended up on the table and I don’t think that they actually.

00;49;44;23 – 00;49;48;02
Megan
Scooted it over its own wheels, so they scooted the cart over towards the patient.

00;49;48;02 – 00;49;53;03
Amy
And I think that it was next to them for a period of time, and I don’t think it ever ended up on the patient.

00;49;53;03 – 00;49;54;22
Megan
And no, they called they had to call the they.

00;49;54;22 – 00;50;15;25
Amy
Called it before it ended up actually on the patient. But there is a real concern that if someone was not paying attention, if someone was left the room to go for a bathroom break really quick, again, having these live pieces that can be used that could actually potentially cause harm. So think about your fake medication. Think about, you know, all of these other things that could be in the room.

00;50;15;27 – 00;50;18;10
Amy
You want to make sure that all of those things are removed.

00;50;18;13 – 00;50;39;17
Megan
So, Sharps is the other consideration to make sure that if Sharps are a part of the simulation that they’re in the pre briefing discussed where the patient can be stuck, what is the whole safety protocol? It needs to be a part of the dress rehearsal so that the nice patient is fully aware of that. And then during the pre briefing it needs to be discussed if not shown, which I Yeah.

00;50;39;23 – 00;50;42;00
Megan
Showed so that they are aware of where.

00;50;42;00 – 00;51;09;05
Amy
That injection pad will be on the belly or it will be on the left bicep, whatever it is that needs to be made very clear. But you also need to have a safe word. Yes. Or an ab band. Yes. To allow the ESP to identify if they feel unsafe, if they’re unsure because I think as health care providers, we know we wouldn’t take any of that simulated medication because we don’t you know, it’s not.

00;51;09;08 – 00;51;11;00
Megan
It’s been there for years, probably.

00;51;11;00 – 00;51;14;23
Amy
Whatever whether or it’s you know, please don’t have any expired medication.

00;51;14;23 – 00;51;15;26
Megan
No. To do that.

00;51;15;26 – 00;51;19;07
Amy
But whatever whatever the case may be, Again,

00;51;19;07 – 00;51;26;01
Amy
you as an educator know what is acceptable and what isn’t. But you can’t assume that a non clinical health care provider would know

00;51;26;01 – 00;51;42;09
Amy
it. So they need to know do not allow them to put a needle anywhere but in the F stick or in an injection pad or wherever. Right. And they need to know that there’s four layers of safety and they have sticks that they’re not going to get, you know, harm to.

00;51;42;09 – 00;51;53;06
Amy
Again, you’ve done a lot of work to make sure that the SPS are safe, but conceptually, where can they do this? Because if they feel unsafe, they need to be able to identify that.

00;51;53;13 – 00;52;01;03
Megan
Well and this and this patient needs to know all of this as well. Again. Yes, I have gotten stuck in the past. It has happened. And again.

00;52;01;08 – 00;52;02;25
Amy
Not what I was the facilitator.

00;52;02;25 – 00;52;19;24
Megan
But that’s the kind of stuff that for me I was like, it’s fine, it’s okay. I’m not going to break this again. This whole, like, overtly, like, dedicated to being a serious patient looks fine. It’s cool, it’s fine. But when we would train on it, it’d be like, no one’s getting stuck. This simulation will end before that happens.

00;52;19;24 – 00;52;35;06
Megan
Break the simulation. And that’s where we came up with the safe word and things along those lines so that there was the ability because at that time I would have just been like, Stop, don’t do that anymore. I didn’t have a way of ending it. So having that safe word where it does pause the same, it stops everything.

00;52;35;08 – 00;52;45;24
Megan
But also on the AV being there is an orange button that the nice patient can press, and then that comes back to the facilitator in the room so they know that something’s wrong. They need to end the simulation.

00;52;45;24 – 00;52;52;14
Megan
But with all of that, the biggest thing is if you’re going to have sharps because it’s a part of the SIM, it has to be like a well-choreographed dance.

00;52;52;18 – 00;53;03;07
Megan
Everyone needs to know their part. Everyone needs to know what’s happening. If it is not a part of the sim, do not have it in the room, just take it out. It’s not. It is not worth the risk of having it in the room.

00;53;03;09 – 00;53;11;04
Amy
Well, this has been our time for a simulation nation on psychological safety with students and standardized patients. Thanks for joining us.

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