Harbor-UCLA Pediatrics

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Harbor-UCLA Pediatrics: Inside the Simulation Center

The Sim Center has come a long way since 2011, when it was only beginning in earnest. Many of the programs and features that are present today existed only in the minds of Dr. Tom Kallay, Director of Simulation and Skills Center at Harbor-UCLA and his indispensable Simulation Coordinator Johnny DiBonaventura.
In 2011, there was no control room, no high definition televisions, and no video recording. There was, however, blue Cold War-era carpet -- a furry reminder that the space in which the Sim Center currently occupies was once a part of modest military barracks.

The carpet is gone now. Tiled floors now lie at the foot of million dollar equipment that peppers the Simulation Center, which today stands vastly improved and more widely used compared to its early days in 2011.

Who Uses the Sim Center?
Since 2011, we've had 17 divisions and departments participate from our campus. A lot of people—about 1,500 per year--surgery and surgical sub-specialties, nursing, pediatrics, Peds ICU, anesthesia, and so on. We are even having some allied health care technicians come through as well. Two research projects have been completed there to date; one educational and the other centered on improving patient safety. We are also looking forward to participating in a couple grant projects which are in the works.

How did you get involved in simulation education?
I enrolled in a medical education fellowship in 2006; this is where I was introduced to simulation-based medical education. It was during this fellowship that I developed the idea of starting a simulation program here at Harbor-UCLA. In order to assess and develop campus interest, I met with various program directors or their designees and formed a small group of interested individuals.

We had representatives from Nursing, Surgery, Obstetrics, as well as Emergency, Family and Internal Medicine. My goals for these meetings were to declare the campus-wide interest, and to begin to develop a framework for a multi-disciplinary Simulation Center for the Harbor-UCLA campus. In 2009 Dr. Darrell Harrington, head of the Graduate Medical Education Committee, designated us as a GMEC Subcommittee. We were now official.

How did you eventually get the Sim Center started?
In 2010, I arranged a meeting with the acting Chief Medical Officer, Dr. Gail Anderson. He believed in my vision of starting a medical simulation center for Harbor-UCLA, a center which would be open to all members on the campus that would promote education, patient safety, and research. I will always have tremendous gratitude for Dr. Anderson's trust in me; the Simulation Center at Harbor-UCLA would not be in existence if it was not for his support.

Space was an issue. Nothing was available in the hospital, so I looked around the LABioMed campus. With the help of my Division Chief, Dr. Richard Mink, we were able to locate an unused lab in building B4 North. It was an animal research facility that had not been utilized for a few years. I presented my idea to the LA Biomed Space Committee in early 2011, and they granted me permission to utilize the space for simulation education.

Once I had the space, I needed someone to staff it full time. This individual needed to have experience in medical simulation, and have the skills required to operate simulation equipment and software. By chance, I had met Johnny DiBonaventura at Providence Little Company of Mary who was functioning as a simulation technician for their simulation center. He was doing simulation work there for the nursing department, but wanted to expand his experience.

I recruited him to come to Harbor as he had the skill set I was looking for, and the opportunity to work with multiple disciplines was something he desired. He made the decision to join the project, as he recognized the opportunity to build a unique and multi-disciplinary simulation center from the bottom up. He has been outstanding in contributing to the growth of the Center and fostering a productive environment.

What is the purpose of the Sim Center?
The Simulation Center exists to promote education, patient safety, and research while utilizing innovative educational techniques. Simulation-based medical education provides a venue for health care practitioners to practice medicine in an environment that is safe for both the learners and patients. Virtually anything that occurs in the hospital can be simulated—acute medical or surgical conditions, procedures, or even difficult conversations. It is a place where trainees can be introduced to new equipment or medical devices which they will soon be using on real people, or practice team function and communication.

It is important to understand, however, that simulation does not replace real patient interaction, but serves as a safe training ground to prepare for when you're actually dealing with real people. It just makes sense –- if you're going to learn how to use this laparoscopic tool – so you can safely to cut and suture with it --why not learn to do it on this (pointing to a laparascopic trainer) before using it on an actual human being.

What's the temperament of people who use the Sim Center?
When I'm doing a session in here, I make it clear that this is a safe place: a place to learn, a place to make mistakes. In the hospital, if a mistake is made, a common reaction is to be very hard on oneself. However, this reaction can be a hindrance to what the greatest professionals do: consistently strive for improvement. What we are trying to do is promote healthy reactions to mistakes; while not downplaying the significance of what occurred, it must also be looked at as an opportunity to improve. Mistakes are learning opportunities, and we actually encourage them in order to expose gaps in knowledge or skill. We promote a much more relaxed atmosphere than at the hospital. That being said, it can get tense.

When we start a scenario, we observe from the control room that initially people may be joking around a little bit, but when the manikin begins to decompensate with the alarms going off, and the nurse is saying “What are you going to do? What would you like me to do?” we notice how they get involved in the scenario as the moment intensifies and they start to sweat a little. That is when we know we are succeeding, as they are practicing to be functional while emotions are high—like in the real world.

What happens after Scenarios?
Every department is different, but usually the session is debriefed by a faculty member. Issues such as team function, communication, and medical decision-making are discussed. Debriefing is a technique that takes practice as well—you want the learners to learn and not feel embarrassed by their actions. I usually supply some written material containing the objectives pertinent to the scenario. Others utilize video recordings of the sessions to highlight learning points. Either way, the debriefing session is an integral part of the simulation exercise.

Can you talk about the equipment you have?
We have been fortunate to obtain a significant amount of simulation and medical equipment. This includes high-fidelity mannequins which simulate a full-size human being with life-like physiology, task trainers which are 3-dimensional representations of various body parts designed to allow for procedural practice, or laparoscopic surgery trainers. The manikins breathe, talk, have pulses, and have functional pupils among other capabilities. We have also been fortunate to procure donations of medical equipment such as ultrasound machines, ventilators, and a bronchoscopy cart. We developed a relationship with our warehouse to supply us with expired medical supplies such as central lines, IVs, and endotracheal tubes.

How do you procure this expensive equipment?
We've been creative about getting our equipment. We have been able to access funds through the Committee of Interns and Residents as well as the Pediatric Trauma Fund, given our dedication to educating healthcare trainees across all disciplines. Some of our manikins have also been obtain through grant support.

We were also able to obtain much of our capital equipment such as crash carts and defibrillators when MLK closed down. They were redistributing the equipment throughout the county and we were granted permission to obtain some of it. Johnny and I are always looking for opportunities. The amount of expired equipment and supplies is truly mind-boggling from our facility alone, and we offer an alternative to adding to our landfills: use it for simulation education.

What's in the future for the Sim Center?
Johnny and I hope that the work we have done thus far will provide a foundation of simulation education at Harbor-UCLA, and contribute to fostering a culture of collaboration and teamwork through training. We would like to be an integral part of training programs, and while fulfilling professional medical education requirements, also contribute to improved patient safety and outcomes. In addition to education, we also foresee ourselves participating in grant as well as simulation education research.

To date, over 3,500 physicians, nurses and allied health care professionals have come through the simulation center since March of 2011. Our attendance has increased by an average of 37% per year, and we intend to continue growing. We are fortunate to be on a campus as unique as Harbor-UCLA, to work with some of the best trainees, faculty and administration—as this is what truly makes the Simulation and Skills Center at Harbor-UCLA a special place.