Combining Family Communication with
Advanced Medical Simulation
An Exploration of Hybrid Simulation
by Kavantissa M. Keppetipola
Second Year Medical Student, Rush Medical College
Dr. Lisa McQueen and Dr. Diana Mitchell, two Pediatric physicians at The University of Chicago Medical Center, are pioneering a new model of simulation training that integrates high-level medical and communication skills in critical care situations. These simulations address the specific needs of pediatric critical care situations, and can potentially minimize costs for expensive mannequins. Parents and family members are integral to the outcome of the simulation, but it takes special communication skills and professionalism to talk with them and address their concerns successfully, especially during the simulation itself, and especially if the simulation has a bad outcome. One traditional way of teaching those skills is through simulated patient encounters, but often the healthcare provider is already primed for the situation, and the experience is not as authentic as having to deal with those sensitive situations on the fly.
To that end, the team at the University of Chicago takes pediatric critical care cases that require advanced medical, procedural, and teamwork skills and combine them with a simulated parent. This adds another layer of reality to the case; in the real world, the family of the pediatric patient will often be close by and asking lots of questions of the healthcare providers. The team leader has to communicate with the family and the medical team simultaneously, which is a tough skill to master and has been tough to teach in simulations.
One way of dealing with parents is to ask them to leave the room, but if the team leader chooses to have the simulated parents leave, essential medical information will be lost. In one simulation of toddler with a suspected drug toxicity, the simulated parents had drug bottles with printed labels. The team leader initially asked the parents to leave, but then realized that the parent had essential information needed to treat the patient. The team leader then asked the parents to come back and communicate with them, creating a valuable teaching experience.
The presence of a simulated parent in the room also makes the simulation more realistic and creates an organic atmosphere in which the simulated parents can moderately improvise and add a dimension to the simulation. Other members of the healthcare team can be told to change the simulation by making an error in real-time to add more complexity. In one such simulation, one of the nurses on the healthcare team was asked to make an error on purpose during the case. Upon hearing of the error, the team leader reacted in surprise, and the simulated parent also reacted in surprise and shock. The team leader then had to address the medical error and assuage the concerns of the parent. In another simulation, a chaplain was called to facilitate communication, but the simulated parent thought that the presence of the chaplain meant last rites were going to be needed soon, and she became distraught. The simulated patients thus bring a valuable teaching experience to each simulation because medical team leaders need to be able to manage the entirety of the critical care situation, along with any medical or people-related complications.
This technique can still be applied to more traditional simulated patient encounters outside of the critical care setting. During an encounter in which a resident is asked to obtain informed consent for a blood transfusion, the encounter can teach how to establish trust in the doctor-patient relationship by having the simulated patient be distrustful due to issues the patient has had with past physicians. Another possible application is having participants deal with simulated patient parents who are against vaccinating their child during an encounter in which they must perform a pediatric spinal tap to confirm a diagnosis of meningitis due to H. influenzae. The possibilities are endless, but the common theme is using simulated patients to teach residents and fellows how to integrate patient communication skills while they are performing medical and procedural tasks.
Drs. McQueen and Mitchell’s next steps are to refine their process and get the necessary funding to incorporate more simulated family members in simulations. They want to incorporate more members of their actual healthcare teams into the simulations, so as to achieve as close to real-world conditions as possible. They are also planning to run hybrid simulations with their colleagues in related specialties including obstetrics, surgery, and and hope to expand to other disciplines. However, one of their main goals is to determine whether their simulations make a difference; they want to measure the impact of their simulations on the real-life care of their patients, and hopefully see an improvement in the latter as a result of their hybrid simulations. This is, as Dr. McQueen puts it, the “holy grail” of simulation research, and they welcome any ideas or input on how to best observe simulation impact on real-world outcomes.
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