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"What's so beautiful about simulation when it comes to the safety front and the quality front is that simulation, if done right, could really tackle areas of deficiencies and nightmare (situations)," says Dr. Amitai Ziv, deputy director of the Sheba Medical Center in Israel and founder of MSR, Israel's Center for Medical Simulation. Simulation allows all interested parties (e.g., staff, volunteers, family members) to learn what to do in tough scenarios before encountering them in the real world, where the consequences can be more severe. Simulation has the concepts of reflection, debriefing and transparency embedded within it, and can only enhance safety and quality education and care, as Dr. Ziv explains in these videos.
Dr. Ziv describes how to involve clients, patients and families in designing, building and evaluating simulations. Patients and families should be involved in needs assessment and program planning because they can help to identify problems in areas where practioners think everything is fine.
Dr. Ziv talks about the cultural shifts that are required for a simulation program to succeed. He notes that often, training involves only students, doctors and staff who are new. Dr. Ziv argues that for real change to occur, senior staff must be involved in the simulation program.
Dr. Ziv describes how to use video and video observation rooms to help students and professionals learn from simulation and reflection. The key is providing the time and opportunities to review simulations, involving staff or other professionals with simulation training experience and allowing participants to review videos at home so they can reflect on their responses and actions.
Dr. Ziv discusses maximizing learning by engaging in active observation – "being in the hot seat." Given the time and financial constraints of the average hospital, how long a participant spends "in the hot seat" (i.e., actually taking part in a simulation) will be limited. But by providing structured opportunities for other participants to take part in the debriefing, participants can gain from the experience, even if they didn't take part in the simulation.
Building a simulation program can be daunting, particularly in a psychiatric facility. Dr. Ziv talks about what needs to be done to make the program a success, including performing a needs assessment to identify gaps and deficiencies in the system, and then designing a program driven by that assessment that ties in with the hospital's quality care and patient safety goals. Simulation in psychiatry faces other unique challenges: "The reality of psychiatry is tough," says Dr. Ziv, with patients who might be "unpopular" or not as compliant, and who might also be struggling with discrimination and issues of informed consent.