Holland Bloorview Kids Rehabilitation Hospital—Canada’s largest children’s rehabilitation hospital—began incorporating simulation within a year after the building was constructed in 1996. From early on, the hospital has developed a needs-based approach to simulation, meaning it has grown organically to reflect its needs.
Though not a “simulation centre” per se, Holland Bloorview’s Teaching and Learning Institute currently employs two labs/classrooms that are predominantly used for simulation-based education. It is also not uncommon for staff to use simulation outside of the classroom in the clinical setting, depending on the scenario. These facilities are available to a wide variety of groups and individuals, including researchers, students and hospital staff.
“For a system, by a system”
The Teaching and Learning Institute develops simulation scenarios for other programs and departments within Holland Bloorview. Their motto: “For a system, by a system”.
“We are mindful of how complex our healthcare delivery system is and we are extremely excited to build simulation opportunities which reflect that complexity,” said Dr. Kathryn Parker, the Institute’s Director of Academic Affairs and Simulation Lead. “In other words, building simulations which reflect the continuity of care within paediatric rehabilitation from a systems perspective is an exciting opportunity for Holland Bloorview.”
During September 2011, the Teaching and Learning Institute conducted an internal scan of the hospital where 19 student coordinators—representing various professional groups (OT, PT, SLP, Medicine, Research, etc.)—were assigned the task of surveying clinicians. In this survey, clinicians were asked to name the three skills (competencies) they hoped for students to have at the completion of their placement at the hospital.
“Our goal is to ensure every student that comes through Holland Bloorview has an optimal experience,” said Kim Jones-Galley, the Institute’s Student Coordinator. “My role as a student coordinator is to make sure we can.”
The responses—shared in October 2011—were aggregated into four large clusters:
1) Communication skills
- - Develop effective communication skills with team members
- - Demonstrate the communication skills and attitudes needed to positively impact team functioning
- - Listening skills
- - Develop comfort level with families so that they can share their stories with them in order to have a connection
2) Technical skills (specific to Rehab expertise)
- - Take a developmental history
- - Appropriate investigations
- - Use appropriate assessment tools
- - Assessment, implementation and evaluation of care plan
- - Competency in administering standardized tests appropriate to the population
3) Collaboration & team work
- - Ability to learn from and work in an interprofessional environment.
- - Develop collaborative practice with team members to achieve hopes and expectations of clients and families
- - Articulate the roles of several other healthcare providers
- - Identify ways in which their role overlaps with other healthcare professional roles
4) Professionalism
- - Development of the professional self (ability and confidence to give and receive feedback)
- - Increase motivation and passion for the profession
- - Development of professional values and ethics
- - An increased level of independence as a professional.
The Teaching and Learning Institute now uses this information—combined with interview responses conducted by Dr. Parker—to concentrate on developing these skills in hospital staff, with particular emphasis on communications and team building from a systems perspective. Communication, collaboration and ethical decision making are cornerstones of interprofessional education, and the use of simulation as a teaching tool for IPE continues to evolve at Holland Bloorview.
Using simulation to address internal processes: Code whites
The Teaching and Learning Institute uses simulation to help hospital staff with internal processes. Examples of this include issues surrounding hospital codes, including code whites and the unique modalities for responding to the needs of autistic children.
The issue of code whites and how it affects autistic patients first arose when staff from the hospital’s Child Development Program came to Dr. Parker, notifying her of the current challenges code whites pose to these individuals. The current procedure, they argued, was potentially harmful and confusing to autistic patients as people with autism are more sensitive to movement, sound and light. In response, the Teaching and Learning Institute, members of the Child Development Program and members of the Family Leadership program partnered with the
University of Toronto’s Standardized Patient Program (SPP) to produce an alternative scenario to alleviate these potential problems.
“Our hope is that this code white simulation will result in better care for our autistic clients and their families,” said Dr. Parker. “To this end, full engagement with our client and family members in the building process is integral to its success. We also hope that simulation will serve as a professional development tool as we continue to build our organizational capacity to work with autistic children.”
The Teaching and Learning team looks forward to building simulations following the code white “storyline” (i.e. what happens after the code white?). These “rolling” simulations are reflective of the continuity of care at Holland Bloorview.
The partners will show a live demonstration of the new scenario at Holland Bloorview on March 7, 2012 at Holland Bloorview’s 2nd annual Teaching and Learning Day. For more information, including attendance, please contact Dr. Parker at
kparker@hollandbloorview.ca.
Simulation and ethics
Holland Bloorview is also using simulation-based education to help learners use new tools. A while back, Maria McDonald, Bioethicist and Privacy Officer, constructed a scenario around an ethics consultation to help staff use an ethics worksheet more confidently during ethics conversations. Staff were feeling inadequately prepared to lead an ethics discussion and, as a result, McDonald was frequently asked to lead ethics discussions.
In response, McDonald asked the staff at the Teaching and Learning Institute to help develop a simulation exercise based on an ethics consultation that would teach staff members how to use the ethics worksheet to lead the discussion. The experiment was not only successful, but it also helped jumpstart conversations about different techniques to stimulate ethics conversations. Staff became more excited and began asking more questions. As a result, the hospital is now developing a new scenario involving ethics.
“Using this simulation process not only helped us become more confident in using the worksheet,” says McDonald, “it also prompted us to ask more questions on how to facilitate ethics consultations. This led us to then talk about other techniques for ethics discussions.”
The Teaching and Learning team, under the leadership of Darlene Hubley, Interprofessional Education Leader, has also developed a “New Student” simulation scenario to help clinical teams better deal with the challenges of integrating a new member to the team. This scenario is strongly related to interprofessional care and team building.
The educational impact of building scenarios
Of new interest to Dr. Parker is the impact of scenario building on learning. Dr. Parker and her team will start to examine the role of building simulations on members of the Holland Bloorview community. They believe it helps infuse energy in learners and has the potential to impact the “builders” of the simulation.
“Anecdotally, we are already seeing how constructing the simulation is impacting our clinicians and staff,” said Dr. Parker. “We intend to examine the impact of the building process in a more scientifically rigorous way in the coming year.”
For more information on Holland Bloorview’s Teaching and Learning Institute, please contact Barbara Smith at
bsmith@hollandbloorview.ca.