DeVry Medical International’s Institute for Research and Clinical Strategy Provides Innovation in Healthcare With Simulation & Beyond

devry healthcare simulation

Did you know about the innovative healthcare technology based learning programs at Devry International University? The Institute for Research and Clinical Strategy (IRCS) at DeVry Medical International (DMI) is a dedicated academic unit committed to researching and developing simulation technology as it pertains to clinical education.

Medical Simulation

One problem plaguing medical and nursing educators is a lack of good clinical sites with the ability to provide a standardized, comprehensive clinical experience. That’s why DMI has turned to simulation centers and technologies to supplement preliminary in-person patient encounters.

The benefits are immeasurable. First, the controlled environment of the simulation center provides students with increased competence and confidence in a number of skills before they enter clinical environments with live patients. By allowing faculty to create and replicate various scenarios, students log practice hours in a true-to-life environment that may not have been possible in a conventional clinical setting. And by supplementing with simulation technologies, students are afforded an arguably more thorough learning process than live clinical experiences alone can provide. The end result is increased patient safety.

Mobile Applications

Games are an effective source of entertainment, with the best ones engaging players in skill building, strategy, and competition. With the prevalence of mobile devices, gaming has taken a turn for the convenient, as mobile users are able to challenge friends from any location and at any time of day. What if we could harness the intrinsic engagement of mobile gaming, and leverage it to build practical skills in the medical and veterinary world? Through strategic partnerships with Games Learning Society and Learning Games Network, DMI has done just that.


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With mobile game-based simulations, medical and veterinary students have access to a range of designed experiences — from hand washing to emergency patient intervention — to facilitate practice and mastery before interfacing with live patients or animals. Each of these game-based mobile applications records user proficiency in the given task. For faculty, this means continuous access to students’ progress; for many students, though, this also means friendly competition and enhanced engagement through learning as game-play or performance.

Virtual Learning Environments

Chamberlain College of Nursing offers post-licensure educational opportunities through use of a virtual learning environment, used in tandem with traditional clinical placements. The current environment, called Second Life, is a virtual, three-dimensional application that is fully interactive and mimics the real world through the use of avatars.

These types of learning environments in the field of nursing are growing in popularity since they have become an opportune adjunct to practicum sites. One major benefit of a virtual learning environment, like Second Life, is that it can provide some of the necessary experiences for students, without relying solely on external sites. Additionally, faculty have enhanced control over the student experience in Second Life and the option to tailor scenarios to curriculum and student need.

Second Life allows students to navigate real-world scenarios in realistic environments that may not have been possible on-site. These experiences include but are not necessarily limited to patient interactions. For example, Second Life provides students the opportunity to explore and renovate an abandoned wing of a hospital to accommodate a new a cardiac wellness center that has a working budget. In traditional practicums, budget details are not shared with students; in the virtual learning environment, though, faculty can create such scenarios to help students develop the skills they need to assume their future roles.

These developments have reshaped the learning landscape by creating new opportunities in the Master of Science in Nursing (MSN) degree program’s indirect care tracks at the graduate level, while supporting learning in the Doctor of Nursing Practice (DNP) degree program, Bachelor of Science in Nursing (BSN) degree program, and Registered Nurse (RN) to BSN online degree completion option.

Learn more at the IRCS Website!


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Plymouth University Pennisula Offers Postgraduate Certificate, Diploma and Masters in Simulation & Pt Safety

post graduate healthcare simulation masters diploma certificate

Do you train healthcare providers or organise systems to improve patient safety? This three year masters programme will enable you to apply innovative educational methods and processes to improve patient outcomes. Explore an in-depth range of simulation-based learning techniques and be equipped with the skills required to plan and conduct your dissertation. Be primed with the advanced knowledge and understanding to confidently lead improvements in the quality of patient safety in your workplace.

In your first year, you’ll explore a range of simulation-based learning methods that can improve patient safety and quality of care through enhanced learning. You’ll also advance your knowledge, understanding and skills in patient safety and the application of these to your own workplace. You’ll be introduced to the role of human factors and develop a critical understanding of the current state of patient safety within healthcare and examine strategies to improve it.

In your second year, you’ll be provided with the knowledge and skills associated with the project design, development and knowledge transfer process. You’ll also explore the physical and psychological links between organisations, employees and their work environment and how the concept of human factors influences the way we work. The use of simulation for training and assessment of human factors will be integral to the module.

Key Program features

  • Your learning journey – this three year masters programme will be delivered part-time following a one day induction event which covers masters level learning, the Managed Learning Environment, library resources and the programme structure, aims and outcomes. The programme will include four taught modules, plus the dissertation, totalling 180 credits.
  • Alternatively, choose to study full time – this is particularly suitable if you are undertaking an intercalated degree from medicine or dentistry. Taught modules will be delivered in the autumn and spring terms. You’ll be supported by a PUPSMD staff member and can attend seminars of the medical education research group CAMERA.
  • Develop an understanding of the factors involved in quality improvement strategies and their evaluation using outcomes related to patient safety.

Learn more at the Plymouth University Peninsula Simulation Pages!

Nena Sim Neonatal Simulator from Epona with Realistic Movement

nema baby healthcare simulator

Have you seen the Nena Sim Neonatal simulator from Epona Medical? Besides being the only baby simulator that has eyes, head, limb movement, Nena Sim can also realistically simulate vocal sounds, infant breathing pattens and complications, circulation features and anatomical airways. Check out this video demo below:

About Nena Sim

Nena Sim is the world’s most realistic baby simulator. NENA Sim is born to complement realistic multidisciplinary team and/or individual baby patient simulation training. Nena Sim offers an ideal training solution for a wide range of healthcare professional including but not limited to patient care, emergency medical intervention and resuscitation training for dynamic team or individual training.

  • Suitable for a wide range of healthcare professional
  • Realistic eyes, head, and limbs movements
  • Simulate various breathing pattern with different rate, depth and complications.
  • Playable vocal sound recordings.
  • Blood pressure and heart-rate set up functions.
  • Offer various parameters output on the patient monitor: ECGs, SpO2, CO2, ABP, CVP, PAP, PCWP, NIBP and TOF.
  • Intubation through anatomical realistic airway
  • User-friendly touchscreen interface allowing the instructor to input the baby movements and parameters output on the patient monitor.
  • Different language options.

Learn more on the Epona Website today!


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SimGHOSTS 2016 Australia Day 2 Starts with Exploration of NASA Influences

simghosts-2016-australia

Today was Day 2 of the 3rd annual SimGHOSTS technology training event in Melbourne at the Australian Catholic University. Yesterday we heard from two plenary speakers, with the keynote address sponsored by Laerdal Medical:

About Laerdal Sponsored Keynote Speaker Lance Baily

Lance is an innovator and thought leader in the world of healthcare simulation. Using his background in digital media production and EMS fire fighting, as well as his work as a Simulation Technology Specialist, Lance founded several of the world’s leading websites, organizations, and events in the field of healthcare simulation. Lance also served as the inaugural Director of the Nevada System of Higher Education’s massive multi-institutional Clinical Simulation Center of Las Vegas. Desiring to make a global impact, Lance founded what has become the world’s most-read medical simulation resource website: HealthySimulation.com. Never satisfied with the status quo, Lance went on to create SimGHOSTS.org, a non-profit organization that supports professionals in the healthcare simulation industry through hands-on training events, online resources, and professional development. Because of overwhelming global demand, SimGHOSTS now operates four annual events, including ones in the United States, the United Kingdom, Australia, and the United Arab Emirates. SimGHOSTS has also forged successful affiliations with simulation organizations all over the world, including SSH, ASPE, ASPiH, Simulation Australia, and IPSS.

In a drive to create excellence, SimGHOSTS has recently partnered with INACSL to develop a new professional competency standard for the position of Healthcare Simulation Technology Specialist. Lance continues to be a change-maker and innovator in the field of healthcare simulation. All of his projects and efforts are based on a core belief: that emerging technology can create community and empower people to solve bigger problems faster.

Keynote Presentation “To Boldly Go”

In his best selling book Outliers, Malcolm Gladwell examines the factors that contribute to high levels of success. Gladwell considers why the majority of Canadian ice hockey players are born in the first few months of the year, how Microsoft co-founder Bill Gates achieved his extreme wealth, and why the Beatles became one of the most successful musical acts in human history.

Throughout his book, Gladwell theorizes how historical and cultural circumstances can pave the way for such phenomenal success. What can the healthcare simulation industry learn from a similar of exploration of its own past, present, and future? Simulation Evangelist Lance Baily has applied Gladwell’s theories to our industry and will explain why his projects, including HealthySimulation.com and SimGHOSTS.org, have made such huge global impacts in just five short years. By understanding the core truths behind the success of these projects, participants will take away valuable arguments they can use to advocate for the expanded use of simulation in their own home institutions. Finally, Lance will explore how the historical and cultural forces that are now in motion will transform healthcare simulation as we know it from a small community of early-adopters to a universal standard embraced by all.

Day 1 Afternoon Plenary

Stephen Guinea is the Coordinator of Health Simulation for the Faculty of Health Sciences at Australian Catholic University (ACU). Within this role, Stephen has driven the strategic direction of health simulation at ACU focusing on simulation learning environments, staff capacity and capability and curriculum integration with the purpose of a quality student (and staff) experience of simulation. Stephen’s research interests include simulation design for authentic learning, clinical skills development and integrating theories of workplace learning into university curriculum. Stephen has received three learning and teaching awards including a 2013 Office for Learning and Teaching Citation for Outstanding Contribution to Student Learning. Stephen’s PhD research focused on designing sociocultural simulation for international nursing students as preparation for the clinical placement.

One of the greatest challenges facing health simulation programs is meeting the needs of the various stakeholders in a sustainable way. A significant part of this challenge is understanding the various needs and expectations, creating and communicating a vision, and enacting the vision in a way that is sustainable. The Faculty of Health Sciences at Australian Catholic University (ACU) has taken a strategic approach to the advancement of health simulation in terms of building facilities, capacity and capability of simulation technical services, education and training, curriculum integration and research. The success of such an approach is dependent on communication and relationships.

In this session, Stephen discussed that whilst very large student numbers, limited numbers of simulation technicians and an increasingly sessionalised academic workforce present particular challenges to advancing a simulation agenda for 13 health disciplines across 6 campuses, significant opportunities exist. The rapid advancement of simulation and simulation related technologies and a clear and consistent vision of simulation as a learning and teaching method shared by all stakeholders allows for thinking about how to “do” simulation in a way that meets these challenges. This session described the ongoing approach to building a sustainable simulation program at ACU and the essential contribution simulation technicians make to such success.

Day 2 Morning Plenary

This morning, Dr. Sprick gave us a deeper dive historical exploration of healthcare simulation, connecting the various industries that have contributed to our own.

Dr. Cyle Sprick is the Director of the Clinical Simulation Unit in the School of Medicine at Flinders University in South Australia. Dr Sprick has a PhD in Biomedical Engineering with a focus on clinical simulation. Clinically, Dr Sprick has been a practicing Paramedic since 1996, first in Texas, and then in Adelaide from 2000. Sitting at the nexus of clinical practice, education and biomedical engineering, Dr Sprick brings a unique perspective to clinical simulation. Before moving to Australia in 2000, Cyle worked for Oceaneering Space Systems (a NASA contractor) designing and building cryogenic (liquid air) based life support systems for underwater astronaut training, firefighters, and haz-mat workers. He also worked on the design of a liquid oxygen based life support system for the Mars mission space suit, and various robotic projects.

Augmented patients are an amalgamation of manikins, simulated patients (actors) and task trainers to provide the best of all three when simulating the deteriorating patient. Dr Cyle Sprick from Flinders University in Adelaide has been developing this style of simulation for over a decade. Dr Sprick discussed some of the work of the giants on who’s shoulders we stand as well as some of the new technological developments that are enabling this modality.

Follow @SimGHOSTS on Twitter for all the Latest Daily Tweets!

Lockheed Martin Provided Virtual Reality Healthcare Simulation Training with ICE STORM

ice-storm

Searching youtube for medical simulation stories we came across an interesting product from Lockheed Martin called: ICE STORM (Integrated Clinical Environment; Systems, Training, Operations, Research, Methods). This technology applied Lockheed Martin’s expertise in engineering excellence, modeling and simulation, analytics and technology integration to improve the full lifecycle of the clinical healthcare environment.

Sadly we believe that Lockheed Martin has canceled this product as we cannot find more information about it on their website. Looked like the graphics were really strong! Did you ever experience ICE STORM first hand?

Dr. Paul Phrampus Shares Video: Beyond Healthcare Simulation Debriefing

paul phrampus simulation

UPMC WISER Simulation Center Director and Past President of SSH Dr. Paul Phrampus recently shared this helpful lecture regarding his perspective about the evolving landscape of healthcare simulation debriefing:

Medical, Nursing and Healthcare has become an important teaching and assessment tool to assist in the education of healthcare providers. Simulation can help someone become a better physician, nurse, paramedic, pharmacist through simulation programs in medicine, nursing and EMS. His new Youtube channel will feature videos to assist with faculty development, trian the trainer and other aspects of simulation program development for initial program design as well as program enhancement.

Visit the Simulating Healthcare Youtube Channel for more helpful videos!

7th Annual ASPiH UK Simulation Conference Opens Registration!

Registration is now open for the 2016 Association for Simulated Practice in Healthcare (ASPiH) UK meeting! This is the 7th annual event from the innovative leaders of healthcare simulation support in the United Kingdom.

Key Event Info:
Mercure Grand Hotel
Bristol, UK
Nov. 15th-17th 2016

Speakers confirmed include Professors:

  • Charles Vincent Patient Safety Lead Oxford
  • Wendy Reid Medical Director HEE
  • Brendan McCormack Head of Division of Nursing Aberdeen.
  • Ed Piele Professor Emeritus in Medical Education University of Warwick

Opening Keynote Address

Dr. John Vozenilek  MD, FACEP, Chief Medical Officer Jump trading Simulation and Education Centre University of Illinois will be providing the Opening Keynote address.

Prior to his appointment as Vice President and Chief Medical Officer for Simulation for the Jump Trading Simulation & Education Center, “Dr. Voz” was the Director of Simulation Technology and Immersive Learning program for the Feinberg School of Medicine at Northwestern University where he provided central coordination and oversight for the undergraduate, graduate, interdisciplinary, and continuing medical education programs.

Under his direction, the medical school created additional organizational capabilities and infrastructure, building resources for educators who wish to use additional innovative learning technologies for teaching and assessment, measuring success with patient-based outcomes research. In May of 2008, Dr. Vozenilek co-chaired the first Agency for Healthcare Research and Quality (AHRQ) – sponsored national consensus conference on using simulation research to define and develop clinical expertise. In his work at Northwestern he served as faculty for the Institute for Healthcare Research and its Center for Patient Safety, and continues to teach within its master’s degree program in health care quality and safety.

Learn more & Register at the ASPiH 2016 Event Page today!

Simulation in Healthcare Journal — June 2016 Article List

Simulation in Healthcare

Here is the breakdown of articles in the latest Simulation in Healthcare journal from the Society for Simulation in Healthcare:

Simulation in Healthcare June 2016 – Volume 11 – Issue 3:

  • When the Mannequin Dies, Creation and Exploration of a Theoretical Framework Using a Mixed Methods Approach Tripathy, Shreepada; Miller, Karen H.; Berkenbosch, John W.; McKinley, Tara F.; Boland, Kimberly A.; Brown, Seth A.; Calhoun, Aaron W.
  • “Debriefing-on-Demand”: A Pilot Assessment of Using a “Pause Button” in Medical Simulation McMullen, Michael; Wilson, Rosemary; Fleming, Melinda; Mark, David; Sydor, Devin; Wang, Louie; Zamora, Jorge; Phelan, Rachel; Burjorjee, Jessica E.
  • Standardized Patient Encounters: Periodic Versus Postencounter Evaluation of Nontechnical Clinical Performance Turner, T. Robert; Scerbo, Mark W.; Gliva-McConvey, Gayle A.; Wallace, Amelia M.
  • Simulation-Based Mastery Learning Improves Medical Student Performance and Retention of Core Clinical Skills Reed, Trent; Pirotte, Matthew; McHugh, Mary; Oh, Laura; Lovett, Shannon; Hoyt, Amy E.; Quinones, Donna; Adams, William; Gruener, Gregory; McGaghie, William C.
  • Using Virtual Patients to Teach Empathy: A Randomized Controlled Study to Enhance Medical Students’ Empathic Communication Foster, Adriana; Chaudhary, Neelam; Kim, Thomas; Waller, Jennifer L.; Wong, Joyce; Borish, Michael; Cordar, Andrew; Lok, Benjamin; Buckley, Peter F.
  • Learning Neonatal Intubation Using the Videolaryngoscope: A Randomized Trial on Mannequins Assaad, Michael-Andrew; Lachance, Christian; Moussa, Ahmed
  • Simulation-Based Assessment of ECMO Clinical Specialists Fehr, James J.; Shepard, Mark; McBride, Mary E.; Mehegan, Mary; Reddy, Kavya; Murray, David J.; Boulet, John R.
  • Applying Judgment Analysis Theory and Methods to Obtain an Insight Into Clinical Judgments: Implementation and Findings With a Simulated Neonatal Intensive Care Unit Setup Nadler, Izhak; Globus, Omer; Pessach-Gelblum, Liat; Strauss, Zipora; Sela, Rina; Ziv, Amitai
  • More Than One Way to Debrief: A Critical Review of Healthcare Simulation Debriefing Methods Sawyer, Taylor; Eppich, Walter; Brett-Fleegler, Marisa; Grant, Vincent; Cheng, Adam
  • Creating a Simulated Pharmacy Soto, Cory; Stiner, Jamie; Noji, Daniel O.; Rusheen, Jeffrey M.; Huang, Yue Ming
  • Response to “Unlike History, Should a Simulator Not Repeat Itself?” Smith, Roger

SSH Members can read the full ‘Simulation in Healthcare’ Journal on the LWW Website!

SESAM Lisbon 2016 Day 2 Updates

sesam 2016

Day 1 Recap can be found here.

SESAM’s Clinical Simulation Conference with Dubai Update

Helen Henderson, Lead Simulation Educator from the Khalaf Ahmad Al Habtoor Medical Simulation Center in Dubai Healthcare City provided an update about the 3 year partnership between SESAM and the Dubai based simulation center for simulation conferences. Helen shared details about the past 3 years of events and invited attendees to the International Medical Education Conference in Dubai at the newly renamed Mohammad Bin Rashid Medical University March 2nd – 4th 2017, with the tagline “Health Professional Education in an Interconnected World”.

Plenary Address by Faizal Haji

Following this, Faizal A. Haji provided the presentation “Promises and pitfalls simulation in resource-limited settings”, highlighting updates from the International Pediatric Society in Simulation’s work to develop simulation training support for the African country of Malawi. Malawi, with a population of about 15 million only has about 1/3 of the health workforce it needs to serve its citizens. IPSS has been working with the Malawi Ministry of Health in 2013, starting with a needs assessment of the clinical training services available to healthcare professionals within the country using field notes, key interviews, site visits, and simulation demonstrations. When the number of healthcare professionals was increased, clinical training was reduced because of a lack of faculty — and the quality of providers drastically decreased over the past 10 years. The team investigated the use of telesimulation training to provide education across long distances live with visual aids. While the training programs worked, there was still a need to provide hands-on training but the time to receive such training was extremely limited. While resources such as simulation technology are available (through donations), but because of the limited clinical faculty training was rare.

Faizal highlighted the research article “Development of a simulation and skills centre in east Africa: a Rwandan – Canadian partnership” which succeeded because of:

  1. Long-term partnership
  2. Identification of need for dedicated funding for space/staff
  3. locally driven curriculum
  4. Ongoing mentorship beyond the initial train-the-trainers program.

Faizal concluded by reminding us that we need to be understanding of the health systems we are building simulation programs for, and that we are absolutely able to address high level system issues with low resource simulations to then do focused programatic training in key issue areas.

  • Partnerships make the project work
  • Context matters and educational interventions don’t exist in vaccuum
  • Process matters: how you implement training is just as important to consider as the content itself
  • Bad Habits are hard to fix so be sure to start training programs strong!

Stay tuned to this article for updates throughout the day, and follow the action on #SESAM2016!

22nd Annual Society in Europe for Simulation Applied to Medicine Event Opens in Lisbon Portugal

sesam-2016

Today in Lisbon Portugal more than 700 healthcare simulation champions from around the world met for the 22nd annual Society in Europe for Simulation Applied to Medicine (SESAM).

You can watch the event LIVE on facebook here!

The president of the Portuguese Simulation Society, the Director of the Portuguese Medical Association, and the Portuguese Administer of Health helped to introduce the event which took place at the Lisbon Conference Center near the San Francisco Bridge.

society in europe for simulation applied to medicine

SESAM President Antoine Tesniere thanked the international attendees and reminded them about the event’s opportunities to network, learn, and collaborate

Lou Oberndorf, Founder of METI, introduced the opening keynote lecture series with his name speaking to SESAM as a fellow pioneer in healthcare simulation, being one of the oldest organizations in the world dedicated to the field. “20 years after we have launched this innovative technology and now, virtually any place in the world, you could go into almost every medical school, and many of the nursing schools, and encounter simulation”. Lou challenged the audience to avoid complacency, and to constantly ask for more innovation from one another and from vendors. He then announced his honor at introducing the keynote speaker

Opening Keynote Address by Dr. Rick Satava

satava sesam 2016 Dr. Richard Satava MD FACS, Professor Emeritus of Surgery at the University of Washington Medical Center spoke to the topic of “Next Generation Curriculum and Technology for Simulation”.

He focused his talk on demonstrated development and alid of curriculum competency preliminary proficiency based progression methodology using the fundamentals of robotic surgery as an exemplar.

Dr. Satava asked the audience to consider “Does this training things safer for my patient?” He shared with proficiency-based progression training to consistently meet a high level of skill now and increase that ability as learners move down the line. He then shared how his team built learning devices first through simulated animation to perfect the model before creating a physical prototype. With these prototypes, learners must prove competency with a measured qualitative experience with specific benchmarks, and are not allowed to continue onwards until each step is proven proficient.

For new technologies, Dr. Satava highlighted future laser technologies which will provide non-invasive surgeries and advances in 3d printing. He then closed by reminding us that healthcare technology is neutral, and sooner than later, humans will evolve thanks to use of these technologies.

Registered delegates will be able to watch the keynote sessions live on their mobile devices and watch the recordings after the event from the comfort of their home.

Follow the live tweets on @SESAMSimulation and
@HealthySim with the hashtag #SESAM2016!

*Afternoon Session Update:

Flinders University Professor Harry Owen published the work “Simulation in Healthcare Education”, and provided a breakdown of key historical updates including the first auscultation simulator in 1867 and various OB simulators from the 18th century! About the book: Simulation in healthcare education has a long history, yet in many ways, we have been reinventing the wheel during the last 25 years. Historically, simulators have been much more than simple models, and we can still learn from aspects of simulation used hundreds of years ago. This book gives a narrative history of the development of simulators from the early 1700s to the middle of the 20th century when simulation in healthcare appeared to all but die out.  It is organized around the development of simulation in different countries and includes at the end a guide to simulators in museums and private collections throughout the world.  The aim is to increase understanding of simulation in the professional education of healthcare providers by exploring the historical context of simulators that were developed in the past, what they looked like, how they were used, and examples of simulator use that led to significant harm and an erosion of standards. The book is addressed to the healthcare simulation community and historians of medicine. Buy it through the link below:

Advances in Simulation with Editor in Chief Debra Nestel

Professor Nestel provided an update regarding the recently launched Advances in Simulation journal which is open access, starting with an introduction to the editors of the journal and the supporting reviewer team.

Advances in Simulation Benefits to Authors:

  • SESAM’s Professional Journal
  • Open Access
  • Promotion and Press Coverage

Update from launch 15 months ago:

  • Editorial Board formation
  • Category types
  • Manuscript commissioning
  • Launched January 11 2016
  • 21 articles published
    • 13 research articles
  • Promotional activities
  • Supplements portfolio
  • Secured over 300 reviewers
  • Most accessed articles has been read more than 1700 times

Learn more about free access to Advances in Simulation here.

Afternoon Plenary from SSH President Dr. Chad Epps

Dr. Epps, Executive Director of Simulation at UTHSC and President of SSH, started his plenary with a breakdown about improv, connecting the performance style to healthcare simulation.

As a clinician, and not an educator, Chad shared how he started considering some key questions after building a training assessment criteria for his anesthesiology residents. How did he know his checklist for assessment was valid? How valid was this tool? As, perhaps a tool designed for professional ED professionals would not work that well for an academic setting with residents. And beyond that — how competent was the assessors?

Dr. Epps then shared some resources for assessment development in simulation including the Assessment Standards of Best Practice in Simulation from INACSL and the SSH Accreditation Standards in Assessment. He also recommend the book “Defining Excellence in Simulation Programs” — which you can buy below:

Learn more about Dr. Epps on LinkedIn!