Report from SESAM 2012


The aim for the annual conference is to strengthen the concept of simulation in
healthcare and to contribute to enhancing local, national and international simulation networks. 

This year's meeting took place 14-16 June in Stavanger, Norway and was hosted by SAFER - The Stavanger Acute Medicine Foundation for Education and Research. 


Delegates: 657
Nations: 39
Exhibitors: 18
Keynotes: Tanja Manser, Suzan Kardong-Edgren, and Charlotte Ringsted.                   


The relationship between research and patient safety 

Professor and keynote speaker Tanja Mansur started her opening lecture by looking back to the IOM report 'To Err is Human' (1999) and the goal to cut errors and patient harm by 50% in 5 years time. Although progress since then has been frustatingly low, Mansur pointed out that ''we have achieved a lot already and we are making progress. We need many people to contribute to move forward and also a better understanding of what patient safety means''.  

On challenges related to how to get simulation more fully integrated, Mansur mentioned more evidence, political pressure, willingness to change, and organizational changes.   

Professor Tanja Mansur
Université de Fribourg

On research status and what we need moving forward
There is lots of research on team performance, handover, communication etc., but research on human performance is scarce, according to Mansur. A study showing that task perfomance was pretty much the same in simulation as in real clinical setting shows ''we can use simulation to improve team performance, but we need to know why it really works, as multiple factors contribute to patient outcomes. In order to make improvement efforts, we must know how to measure things. We need skilled people both to run simulations and to examine it''. 

Further needs: More research on refinement, leadership, differentiation (roles) and handover, where there is a ''strong push for standardization''. Moreover, a strategy as to how a study fits into the greater picture, cost effectiveness studies, and long term multicenter studies.  

On a positive note Mansur added that the approach to simulation research is becoming more and more systematic and that strengthening the evidence allows for more translating evidence. She would like to see simulation research as a 'translational science''.  

Evangelists vs. snails 

When describing the difference between the typical early adopter of simulation and the skeptic, professor Mansur used terms that were new to many people in the audience. She said an 'evangelist' type of person is apt to 'run not walk' while the 'snail' tends to 'walk not run' pending evidence on how it all really works. More importantly, Mansur noted that working in silos won't help as ''we need the two kinds of people to work together in order to move forward.''

On challenges in terms of what we need to get simulation more fully integrated, Mansur suggested more evidence, political pressure, willingness to change, and organizational changes.   

Utstein meeting on five most important areas impacting patient safety

Prior to SESAM a consensus meeting, sponsored by The Laerdal Foundation for Acute Medicine and Laerdal Medical, was held at the Utstein Abbey, right outside Stavanger. The goal was to single out five focus areas that impact patient safety more than others. 

These are the five topics the international group of specialists reached consensus on:

1. Technical skills
- Poor competence
- New technology/procedures (innovative techniques to train; avatars, games etc.)
- High risk/low frequence events (expensive, prone to law suits)
- Learning on patients (balance; we should know what we are doing, more just in time training etc.)
- Challenging implementation (resistence to change, time to train, logistics/instructors).  

A number of delegates visited Laerdal Medical
to learn more about the company and how 
the simulators are manufactured. 

2. Non-technical skills (Fragmentation of care and lack of shared understanding compromises patient safety). 
- Teamwork
- Interprofessional training
- Handover/handoff

3. System probing (lack thereof)
- Patients themselves should be an active part of deciding what works. We should learn from their stories.

4. Effectiveness (outcome measures)
- Challenges: we have few tools to determine and measure whether it works
- Often complex
- Few outcomes that measure outcomes on patients

5. Assessment (credentialing and certification - 'hot debate')
- make the important measureable (non-tech skills)
- Dive into the water of high stakes assessment  

The full report is expected completed and published in 6-8 months.   

Suzan Kardong-Edgren
updated the audience on
new frontiers in simulation.

Keynote: New frontiers in simulation

Suzan Kardong-Edgren is a recognized national and international thought leader in simulation and simulation research. In her keynote Dr Edgren brought her line of thoughts in terms of where we are today and where we are heading with simulation in higher education.

Higher education today and tomorrow
Simulation is not fully integrated everywhere and Dr Edgren says she is under the impression that faculty are unwilling to learn and adopt: ''We're in the post course era now. Experiential learning is happening across the world. Students want the pod cast up before the lecture (to prepare) and they would like to make and use apps to learn. Maybe it's even possible using apps to evaluate students?'' Edgren says the universitites, especially in the US are getting more and more expensive, and so students are asking; what am I getting in return? Are there other ways to learn? 

Grades are being outsourced to simulation   
''The traditional grading system is not working anymore as 40% of our students have A's.'' Edgren says we need to assess the students in other ways to get a true picture of what they really know. Grades are now being outsourced and OSCEs are used in simulation. Edgren says that in the future blogging and tweets can also give credits. (Library of Congress are storing all tweets for future documentation).

Right now
- Simulation centers apply to be certified and Spokane University (WA, USA) for one offers a certificate in clinical simulation
- Behance network: here you can put up your best scenario and have it critiqued
- Australia and US collaborate on using simulation to train faculty

Changing into neuro pedagogy 
Screen based scenarios and avatars are getting a lot better and new devices, such as glasses with cameras, provide multiple opportunities for learning; students can learn from what observations the expert makes when entering a patient's room for example. EEG can be used to examine whether the observers are as engaged as the active participants in simulation scenarios.   

How much clinical time can be replaced by simulation?
NCSBN National Simulation Study: The NCSBN is currently conducting a landmark, national, multi-site, longitudinal study of simulation use in prelicensure nursing programs across the USA. Phase 2 of the study is examining the outcomes of various amounts of simulation to replace a portion of the hours spent in traditional clinical settings. Hopefully the study will move the discussion forward. The initial results will be published in September this year.     

Future nursing education
Dr Edgren anticipates use of podcast at home and she expects students will be allowed their own pace to get through school. Simulation will further catch the weak students and prevent them from graduating without passing. ''Tests don't always do that today,'' she said. Dr Edgren expects an increasing use of screen based simulations and that simulation and inter professional education will be routinely integrated. More neuro science studies will support and define the best simulations and ways to learn with simulation.

Others on simulation ten years from now
Barry Issenberg:
- More focus on the cost of NOT doing simulation
- Simulation will be used to certify people
- State and national boards, clinical societies etc. will require more continuing education through experiential learning sessions via simulation vs. lectures
Charlotte Ringsted:
- Simulation will be used more; to warm up and as preparation for specific practice. It will be used as study lab for inter professional practice and for training methods to be applied in clinical practice
- Much more creativity; move towards more authentic participants (patients involved in simulation, patient instructors)
- collaborations between professionals and patients (having authentic people in the room)
- a move from teacher/instructor directed to learner directed scenarios and interventions
Amitai Ziv:
- The field is pushing itself toward patient safety. Luckily patients know their rights better than before hence they will push us
- Proficiency is a big thing and will push
- we'll see the gaming industry more, 2nd life
- Will transition from 'wow' to mature phase

Pulpit Rock tour concluded the 18th SESAM meeting 

Nearly 300 delegates defied the unfavorable weather forecast and stayed an extra day to join the guided tour to the famous Pulpit Rock (Prekestolen). The view from this summit is ranked among the 10 most spectacular in the world. Thankfully the rain stopped and visitors and guides alike enjoyed the hike tremendously.