Simulation training at the Jewish General Hospital

By Diane Weidner, Steinberg Centre for Simulation and Interactive Learning

Health care professionals make their way to the block amphitheatre at the Jewish General Hospital for the combined Surgical and Obstetrics & Gynecology Grand Rounds on this cold December morning, grabbing a hot cup of coffee before taking their seats. Dr. Shannon Fraser, Associate Professor of Minimally Invasive Surgery at McGill University, stands ready at the front of the room in her festive scrub cap, working with the multimedia team to make sure that the audiovisual connections are up and running for the simulation broadcast.

“This is the first time we’re doing this type of in situ simulation at the hospital,” begins Dr. Fraser, who explains that the idea began with a small group of individuals who recognized the value of simulation.  They had gained valuable experience at McGill’s Steinberg Centre for Simulation and Interactive Learning (SCSIL) and wanted to leverage the resources available at the Jewish General Hospital, making use of the high-tech operating room and multimedia capabilities. “Simulation offers a useful educational tool for us to learn from our mistakes in a very safe way, and we hope that it will get you thinking about how we can use this technology going forward.”

Meanwhile, Dr. Errol Stern, Assistant Professor at the McGill Faculty of Medicine, is in the Operating Room nearby, preparing an interprofessional team for their roles in the simulation scenario which is about to unfold.  Participants include nurses, residents, physicians, and technicians from various specialties, including Respiratory Therapy, Anesthesia, Family Medicine, Surgery, and Obstetrics & Gynecology.  The labour and delivery room scenario was developed by Dr. Luis Monton, Assistant Professor in the McGill Department of Obstetrics and Gynecology (ObGyn), and Dr. Milena Garofalo, a fifth-year ObGyn resident who recently completed simulation research at the SCSIL.

Dr. Stern begins with an overview presentation to make sure that everyone understands the goal of today’s scenario, which is to show how simulation can improve team performance. “Our mission is to provide high-quality and safe care for our patients,” he emphasizes. “The focus of today’s scenario is crisis resource management and effective communication. As individuals, you’re good; as teams, you’re better. But when we are able to get multiple teams to work together cohesively, we provide the best possible outcome for our patients.”

In the auditorium, the audience is transfixed, watching the scenario unfold and intensify on the screen before them. The standardized patient has given birth and is suffering from a massive hemorrhage; her condition deteriorates and additional health professionals are called into the operating room.  By the end of the 20-minute simulation, a massive transfusion protocol has been activated and over a dozen health care professionals are in the room, all playing an important part in the patient’s care while around them, the monitors beep incessantly over the chatter of simultaneous conversations.

When the scenario ends, the audience breaks into applause and the emotional release is palpable as the tension breaks.  Dr. Stern leads the team debriefing, allowing all the participants to vocalize their feelings in turn, sharing key learnings and thoughts on how things could have been done differently to optimize communication among members of the team.  Who was in charge?  How did the patient feel?  What were some of the obstacles encountered?  Everyone is visibly engaged in the discussion and process, making this a highly effective learning experience.

Dr. Stern summarizes the importance of team communication: “I was at a restaurant in New York City recently, and the waiter took the time to repeat my order to make sure that he got it right. If we think that clear communication is important in a restaurant setting, imagine how important it is in an emergency setting. Before initiating a plan that has enormous repercussions, you need to make sure that your message has been clearly heard and understood by all members of the team.”

Nursing Care Consultant Andrea Willett participated in the scenario and the planning process, and agrees that closed-loop communication is a major learning point. “This simulation was a good reminder in terms of tasks and status: you need to make sure that you’re taking care of the crisis while still managing the patient and communicating with your team,” she says.

“This has been an incredibly fulfilling experience, made possible because so many individuals were willing to volunteer their time and goodwill,” concludes Dr. Fraser. “It’s been tremendous fun to see so many people from multiple disciplines working together towards a common goal.”

Left to right: Dr. Stephanie Klam, Dr. Milena Garofalo, Dr. Errol Stern, Dr. Shannon Fraser, Dr. Luis Monton, Dr. Ioana Ciuntu