The Emergency Medicine (EM) Simulation Program at the Jewish General Hospital (JGH) promotes a cooperative multidisciplinary team approach to healthcare through medical simulation and dynamic debriefing. There are six simulation educators, including 5 doctors and 1 nurse, and involves a myriad of multidisciplinary professionals.
Emergency Medicine Students, Residents and Attending Staff, as well as Nurse and Respiratory Therapists care manage “simulated” patients with complex life-threatening conditions mimicking real-world emergency medical situations. Participants are given the opportunity to apply their knowledge and skills in an experiential learner-centered environment.
These simulated events occur “in-situ” in the ER or our JGH Simulation Centre. Actors and actresses serve as simulated patient, or life-like mannequins engage participants with speech, blinking and breathing; they even have pulses. Simulated equipment includes blood pressure, oxygen saturation and cardiac monitors.
Our JGH EM Simulation Centre includes a high fidelity Laerdal SimMan manikin connected to a server with 3 video cameras, microphones and speakers, and a simulated patient monitor. We broadcast a composite of multiple video feeds of the healthcare team with hi-quality audio to observers in a remote location or an adjacent conference room. As well, we display the patient monitor, EKG’s, CXR, ultrasound video clips to both the participant in the simulated treatment area and the observers in the remote location.
Simulation-Based Education (SBE) provides an error-tolerant and safe environment for the team to practice, where real patients are not at risk. All learners agree that errors are best to occur in the simulation environment rather in the clinical setting. By stressing and reinforcing the “learning contract” to all participants, members are receptive to the learning process and the feedback received during debriefing. This learning contract stresses that all participants are intelligent, motivated, wish the best for their patients and want to improve. Debriefing is as an extremely important component of the educational process, where participants are able to further explore what went well, and aspects of the scenario which could be improved.
The learners are transformed into an environment that simulates reality; the scenarios are dynamic and parameters change depending on the performance of the Healthcare Team. Each scenario has specific medical learning objectives; as well each scenario advocates Crisis Resource Management (CRM) strategies, including, for example, the value of leadership, effective team communication and decision-making. Healthcare team members are encouraged to summarize and share their mental model thereby exercising effective “leadership” and “followership”.
During the pre-brief, Healthcare teams are reminded of the benefits of CRM in these stressful simulated scenarios, and during debriefing the specifics of team communication is discussed in an interactive fashion. The goal is that lessons learned will be translated to delivering effective and comprehensive care to real patients by fostering better multidisciplinary teams.
The Jewish General Hospital Emergency Medicine (JGH EM) Simulation Program works jointly with the McGill University’s Emergency Medicine Residency Program Directors and Chief Residents to ensure the simulation program complements the residency training curriculum. Simulation-based educational (SBE) activities are especially helpful with respect to the management of rare presentations and topics in which timely coordinated care is paramount.
Furthermore, Dr. Errol Stern, JGH EM Simulation Program Director, is a member of Quality Improvement (QI) Committee, promotes incorporating medical simulation within the Hospital QI Program. With simulation, the root causes of medical critical incidents can be explored, thereby mitigating harm. The aim ultimately is to improve healthcare delivery and team communication during crisis interventions.
Errol Stern MDCM, CHSE, FACEP, FRCP, CSPQ
Emergency Department, Jewish General Hospital
CIUSSS du Centre-Ouest-de-l’Île-de Montréal
Associate Professor, Faculty of Medicine
Department of Emergency Medicine, McGill University
Director, JGH Emergency Medicine Simulation Program
JGH Emergency Medicine Simulation Team
Dr Kamy Apkarian; Dr Haran Balendra; Dr Julia Bernard; Ms Melanie Sheridan;
Dr Madelaine Yona
Jewish General Hospital
3755 Côte-Sainte-Catherine Rd., Suite H-197
Montréal, QC H3T 1E2
In June 2018, the Emergency Medicine Simulation Team developed an “in-situ” simulation event involving Emergency, Neonatology and Gynecology physicians and nurses, Respiratory Therapy and Paramedical Unit Coordinators. This event was featured in the JGH eNews on August 2018.
Fidelity and realism were made possible with comprehensive planning and the use of confederate participants, those persons who knew the script and involved as participants. Furthermore, to assure HealthCare Provider (HCP) observers did not disrupt the realism, videoconferencing broadcasted the simulation event to adjacent conference rooms filled with HCP observers.
During the debriefing of this event, the lessons learned were enthusiastically endorsed, and indeed effected protocol modifications and new equipment procurement.