Breathing Life into Simulation

When Angel Nater traveled from Florida to Massachusetts in fall 2011 for the Comprehensive Instructor Workshop in Medical Simulation offered by Harvard University’s Institute for Medical Simulation, he had high expectations. After all, he figured, this is Harvard, so it’s got to be good.

Nater didn’t leave disappointed.

As a professor and EMS program manager for Seminole State College of Florida, Nater hoped to find a program that would first model simulation techniques and then let him practice those skills.

“One of the challenges, I think, for anyone who's going to embark on simulation is it’s a lot more complicated than just buying a simulator,” Nater says. “There’s a lot of strategy involved and a lot of learning that needs to take place on how to use simulation successfully.”

According to Nater, nursing programs have excelled at incorporating simulation into their training, which has resulted in reams of studies and research touting its effectiveness.

“What we want to do,” Nater says, “is start using an evidence-based approach so we can show our students are learning. The goal is to develop critical thinking skills for EMS providers so when they get into the field they’re able to systematically think about what’s going on with their patient and how they’re going to manage that patient.”

Simulation can’t replace real world experience. But it can be a useful training tool to help instructors see how students respond to life-like situations, and for seasoned EMS providers to practice their craft. Nater began his own career in 1982 as an EMT in New York City. He eventually became a paramedic, and a lieutenant, before leaving for Orlando in 1991, where he managed the ambulance department for a trauma center until 2000. During that time he went back to school and completed his bachelor’s degree in health services administration. He worked as a quality manager for Seminole County in Florida from 2001 to 2008, and then in 2008 became a full-time program manager and educator at Seminole State College, where he trains tomorrow’s EMTs and paramedics.

Training at Harvard

Nater says his training in the Comprehensive Instructor Workshop covered various methods of debriefing; how to design and validate scenarios; and how to assess learning.

“Those were exactly the things that I needed to learn more about,” he says. “I mean, I’ve read a lot of articles and studies, but sometimes reading something is not as powerful as actually seeing it in action and practicing it.”

To cover the cost of the program, Nater applied for and received a matching grant from the state of Florida. The state matched 75% of his tuition and his employer matched the remaining 25% of the $4,200-plus, five-and-a-half-day workshop. Part of the grant covers the $3,900 Institute for Medical Simulation (IMS) Graduate Course, which Nater will attend in May 2012. The grant also covered Nater’s airfare and room and board.

“I felt the money was well worth it,” says Nater. “One of things I really enjoyed about this class was we had participants from different countries—Australia, Spain, Mexico, Canada, the UK—and two-thirds were physicians, such as anesthesiologists, surgeons and emergency room doctors. But the common thing was we were all involved in simulation and wanted to know how to do it more effectively, even though we all had different audiences. This is where that debriefing really becomes very important, because I think without proper training sometimes debriefing can be a negative experience for some people. The techniques that we learned [not only] validate [a student’s] experience and how they responded, but at same time open up the lines of communication so hopefully they can learn from the simulation.”

Nater believes this is something that will continue to evolve in EMS. “I hope we will be at the cutting edge of taking this strategy and enhancing the students’ experience, regardless of whether it’s primary education or continuing education, creating a simulation in which they can truly learn how to work together and handle difficult situations.”

Putting it into Practice

While the immediate group of beneficiaries from Nater’s training will be his faculty and paramedic students, he says there are also opportunities to collaborate with EMS providers throughout the county, as well as opportunities for multidisciplinary collaborations with local hospitals and other programs.

“There are some opportunities for collaboration which we think will ultimately improve communications and relationships between nurses, EMS providers and hospital emergency department personnel,” Nater explains. “We’re all concerned about the continuity of care, so we think if there are better communications between EMS providers and emergency department personnel, that will translate into a seamless continuum of care and hopefully better outcomes for our patients.”

Nater says his program is already doing some innovative things to create more realism in their simulation scenarios, including using moveable walls to create different spaces and utilizing props and other furniture pieces strategically to provide cues or simply distract students during a simulation.

He would also like to incorporate some of the specific techniques he saw during his Harvard training, such as having actors wear headphones through which a coordinator can relay instructions during the simulation which the rest of the participants cannot hear to make the scenario more realistic.

“I think we’re just at the tip of the iceberg,” Nater says. “Nursing has done a really commendable job in the way that they’ve embraced simulation. A lot of hospitals have to do it because they feel like the nurses coming out of school aren’t quite ready for what they need them to do. I think the industry is demanding a need for better prepared students. It used to be that when you got out of paramedic school or nursing school you had your license or your patch, and then it was up to the agency to bring you up to speed. But I think more and more there’s a desire for [students] to come in better prepared and that’s what we’re trying to do.”

To learn more about the Harvard University Institute for Medical Simulation, visit www.harvardmedsim.org.