Guide to

Introducing a New Paradigm for Respiratory Care Training and Student Learning

Guide to FiRSt

Letter From Stefan Frembgen

President of IngMar Medical
Simulation Assisted Respiratory Education has evolved substantially since the first test lungs were developed. Along with this evolution, the goals of both educators and technology providers have expanded: engaging learners in an ever more safety-conscious culture where simulation can provide risk-free learning for complex, critical or infrequently encountered situations. Until today, however, the promise of simulation has remained largely unfulfilled for the majority of respiratory educators. They continue to seek more comprehensive and interactive technology that both accelerates and enhances learning with more intuitive and flexible, integrated solutions. Until now, lab competency exercises for acquiring technical and procedural skills were performed in a sequential format dictated by tradition and technical limitations. As technology has advanced, it is now possible to create a more integrated experience, allowing students to make judgments and mistakes during a procedure. In the field of aviation, this process of iterative learning and error correction has been demonstrated to result in a much stronger and more efficient learning environment than either conventional presentationand-repetition learning or performing the tasks in a real aircraft. As a leading innovator of respiratory simulation technology, we have had the opportunity to observe the significant efforts of committed instructors to develop their curricula beyond technical and procedural competence. We also believe that many of the steps involved in learning are better done simultaneously rather than sequentially. For these reasons, we invite both students and instructors to reconsider some of the assumptions that have, so far, defined respiratory care training. We like to think of the new training model as Fully Interactive Respiratory Simulation Technology, or FIRST, and expect it to inform how curricula are developed and training is conducted in the future. This introductory guide examines the FIRST model and highlights some of the intrinsic differences between the established, sequential/instructor-driven training and simultaneous/experience-driven training. We also examine the ways in which this new model enhances and accelerates learning and better leverages the resources of both independent and institutional respiratory care training centers. After reviewing this guide, you may have questions or suggestions on how to further refine the methodology and training process. We encourage your feedback and look forward to further collaboration with all those committed to better training, serving the ultimate goal of improving patient outcomes. Sincerely, Stefan Frembgen


Stefan Frembgen
President of IngMar Medical

Guide to FiRSt

The Case for FIRST

Challenges of Traditional Methods of Respiratory Care Training

n respiratory care training, as in other sub-specialties of medical education, simulation technology has been initially used to support a conventional model of teaching, where the new technology serves primarily as a surrogate patient. Its purpose is to reduce risk and cost and permit greater repetition to facilitate competency and confidence. As technology has improved, the surrogate has gained fidelity. It can approximate the conditions of a real patient including specific disease states, opening the way for standardization in training and testing. Simulation technology holds great promise for addressing a number of important challenges and trends in respiratory care training, including: Increasing Demand. Respiratory care training in the context of emergency medicine, anesthesiology and intensive care is facing increased pressure to produce greater numbers of practitioners and augment the skill levels of existing medical professionals. Need for Higher Skilled Clinicians. Increasing complexity of technology, managed quality assurance, inhalation drug delivery and risk management in hospitals all have led to a greater need for an augmented skill set on the part of clinicians and caregivers. Limited Availability of Patient Cases. It is impossible to expose students to all the patient conditions that they should be confident to treat. Limited Resources. Training centers are constrained by both reduced public funding and available credit for expanding their training staffs.

Simulation technology holds great promise for addressing a number of important constraints and trends in respiratory care training.

Fully Leveraging the Potential of Respiratory Simulation Technology

Fully Interactive Respiratory Simulation Technology brings a new paradigm to life where simulation technology offers continuous feedback, and truly leads to augmented teaching. This improved training methodology creates both greater opportunity for the student to learn in a more experiential manner and for instructors to better leverage their time and expertise. This augmented teaching paradigm sees the use of new simulation technology, with near continuous feedback, as an adjunct to strong personal instruction.

Guide to FiRSt

The Case for FIRST continued

Fully Interactive Respiratory Simulation Technology (FIRST) expands the functional capabilities of the surrogate patient creating a new way of experiential learning that leverages a variety of principles intrinsic to more interactive technology and leads to augmented teaching

dvances in simulation technology have, to a degree, succeeded in providing a meaningful substitute for a patient. Now, with pressures mounting to fulfill increased demand for greater skill levels of clinicians while having to adapt to more limited personnel resources, a broader view of simulation technology is called for.

Fully Interactive Respiratory Simulation Technology (FIRST) expands the functional capabilities of the surrogate patient creating a new way of experiential learning that leverages a variety of principles intrinsic to more interactive technology and leads to augmented teaching: Simultaneity. Because FIRST incorporates documentation and analysis of a performed simulation in real time, certain steps in the learning process will occur simultaneously rather than sequentially, accelerating the learning process. Continuous Feedback. Because FIRST allows students to view the consequences of their actions in real time, feedback is continuous rather than intermittent. The result is greater depth in learning of concepts and skills, as the environment accommodates, without risk, judgment error or technical inadequacy of a student. Interactivity. Students are engaged with all the procedural aspects of the training in real time and operate in a non-threatening environment with regard to the consequences of their actions. This allows instructors greater flexibility to focus on a broader range of issues. Outcome Orientation. Since students become continuously aware of the consequences of their actions, they have greater focus on the role they play in improving patient safety and care. Repeatability. Because the patient can be exactly reproduced, FIRST provides an ideal basis for objective competency testing. Integrated Evaluation. Flexible criteria that are programmed into the protocol allow for tailored evaluation based on the learning level of each student and their previous exposure to specific procedures.

Augmented Teaching Paradigm Technology serves as a tool for augmented teaching

Surrogate Patient Paradigm Technology serves as a tool to simulate patient conditions

The FIRST principles provide the foundation for a new augmented teaching paradigm that can accelerate and enhance learning. FIRST creates the opportunity for an expanded role for instructors and develops a broader understanding of the significance of diagnostic and procedural decision making for patient safety and clinical outcomes.

Technological Sophistication

< Past

Future>

Guide to FiRSt

Conventional vs. FIRST Model

Conventional Model
Enhanced Learning Accelerated Learning

Evaluate

Analyze

FIRST Model
Document Evaluate Analyze Perform Document Construct Perform Construct

In the conventional model of lab learning, protocols are defined, performed, documented and analyzed sequentially. This method principally addresses cognitive teaching and suffers from limited availability of clinical time and clinical examples. Feedback, essential for true improvement of skills, is not emphasized, and it occurs only between each of the steps.

Effectiveness>

Dene

Conventional Model Time>

FIRST Model
In the FIRST System, where concurrent stages are possible, feedback is continuous rather than intermittent, thus both accelerating and enhancing learning. The fully immersive and interactive simulation environment more closely depicts reality. FIRST also grants instructors greater flexibility to address a broader range of issues, better leverages their time and experience, and enables them to handle a greater number of students while supplying more meaningful feedback.

Conventional Training Model

Sequential Stages Each protocol is defined, set up, conducted, documented, analyzed and evaluated in separate stages Intermittent Feedback Loops Feedback from each stage informs the previous stages for repeated training sessions Observed Teaching Instructors observe and comment Protocol Driven Teaching is based on a set of defined protocols Subjective Evaluation Evaluation is conducted applying subjective standards Patient Surrogate Paradigm Simulation Technology is used primarily to simulate patient conditions

FIRST Training Model

Simultaneous Stages Learning stages are overlapped or simultaneous allowing for real time feedback Immediate Feedback Loops Real-time feedback is outcome-oriented, allowing for real-time modification Interactive Learning Student is fully engaged with outcome-based perspective Outcome/Benchmark Driven Teaching/Learning is based on variables to accomplish a range of outcomes Objective Evaluation Evaluation based on objective standards is made possible Augmented Teaching Paradigm Technology is used to simulate patient conditions and provide rich feedback

Guide to FiRSt

Ventilation Management Training with FIRST

IngMar Medical has several options to allow you to take advantage of FIRST principles to fit your specific needs.
The QuickLung precision test lung can be expanded to represent a spontaneously breathing patient with the Breather Option. The Pulmonary Mechanics Graphics Option enables you to display loops and waveforms on your personal computer. With these options, the QuickLung is capable of providing interactive ventilator management training previously available only on higher end breathing simulators.
QuickLung

For manual ventilation training, the RespiTrainer Advance airway management and manual ventilation task trainer provides immediate visual and haptic feedback. The RespiTrainer Advance can be intubated and ventilated to give trainees fully experiential learning in manual ventilation without risk to a patient. In addition, a straight forward analysis tool gives educators direct insight into the skill levels of their students. The RespiSim-PVI (Patient Ventilator Interaction) option for the ASL 5000 Breathing Simulator offers the most sophisticated implementation of the FIRST system. RespiSimPVI provides an advanced interface for instructor and student incorporating both ventilator and simulator parameters in real time. It facilitates the full range of learning modalities while treating the breathing simulator with a real ventilator, thus creating an immersive, interactive environment. Special hardware allows ventilator data to be recorded and displayed via a new interface for the ASL 000, allowing for simultaneous documentation and analysis of the management of disease states. Patients can range from neonatal through adult. Disease states like COPD, emphysema, asthma and ARDS can be pre-configured. This marks a new way to think about a ventilator management simulation curriculum. Instructors access curriculum content from a concise inventory that can be edited at any time. Further, RespiSim-PVI allows students and instructors to revisit events that had occurred during a training session with playback mode designed for comprehensive debriefing. Through integrating the ASL 000 and RespiSim-PVI with different ventilators, students and instructors can fully leverage the FiRST model. This creates new opportunities for teaching and learning from basic principals of mechanical ventilation to alarm concepts and electronic patient data recording.

RespiTrainer Advance

ASL 5000

Guide to FiRSt

RespiSim-PVI for the ASL 5000

For Students:
Real-time Results. Faster feedback enables more efficient skill development. Teaching Modules. Instructor prep time significantly decreased by curriculum modules created by nationally renown respiratory therapy educators. Timeline View. Events, alarms and other markers are viewable as a timeline. Review. Students can return to highlight and review specific areas. Integrated Display. Displays both patient and ventilator information simultaneously on the same screen. Deeper Experience. Hands-on experience with a range of clinical scenarios which would otherwise take weeks or months in the ICU to attain.

For Instructors:
Direct Observation of Settings. Instructors can directly observe students choices of ventilator settings and changes in patient condition. Consequence Review. Cause and effect of treatment modalities are clearly presented with an immediacy not previously possible. Dynamic Scenarios. Create dynamic patient scenarios and view all data pertaining to the ventilator and patient on one screen! Repeatable Competency Testing. Data can easily be used for student assessment and competency testing. Contingency Testing. Put your students to the test with patient scenarios that can be changed on the fly and with immediate, real-time results. Powerful Debriefing. More sophisticated, interactive training can be leveraged for powerful debriefing like never before.

Clinical events Ventilator alarms Instructor-defined events Student charting Patient model inventory Pre-scripted patients Evolving disease states Real time graphics Waveforms Loops Trends Real time data Ventilator parameters Simulator parameters


IngMar Medical FIRST Products

ASL 5000 Adult/Neonatal Breathing Simulator with options: RespiSim-PVI (Patient Ventilator Interaction) Manikin interface (for Laerdal SimMan) RespiTrainer Airway Management and Manual Ventilation Task Trainers: RespiTrainer Basic (no intubation) RespiTrainer Advance RespiTrainer Infant ET-View (videoscope assisted intubation training) QuickLung and QuickLung Junior Precision Test Lungs form the core of a modular system with options: QuickLung Breather (customized spontaneous breathing) QuickTrigger (manual spontaneous trigger) PMG (Pulmonary Mechanics Graphics)

Learn how you can accelerate and enhance your ventilator management training. Call (800) 583-9910 or email info@ingmarmed.com for more information.

P.O. Box 00 Pittsburgh, PA  USA Tel: () - Toll free (00) -990 info@ingmarmed.com