Traditional Poster Round


Scaffolding learning: Combining deteriorating patient and communication sessions in Simulation–based education

Tuesday, May 15
09:45 - 10:45
Location: The Gate, Atrium Level

Context: : The Royal Children’s Hospital (RCH) is a large tertiary children’s hospital. Clinical incident reports demonstrated 49% of incidents to be related to poor communication, with another 27% related to other human factors. Over the past 2.5 years we have embedded inter-professional simulation based education (SBE) across the hospital, with the emphasis on addressing and improving patient safety, through improved clinical care and communication-between staff and with families.

Description: : Interactive workshops focusing on communication skills [breaking bad news, graded assertiveness, ISBAR, and difficult conversations] were developed. These included interactive sessions with role plays so that all participants had the opportunity to practise the delivered communication framework. Deteriorating patient simulations followed, leading to a communication scenario with an actor, utilising principles of the PERCS Model, with the aim for participants to incorporate learned clinical and communication skills from the workshop into the simulation. Both qualitative and quantitative evaluation data were collected, examining free text comment around participant learning outcomes and future needs, and Likert scales examining outcomes of clinical and human factor learning objectives.

Observation/Evaluation: : To date, 12 deteriorating patient-communication programs have been facilitated across 6 (Paediatric and Neonatal intensive care units, Emergency, the Paediatric and Neonatal retrieval service, and Human Resource) departments. All but one session, was inter-professional. Each program was evaluated. Qualitative comments focused on the benefits of the scaffolded learning in a workshop followed by the opportunity to put the communication workshop with the ‘simulated’ parents into practise after a clinically relevant scenario, and then discussing their technique, and performance gaps. Likert scales were very positive for both content reinforcement and delivery of the program. Many staff requested more educational sessions to be facilitated in this format. Challenges in the program included the time required to facilitate each session (usually 3 hours) and that not every participant was able to experience simulation with an actor. In addition, the cost of utilising actors more often in our simulation program is potentially unsustainable.

Discussion: : A scaffolded educational approach was utilised with the aim of training in human factors and clinical decision-making during deteriorating patient scenarios, and then communicating the events with their families through trained actors. We have found this inter-professional scaffolded approach to SBE to be not only well received, but also, after hearing and reading participant reflections, to be very beneficial, particularly around providing participants real-to-life opportunity to adapt behavioural learning during communication scenarios after emotionally charged situations; an opportunity that does not always arise for junior nursing, medical, and allied health staff when senior staff are present. This scaffolded approach is successfully addressing both participant and organisational needs and is becoming a popular format for delivery of SBE across our organisation. Long term benefits are yet to be established.


Clinical Lead in Simulation and Neonatologist, Paediatric, Infant, Perinatal Emergency Retrieval Service, Victoria
Royal Children's Hospital, Melbourne, The University of Melbourne
Melbourne, Victoria, Australia

Jenni Sokol (FRACP, FCICM, MHPE, GCCS) is the Royal Children’s Hospital (RCH) Head of Simulation and has been involved in Simulation-based Education for the past 14 years. She has led the RCH Simulation Program and the Simulation Team since its commencement in June 2015, focusing on training to improve patient safety, management of the deteriorating patient, and communication within teams and with families and patients, to improve clinical outcomes across the hospital. Jenni also works as Consultant Neonatologist with the Victorian Paediatric, Infant, Perinatal, Emergency Retrieval (PIPER) Service at the RCH and is trained in Neonatology and Paediatric Intensive Care Medicine.


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Melissa Heywood

Clinical Nurse Consultant and Simulation Educator
Victorian Paediatric Palliative Care Program and Simulation Program, Royal Children's Hospital, Australia


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Joanne McKittrick

Clinical Nurse Consultant and Simulation Educator
The Royal Children's Hospital


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Mitchell Finlayson

Simulation Technologist
The Royal Children's Hospital


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Peter Weinstock, MD, PhD

Director - Simulator Program
Boston Children's Hospital, MA

Chair and Executive Director, Boston Children's Hospital Simulator Program (SIMPeds)
Senior Assoc. Critical Care Medicine
Associate Professor of Anesthesia, Harvard Medical School

A practicing pediatric intensive care unit physician, Dr. Weinstock combines >20 years in surgery, medicine, education and innovation to lead the Boston Children's Simulator Program (SIMPeds) to one of largest most integrated "return on investment" simulator enterprises world-wide. Dr. Weinstock has weaved sustainable medical simulation ecosystems into the fabric of medical centers and regional health care systems on 6 continents and is founding president of the International Pediatric Simulation Society (IPSS). He serves on multiple advisory boards including education, simulation, social robotics and AI, and lectures internationally including "TED" on combining simulation, human factors, 3DP and special effects -- all to prepare world-class clinicians and healthcare systems to perform at their best, as well as to reduce fear and anxiety in patients and families.


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Scaffolding learning: Combining deteriorating patient and communication sessions in Simulation–based education

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