In this episode we interview Andrew Buttery and Andy shares his story into simulation and passion for learning. Proudly sponsored by Innovative SimSolutions LLC.

Andrew Graham Buttery; BSc; MSc; DipMedEd (Dist.); RODP (Ex RC(UK) ALS Instructor, CHSE (expired)

After 20 years clinical work as an Operating Department Practitioner (ODP), my increasing interest in education and improvement led to my first full-time educator role as Simulation Specialist, and only full-time clinician, for the Trent Simulation & Clinical Skills Centre, Nottingham in 2004 with a concurrent secondment to design and deliver an Anaesthetic Assistant Course at the Nottingham School of Nursing. I served on the Board of the Association of ODP during the process to join the HCP (Health Professions Council, as was), contributing to the QAA Benchmarking and the HPC Standards of Proficiency for ODP and taking part in numerous professional Validation of ODP Programmes. 2004 I attended a 4 – Day Aviation “Crew Resource Management” Train-the-Trainer course and have been delivering Simulation & Human Factors Education ever since. I was treasurer for NAMS (National Association for Medical Simulation) before it became ASPiH (Association for Simulated Practice in Healthcare) and was a member of Faculty for the NAMS/Laerdal collaboration “SimSKills” Train the Trainers Course and have contributed to several Laerdal “Simulation User Group (SUN) Meetings. I was one of two Human Factors Editors for SESAM 2014 and the European subject expert on the SSH working panel for the first Certification as Healthcare Simulation Educator (CHSE) during two USA workshop events. I qualified as a TeamSTEPPS Master trainer in 2015.

I co-designed and delivered a workshop on Human Factors Education for the UK Clinical Human

Factors Group [http://chfg.org/] in 2012.

I left Trent Simulation for Doha, Qatar in 2015, returning to a Patient Safety Management role at Nottingham University Hospitals (NUH) in 2016 then Simulation Faculty Director for Canterbury Christ Church University in 2017 and now Regional Simulation and Human Factors Project Lead. The affidavit for my NUH Corporate “NUHonours” Award in 2011 included: “Andy’s passion for human factors and patient safety and his desire to share this knowledge with others is demonstrated every day he teaches…”

I have delivered presentations and workshops, mostly upon Simulation Faculty Development, at local, national and international conferences and was a member of the expert panel for a plenum event at SESAM (Society for Simulation in Europe) 2013. I have led pre-conference workshops for the ASPiH National Conference. I contribute to NHS E National Programmes & Training, I designed and led the MSc Simulation Pathway Lead for Canterbury Christ Church University. I presented to the Royal College of Physicians National Clinical Trainer Conference 2022. I am member of the ASPiH Executive and the Operative board of IJoHS.

Publications

C Wood, C Buss, A Buttery, D Gardiner. Evaluation of deceased donation simulation. Journal of the

Intensive Care Society. 2012 April; 13(2): 107-114 https://www.researchgate.net/publication/271850263_Evaluation_of_Deceased_Donation_Simulation

S Timmons, B Baxendale, A Buttery, G Miles, B Roe, S Browes. Implementing Human Factors in

Clinical Practice. Emerg Med J. 2014 March; https://emj.bmj.com/content/emermed/early/2014/03/14/emermed-2013-203203.full.pdf

E Ferguson, A Buttery, G Miles, C Tatalia, D D Clarke, A Lonsdale, B Baxendale, C Lawrence. The

Temporal Rating of Emergency Non-Technical skills (TRENT) index for self and others:

psychometric properties and emotional responses. BMC Medical Education (2014) 14; 240 https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-014-0240-y

J Scott,

Innovative SimSolutions.
Your turnkey solution provider for medical simulation programs, sim centers & faculty design.

Transcript

Disclaimer: 0:00

The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors.

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Intro: 0:44

Welcome to The Sim Cafe , a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser . Join our host, Deb Tauber and co-host Jerrod Jeffries as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in, and learn something new from The Sim Cafe.

Deb: 1:25

Welcome to another episode of The Sim Cafe. And I'm Deb Tauber, your host with co-host Jerrod Jeffries . And our guest is Andy Buttery. So welcome Andy, and thank you for being a guest on the show. We're very grateful to have you. And why don't you go ahead and tell our learners a little bit about yourself.

Andy: 1:46

Well, thank you for inviting me. It's a pleasure to be here. I think that my history has meandered to this point really via starting out as a, as a chemist, which I did for a long time before I drifted into healthcare. And I was a, an operating department practitioner, which is a very much UK role, but , uh, we work in critical care across critical care. Did that for 20 odd years, I would say was very good at it, I would say. And drifted into simulation via for same as a lot of people, a combination of , um, broader education and critical care life support resuscitation training. So I designed, developed and delivered a course for nurses to workers and ethicist assistants in the uk, the Nottingham School of Nursing. And I was developing more and more training in life support, and that led me to be ideally placed to get involved with us starting to do simulation in operating theaters with the lead or SimMan . When that mannequin first appeared back in the day. I am older than SimMan , but my experience of simulation is probably about as old as SimMan , I would say. So we went off and , uh, we went to a course to learn how to program and use the SimMan on the fly. And at the same time, this was 2004, we took a aviation designed and delivered four day course train the trainers for trainer team resource management. So this combination of simulation as a platform for behavioral learning and behavioral learning as a rooting to team resource management and team resource management as a route into human factors and ergonomics , um, began for me really back then. And I am a unashamed advocate as simulation as the tool for interprofessional education, for behavioral learning and for clinical human factors. Um , so that's basically my history. I've wobbled about a bit along the way. I spent 18 months out in Doha in Qatar, people that you must be aware of, like <inaudible> and the like. Um , I've worked with off and on. So a thousand years ago, EO and I with um, a couple of other people developed and ran the AI Sim skills course, which was probably one of the first simulation faculty development courses . And , uh, EO and I have been rubbing shoulders now and again ever since. And we are both on the ASPI executive at the moment. That's the sort of potted history that that takes you up to now. I think , um, I would add that , um, when I came back from Doha, the first job I got back in the UK was actually in patient safety. It was a patient safety management leadership type role. And that was a very interesting experience and gave me a lot more focus on being outcome driven . Um , McGahey would want me to say translational outcomes. Kirkpatrick the , you know, the highest level of Kirkpatrick. And this is why of course we celebrate people like Professor Tim Draycott , who's , uh, down the road from us in Bristol, who's the obstetrician who developed the prompt course, which , uh, is a massive charity doing wonderful work worldwide. And , uh, he , uh, is celebrated of course because he , um, he's my favorite sort of , um, subject matter expert to work with. This is somebody who is a committed and enthusiastic clinician who saw a need to improve outcomes. This case, it was showed a dystocia and selected simulation as one of the tools in his toolbox to achieve those improved outcomes. And that's the sort of , uh, person i, I prefer to meet rather than somebody who sees a mannequin and thinks, oh yeah, I could , uh, I I can imagine what I could do with that or, or <laugh> worse , those that effect.

Deb: 6:33

Right. I agree. It's always so inspirational to meet people in simulation who are passionate from the core about what they're doing and why they're doing it. Do you have a favorite or most impactful simulation story that you'd like to share with our listeners?

Andy: 6:50

I do. It's not from simulation practice, actually. It's a comment that somebody said on the platform at a simulation conference. I , it was an ASPI conference quite a while ago. You know, you hear these comments, I I could have selected one by Roger Nebo actually, but this one is from Professor Debra Nesto , who I'm <laugh> . We , we all are aware of and in awe of, and I can still remember her saying now that this was the moment when I realized that in sim healthcare simulation, by taking the patient out of the event, you had the most powerful opportunity to put the patient's voice in. And that is my sentinel moment for simulation that , uh, I'm delighted to, to share with people and I've enjoyed , um, ensuring that we optimize putting the patient's voice in to the simulation that we deliver. And I think that that's , um, achievable no matter what simulation modality , uh, you are addressing or , or using, it's still possible to keep the patient's voice in there. Um, unless you are talking the most straightforward and constrained competence training on certain part test trainer of some sort. So hail professor Deborah Al , and , uh, that was my sentinel moment. I still celebrate.

Deb: 8:32

No, I think it's a , a great point. It's part of the CUSON competencies, right ? Patient and family-centered care, making sure that that patient is at the locus of everything that you do and everything that we do , um, to make sure that we're keeping them front and center.

Andy: 8:49

Absolutely. I used to begin thinking about simulation as, as the most concrete example of learner-centered education. And I then had to develop that to recognize that this wasn't simply a case of learner-centered , um, education. It was actually service user-centered, centered , um, education. And that's my delight.

Deb: 9:18

Andy, where do you see the future of simulation going?

Andy: 9:23

Um, this might be , um, somewhat controversial , um, but I am quite convinced that the future of simulation will see us having less and less reliance on more and more expensive equipment and more reliance on simple solutions that allow us to have human interactions that are safe simulations. So bringing simulated people , um, standardized patients, however you want to refer to them, out of the control room , um, and into the simulation scenario interacting with with the people. And my challenge to industry is, and has been for a long time that the equipment that permits physiological simulation is moving outta the mannequins. The mannequins are becoming more like robots and the physiological measurement of a deranged physiology or whatever is moving out into the equipment, into things like the sim scope , ultrasound simulators , um, all this sort of thing. And this is , uh, the way that I see the future going. I think that I wouldn't be surprised in a short period of time to have actors wearing some sort of catsuit, some sort of wetsuit, which you can ultrasound, ECG, osculate, cannulate, and still maintain everything other than invasive airway maneuvers you'll be able to do with an actor. And I think that we will recognize that 21st century equipment permits us to take the experts outta the control room and into the simulation and appropriately trained and appropriately co-faculty supported, engaged with the learners like that. And as Deborah would say, keep that service user voice eloquently and accurately portrayed at the center of the simulation. So I think that that's one limb of the future that I expect to see. It's a fool who predicts the future, of course. And we all delight seeing these pictures of guesses in the past of what the future would look like by now when we're all flying around in helicopters or , or whatever. But that would be my prediction. And the other side to that is coming out of mannequins and going a little bit more into the world of augmented reality and XR and the like. I think that the next step there is for platforms that allow us to effectively, efficiently cost, effectively create our own content rather than buying in content. So we'll have an opportunity to share that content and distribute it, but we won't all be buying in the same created content. We'll be using industry platforms and hardware to create and deliver our own content. This is , um, how I imagine this sort of thing going. I think you could , um, extend this. So there is a scenario authoring platform called iRIS which we've seen via CAE as well, which has this opportunity for us to share scenarios. And for me, the biggest thing about Iris is not merely that it lets us share scenarios, but that it engages us in a quality assured route as supplied by an Axel and ASPI and others. That's where iRIS gets its content from. It gives us that quality assured route to a well educationally governance scenario at the end of it. And then you keep your IP no matter how many times it's shared and distributed. Um , so I can see that expanding into the world of , um, virtual reality and the like, there's no joke that the, in the UK times newspaper crossword or it might be , um, wordle in the New York Times or or whatever is actually a enemy plot because what it does is it occupies all the best minds in the country for 20 minutes every morning, the peak of their mental performance instead of working, they're all doing the , uh, the Times crossword or the New York Times word or , or whatever. And I dread to think how much time expert simulators across the planet have spent going, okay, so this guy's going to have an anaphylactic reaction to the antibiotic, so we need to name him, don't we? Let's call him Andy Buttery and we'll make him , uh, grumpy, cynical geezer and , uh, you know , not very nice. Nobody likes him and he needs to have an address, doesn't he? So it's good . We'll, we'll put him on 47 Acacia Avenue and , uh, what's his date of birth? And hours and hours of of time replicated millions of times across the planet creating people when it's like Highlander, isn't it? You only need one. And we can sit them on Iris or wherever it might be, and we can all share them and it's, it freezes from from all of that. So a again, I think that there's a lot more work that we will do in that way in the future that's collaborative and it allows us other things. So , um, as I say, it's a fool who predicts the future, but one thing I do know about do recognize is safe to say is that the future we'll see is , um, with a more digital and digitally disruptive care system. And what we'll be looking for is an agile simulation response. So , um, in my region we are piloting an evaluation of a simulated electronic patient record. And so I used to go to work at six o'clock in the morning because I had to write out that day's patient notes because the day the previous days had been scribbled on. And so you had to replicate all that paper. Um , all of that is going now. We've supposed to have had a paperless HSS since 2017 and it is slowly arriving in the future. Now how is that managed by an agile simulation response? That means that our learners s tep into a generic environment that prepares them for the actual practice world that they will step into. So in terms of the future, I think that we will see platforms like the simulated electronic patient record, simulated drug prescribing, and they'll give us new opportunities as well w ho never underestimate what simulation surprises await. So you think about the, let's imagine for a moment that every simulation center in the world all has the s ane simulated patient r ecord system. What a huge petri dish. We could take the symptoms from the next pandemic, l ook them into that system and just see what happens, see how our learners best respond to the deranged physiology t hat results whatever. U m, there's a whole range of stuff to do that's, um, experimental. There's something about simulation as an opportunity to ask endless what ifs and, and trying it that way. And I think some of this b ig data stuff w ill g ather in the way that platforms like Iris a nd simulated e p R and a ll the rest o f i t, o ffer u s opportunities to play around with how people respond to the problems that we put before them using in the context of the digital age that we a re living in.

Jerrod: 18:01

Andy, one thing to push right is I , I love the vision too because right, humans make mistakes. Any James Bond or villain film, it's like how do you attack the human? That's the weakness. And as this digitization increases and becomes more collective in a way to say, this is tried and true, this is peer reviewed, this has been used so many times, this is maybe what I'm hearing quite a bit of, okay, once you start becoming more automated, once you start becoming more of a consistent across the spectrum, whatever platform it may be, I think did look at Iris at at CSSAM, it's a great one. And I think there's so many ways when it comes to the community or the collective, because we are pretty niche still. Healthcare simulation is, you know, if we talked about Ireland and we talked about England or whatever it is, it's, there's not tons of people doing it across each country, but as a collective or as a global force to be reckoned with, then you have the scale, then you have the numbers. And to be able to do this as a collective, I think is much more powerful in how we can do it collaboratively and collectively. And I think much of your vision is very much along that same track. So that's, that's fantastic.

Andy: 19:10

Thank you very much.

Deb: 19:11

We'll go on to our next question, Andy, what were the lessons you learned during the pandemic and have your goals altered from one, three or five years since the pandemic?

Andy: 19:23

I have to begin with a caveat. I thought I thought quite a while about what you're actually asking me here. And I begin with a caveat, which is that I work for a project now, but my project ends September 24. So I've, I've got quite a time constrained view at the moment and that's made me think very carefully about what I do that's sustainable, what the sustainable legacy of what I do. It's difficult for me to talk in the more detailed terms about , um, the sort of a one and five year approach and all the rest of it. But what I recognized in the pandemic was the agility, the actual rapid uptake of , um, understanding of what was needed and the change that was coming and the response to people's needs. How to continue what remained of business as usual in a safe way. Simulation centers , um, everywhere we're trying to cope with, we still need to do this stuff, but we can't do it in our standard face-to-face way anymore. How are we gonna do it? So I'm a , the executive of our national association, which is api , the Association for Simulated Practice in Healthcare. And we worked with the national organizers of education to create really quick tools for how to deliver simulation safely and how simulation could support safe care and uh, safe learning. And I'm fascinated now in terms of the future with what is shaking out from the disruption of the pandemic. And uh , it's the same as everything else, isn't it? Some things that were born in the pandemic , um, are flourishing and some will wither and , and fall. And uh , we can see that I think in the field of virtual reality. So I'm fascinated by the resonances and the blurring post pandemic between technology enhanced learning and technology enhanced care. And what we've got now is we've got technology enhanced learning, technology enhanced care, and if we are not careful, we are going to find a technological way with virtual reality or whatever it might be to actually replicate what we tried to get away from. Um, but with a headset or whatever. So we've gotta be really careful , um, that we actually have good educational governance and we recognize , um, what is simulation and what is , um, observation , um, and what is well governance for good outcomes and what isn't.

Jerrod: 22:20

So when it comes to that shift, are there any particular practices you want to be more cautious of? Because I'm , I'm hearing like, what is it the, and Deb maybe you can help me here , the old dog new tricks or something. Are there any examples that you think that we should be staying away from that you start seeing similar or vice versa, that ones that you wanna make sure we're adopting into this new ages simulation?

Andy: 22:42

Actually, my answer is, is no, I don't think there are any specific examples that leap to mind. What I would say is that we have to be really careful about the governance of the interactions. So it was like I was saying about post pandemic, what survives, what will shake out as sustainable and good and what will shake out as a useful solution at the time, but has no longevity. And I think it's the same with what's going on now.

Jerrod: 23:12

Well, I mean , well said and hopefully that, you know, we continuously learn from 'em and I think that with this data or digital push, we're able to see what does work versus what doesn't and have decisions become so , uh, subjective in the past. It's like, oh no, I , I saw someone that made that work. And it's like, yeah, one out of like 10, but it should be okay. Do do nine out of 10 make it work. And I think that's the big difference.

Andy: 23:38

Absolutely. Really stute , um, it , there's this thing about, there are two questions, whether you are appropriately examining your process or whether you are appropriately examining your content. Uh , we probably all aware of papers like this, so it is possible to publish a paper in the simulation literature, which is fantastic and flourishing.

Jerrod: 24:01

Unfortunately. I think all of us know papers like that <laugh> , and that's when it becomes commonplace. You're like , uh,

Andy: 24:07

<laugh> .

Jerrod: 24:08

But Andy, I also wanna touch upon, you know, you hit the governance piece and I love this shift in thinking as well, but I want to get to know a little more about ASPE as well, So can you just give a little plug about that before , first and foremost,

Andy: 24:24

Delighted to and thank you for asking. So our conference is in Brighton in November and we will be expecting, so 600 people plus um, will come to Brighton to be involved in the ASPE conference 2023.

Jerrod: 24:45

Who are these attendees and where are they from?

Andy: 24:47

Where are they from? They're from universities, hospitals , um, and across the care spectrum, general practice radiographers. So in my region I've got people in palliative care hospices who are doing more and more , uh, with simulation and , um, it's all really positive from birth to death and into social care and wellbeing. And increasingly we are looking more at the sort of systems probing type of stuff of , uh, of simulation and the opportunities that that offers. We've got some excellent keynote speakers covering a range of stuff. We always pick a theme and the theme for 23 is sustainable simulation, but we are eager to find the ways that we can make simulation sustainable, both in terms of ongoing legacy, but also in terms of the green agenda and the environment and the like. I came from a simulation center where we would've been delighted to refill fluid bags , uh, uh, and all this sort of thing. And um , I , I ru those days, I regret those days and I look forward to the days where we find ways that ensures that , um, the environment is the definer of what's cost effective . Um , and there there's a lot more that we can do like that. So that's the ASPE conference. But ASPE is more than just the conference. So we have webinars and um, uh, journal clubs, special interest groups and the like with an increasing range of activity. And my list of people sounded a little bit like subject matter experts, but we are heavy supporters of simulation technicians, so we've been delighted. So one of our main industry sponsors has celebrated its 60th birthday by fully sponsoring , um, 60 simulation technicians to attend the conference. And we are delighted that , um, the technicians have , uh, leapt at this opportunity. We're going to have conference so strong for what we can provide for simulation technicians and what they can provide for each other. It's not just new collaborative networks, it's the sparking, it's the germination of new ideas that begin to develop.

Jerrod: 27:27

Fantastic. Yeah, I mean those collaboration among these professional organizations yourself of course included. It's, there's nothing like it in to have the connection and collaboration is, is very powerful. Yeah , yeah . So with that, what are some of the biggest things that you would like our listeners to know? Was there, you know, somewhat of an aha moment for you or in particular something you'd wanna pass on to the listeners to, to really raise the benchmark here?

Andy: 27:53

Okay, so I rise to this challenge and I'm gonna offer you my personal definition of what simulation actually is. Okay. It's a care event, risk managed for learning and curiosity to be prioritized above care, full stop. It's got no modalities, no mannequins or anything else in it.

Jerrod: 28:18

We definitely gotta include that one in the show notes. I like that a lot, Andy. That seems more of the signal throughout the noise. So it's just saying, okay, we don't need all this fancy stuff. We don't need, you know, bells and whistles. What you need to do is prioritize patient care and that's the most sync way to really , uh, remove all the noise around that.

Andy: 28:36

One of the things that you were interested about is , um, accreditation and the wonderful work that SSH has been doing and ASPE has standards we will be launching our new standards at , um, conference 2023 was ASPE has new standards and ASPE does as a society, accredit centers and individuals. U m, we haven't gone down the exam route, um, to date, but I just wanted to celebrate one of the ways that SSH is so generous from the research grants that you can apply for at the moment across the board. So I was invited from Nottingham in the middle of the UK to, uh, go across to America to take part in the first few workshops that began the work to develop the C H S E . Y ou c all i t, do you c all it cheesy

Deb: 29:39

<laugh> ? Some of us call it cheesy. Yes.

Andy: 29:43

Yes. I was , uh, uh, it didn't feel cheesy when I , when I passed , um, uh, and , and got mine. Um, but that work, it focused my mind so much on the nature of simulation for health and care and what we were about and what mattered that I've been living off it ever since. And that was a , a very generous invitation from S ss a . So I still celebrate that and I think it , I would not diminish the amount that it influenced the way I think about simulation for health and care. Now,

Deb: 30:18

Thank you for sharing that. I'm a big fan of SSH <laugh> . We're gonna go ahead and ask our last question. Are there any final words that you'd like our listeners to remember this conversation by?

Andy: 30:33

Uh , thank you for this. I've really enjoyed it. And I'm going to return to my definition of simulation and I'm going to just look at the detail of it. So I said simulation is a care event, risk managed for learning and curiosity prioritized above care. And the first thing I would like to add to that is I would like to say it's a service user focused risk managed care event. So let's add that and just go back to the fact that throughout this I've wanted to celebrate the fact that we have such a powerful opportunity to keep the service user voice at the center of everything that we do and to listen to it. And we're very engaged in the UK in co-production , um, and developing a relationship with experts by lived experience and the whole process of co-production into informing and improving health and care. And the other bit that I want to pick up is that I deliberately and carefully said risk managed for learning and curiosity. Very proud that I'm one of the co-authors , um, with the lead author, professor Sharon Marie Weldon of a paper that's in the International Journal of Healthcare Simulation on what we've called transformative simulation. And the reason why we wrote that the , the key driver for it was a recognition that if you want to look at simulation literature relevant to what you are thinking about doing, you can't just look in healthcare simulation or the international journal or advances in simulation. You have to fish around in niche specialist journals because niche specialists have used simulation as the tool of choice and they can't get it published anywhere else. And the reason why they can't get it published anywhere else 'cause they can't mash it into the format that fits the way that that publication likes to peer review its articles. So some simulation, some great simulation actually begins , um, not with a set of intended learning outcomes, not with a set of curricular learning objectives. It begins with somebody who doesn't quite know what they're doing but is really interested in it, who is curious. And so that's my final comment.

Deb: 33:16

Thank you. Thank you very much. Jerro\d, do you have anything you wanna add?

Jerrod: 33:21

No, I love that it relates, but I watched a , a silly movie the other week. It's called Sully. It is Tom Hanks. He, he lands a , you know, plane fence , whatever . But in that court case or whatever, he was like, you guys have done all these simulations. 'cause he turns and , and I'll recap it slightly, but he lands on the Hudson, instead of turning to New Jersey or LaGuardia two airports outta new New York and New Jersey and the insurance company or someone is you could have turned back and landed safely. Every single one of our computer simulations landed safely. Like, you failed you , you're a hero, but you failed. And in the court case, right, he responds with every single one of computer simulations had that. But you remove all human competence and behavior and likelihood, and this is what's funny is we're trying to train for all these instances, but I think a lot of times we're removing that human aspect. And to what I'm understanding from, from part of that, there's all these hidden gems and pieces of competency from everyday users and people and healthcare professionals that don't get to see the light of day because they're not deemed worthy, they're not deemed fitting for publication. And it's like these people have been their lives being academics, researchers, profession , healthcare professionals, but now they can't choose to share that expertise because it doesn't fit this mold, this square, you know, in a square hole and such. And so really, really resonates with me, you know, the lasting bits. So, so thank you for sharing that.

Andy: 34:48

Yeah. Um , what a day that was for Sullenberger and all the passengers on that plane. I think that one of the things that we're really getting to grips with , um, in the field of human factors and safety is whole nagel and the , um, it's not just Eric Gel, but he's probably the loudest voice about it. The idea of safety too. And the idea that it is ridiculous to try and learn how to make self healthcare safer by ruthlessly examining what happens when it goes wrong. You know, silly could have crashed that plane a million ways and he only landed it successfully the one way . And simulation can offer us the golden opportunity, the platform to look at a lot of the what ifs about why things go right and how they go right. Healthcare clearly at the moment as problems that need to be addressed and, and their unknown unknowns, there are problems that we need insight into. And one of the mistakes we might be making in simulation is working so hard to make it accurately replicate in realism the world as it is when what we need to be doing is changing the world as it is. So , um, maybe we need more of a caricature simulation that has enough realism to allow us to play with it. Um , we need to learn the difference between hindsight and reflection and stop beating ourselves up with hindsight and start learning with reflection and thinking what are the ways that this wonderful platform centered on the service user offers us to investigate things in , in new ways and different ways and ways that address the fact that for unknown reasons, we usually get it right. And another thing, what do we do following this epic investigation and punishment of the guilty practitioner? The usual result is we create a, a checklist and we probably embark on a program of training when things go wrong in clinical practice and epically wrong. It's usually one-off sets of occurrences and it's usually unique. And yet we ruthlessly examine what went wrong instead of patiently and generously examining what goes right.

Deb: 37:30

Wow. Thank you for that. And with that, I think we're gonna conclude this episode. And Andy Buttery, we really appreciate having you on today. Happy simulating.

Innovative Sim Solutions Tag: 37:43

Thanks to Innovative Sim Solutions for sponsoring this week's episode .

Outro: 37:55

Thanks for joining us here at The Sim Cafe . We hope you enjoyed. Visit us at www.innovativesimsolutions.com and be sure to hit that like and subscribe button so you never miss an episode. Innovative Sim Solutions is your one stop shop for your simulation. Needs a turnkey solution.