Research Contexts of This Study

This research was conducted mostly as part of the MediPeda projects (2007–2010) and MediPro project (2012–2014). Therefore, the research environments were the same ones that were involved in those projects. The environments are described in more detail in the following.

ENVI – Virtual Centre of Wellness Campus™

The ENVI Virtual Center of Wellness Campus™ (see Figure 1) was built in the Rovaniemi University of Applied Sciences and the Lapland Vocational College (Rovaniemi, Finland) during the years 2005–2008 (for a more detailed description of the campus, see Keskitalo, 2011; www.envi.fi).

Figure 1: ENVI Virtual Center for Wellness Campus™. Published by permission of the Rovaniemi University of Applied Sciences and the Lapland Vocational College, 2010.

ENVI consists of an incident environment and a simulated ambulance, an emer-gency treatment and intensive care unit, a cardiac care unit, a surgical unit and a

bed ward as well as a maternity/child health clinic and distance consultation room.

ENVI has specifically been developed to allow personnel and students in the fields of healthcare and social services to develop, test and maintain their know-how and knowledge. For example, in the environment, students and multi-professional care teams can practice team skills during the healthcare process, from the scene of an accident to a hospital and finally to rehabilitation. Learners can also choose to practice just part of the process or basic skills in some of these spaces.

However, ENVI is not an ordinary simulation center, as it combines physi-cal simulated environments and computer-directed interactive patient simulators with full-scale three-dimensional (3D) simulated incident environments that are completed with special effects. Learners can view, navigate and interact in the in-cident environment using a hand-held interaction device. Hence, the inin-cident en-vironment provides full-body movement in front of a large-scale display in a 3D environment (Haukkamaa, Yliräisänen-Seppänen & Timonen, 2010). This is the feature that makes ENVI unique compared to other simulation centers. However, in 2013 ENVI was still evolving, and currently it has been moved to another loca-tion. I conducted Sub-studies I and II in ENVI.

The Arcada Patient Safety and Learning Center

The Arcada Patient Safety and Learning Center (APSLC) is situated in the Ar-cada University of Applied Sciences (Helsinki, Finland), where the first case study and data collection (Sub-studies III–IV) were arranged together with facilitators.

The APSLC is a simulation center consisting of separate rooms where students and professionals from different healthcare fields can practice specific skills or go through entire scenarios related to the content areas. It is equipped with the technology appropriate in the work of healthcare professionals. The environment includes a computer-directed patient simulator and a monitor displaying the vi-tal signs of the patient simulator. The patient simulator is interactive and it can display different disorders, bodily functions and respirations. One room is for the facilitator, where he or she can control the simulator and guide the students’ learn-ing process via audio devices. One room is usually dedicated to debrieflearn-ing, where appropriate technologies such as video and audio recording devices are available.

In this room, those students who are not actively taking part in the scenario can watch the scenario through a TV screen. The center is used by Arcada’s Bachelor’s and Master’s degree students, but continuing training courses are also offered.

Simulation Centers of Stanford University

The Patient Simulation Center of Innovation (Figure 2) is situated in the VA Palo Alto Health Care System (Palo Alto, CA, USA). The Center currently occupies around 2200 ft² (approx. 204 m²). It has two large simulation rooms: one set up

as an operating room and one as an intensive care unit, emergency department, or ward. The center has five computer-directed patient simulators: three permanently set up and one adult simulator for in-situ training exercises in actual clinical en-vironments. Furthermore, it provides an infant simulator for pediatric anesthesia training. The simulation center has concentrated training on topics such as an-esthesiology, intensive care and rapid response teams, emergency medicine, and respiratory therapy.

Figure 2. Training in the Patient Simulation Center of Innovation.

The simulation group at VA Palo Alto is the pioneering inventor of modern mannequin-based patient simulation. They performed their first pilot-test simula-tions in 1986, and have had a dedicated simulation center since 1995. They are also responsible for adapting and implementing many concepts and practices used in commercial aviation simulations to medicine. These include introducing the training of behavioral and team skills in simulations, for instance, anesthesia crisis resource management courses (ACRM) (e.g., Gaba, Howard, Fish, Smith & Sowb, 2001; Howard et al., 1992.)

Data were also collected at the Goodman Surgical Simulation Center, which is situated in the middle of Stanford Hospital (Palo Alto, CA, USA). The center allows for convenient drop-in practice and pre-surgical planning, while providing tools to improve learners’ skills. The center was opened in June 2007. Its skills area is open 24/7 (via card access) to all surgical residents. In addition to the center’s accessibility, there are two surgical education fellows in the center on a daily basis.

The center has vascular trainers, virtual reality laparoscopic trainers, box trainers, colonoscopy trainers and two patient simulators.

The center offers training for a variety of learners and disciplines. It is used by surgical residents, medical students, residents from other disciplines, nursing professionals and respiratory therapists, to mention a few. Surgical residents, for example, have a weekly exercise time. During this time, they practice skills and de-cision making relevant to their surgical rotation in the simulation center. In Stan-ford University’s simulation centers we conducted our second case study and data collection (Sub-studies III and IV).