Training is necessary on several levels in corrections, from interacting with inmates to health care issues behind bars. One type of training that is being introduced to the corrections environment with some success is Simulation Training, where students palce themselves in situations to learn techniques.

According to Robyn Gershon, MHS, Dr. P.H., Associate Professor, Mailman School of Public Health at Columbia University, learning information about health safety can be made several fold easier when this type of training is used. 

'They won't realize they are learning and all of a sudden they will realize how much they have learned. It tends to 'stick' when you do this kind of learning. It tends to remain with you, unlike stuff you may learn from a test or reading a book,' said Gershon.

Gershon will present Simulation Training in a workshop at the American Correctional Association's Winter Conference in Nashville on January 22. The workshop will teach participants about Simulation Training, how to use it and specific situations they can use in their own facilities related to health safety.

The Corrections Connection recently spoke with Gershon about her upcoming presentation.

Q: What is simulation training?

A: It was developed after WW2 and was part of an embedded learning theory developed by psychologists for pilots. The developers thought that if you had a storyline built in then the learners would focus on the story line and the learning would be strung along like beads. As you moved the through the process you would take another bead off. It was a way in which you could learn complex information but you would be able to retain it as if it was a story. People by human nature tend to remember stories.

This process is very important when you are dealing with rare events. For these rare events like an airplane, car or inside a prison, we want staff to be as prepared as they can be in terms of safety. Their well being is paramount.

Q: How did you start teaching this process?

A: One of our teams was charged with finding better ways to train. People don't like training. Most people don't show up; they are bored; they sleep. There is not much about training that is fun. A lot of it is regulatory. The book of OSHA regulations [for example] is a very thick paperback that is impenetrable. So it is hard going.They have to talk about regulations and what they have to do and people don't like to be told what they have to do.Our team decided to completely revamp the blood bourne pathogen training program from every angle. That meant new employee training, all the way to annual update re-training.

Q: How did this training become corrections-related? 

A: In 1996, and 1997,we received two different prison healthcare workers grants.For both studies we have been involved in simulation training. One study was done in Texas DOC in five facilities with large numbers of healthcare workers. Rhode Island DOC and all of the Maryland Department of Corrections have been involved and we are about to enter into NY DOC.

It involves testing their blood for Hep B and C and their vaccination status. We also do TB testing. They fill out a questionnaire to determine what kind of exposures people are having or why they are having them. Things they would not normally reveal, they will on an anonymous questionnaire. We use this to train on those results.

The serum is sent to CDC and tested. We found a very surprisingly high rate of Hepatitis B. This is not surprising for healthcare workers, because they tend to have rates of about 1-3%. We tested 400 people and about 3% had Hep C. We were on the upper end for Hep B. We [normally] see rates of 4-5% for Hep B and here they were 10-12% positive for Hep B. But what was interesting is that about 90% of the ones that Hep C had no idea or Hep B. That is 1 out of 10 people. They were higher than we normally see and when we asked them. Based on this data we know that we have to do training on Hep C.They had to get their partners tested and their children test and it was quite painful to find out that information.

In addition, we made a video based on true stories of exposures with real people. The film just won a prize at the New York Film festival as a training film. When people tell their stories you get emotional involved. What you remember is more than what you would remember given a flat piece of paper.

Another focus for us was creating a Self Study Packet that has straight didactic information and at the end of each session participants are asked questions and a take a test.Another element is the simulation We hired a world expert on simulation training who did simulations for the government for minors who were semi-literate. 

Q: What form will the simulations take? 

A: They are paper and pen versions for the ACA workshop, but there are also computer software programs that provide simulations if you have the resources.There will be computer slides as well.We use total quality techniques, break into little teams and utilize TQM principals. We set the ground work and ground stage of how we will do things. It is very interactive. We keep it extremely user-friendly.

When I have done this before people say 'this was the most fun I have had' and we are talking about horrific scenarios like needle sticks with HIV blood turning HIV positive, having to tell your family, being afraid to tell your family. They are always based on true stories. That is why they are so real.

Q: Can you give us an example of a real-life situation that has occurred in a correctional facility?

A: One of the stories is where a nurse was stuck with IV needle that came out of IV tubing and the patient had HIV/AIDS. The patient was very agitated and was out of control. She screamed for help. Help was slow. One nurse grabbed hold of the needle and the inmate swung his arm and the nurse accidentally stuck the other nurse. The patient passed away shortly and then the nurse did. It's a reality. These people with infections are coming in and staying longer and they are living longer.We have to be very mindful that this is not a problem going away.

Q: Why is it important for correctional staff to be educated on OSHA standards?

A: It is important because the prevalence rates in inmates is not just a few percentagepoints greater than what you find in the normal hospital setting. It is as high as 47% for Hep C (1 out of 2 inmates) in some states. And with HIV, 8% (women) and 15% (men). General public is .5%-1%. A 15-fold higher for prevalence.Twenty percent have Hep B but it is very low in the general population (1-3%).

That is because a lot of inmates are in there for IV drug use and they have a high risk.

Q: Do you cover the importance of why staff should be immunized for Hepatitis B?

A: I would advocate for facilities providing vaccinations and I believe all correctional staff should be vaccinated.It is safe and effective. There is a series of three shots and it should give you immunity for 10, 15, 20 years.We highly recommend it if you are working with high prevalence patients like they are.

This information will be part of the storyline [in the training.] There are points for decision making. We do the decision making by ourselves, in groups of three and then as a large group, so we really come to learn about the process. When you have to articulate why you do the things you do in front a group, you get to see it better and understand the decisions you are making and why.

We start to tease apart what are the barriers to doing safely. In prison, there are a lot of barriers that general population healthcare workers don't have to face.

Q: Does the workshop cover the best defense against exposure to communicable disease?

A: We will be really talking about bloodbourne pathogens: Hep B, Hep C and HIV. There are 20 others, but we will focus on those big three. Vaccination for Hep B.We are talking about primary prevention. Standard precautions, safe work practices, but not in a boring way.Preventing exposure in the first place is the primary goal.

Q: What are the training drawbacks in prisons?

A: One of the biggest drawbacks is limited resources. A real-live super duper trainer would be great. But lets face it, most really-good trainers are very expensive and computer simulations are as well.

Q: Who do you believe should attend this workshop? Why?

A: I think the primary person who should attend is someone who has any supervisory or training responsibilities inside the prison, whether it's training staff, healthcare workers, inmates.

Also, if someone has potential risk including healthcare workers, correctional officers.

Decision makers (administrators, commissioners) are critical. They can be the ones that say 'this may be the way to go' for training. It will change the way they provide training. To make the stories real, you have to take home the templates tailor it to your own settings.Then every year you have to give a fresh story or fresh idea.

Attendees should be prepared to leave their prior experiences about training behind. This is not another one of your ho-hum training. Be prepared for something different.Be prepared to have fun.

You don't need a healthcare background. Just an open mind.