Medical Simulation is now becoming something that is more prevalent, certainly in medical training, as it is becoming part of the core training of junior doctors and it is probably only a matter of time before it becomes the standard in both nursing and paramedic training.
But why is it considered useful….or is it just playing with dolls?
Jackie Eder van Hook in her document “Building a National Agenda for Simulation-based Medical Education” noted in 2004 that medical errors in the US kill up to 98,000 people with an estimated cost between $37 and $50 million dollars per year, and the shortage of nurses and the reduction in hours of medical training may well only compound this problem.
What is simulation?
There are varying types of simulation that can be undertaken:
- Low tech simulators- mannequins to practice simple physical tasks on, such as the one we ll practice our basic life support skills on.
- Simulated patients- actors playing the part of a patient. I encountered this in an OSCE situation for my Anaesthetic Practitioner exams.
- Screen based computer simulations- problem based learning for example. The ALS model is based on this with its computer based courses.
- Complex task trainers- high fidelity tools integrated with computers. These devices can help simulate bronchoscopy or laparoscopy for example.
The focus of simulation training is not always about the tasks, but greater benefit can be had from focusing on the ways the teams behave and interact with each other. Crisis Resource Management has had its place in other industries for some time, aviation being a great example, and the medical profession is gradually learning lessons from these.
- The ability to provide feedback- a very important part of the simulation process. Ken Spearpoint, in CCP Podcast 005 makes the point that the debrief is something that he will spend a lot of time over.
- Repetitive practice- Dr Scott Weingart loves to say how we train is how we fight! If we practice the skills we may need one day with some degree of repetition then this becomes an unconscious task delivered well and effectively.
- Curriculum integration
- The ability to range the difficulty levels- it may be appropriate to give the learner their first exposure of a situation in a simulated scenario. Simulation can bridge the gap between text book leaning and the first encounter.
- Teamwork- as mentioned above crisis resource management involves working as a team and/or becoming an effective team leader. There are a number of useful principles which can be learned and then practiced in the simulation environment. There are some common pitfalls which can be addressed around teamwork during simulation:
- Lack of understanding of roles and responsibilities of other team members.
- Absence of clearly defined roles of team members leading to greater confusion.
- Assumption that all team members will perform to their maximum capability.
The educational benefits of simulation in medical education include the following:
- Deliberate practice with feedback- systematic approaches can be taught to the learners. they can then be given feedback by others, but just as importantly they can learn to self critique effectively. The feedback process is the most important part of the simulation process as this is how the learner will evaluate their and others progress.
- Exposure to uncommon events- not all things in medicine will be encountered everyday. It can be useful to help the learner experience those events in the hope that they will be more prepared if they do come along.
- Reproducibility- with a good structure the scenario can be replayed again and again, allowing the learners to reevaluate and if necessary change their practice.
- Opportunity for assessment of learners- there may be learners who can ‘talk the talk’ but can they ‘walk the walk’! Are they able to put their knowledge into practice in a potentially stressful environment?
- Range of difficulty levels- not all learners learn at the same rate or are at the same level when entering the training room. The experience can be tailored accordingly.
- The absence of risks to patients- mistakes can be made which will not cost the patient their health or their life!
Here to Stay……
It would seem that medical simulation is here to stay as it allows some of the changes in the training of the medical team and the possible shortfalls in staffing levels to be addressed in a safe non-threatening environment. With increasing and chaeper technology the simulation is only going to become more realistic and hopefully, therefore of more benefit to learners and ultimately to the patients receiving their care.
Shapiro MJ, Morey JC, Small SD, Langford V, Kaylor CJ, Jagminas L, et al. Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Qual Saf Health Care. 2004;13:417–21
Gupta A, Peckler B, Schoken D. Introduction of hi-fidelity simulation techniques as an ideal teaching tool for upcoming emergency medicine and trauma residency programs in India. J Emerg Trauma Shock. 2008;1:15–8.
Risser DT, Rice MM, Salisbury ML, Simon R, Jay GD, Berns SD. The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium. Ann Emerg Med. 1999;34:373–83
Rosen MA, Salas E, Wu TS, Silvestri S, Lazzara EH, Lyons R, et al. Promoting teamwork: an event-based approach to simulation-based teamwork training for emergency medicine residents. Acad Emerg Med. 2008;15:1190–8
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