Distributed simulation - Accessible immersive training

Imperial College London, UK.
Medical Teacher (Impact Factor: 1.68). 01/2010; 32(1):65-70. DOI: 10.3109/01421590903419749
Source: PubMed


Distributed simulation (DS) is the concept of high-fidelity immersive simulation on-demand, made widely available wherever and whenever it is required. DS provides an easily transportable, self-contained 'set' for creating simulated environments within an inflatable enclosure, at a small fraction of the cost of dedicated, static simulation facilities. High-fidelity simulation is currently confined to a relatively small number of specialised centres. This is largely because full-immersion simulation is perceived to require static, dedicated and sophisticated equipment, supported by expert faculty. Alternatives are needed for healthcare professionals who cannot access such centres. We propose that elements of immersive simulations can be provided within a lightweight, low-cost and self-contained setting which is portable and can therefore be accessed by a wide range of clinicians. We will argue that mobile simulated environments can be taken to where they are needed, making simulation more widely available. We develop the notion that a simulation environment need not be a fixed, static resource, but rather a 'container' for a range of activities and performances, designed around the needs of individual users. We critically examine the potential of DS to widen access to an otherwise limited resource, putting flexible, 'just in time' training within reach of all clinicians. Finally, we frame DS as a 'disruptive innovation' with potential to radically alter the landscape of simulation-based training.

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    • "Subsequently, students can be encouraged to actively seek opportunities to perform these skills clinically when appropriate. Low fidelity simulation programmes, such as our BSS course, not only have a positive impact on skills training, but are also accessible and inexpensive [7]. However, the experience of working on a plastic model is considerably different from performing the same procedure on a human. "
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    ABSTRACT: Changes in undergraduate medical curricula, combined with reforms in postgraduate education, have training implications for surgical skills acquisition in a climate of reduced clinical exposure. Confidence and prior experience influences the educational impact of learning. Currently there is no basic surgical skills (BSS) programme integrated into undergraduate curricula in the United Kingdom. We explored the role of a dedicated BSS programme for undergraduates in improving confidence and influencing careers in King's College London School of Medicine, and the programme was evaluated. A programme was designed in-line with the established Royal College of Surgeons course. Undergraduates were taught four key skills over four weeks: knot-tying, basic-suturing, tying-at-depth and chest-drain insertion, using low-fidelity bench-top models. A Likert-style questionnaire was designed to determine educational value and influence on career choice. Qualitative data was collected. Only 29% and 42% of students had undertaken previous practice in knot-tying and basic suturing, respectively. 96% agreed that skills exposure prior to starting surgical rotations was essential and felt a dedicated course would augment undergraduate training. There was a significant increase in confidence in the practice and knowledge of all skills taught (p<0.01), with a greater motivation to be actively involved in the surgical firm and theatres. A simple, structured BSS programme can increase the confidence and motivation of students. Early surgical skills targeting is valuable for students entering surgical, related allied, and even traditionally non-surgical specialties such as general practice. Such experience can increase the confidence of future junior doctors and trainees. We advocate the introduction of a BSS programme into United Kingdom undergraduate curricula.
    Journal of Educational Evaluation for Health Professions 10/2013; 10:10. DOI:10.3352/jeehp.2013.10.10
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    • "Distributed Simulation (DS) is a validated, low-cost and portable concept, devised to widen access to contextualised simulation. It comprises an inflatable shell containing the minimum necessary cues to provide a sense of realism and inbuilt recording facilities (Kneebone et al. 2010). Such inflatable simulation facilities have been promoted in educational policy (Temple 2010). "
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    ABSTRACT: Background: Simulation offers recognised training benefits, but the cost of high-fidelity contextualised simulation is prohibitive and its accessibility limited to specialised Distributed Simulation centres. Distributed simulation (DS) is an innovative concept of low-cost, portable and high-fidelity contextualised simulation. However, it has previously only been trialled at a central London teaching hospital. Aims: (1) To explore the off-site feasibility of DS. (2) To determine the response of end-users to DS. Methods: A DS naive researcher recreated a standardised porcine laparoscopic cholecystectomy scenario at a District General Hospital using DS. A research diary detailed the logistical feasibility of the project, whilst mixed methods were used to determine the response of the 10 surgeons who completed the full-team simulation. Results: DS is feasible off-site with end-users comparing it favourably to their previous simulation experiences. Surgeons perceived DS as being most useful for building the operative confidence of juniors between learning the basics on a bench top model and before entering the operating theatre. Conclusions: DS has the potential to provide high-fidelity contextualised simulation as an adjunct to, and not a replacement for, surgical training. Unlike other modalities, it is low cost and portable, thereby addressing concerns over affordability and accessibility.
    Medical Teacher 11/2012; 35(4). DOI:10.3109/0142159X.2012.731095 · 1.68 Impact Factor
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    • "Crisis events can also be modeled, allowing healthcare teams to be evaluated in realistic environment including rare but important clinical events essential for teaching patient-safety (Sica et al. 1999; Wong et al. 2002). Distributed simulation using portable, low-cost, and highly immersive environment offers a new avenue of testing clinical skills in authentic setting (Kneebone et al. 2010). Onscreen simulations, such as virtual patients, are another growing form and one that has been found to have utility in assessment as well as learning (Fischer et al. 2005; Round et al. 2009). "
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    ABSTRACT: The uptake of information and communication technologies (ICTs) in health professions education can have far-reaching consequences on assessment. The medical education community still needs to develop a deeper understanding of how technology can underpin and extend assessment practices. This article was developed by the 2010 Ottawa Conference Consensus Group on technology-enabled assessment to guide practitioners and researchers working in this area. This article highlights the changing nature of ICTs in assessment, the importance of aligning technology-enabled assessment with local context and needs, the need for better evidence to support use of technologies in health profession education assessment, and a number of challenges, particularly validity threats, that need to be addressed while incorporating technology in assessment. Our recommendations are intended for all practitioners across health professional education. Recommendations include adhering to principles of good assessment, the need for developing coherent institutional policy, using technologies to broaden the competencies to be assessed, linking patient-outcome data to assessment of practitioner performance, and capitalizing on technologies for the management of the entire life-cycle of assessment.
    Medical Teacher 05/2011; 33(5):364-9. DOI:10.3109/0142159X.2011.565832 · 1.68 Impact Factor
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