Simulation, safety and surgery
Department of Surgery and Cancer, Imperial College London, 2nd Floor, Paterson Centre, St Mary's Hospital, Praed Street, London W2 1NY, UK. Quality and Safety in Health Care
(Impact Factor: 2.16).
10/2010; 19 Suppl 3(Suppl 3):i47-52. DOI: 10.1136/qshc.2010.042424
This paper explores the place of simulation in contemporary healthcare education and training, highlighting the challenges of recreating complex clinical settings which can support the development of competent, rounded and caring practitioners, and address issues around human factors as well as technical skill. It frames the relationship between clinical and simulation-based practice as a mutually dependent, two-way process.
According to this view, simulation is less like a photograph of clinical care than a painting of it-a process that requires selection and interpretation. The paper presents simulation as a canvas on which to paint this picture. To be effective, simulation must mirror the essentials of a clinical setting without reproducing every detail. After highlighting key issues with current approaches to simulation, the paper considers how authenticity and perceived realism can be heightened through innovative uses of technology and design, putting forward a conceptual framework based on the notion of 'circles of focus.' The paper then outlines the concept of Distributed Simulation, using low-cost, portable yet immersive environments to address limitations of access to dedicated facilities.
The paper concludes by considering theoretical and practical implications of these innovations, focussing especially on surgery and other craft specialties.
Available from: sajs.org.za
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ABSTRACT: Minimally invasive techniques are now well established in paediatric surgery. Training has traditionally been based on an apprenticeship model, as for open surgery. More recently the constraints of litigation, finance and restriction of doctors' working hours have led to a need to rethink this training. Simulation to learn and improve skills is by no means a new concept, but has been suggested as a way to address the above issues because it provides an ideal platform for acquiring the necessary skills for modern laparoscopic surgery. This paper explores some of the current issues of learning minimally invasive surgical skills in a simulated environment, and suggests that such simulation should not be seen in isolation but as a part of a wider and encompassing curriculum of learning for the 21st-century surgeon.
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie 02/2011; 49(1):4-6. · 0.40 Impact Factor
Available from: heapol.oxfordjournals.org
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ABSTRACT: The effort to increase access to emergency and surgical care in low-income countries has received global attention. While most of the literature on this issue focuses on workforce challenges, it is critical to recognize infrastructure gaps that hinder the ability of health systems to make emergency and surgical care a reality.
This study reviews key barriers to the provision of emergency and surgical care in sub-Saharan Africa using aggregate data from the Service Provision Assessments and Demographic and Health Surveys of five countries: Ghana, Kenya, Rwanda, Tanzania and Uganda. For hospitals and health centres, competency was assessed in six areas: basic infrastructure, equipment, medicine storage, infection control, education and quality control. Percentage of compliant facilities in each country was calculated for each of the six areas to facilitate comparison of hospitals and health centres across the five countries.
The percentage of hospitals with dependable running water and electricity ranged from 22% to 46%. In countries analysed, only 19-50% of hospitals had the ability to provide 24-hour emergency care. For storage of medication, only 18% to 41% of facilities had unexpired drugs and current inventories. Availability of supplies to control infection and safely dispose of hazardous waste was generally poor (less than 50%) across all facilities. As few as 14% of hospitals (and as high as 76%) among those surveyed had training and supervision in place.
No surveyed hospital had enough infrastructure to follow minimum standards and practices that the World Health Organization has deemed essential for the provision of emergency and surgical care. The countries where these hospitals are located may be representative of other low-income countries in sub-Saharan Africa. Thus, the results suggest that increased attention to building up the infrastructure within struggling health systems is necessary for improvements in global access to medical care.
Health Policy and Planning 03/2011; 27(3):234-44. DOI:10.1093/heapol/czr023 · 3.47 Impact Factor
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ABSTRACT: Simulation-based team training (SBTT) in healthcare is gaining acceptance. Guidelines for appropriate use of SBTT exist, but the evidence base remains limited. Insights from other academic disciplines with sophisticated models of team working may point to opportunities to build on current frameworks applied to team training in healthcare. The purpose of this consensus statement is threefold: (1) to highlight current best practices in designing SBTT in healthcare and to identify gaps in current implementation; (2) to explore validated concepts and principles from relevant academic disciplines and industries; and (3) to identify potential high-yield areas for future research and development.
We performed a selective review and critical synthesis of literature in healthcare simulation related to team learning as well as from other relevant disciplines such as psychology, business, and organizational behavior. We discuss appropriate use of SBTT and identify gaps in the literature.
Healthcare educators should apply rigorous curriculum development processes and generate learning opportunities that address the interrelated conceptual levels of team working by addressing learning needs at the level of the individual, the team, the organization, and the healthcare system. The interplay between these conceptual levels and their relative importance to team-based learning should be explored and described. Instructional design factors and contextual features that impact the effect of SBTT should be studied. Further development of validated assessment tools of team performance relevant to professional practice is a high priority and is essential to provide formative, summative, and diagnostic feedback and evaluation of SBTT. Standardized reporting of curriculum design and debriefing approaches, although difficult, would help move the field forward by allowing educators to characterize effective SBTT instruction.
Much work is needed to establish a robust and defensible evidence base for SBTT. The complexity and expense of SBTT require that specific programs or interventions are appropriately designed, implemented, and evaluated. The healthcare sector needs to understand how team performance can be optimized through appropriate training methods. The specific role of simulation in team training needs to be more clearly articulated, and the training conditions that make SBTT in healthcare effective need to be better characterized.
Simulation in healthcare: journal of the Society for Simulation in Healthcare 08/2011; 6 Suppl(7):S14-9. DOI:10.1097/SIH.0b013e318229f550 · 1.48 Impact Factor
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