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.
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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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