Simulation, safety and surgery.
ABSTRACT 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.
SourceAvailable from: Stanley J. Hamstra[Show abstract] [Hide abstract]
ABSTRACT: The competent performance of a female pelvic examination requires both technical proficiency and superlative communication skills. However, the ideal medium with which to assess these skills remains to be elucidated. Part-task trainers (PTTs) offer an effective and affordable means of testing technical skills, but may not allow students to demonstrate their communication skills. Hybrids involving standardised patients (SPs) (SP-PTT) offer a more realistic assessment of communication, but students may feel awkward when examining the female genitalia. The objective of this study was to compare the use of PTTs with that of SP-PTT hybrids in the assessment of technical and communication skills in the female pelvic examination. A total of 145 medical students were randomised to one of three conditions during their summative objective structured clinical examination (OSCE) at the completion of clerkship. Students performed the female pelvic examination on: (i) a PTT alone ('plastic' condition); (ii) an SP-PTT hybrid with an SP who did not engage in any superfluous conversation ('perfunctory' condition), or (iii) an SP-PTT hybrid with an SP who was trained to offer small talk and banter, which was judged to better reflect the typical doctor-patient interaction ('pleasant' condition). Communication skills did not differ significantly among the three groups (p = 0.354). There was a significant difference among groups in technical skills scores (p = 0.0018). Students in the 'plastic' condition performed best, followed by those in the 'perfunctory' and 'pleasant' conditions, respectively. Medical students demonstrate equivalent communication skills whether they work with a PTT or an SP-PTT hybrid, but their technical skills suffer in the presence of an SP. Working with the PTT alone does not appear to disadvantage students in terms of communication skills, but may offer better conditions for performing technical aspects of the procedure. Whether the 'plastic patient' is the most meaningful and valid means of predicting overall competence in the clinical setting is still a matter for debate.Medical Education 12/2013; 47(12):1209-14. DOI:10.1111/medu.12280 · 3.62 Impact Factor
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ABSTRACT: To design a surgical training environment based on task and crisis analysis of the surgical workflow. The environment consists of: (1) real surgical instruments that are augmented with realistic haptic feedback and VR capabilities, (2) human sensory channels such as tactile, auditory and visual in real time, and (3) the ability to facilitate deliberate exposure to adverse events enabling mediation of error recovery strategies. Five surgeons were immersed in our medical simulation environment through task and crisis scenarios of a typical vertebroplasty workflow. Based on a five-point Likert-scale survey, the face validity of our simulation environment was confirmed by investigating surgeon behavior and workflow response. The result of the conducted user-study corroborates our unique medical simulation concept of combining VR and human multisensory responses into surgical workflow.International Journal of Computer Assisted Radiology and Surgery 01/2014; 9(5). DOI:10.1007/s11548-013-0970-z · 1.66 Impact Factor
British Journal of Educational Technology 09/2013; 44(5). DOI:10.1111/j.1467-8535.2012.01348.x · 1.54 Impact Factor