Lessons for Continuing Medical Education From Simulation Research in Undergraduate and Graduate Medical Education Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines

Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-3008, USA.
Chest (Impact Factor: 7.48). 04/2009; 135(3 Suppl):62S-68S. DOI: 10.1378/chest.08-2521
Source: PubMed


Simulation technology is widely used in undergraduate and graduate medical education as well as for personnel training and evaluation in other healthcare professions. Simulation provides safe and effective opportunities for learners at all levels to practice and acquire clinical skills needed for patient care. A growing body of research evidence documents the utility of simulation technology for educating healthcare professionals. However, simulation has not been widely endorsed or used for continuing medical education (CME).
This article reviews and evaluates evidence from studies on simulation technology in undergraduate and graduate medical education and addresses its implications for CME.
The Agency for Healthcare Research and Quality Evidence Report suggests that simulation training is effective, especially for psychomotor and communication skills, but that the strength of the evidence is low. In another review, the Best Evidence Medical Education collaboration supported the use of simulation technology, focusing on high-fidelity medical simulations under specific conditions. Other studies enumerate best practices that include mastery learning, deliberate practice, and recognition and attention to cultural barriers within the medical profession that present obstacles to wider use of this technology.
Simulation technology is a powerful tool for the education of physicians and other healthcare professionals at all levels. Its educational effectiveness depends on informed use for trainees, including providing feedback, engaging learners in deliberate practice, integrating simulation into an overall curriculum, as well as on the instruction and competence of faculty in its use. Medical simulation complements, but does not replace, educational activities based on real patient-care experiences.

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Available from: William C Mcgaghie, Jul 17, 2015
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    • "" Standardized patients " (live persons trained to portray patients with a variety of presenting complaints and pathologies) [17] are the standard for patient-provider communication simulations and a wellestablished and effective medical training method181920. The STAT-911 training study incorporates essential elements of successful simulations, including: (a) the simulation is a valid representation of clinical practice, (b) immediate feedback, (c) repetitive practice, (d) increasing levels of difficulty and clinical variation, (e) a controlled environment, and (f ) clearly defined outcome measures [17]. Post-simulation debriefing with feedback from an expert instructor can deepen the learning process, by guiding the trainees' self-reflection, answering questions , and ensuring the application of training princi- ples [21, 22]. "
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    ABSTRACT: 9-1-1 dispatchers are often the first contact for bystanders witnessing an out-of-hospital cardiac arrest. In the time before Emergency Medical Services arrives, dispatcher identification of the need for, and provision of Telephone-CPR (T-CPR) can improve survival. Our study aims to evaluate the use of phone-based standardized patient simulation training to improve identification of the need for T-CPR and shorten time to start of T-CPR instructions. The STAT-911 study is a randomized controlled trial. We will recruit 160 dispatchers from 9-1-1 call-centers in the Pacific Northwest; they are randomized to an intervention or control group. Intervention participants complete four telephone simulation training sessions over 6–8 months. Training sessions consist of three mock 9-1-1 calls, with a standardized patient playing a caller witnessing a medical emergency. After the mock calls, an instructor who has been listening in and scoring the dispatcher’s call management, connects to the dispatcher and provides feedback on select call processing skills. After the last training session, all participants complete the simulation test: a call session that includes two mock 9-1-1 calls of medium complexity. During the study, audio from all actual cardiac arrest calls handled by the dispatchers will be collected. All dispatchers complete a baseline survey, and after the intervention, a follow-up survey to measure confidence. Primary outcomes are proportion of calls where dispatchers identify the need for T-CPR, and time to start of T-CPR, assessed by comparing performance on two calls in the simulation test. Secondary outcomes are proportion of actual cardiac arrest calls in which dispatchers identify the need for T-CPR and time to start of T-CPR; performance on call-taking skills during the simulation test; self-reported confidence in the baseline and follow-up surveys; and calculated costs of the intervention training sessions and projected costs for field implementation of training sessions. The STAT-911 study will evaluate if over-the-phone simulation training with standardized patients can improve 9-1-1 dispatchers’ ability identify the need for, and promptly begin T-CPR. Furthermore, it will advance knowledge on the effectiveness of simulation training for health services phone-operators interacting with clients, patients, or bystanders in diagnosis, triage, and treatment decisions. Trial registration Registration Number: NCT01972087. Registered 23 October 2013.
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    • "This may be due in part to decreased senior resident fatigue during teaching duties given shorter consecutive duty hours and the addition of the simulation-based medical education curriculum. Both high-fidelity and low-fidelity procedural simulation have been successfully used as medical education tools in post-graduate training [31-34]. The study participants felt that the implementation of the SRRB allowed less staff physician supervision for the senior residents but did not feel there was any significant difference in the senior residents’ ability to learn successfully after the implementation of the SRRB. "
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    Full-text · Article · Aug 2013 · BMC Medical Education
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    • "To date, the use of simulation is a common tool in undergraduate and graduate medical education, whereas its utilization in continuing medical education (CME) has yet to be explored. Currently, CME training programs are increasingly focusing on simulation to optimize learning outcomes.10,11 "
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