Simulation, safety and surgery

ArticleinQuality and Safety in Health Care 19 Suppl 3(Suppl 3):i47-52 · October 2010with10 Reads
DOI: 10.1136/qshc.2010.042424 · Source: PubMed
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.
    • "Although offering obvious benefits to educational, creating institutions, this assessment focus can lead to a culture of 'teaching and learning to the test' which underplays the complexity and uncertainty of real-world clinical care, creating an artificial and unhelpful distinction between 'technical' and 'non-technical' skills. This paper next argues that simulation offers possibilities that have not been fully exploited, partly because of restrictions in access that an 'insider' perspective entails [23, 24]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Simulation is firmly established as a mainstay of clinical education, and extensive research has demonstrated its value. Current practice uses inanimate simulators (with a range of complexity, sophistication and cost) to address the patient ‘as body’ and trained actors or lay people (Simulated Patients) to address the patient ‘as person’. These approaches are often separate.Healthcare simulation to date has been largely for the training and assessment of clinical ‘insiders’, simulating current practices. A close coupling with the clinical world restricts access to the facilities and practices of simulation, often excluding patients, families and publics. Yet such perspectives are an essential component of clinical practice. Main bodyThis paper argues that simulation offers opportunities to move outside a clinical ‘insider’ frame and create connections with other individuals and groups. Simulation becomes a bridge between experts whose worlds do not usually intersect, inviting an exchange of insights around embodied practices—the ‘doing’ of medicine—without jeopardising the safety of actual patients.Healthcare practice and education take place within a clinical frame that often conceals parallels with other domains of expert practice. Valuable insights emerge by viewing clinical practice not only as the application of medical science but also as performance and craftsmanship.Such connections require a redefinition of simulation. Its essence is not expensive elaborate facilities. Developments such as hybrid, distributed and sequential simulation offer examples of how simulation can combine ‘patient as body’ with ‘patient as person’ at relatively low cost, democratising simulation and exerting traction beyond the clinical sphere.The essence of simulation is a purposeful design, based on an active process of selection from an originary world, abstraction of what is criterial and re-presentation in another setting for a particular purpose or audience. This may be done within traditional simulation centres, or outside in local communities, public spaces or arts and performance venues. Conclusions Simulation has established a central role in clinical education but usually focuses on learning to do things as they are already done. Imaginatively designed, simulation offers untapped potential for deep engagement with patients, publics and experts outside medicine.
    Article · Jan 2016
    • "A simplistic perspective frames simulation as a means of gaining technical skills. A more realistic view should frame it as a means to gaining mastery within a complex clinical world [9] . The role of more authentic simulators combined with an immersive environment may provide a more " real feel " or naturalism to the simulation process. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Simulation occupies a central position in surgical education. It offers a safe environment for trainees to develop and improve their skills through sustained deliberate self-practice and appropriate feedback. This review explores the role of simulators and the simulation environment in light of educational theory to promote effective learning. Data sources: Information was obtained from peer-reviewed publications, books and online material. Conclusion: A simplistic perspective frames simulation as a means of gaining technical skills on basic models by offering a safe alternative to carrying out procedures on real patients. Although necessary, that aspect of simulation requires greater depth to satisfy the growing demand for alternatives to traditional clinical learning. A more realistic view should frame simulation as a means to gaining mastery within a complex clinical world. In order to strike the balance on simulating an ideal clinical scenario, alignment of the simulator and the simulation environment in the appropriate context appears crucial.
    Full-text · Article · Aug 2012
  • [Show abstract] [Hide abstract] ABSTRACT: This chapter starts from the premise that simulation is a key element in surgical education, but that current approaches can lead to unhelpful oversimplication of the complexities of real world clinical practice. The chapter’s aim is to set the scene for later sections of the book, where further aspects of simulation will be examined. After describing the nature of simulation and outlining its strengths and limitations, the chapter makes the case for placing the complexity and ‘unruliness’ of patient care at the center of simulation activity and considers some theoretical issues raised by this position. Issues of realism, access and resourcing are then addressed, putting forward possible solutions from the author’s research work in these areas.
    Chapter · Jan 2011 · International Journal of Surgery (London, England)
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