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Simulation Based Medical Education: An opportunity to learn from errors

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Abstract

Medical professionals and educators recognize that Simulation Based Medical Education (SBME) can contribute considerably to improving medical care by boosting medical professionals' performance and enhancing patient safety. A central characteristic of SBME is its unique approach to making (and learning from) mistakes, which is regarded as a powerful educational experience and as an opportunity for professional improvement. The basic assumption underlying SBME is that increased practice in learning from mistakes and in error management in a simulated environment will reduce occurrences of errors in real life and will provide professionals with the correct attitude and skills to cope competently with those mistakes that could not be prevented. The main message of the present paper is that this assumption, which serves as the driving force of SBME, should also serve as a starting point for critical thinking and questioning regarding the multiple aspects and components of SBME. These questions, in turn, should lead to empirical research that will provide feedback concerning changes that may be necessary in order to attain the goal of improving medical professionals' performance. Based on such research, SBME will be held accountable for its outcomes, i.e. whether its educational techniques indeed result in decreased occurrence of errors or not, and whether the ability to cope with the errors that do occur is significantly improved. The first of three issues that were addressed concerns individuals' experience of performing mistakes. It is suggested that in order to benefit fully from the experience of performing mistakes in a simulated context, medical educators should create a balance between the emotional load associated with the experience and the professional lessons that can be learned. Furthermore, research should focus on the long-term effects of the experience in changing professionals' attitudes and behaviour. The second question concerned the contribution of the different components of the educational experience to creating the desired changes in professionals' performance. Analysis of the teaching and learning involved in each stage of the educational event should serve as the basis for research that aims at identifying the unique contribution and efficiency of each element, and defining the essential core activities of a simulated experience. Finally, the need to define a newly emerging profession-SBME educator-was addressed. The professional qualifications are, clearly, multidisciplinary and should be based on the growing experience of medical educators in training students and professionals. Defining the profession is essential in order to create academic environments in which professionals will be trained to develop and implement new programmes, accompanied by research and assessment.

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... In healthcare, simulation-based training includes any educational activity that leverages simulation to replicate clinical scenarios (Ziv et al., 2005). Simulation-based training provides a safe space for participants to learn from their mistakes without adverse consequences (Ziv et al., 2005). ...
... In healthcare, simulation-based training includes any educational activity that leverages simulation to replicate clinical scenarios (Ziv et al., 2005). Simulation-based training provides a safe space for participants to learn from their mistakes without adverse consequences (Ziv et al., 2005). Virtual patients are computer simulations, a promising technological innovation, that can provide: 1) uniform and reliable training, 2) replication of a wide range of patients' behaviors (Talbot et al., 2019), and 3) simulation of FIGURE 2 | Trainees using the two interfaces: single-view interface (left), spectrum-view interface (right). ...
... Feedback provides the opportunity for trainees to learn from their mistakes and correct errors before applying their new skills in a real medical setting (Ziv et al., 2005). The JAYLA platform provides instant feedback to trainees. ...
Article
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This initial exploratory study's primary focus is to investigate the effectiveness of a virtual patient training platform to present a health condition with a range of symptoms and severity levels. The secondary goal is to examine visualization's role in better demonstrating variances of symptoms and severity levels to improve learning outcomes. We designed and developed a training platform with a four-year-old pediatric virtual patient named JAYLA to teach medical learners the spectrum of symptoms and severity levels of Autism Spectrum Disorder in young children. JAYLA presents three sets of verbal and nonverbal behaviors associated with age-appropriate, mild autism, and severe autism. To better distinguish the severity levels, we designed an innovative interface called the spectrum-view, displaying all three simulated severity levels side-by-side and within the eye span. We compared its effectiveness with a traditional single-view interface, displaying only one severity level at a time. We performed a user study with thirty-four pediatric trainees to evaluate JAYLA's effectiveness. Results suggest that training with JAYLA improved the trainees' performance in careful observation and accurate classification of real children's behaviors in video vignettes. However, we did not find any significant difference between the two interface conditions. The findings demonstrate the applicability of the JAYLA platform to enhance professional training for early detection of autism in young children, which is essential to improve the quality of life for affected individuals, their families, and society.
... The concept of learning from errors in simulation basedlearning (SBL) is not new ( Ziv, Ben-David, & Ziv, 2005 ). SBL offers 'permission to fail, encouraging learners to deliberately experience and learn from such failures in a way that would be inconceivable with actual patients' ( Kneebone, Scott, Darzi, & Horrocks, 2004, p. 1098. ...
... SBL offers 'permission to fail, encouraging learners to deliberately experience and learn from such failures in a way that would be inconceivable with actual patients' ( Kneebone, Scott, Darzi, & Horrocks, 2004, p. 1098. SBL aims to improve patient safety as making and learning from errors in simulation can minimise the occurrence of similar mistakes in clinical practice ( Ziv et al., 2005 ). For example, recent studies suggest that when students identify, acknowledge, and correct their mistakes, it is less likely that they repeat them ( Palominos, Levett-Jones, Power, & Martinez-Maldonado, 2019 ). ...
Article
Background Productive failure simulations require students to participate in a simulation before receiving instruction. This approach contrasts with traditional simulations that typically begin with instruction followed by the simulation. Although previous studies have demonstrated that productive failure facilitates meaningful learning outcomes, students’ perspectives after being exposed to this approach have not been examined in simulation-based learning. Objective To explore nursing students’ perceptions of a productive failure simulation. Design Descriptive exploratory study. Participants Undergraduate nursing students from one large metropolitan Australian university. Methods Students involved in a productive failure simulation were invited to participate in semi-structured interviews on completion of their simulation experience. The interviews were audio-recorded, transcribed and the qualitative data were subjected to thematic analysis. Findings Fifteen small group interviews and seven individual interviews were conducted (n = 66). Three themes emerged from the analysis of the qualitative data: (i) the benefits of simulation prior to instruction; (ii) the value of performing a second simulation; and (iii) the importance of normalising errors. Conclusion The productive failure simulations helped students identify their knowledge and skill deficits and this acted as a catalyst for their learning. The normalisation of errors by the educator minimised the stress of trying to be “perfect” and assisted students to persevere despite setbacks. The provision of a second simulation helped the students rectify their errors in preparation for their future clinical practice. These aspects were considered essential for a meaningful productive failure simulation experience.
... Simulation-based training in endoscopy provides a learner-centered experience, allowing trainees to learn from mistakes in a low-risk environment. Two recent systematic reviews conclude that simulation-based training, prior to patient-based education, supplements traditional clinical training in endoscopy and is of greatest utility for novices [2,3]. ...
... For more than 30 years, different types of simulators, including mechanical, animal, animal part, and computer-based models, have been developed to teach and learn endoscopic procedures. The goals of simulator-based teaching methods should be to shorten and improve the learning time in endoscopy for beginners, the maintenance of competency when endoscopic procedures are not regularly performed, and the testing and learning of new, mainly interventional methods, before the procedure is performed on the patient [2]. ...
Article
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Background: Virtual reality simulation in gastrointestinal endoscopy is an educational tool that allows repetitive instruction in a non-patient care environment. Aim: To determine the impact of a virtual endoscopy training curriculum applying an objective pre- and post-training analysis on trainee endoscopists. Methods: A before-after training study was carried out. Subjects were first year fellows of gastroenterology, who completed a questionnaire and then performed two pre-training simulated cases. The virtual endoscopy training curriculum consisted of an 8-h workday utilizing two GI MENTOR™ in a specialized clinical simulation center. After the training, all subjects completed the same two cases they did in the pre-training. Pre- and post-training results' comparisons were made by paired t test. Results: Totally, 126 subjects were included (mean age 30 years, 61% female). A significant improvement from pre- to post-training was observed in psychomotor skills (total time, percentage, and number of balloons exploded) and endoscopic skills (cecal intubation time, percentage of examined mucosa, and efficacy of screening). There was also an improvement in the quality of the endoscopic study; percentage of examined mucosa over 85% showed a significant improvement post-training with an adjusted OR of 2.72 (95% CI 1.51-4.89, p = 0.001). Conclusions: Virtual endoscopy training curriculum produces a significant improvement in the trainee endoscopists performance and their psychomotor skills and introduces the concept of a quality endoscopic study in a non-patient, risk-free environment.
... Interpretation within the context of the wider literature Healthcare has used simulation as an educational tool for training staff on clinical interventions, such as acute management of patients in emergency and in basic and advanced life support programmes rather than for the sole purpose of deconstructing and learning from safety incidents [22,[58][59][60]. Previous studies have highlighted how staff working patterns, staff shortages and time pressures made simulation training a challenging prospect in healthcare [60][61][62][63]. ...
... Interpretation within the context of the wider literature Healthcare has used simulation as an educational tool for training staff on clinical interventions, such as acute management of patients in emergency and in basic and advanced life support programmes rather than for the sole purpose of deconstructing and learning from safety incidents [22,[58][59][60]. Previous studies have highlighted how staff working patterns, staff shortages and time pressures made simulation training a challenging prospect in healthcare [60][61][62][63]. We recommend that organizations take account of these important barriers and explore how to better adapt and embed these tools into healthcare organizations. ...
Article
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Background A high reliability organization is an organization that has sustained almost error-free performance, despite operating in hazardous conditions where the consequences of errors could be catastrophic. A number of tools and initiatives have been used within High Reliability Organizations to learn from safety incidents, some of which have the potential to be adapted and used in health care. We conducted a systematic review to identify any learning tools deemed to be effective that could be adapted and used by multidisciplinary teams in healthcare following a patient safety incident. Methods This review followed the PRISMA-P reporting guidelines and was registered with the PROSPERO (CRD42017071528). A search of databases was carried out in January 2021, from the date of their commencement. Electronic databases include Web of Science, Science Direct, MEDLINE in Process Jan 1950-present, EMBASE Jan 1974-present, CINAHL 1982-present, PsycINFO 1967-present, Scopus and Google Scholar. We also searched the grey literature including reports from government agencies, relevant doctoral dissertations and conference proceedings. A customised data extraction form was used to capture pertinent information from included studies and Critical Appraisal Skills Programme tool to appraise on their quality. Results A total of 5,921 articles were identified, with 964 duplicate articles removed and 4932 excluded at the title (4055), abstract (510) and full text (367) stages. Twenty-five articles were included in the review. Learning tools identified included debriefing, simulation, Crew Resource Management and reporting systems to disseminate safety messages. Debriefing involved deconstructing incidents using reflective questions, whilst simulation training involved asking staff to relive the event again by performing the task(s) in a role-play scenario. Crew resource management is a set of training procedures that focus on communication, leadership, and decision making. Sophisticated Incident reporting systems provide valuable information on hazards and were widely recommended as a way of disseminating key safety messages following safety incidents. These learning tools were found to have a positive impact on learning if conducted soon after the incident with efficient facilitation. Conclusion Healthcare organizations should find ways to adapt the learning tools or initiatives used in high reliability organizations following safety incidents. It is challenging to recommend any specific one as all learning tools have shown considerable promise. However, the way these tools or initiatives are implemented is critical and so further work is needed to explore how to successfully embed them into health care organizations so that everyone at every level of the organization embraces them.
... A central characteristic of simulation-based (technical) medical education is its unique approach to making and learning from mistakes [19]. We noticed that moments of corrective feedback were fresher in students' memories when asked about meaningful learning experiences. ...
... It is the flow of the interaction that can facilitate a meaningful learning experience. In addition, it might be important to create a balance between emotional load associated with the experience and the professional lessons that can be learned [19]. ...
Article
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Introduction: Communication training with simulated patients (SPs) is widely accepted as a valuable and effective means of teaching communication skills. However, it is unclear which elements within SP-student encounters make these learning experiences meaningful. This study focuses on the SP's role during meaningful learning of the student by giving an in-depth understanding of the contribution of the SP from a student perspective. Methods: Fifteen bachelor Technical Medicine students were interviewed. Technical medicine students become technical physicians who optimize individual patient care through the use of personalized technology. Their perceptions of meaningful learning experiences during SP-student encounters were explored through in-depth, semi-structured interviews, and analyzed using thematic analysis. Results: Three main themes were identified that described what students considered to be important for meaningful learning experiences. First, SPs provide implicit feedback-in-action. Through this, students received an impression of their communication during the encounter. Implicit feedback-in-action was perceived as an authentic reaction of the SPs. Second, implicit feedback-in-action could lead to a process of reflection-in-action, meaning that students reflect on their own actions during the consultation. Third, interactions with SPs contributed to students' identity development, enabling them to know themselves on a professional and personal level. Discussion: During SP encounters, students learn more than just communication skills; the interaction with SPs contributes to their professional and personal identity development. Primarily, the authentic response of an SP during the interaction provides students an understanding of how well they communicate. This raises issues whether standardizing SPs might limit opportunities for meaningful learning.
... High-fidelity simulation uses a computer-controlled 3D simulator for displaying various clinical manifestations, while an experienced instructor manages the mannequin according to the simulated case. SBT is considered an efficient tool for teaching competency tasks, including professionalism, medical knowledge, team performance, medical humanistic care and communications skills [2,3]. The advantages of high-fidelity simulation have been demonstrated in several studies in critical care, emergency medicine, surgery and anesthesiology [4,5]. ...
... As mentioned in previous reports, there is no doubt about the benefits of SBT in learning asthma exacerbation, but whether more simulation-based training would be better is unknown [3,6,9]. It was demonstrated that students progress rapidly and acquire higher performance scores after practicing with different scenarios or repeatedly practicing on the same scenario [10]. ...
Article
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Objectives: To evaluate the effect of prior exposure to simulation-based training on medical students' performance in simulation-based training in asthma exacerbation. Methods: Third-year novice medical students, who had no prior experience in simulation education and completed diagnostics and internal medicine courses, were recruited in this prospective observational study and divided into the pre-exposure and unexposed groups. Each group received a four-hour asthma exacerbation simulation-based training. The pre-exposure group was exposed to a myocardial infarction simulation training two weeks prior to the asthma simulation training. The main outcome was the performance scores in clinical skills and abilities. Performance and task checklist completion were recorded during the training. In addition, the knowledge level was tested before and after the simulation training. Students' satisfaction was evaluated using a feedback questionnaire. Results: In a class of 203 third-year novice medical students, 101 (49.8%) and 102 (50.2%) were assigned to the unexposed and pre-exposure groups, respectively. Scores were higher in the post-simulation test compared with the pre-simulation test. Checklist completion was greater in the pre-exposure group compared with the unexposed group (p < 0.001). Performances in communication and medical humanistic care were better in the pre-exposure group than in the unexposed group (p < 0.001). There were no differences in medical history taking, physical examination, auxiliary examination interpretation and treatment formulation between the two groups (p > 0.001). Totally 73.21% and 26.13% of students strongly agreed and agreed, respectively, that asthma exacerbation simulation-based training was necessary and valuable. Conclusions: Prior exposure to simulation training can improve performance in medical students, including communication skills, medical humanistic care and checklist completion in subsequent asthma exacerbation simulation-based training.
... Սի մուլ յա ցիան կա մուրջ է լսա րա նա յին ու սուց ման և ճշգ րիտ կլի նի կա կան փոր ձի միջև՝ որ տեղ ար հես տա կա նո րեն ներ կայաց վում են բարդ ի րա կան պրո ցես նե րը: Սի մուլ յա ցիան բժշկական կրթութ յան մեջ հան դի սա նում է որ պես ի րա կան հի վան դի այ լընտ րանք [28,29]: ...
... Simulation is a bridge between classroom learning and true clinical experience with an artificial representation of a complex real process. Simulation in medical education as an alternative to the real patient [28,29] Simulation is an active process that uses clinical scenarios to help students combine new information and new experiences with prior knowledge and understanding. Fidelity describes the degree of realism; low fidelity models can be developed and updated to high fidelity [30] Patient safety and less available patients for learning had to lead to the development of simulation centers and clinical competence labs in medical education. ...
Book
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Medical education is a challenge in all areas as the health and education system is changing dramatically. This book is an attempt to give an up-to-date, comprehensive and summative overview of the current state of simulation in medical education. This book introduces all aspects of the use of simulators in medical education during study and clinical treatment. The book also deals with aspects of simulation in adult education theories. The book is designed as a guide -manual for medical university and college professors, and students.
... Simulation-based teaching has been effectively adapted in clinical specialties such as anaesthesia, emergency medicine, intensive care medicine, surgery, obstetrics, paediatrics, ophthalmology and radiology. [9] The simulators can be used to teach basic anatomy and physiology integrating with clinical aspects, in close to real-life settings. However, effectively using the same for teaching the basic science concepts to undergraduate pre-clinical students is not yet an established practice. ...
Article
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Objectives A good conceptual understanding of physiology is very important to build a strong foundation for medical students. It is a daunting job for teachers to emphasise the clinical relevance of basic science subjects as exposure to patients invariably starts after these subjects have been taught. With the introduction of early clinical exposure in the newly revised Indian undergraduate medical curriculum, this problem can be addressed to a certain extent. We developed an integrated simulation module for teaching cardiovascular physiology to pre-clinical students as a part of early clinical exposure. Materials and Methods We included 145 medical students of a Private Medical College of a Deemed to be University in Mangalore, Karnataka, India. The teaching module covered the topics of cardiovascular physiology such as functional anatomy, cardiac cycle, normal electrocardiogram (ECG), arrhythmia, arterial pulse examination, heart sounds and hands-on cardiovascular examination using a variety of simulators. The assessment was done by pre-test and post-test. A retro-pre questionnaire was used to assess their self-perceived knowledge gain and level of clinical skills. Feedback on overall experience was collected from the participants. Results The student feedback showed that learning experience was life-like (98.6%), effective, innovative and enjoyable (99.3%) and making the overall experience of learning easier (95.2%). It also improved participation, communication (93.8%), clinical skills and a better understanding of patient care (99.3%). The results of the retro- pre questionnaire to assess their self-perceived knowledge gain (95%) and level of clinical skills (96%) were highly satisfactory. The assessment of knowledge domain showed 100% of the students achieved pass percentage (>50%) with significant difference among pre- and post-test scores. Faculty (100%) opined that simulation-based teaching resulted in effected learning. Conclusions The use of simulation-based teaching in cardiovascular physiology as part of early clinical exposure leads to enhanced learning and clinical application. This will stimulate interest in subject and promote better learning.
... While some may criticize the relatively sterile nature of video simulations in comparison to real world deadly force encounters and question the transferability of any findings (e.g., Guy, 2019); experimental designs utilizing high fidelity simulations or scenarios, in which experienced practitioners are able to use ergonomically identical equipment, are widely used in both the research of and training for rare and dangerous phenomena in many other high-risk professions. These professions include medicine (e.g., Bond et al., 2007;Cheng et al., 2014;Ziv et al., 2005) -which has an entire journal devoted to simulation; aviation (e.g., Lee, 2017;Rehmann et al., 1995); and the military (e.g., Best et al., 2013) to name a few. For the purposes of this study, a Ti Training brand firearms training simulator was used in conjunction with a Sirt brand laser-training pistol. ...
Article
The purpose of this study was to explore the feasibility of engineering resilience into the split-second decision environment police officers face during potential deadly force encounters. Using a randomized controlled experiment that incorporated a police firearms training simulator and 313 active law enforcement officers, this study examined the effects of muzzle-position-where an officer points their weapon-on both officer response time to legitimate threats and the likelihood for misdiagnosis shooting errors when no threat was present. The results demonstrate that officers can significantly improve shoot/no-shoot decision-making without sacrificing a significant amount of time by taking a lower muzzle-position when they are dealing with an ambiguously armed person-a person whose hands are not visible.
... Simulation-based medical education (SBME) has become more prevalent in undergraduate medical education in the last fifteen years [1][2][3]. This increase has been fueled by the need for updated medical training models, education using standardized clinical cases, consideration of patient safety, and research supporting the educational benefits of simulation [4]. ...
Preprint
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Background: Simulation-based medical education is more prevalent in undergraduate preclinical medical education and acts as a foundation for clinical learning in years three and four. Currently, there is a call to teach clinical application of basic science material in preclinical years one and two. Methods: Two groups of students participated in this investigation; a historical control of 270 students from the 2010 matriculating class and students receiving the intervention (anatomy lecture plus airway management simulation) from the 2012 matriculating class (n=337). Descriptive statistics were calculated for demographic and academic performance variables. Unadjusted and adjusted odds of passage of mid-term and final assessment were calculated. The final assessment was defined as one correct, two correct, and all three questions correct. Results: Adjusted odds of passage of mid-term exam for the control group were 3.9 (95% CI: 2.7-5.9), virtually unchanged from the unadjusted odds of passage. Control group results for final exam passage as defined as one correct increased from .7 to .9 when adjusted for variables (95% CI:.3-2.5). Odds of passage of final assessment, for the control group, for adjusted models for two or greater correct increased from 4.1 to 5.6 (95% CI:2.6-13.7) and from 34.1 to 44.0 (95% CI: 21.7-102.5) when three answers (or 100%) are needed for passage. Conclusions: When passage criteria for the final exam were defined as one correct, addition of a simulation exercise to the anatomy lecture increased the rate of passage by 11% after adjusting for covariates. However, when passage criteria for the final exam was defined as two or three correct, addition of a simulation exercise to the anatomy lecture decreased the rate of passage.
... Simulation-based medical education (SBME) has become more prevalent in undergraduate medical education in the last fifteen years [1][2][3]. This increase has been fueled by the need for updated medical training models, education using standardized clinical cases, consideration of patient safety, and research supporting the educational benefits of simulation [4]. ...
Preprint
Full-text available
Background: Simulation-based medical education is more prevalent in undergraduate preclinical medical education and acts as a foundation for clinical learning in years three and four. Currently, there is a call to teach clinical application of basic science material in preclinical years one and two. Methods: Two groups of students participated in this investigation; a historical control of 270 students from the 2010 matriculating class and students receiving the intervention (anatomy lecture plus airway management simulation) from the 2012 matriculating class (n=337). Descriptive statistics were calculated for demographic and academic performance variables. Unadjusted and adjusted odds of passage of mid-term and final assessment were calculated. The final assessment was defined as one correct, two correct, and all three questions correct. Results: Adjusted odds of passage of mid-term exam for the control group were 3.9 (95% CI: 2.7-5.9), virtually unchanged from the unadjusted odds of passage. Control group results for final exam passage as defined as one correct increased from .7 to .9 when adjusted for variables (95% CI:.3-2.5). Odds of passage of final assessment, for the control group, for adjusted models for two or greater correct increased from 4.1 to 5.6 (95% CI:2.6-13.7) and from 34.1 to 44.0 (95% CI: 21.7-102.5) when three answers (or 100%) are needed for passage. Conclusions: When passage criteria for the final exam were defined as one correct, addition of a simulation exercise to the anatomy lecture increased the rate of passage by 11% after adjusting for covariates. However, when passage criteria for the final exam was defined as two or three correct, addition of a simulation exercise to the anatomy lecture decreased the rate of passage.
... Under the simulation banner, approaches include the use of computer-based simulation (e.g., use of avatars), standardised patients, mannequins, virtual reality, objective structured clinical examinations (OSCEs) and role-plays (Bearman, Nestel, & Andreatta, 2013). Simulation-based education (SBE) refers to education programs and approaches that integrate these simulation modalities as an integral component of the learning (Ziv, Ben-David, & Ziv, 2005). ...
Article
Background Within psychology, interest in simulation has grown, with publications on role‐play and objective structured clinical examinations emerging. This study examines the impacts of simulation‐based education on students' clinical competence and confidence when compared with traditional case‐based education. The perceived alignment between simulation‐based education and clinical practice is also considered. Methods Twelve first‐year clinical psychology students participated in this mixed methods study. Participants completed two objective structured clinical examinations, during which their clinical competence was rated using the Global Rating Scale and Cognitive Therapy Scale—Revised. Following the first examination, participants were randomly allocated to the simulation‐ or case‐based education conditions, where they engaged with video simulations or written case study, respectively. Clinical competence was then assessed post‐intervention, and consenting participants completed a follow‐up focus group. Results Post‐intervention, those in the simulation‐based education condition rated their confidence in applying knowledge learnt to real‐world settings higher than did those in the case‐based education condition. The simulated‐based education group also showed increased competence as rated on the Global Rating Scale and Cognitive Therapy Scale—Revised; however, this improvement was not greater overall than that observed in the case‐based education group. From a qualitative perspective, several themes emerged, including a “disconnect” between case‐based materials and clinical practice and the importance of explicit instructions in guiding student learning. Conclusions From a student perspective, simulation‐based education is preferred over case‐based education as a clinical education approach. However, there is no clear evidence that simulation‐based education enhances clinical skill performance over and above case‐based education. KEY POINTS (1) Students in the simulation‐based education condition rated their confidence in applying knowledge learnt to real‐world settings significantly higher than those in the case‐based education condition. (2) Students engaging in simulation‐based education prefer explicit instructions regarding the learning objectives of activity to guide their learning (3) While students regard simulation‐based education more favourably than they do casebased education, as yet there is no clear evidence that simulation‐based education enhances clinical skill performance over and above case‐based education.
... In his book Learning from Our Mistakes 2 , Henry Perkinson argued for a Darwinian learning theory that says we learn from our mistakes. Learning from mistakes has been employed in the educational fields of social studies 3,4 , business 5,6 , science 7-9 , mathematics 10-13 , software engineering [14][15][16][17] , drivers education 18 , medicine 19 , and other fields [20][21][22] . ...
... The unique feature of simulation-based medical education is learning from mistakes and error management in the true-to-life conditions. It is believed that such an approach significantly reduces the number of mistakes in real practice and provides healthcare professionals with the proper attitude to cope with errors in the most efficient way [4]. ...
Article
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Background Medical simulation is a teaching method, which enables the development of clinical skills by implementing a simulation scenario in a true-to-life environment, but without exposing patients to any risk. So far, there has been no information on the use of high-fidelity simulation in undergraduate clinical nephrology teaching. Aim of this study was to analyze students' opinions and reactions to the simulation module in nephrology. Methods The survey consisting of the Satisfaction with Simulation Experience Scale (SSES) and open-ended question concerning the overall impression of classes was conducted among 103 5th year medical students, who took part in the simulation training in nephrology. SSES consisted of three parts (debriefing, reasoning, education). Statements from the open-ended question were interpreted by means of the Atlas.ti software for qualitative data analysis. Results The overall score for simulation classes was 4.39 ± 0.69 points. Students rated debriefing, reasoning and education at 4.43 ± 0.78, 4.32 ± 0.7 and 4.39 ± 0.73 points, respectively. 87.4% and 84.5% of participants agreed that simulation developed their 'clinical reasoning' and 'decision-making' skills in nephrology, respectively. Thematic analysis revealed that students evaluated the module as 'interesting', 'useful' and 'informative', but they found number of classes significantly insufficient. Students pointed out that due to the small emphasis placed on practical aspects in the existing curriculum e.g. routes of drug administration and conversion of doses, they could not fully benefit from simulation. Conclusion Medical simulation is a valuable constituent of the nephrology course. Putting greater emphasis on practical aspects from the beginning of training may enable students to benefit more from simulation modules.
... At a lower cognitive level, simulation is used to develop simple psycho-motor skills to gain competence with a procedure or technique (Abdulmohsen, 2010;Dent, 2001). At a higher cognitive level, it is used to challenge the student's ability to problemsolve and adapt to the patient presented (Cannon-Bowers, 2008;Cheng et al., 2007;Ziv et al., 2005). ...
Article
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Background: Simulation is a broad concept used as an education pedagogy for a wide range of disciplines. The use of simulation to educate paramedics is a frequently used but untested modality to teach psycho-motor skills, acquire new knowledge and gain competence in practice. This review identifies how simulation is currently being used for the education of paramedics, and establish the context for future application. Methods: A scoping review of the literature was undertaken following the PRISMA systematic approach. Flexible inclusion criteria were used to capture research and non-research articles that would contribute to the synthesis of literature with a specific knowledge base pertaining to simulation use for paramedic education. Results: Initial searching yielded 1388 records, of which 22 remained after initial title and abstract reading. Following secondary full-text screening, 18 articles were deemed appropriate for final inclusion: eight are research, two literature reviews and eight non-research. Across all the literature, a range of concepts are discussed: Skill vs Scenario, Virtual Learning, Inter-Professional Learning, Fidelity, Cost, Equipment, Improvement of Competency, Patient Safety, Perception of Simulation. Conclusion: It is evident that simulation is a primary teaching modality, consistently used to educate and train paramedics. Simulation is inherently effective at teaching clinical skills and building student competence in particular areas. Similarly, simulation is effective at providing paramedics with experiences and opportunities to learn in varied environments using differing techniques. This allows students to apply the relevant skills and knowledge when faced with real patients.
... [1] Simulation-based training provides the opportunity of learning in a safe, low risk environment and as such allows the trainees to learn from their own mistakes. [2,3] Simulation in endoscopy has shown reasonable accepted face validity, however evidences for construct validity were reported in many studies as good performance measures related mainly to procedural time. [4] Evidences exist from multiple systematic reviews that simulation-based endoscopy (SBE) training (e.g., virtual reality (VR)) can be educationally effective in preparation of novices in diagnostic esophagogastroduodenoscopy, colonoscopy and/or sigmoidoscopy before the conventional patient-based endoscopy training. ...
Article
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Background/aims: : This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist. Materials and methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills. Results: : The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90). Conclusion: : The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.
... Its central tenet is student-tailored making and learning from mistakes and errors, which are prevented or immediately terminated to protect the patient in clinical settings [20], [21]. Using SBEs, the causes of mistakes made during the training can be reviewed openly without liabilities, allowing students to confront the mistakes and recognise the importance and value of the experience, and possibly improving the quality of event reporting [20], [22]. Standardized patients (SPs), physical training simulators such as manikins, and computer-based simulation or virtual training simulators [23] are the main SBE types employed by medical educators. ...
Article
Full-text available
Recent technological advances in robotic sensing and actuation methods have prompted development of a range of new medical training simulators with multiple feedback modalities. Learning to interpret facial expressions of a patient during medical examinations or procedures has been one of the key focus areas in medical training. This article reviews facial expression rendering systems in medical training simulators that have been reported to date. Facial expression rendering approaches in other domains are also summarized to incorporate the knowledge from those works into developing systems for medical training simulators. Classifications and comparisons of medical training simulators with facial expression rendering are presented, and important design features, merits and limitations are outlined. Medical educators, students and developers are identified as the three key stakeholders involved with these systems and their considerations and needs are presented. Physical-virtual (hybrid) approaches provide multimodal feedback, present accurate facial expression rendering, and can simulate patients of different age, gender and ethnicity group; makes it more versatile than virtual and physical systems. The overall findings of this review and proposed future directions are beneficial to researchers interested in initiating or developing such facial expression rendering systems in medical training simulators.
... Integration of simulation-based medical education (SBME) into traditional training approaches has the potential to drastically improve the rate of clinical skill acquisition and reduce overall strain on the medical system. One of the arguable strengths of SBME lies in creating a safe environment for trainees to make and learn from mistakes that would otherwise have been harmful for patients [1]. This is especially significant in skillsets consisting of steep learning curves, such as those found in cerebral angiography (CA) training. ...
Article
Full-text available
Background: Simulation-based medical education (SBME) is growing as a powerful aid in delivering proficient skills training in many specialties. Cerebral angiography (CA), a spatially and navigationally challenging endovascular procedure, can benefit from SBME by training targetable skills outside of the Angiosuite. In order to standardize and specify training requirements, navigational challenges and needs have to be identified. Furthermore, to enable successful adoption of these strategies, simulation adoption barriers, such as necessity of supervisory resources, must be reduced. In this study, we assessed the navigational challenges in simulated CA through a self-guided novice training program. Methods: Novice participants (n = 14) received virtual reality (ANGIO Mentor, Simbionix) diagnostic cerebral angiography training and were tested on a right middle cerebral artery aneurysm case over 8 sessions with a reference instructional outline. The navigational trajectories for the guidewire and catheter were analyzed and rates in erroneous vessel access were analyzed. Participants were given a Mental Rotations Test (MRT) and were analyzed based on MRT performance. Results: After 8 sessions, there was a significant (p < 0.05) reduction on navigational error prevalence. The L-SUB and L-CCA saw the biggest drop in erroneous access, whereas the R-ECA, the biggest consumer of error time, saw no changes in access frequency. Individuals with high MRT score performed much better (p < 0.05) than those with low MRT score. Conclusions: Through self-guided simulation training, we demonstrated the navigational challenges encountered in simulated CA. To establish better assessments and standards in medical training, we can create self-guided training curricula aimed at correcting errors, enabling repetitive practice, and reducing human resource needs.
... Simulation is a new exciting technology incorporated in undergraduate medical curriculum. It is well accepted by educators across the world to improve experiential learning by enhancing the performance of medical professionals [9]. Simulation is defined as imitation of the "real world" setting to model the environment, resources needed, and the people involved [10]. ...
... Visual and auditory learning styles should be used in combination alongside a simulator, 23 and by doing so, a triangle can be achieved in which learning by doing takes centre stage in enhancing the learning process. 24 In this study, a staircase increment is found in the percentage of students (72,02% KSA; 77,72% Pakistan; and 86,36% US), coupling the promotion of self-learning and CBL. ...
Article
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Objective This study aims to determine the perceptions of medical students in Pakistan, KSA, and the US regarding the significance of case-based learning (CBL). Methods For this cross-sectional study, data were collected by administering an online questionnaire to students in medical schools across Pakistan, KSA, and the US. Results A total of 344 medical students participated in this study, the great majority of whom agree that CBL paves the way for developing a sound understanding of the core subject, provides insight into real-life experiences, helps them transform from fact memorisers into problem solvers, and keeps them engaged during sessions, which motivates them to attend more of these. A comparison of respondents from Pakistan and KSA shows that CBL promotes deep learning and fostered their critical thinking; however, there was a difference in perception in some categories, including CBL as a tool used for grasping key concepts (p = 0.004), providing insight into real-life experiences (p = 0.001), offering a platform for self-directed learning (p = 0.000), nurturing collaborative abilities (p = 0.004), and maintaining students’ engagement (p = 0.002). Conclusion Our study shows that the selected cohort of medical students perceive CBL as an effective learning tool, as the majority feel overwhelmingly positive towards it. This study thus proposes the introduction of clinical exposure for medical students early in MBBS programmes, which will help promote collaborative skills and self-directed learning among them.
... Simulation-based medical education (SBME) has become more prevalent in undergraduate medical education in the last fifteen years [1][2][3]. This increase has been fueled by the need for updated medical training models, education using standardized clinical cases, consideration of patient safety, and research supporting the educational benefits of simulation [4]. ...
Preprint
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Background: Simulation-based medical education is more prevalent in undergraduate preclinical medical education and acts as a foundation for clinical learning in years three and four. Currently, there is a call to teach clinical application of basic science material in preclinical years one and two. Methods: Two groups of students participated in this investigation; a historical control of 270 students from the 2010 matriculating class and students receiving the intervention (anatomy lecture plus airway management simulation) from the 2012 matriculating class (n=337). Descriptive statistics were calculated for demographic and academic performance variables. Unadjusted and adjusted odds of passage of mid-term and final assessment were calculated. The final assessment was defined as one correct, two correct, and all three questions correct. Results: Adjusted odds of passage of mid-term exam for the control group were 3.9 (95% CI: 2.7-5.9), virtually unchanged from the unadjusted odds of passage. Control group results for final exam passage as defined as one correct increased from .7 to .9 when adjusted for variables (95% CI:.3-2.5). Odds of passage of final assessment, for the control group, for adjusted models for two or greater correct increased from 4.1 to 5.6 (95% CI:2.6-13.7) and from 34.1 to 44.0 (95% CI: 21.7-102.5) when three answers (or 100%) are needed for passage. Conclusions: When passage criteria for the final exam were defined as one correct, addition of a simulation exercise to the anatomy lecture increased the rate of passage by 11% after adjusting for covariates. However, when passage criteria for the final exam was defined as two or three correct, addition of a simulation exercise to the anatomy lecture decreased the rate of passage.
... Research has shown that simulation experiences such as these promote critical thinking and active learning while allowing students to build confidence and practice skills in a supportive environment without risk of consequences to patients. 3 With the suspension of clerkship rotations, these simulated learning experiences also came to a halt. ...
Article
Problem: In March 2020, the novel coronavirus 2019 (COVID-19) became a global pandemic. Medical schools around the United States faced difficult decisions, temporarily suspending hospital-based clerkship rotations for medical students due to potential shortages of personal protective equipment and a need to social distance. This decision created a need for innovative, virtual learning opportunities to support undergraduate medical education. Approach: Educators at Yale School of Medicine developed a novel medical student curriculum converting high-fidelity, mannequin-based simulation into a fully online virtual telesimulation format. By using a virtual videoconferencing platform to deliver remote telesimulation as an immersive educational experience for widely dispersed students, this novel technology retains the experiential strengths of simulation-based learning while complying with needs for social distancing during the pandemic. The curriculum comprises simulated clinical scenarios that include live patient actors, facilitator interactions, and real-time assessment of vital signs, labs, and imaging. Each 90-minute session includes two sets of simulation scenarios and faculty-led teledebriefs. A team of three students performs the first scenario while an additional team of three students observes. Teams reverse roles for the second scenario. Outcomes: The six-week virtual telesimulation elective enrolled the maximum 48 medical students and covered core clinical clerkship content areas. Communication patterns within the virtual telesimulation format require more deliberate turn-taking than normal conversation. Using the chat function within the video-conferencing platform allowed teams to complete simultaneous tasks. A nurse confederate provided cues not available in the virtual telesimulation format. Next steps: Rapid dissemination of this program, including online webinars and live demonstration sessions with student volunteers, support the development of similar programs at other universities. Evaluation and process improvement efforts include planned qualitative evaluation of this new format to further understand and refine the learning experience. Future work is needed to evaluate clinical skill development in this educational modality.
... [13] The trainees in SBME may achieve professional improvement by learning from their mistakes, which will help them avoid the same mistakes in real-life contexts. [14] The primary motivation of our research was to evaluate the effectiveness of SBME in training undergraduate students. We divided the 1178 students in our sample into the control and SBME groups according to a certain percentage. ...
Article
Full-text available
Over the past decades, extensive studies have underscored the growing importance of simulation-based medical education (SBME) for medical students. However, the underlying influence of SBME on undergraduate students is yet to be investigated. This work is a single-center cohort study involving 1178 undergraduate students who were divided into a control group and an SBME group. All participants gave their written informed consent. We compared the theoretical and practical achievements of these 2 groups and distributed a feedback questionnaire. Results show that SBME significantly improves the practical or theoretical achievements of students (P < .001). The humanistic care (improvement rate: 69.2%) and doctor-patient communication (improvement rate: 56.3%) performances of these studies were vastly improved. The students in the SBME group tend to allocate more time to communicating with others. SBME is an effective teaching method that can improve the reflective capacity and communication skills of undergraduate medical students, thereby resulting in their relatively improved performance.
... They use different methods in line with experiential learning theory; for example, they ask trainees to think aloud, 23 try and retry, and include learning from making mistakes. 24 They put effort into stimulating group discussion at the end of the session, e.g., seeking logic behind procedures or discussing why it succeeded or not succeeded. ...
Article
Objectives: This study examined trainer perceptions of simulation-based learning for Continuing Professional Development in international settings. Methods: A qualitative research methodology was used to gain insight into trainer perceptions. Seventeen international physician trainers involved in simulation training in cardiovascular catheterization and intervention were interviewed. An inductive thematic analysis was performed following steps described by Braun and Clarke; researchers inductively approached, and then carefully dissected the transcripts into individual stories, grounded the problems, and explored themes. Results: Trainer perceptions are largely aligned with learning theories, even though they were not specifically educated in simulation-based learning and program design principles in advance. Trainers perceive their primary role as facilitators to be most important and consider structuring sessions, facilitating group learning, and stimulating reflection to be crucial themes in simulation-based learning. They believe that building trust is an underlying principle to function in their role and feel responsible for being prepared to improve trainee satisfaction as adult learners. Trainers believe that learning from making mistakes is an important mechanism in simulation-based learning, but they give less attention to giving feedback. Conclusions: Trainers with basic training in facilitation skills in a classroom may unconsciously follow teacher-student instructional models with which they are familiar. This study confirms that trainers in simulation-based learning need pedagogical and facilitating skills to guide trainees and facilitate group processes. Educational training for trainers should include building trust and giving feedback in a more explicit place. In future studies, a mixed-method methodology is suggested to evaluate multi-layered complexities of educational practices.
... Diversos estudios y revisiones sistemáticas demuestran que esta metodología de aprendizaje es de gran utilidad para los endoscopistas principiantes y acelera la curva de aprendizaje. [4][5][6] La simulación puede llevarse a cabo con modelos mecánicos que fueron usados a partir de finales de la década del 60, vivos, ex vivo o preparados anatómicos (usualmente en cursos denominados Hands On) y virtuales. Cada modelo tiene ventajas y desventajas. ...
Article
Full-text available
La American Society of Gastrointestinal Endoscopy (ASGE) define la competencia como el nivel mínimo de habilidad, conocimiento y/o experiencia derivado de la capacitación que permitirá realizar con destreza una tarea o procedimiento. 1 La formación en endoscopía digestiva, para la ma-yoría de los que nos dedicamos a ella, fue realizada en hospitales durante nuestra residencia o concurrencia. La adquisición de la competencia requirió y requiere super-visión continua por tutores o mentores capacitados desde lo docente, e insume mucho tiempo para evitar errores o eventos adversos, durante el desarrollo de la curva de aprendizaje. A mayor complejidad del procedimiento, resulta más necesaria una tutela estrecha. La supervi-sión continua prolonga los procedimientos, por lo que disminuye la cantidad programable a diario. Esto tiene implicancias económicas para la institución y produce demoras en los turnos. También tiene un costo en cuanto al rendimiento de los equipos: al ser manejados por personal de escasa experiencia, se favorecen las roturas por el uso incorrecto. Como contraparte, los estándares actuales impiden que, desde un punto de vista ético, los médicos en formación utilicen pacientes para el aprendizaje. ¿Cuál es la razón que obliga a la tutela? Para el paciente objeto del procedimiento este es único e irrepetible-en general-y debiera hacerse de la mejor manera posible. Ese evento para el paciente individual en principio es único. Los sistemas de simulación cada vez se desarrollan más en el mundo. Es posible que el salto brusco de la cirugía abierta a la laparoscópica en los años 90 haya sido un dis-parador en el mundo quirúrgico. En éste área puntual, se dio la circunstancia de que los cirujanos de mayor ex-periencia, en el área abierta, debieron adaptarse a las téc-nicas laparoscópicas. La aparición posterior de la cirugía robótica modificó más aún el enfoque. Las técnicas reales se parecieron cada vez más a las virtuales. El entrenamiento por simulación tiene como objetivo adquirir destrezas endoscópicas, acelerar los tiempos de la formación básica, mejorar los conocimientos teóricos y enseñar el uso correcto del instrumental. 2 Esto se puede efectuar en un ambiente distendido, donde se establece un feedback continuo entre el alumno y el entrenador, sin necesidad de estar trabajando con el paciente, lo que obviamente evita riesgos. 3 De hecho, el error es parte del aprendizaje, y un procedimiento o maniobra se pueden repetir tantas veces como sea necesario, hasta que se rea-lice correctamente. Esto implica que, al ejecutar el pro-cedimiento en un paciente real, será más sencillo hacerlo cabalmente, disminuyendo la posibilidad de errores, que
... Simulation learning entails the public exposure of actions that are evaluated and discussed, and making mistakes and discussing them without inhibitions can be challenging. 6,7 We must also consider that in this educational context, a group of humans is actively interacting, and occasionally, some spontaneous behaviors may occur during a simulation session, which is the topic of the present article. ...
Introduction: Applause is a common behavior during simulation case learning sessions. Some simulation facilitators believe that this should not be allowed, arguing that it can mislead students when they make mistakes during simulation. This study was conducted to explore the opinions of students about spontaneous applause (initiated by the participants), as a habitual behavior in the simulation sessions, in the undergraduate and postgraduate nursing degrees. Methods: A qualitative research study was conducted based on the content analysis of 7 focus groups composed of simulation students (N = 101, both undergraduate and graduate students). The participants were asked to conduct a debate about the following question: What is your opinion about the spontaneous applause given to participants by their peers at the completion of the scenario as they go to the debriefing, and why? An inductive method of content analysis was used to interpret the data. Results: The majority considered applause as a sign of support; one student disapproved of the practice. For most participants, receiving spontaneous applause from their peers after finishing the simulation represented a spontaneous example of moral support that reduced the participants' stress. Conclusions: Applause within the context of clinical simulation is a motivational act, which should not be repressed by the facilitator, as long as it is a spontaneous and genuine act by the participants once the simulation experience ends.
... n the modern medical education era the clinical skill lab (CSL) is very well known teaching equipment 1 . This allows students to 'mistake forgiving' training on manikins before performing the same procedure on real patient. ...
Article
Clinical skill lab (CSL) is a part of simulation-based medical education (SBME) which now a days becomes an integral part of modern medical education. This cross-sectional analytic study was performed at Sylhet Women's Medical College, Sylhet, Bangladesh to assess the difference between CSL and traditional multimedia (MM) presentation in case of endotracheal intubation from January 2021 to February 2021. Total 78 first year nursing students were enrolled in study. Both groups were tested by same pre-tested multiple-choice questions. These 10 questions were set according to modified bloom's taxonomy domains. There was no significant difference in the mean scores of both groups. Male of CSL group had scored significantly better than the female of the same group. The top and bottom domains of modified bloom's taxonomy were significantly better taught in CSL group, whereas the others were better in the multimedia group.
... n the modern medical education era the clinical skill lab (CSL) is very well known teaching equipment 1 . This allows students to 'mistake forgiving' training on manikins before performing the same procedure on real patient. ...
Article
Full-text available
Clinical skill lab (CSL) is a part of simulation-based medical education (SBME) which now a days becomes an integral part of modern medical education. This cross-sectional analytic study was performed at Sylhet Women's Medical College, Sylhet, Bangladesh to assess the difference between CSL and traditional multimedia (MM) presentation in case of endotracheal intubation from January 2021 to February 2021. Total 78 first year nursing students were enrolled in study. Both groups were tested by same pre-tested multiple-choice questions. These 10 questions were set according to modified bloom's taxonomy domains. There was no significant difference in the mean scores of both groups. Male of CSL group had scored significantly better than the female of the same group. The top and bottom domains of modified bloom's taxonomy were significantly better taught in CSL group, whereas the others were better in the multimedia group. [Mymensingh Med J 2021 Jul; 30 (3):803-807 ]
... The awareness of reducing medication errors and risk situations for the patient has increased in recent years, due to increasing pressure from health centers, regulatory and certification bodies, and civil society. However, this awareness should be reflected in the integration of strategies within the curriculum that trigger the motivation and involvement of students to reduce risks for patients, in settings in which they can learn from the mistakes in a safe environment for learning (Ziv, Ben-David & Ziv, 2005). ...
Conference Paper
: In medicine, the awareness of reducing medication errors and risk situations for patients has increased in recent years, due to different driving forces such as patient advocate movements, and quality management strategies of health centers and regulatory bodies. However, this awareness should be reflected in the integration of strategies to prevent errors and risks by training medical students, residents, and specialists in patient safety principles. The inclusion of technologies for tridimensional visualization, such as virtual reality enables the development of innovative training proposals that contribute to a patient safety culture. The objective of this project was to design a virtual reality environment for the training on patient safety culture by triangulating the perspectives of teachers, the hospital, and the school of medicine. The development consisted of the phases of planning, design, and implementation. Planning referred to the development of learning objectives and conceptualization of scenarios. The design consisted of the technical exploration of the different tools, and the iteration on the generation of a working prototype. As a result, a virtual setting was developed for medical students to familiarize themselves and understand the environment and the processes of quality care. The reported experience proposes key elements for new developers to consider, the link to the needs of the organization, and the technical feasibility of the systems that are now available in the market. Keywords: higher education, educational innovation, educational technology, virtual reality, medical education, patient safety
... Simulation-based medical education (SBME) permits health professionals to engage in deliberate practice in a safe, learner-centred environment [64]. SBME can be a powerful education method when coupled with directed learning outcomes, structured feedback and competency assessments sequenced at progressive levels of difficulty [64][65][66]. SBME has been used to establish competency in a range of skills (e.g. decision-making, communication) within a variety of healthcare professions including medicine and pharmacy [64]. ...
Article
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Purpose Adverse drug reactions (ADRs) contribute significantly to healthcare burden. However, they are largely preventable through appropriate management processes. This narrative review aims to identify the quality indicators that should be considered for routine monitoring of processes within hospital ADR management systems. It also examines the potential reasons behind variation in ADR management practices amongst HCPs, and explores possible solutions, focusing on targeted education programmes, to improve both the quality and quantity indicators of ADR management processes. Methods A comprehensive literature review was conducted to explore relevant themes and topics concerning ADR management, quality indicators and educational interventions. Results Substantial variability exists in ADR management amongst healthcare professionals (HCPs) with regard to reporting rates, characteristics of ADRs reported, quality of assessment, completeness of reports and, most importantly, risk communication practices. These variable practices not only threaten patient safety but also undermine pharmacovigilance processes. To date, quality indicators to monitor ADR management practices within hospital settings remain ill-defined. Furthermore, evidence behind effective interventions, especially in the form of targeted education strategies, to improve the quality of ADR management remains limited. Conclusions The focus of ADR management in hospitals should be to promote patient safety through comprehensive assessment, risk communication and safe prescribing. There is a need to develop a system to define, measure and monitor the quality of ADR management. Educational strategies may help improve the quality of ADR management processes.
... [8] In simulation-based medical education, simulation tools are used to imitate clinical scenarios and as a substitute for the real patient so that errors by trainers or trainees would not distress the patient. [9] The simulated scenarios of rare or unusual cases can give realistic exposure to students and inexperienced junior doctors and ensure that students and trainees gain clinical experience without having to depend on chance encounters of certain cases. [10] Simulation-based learning augments the effectiveness of the learning process in a controlled and safe environment. ...
Research
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This cross-sectional descriptive study was conducted on 92 medical students: 54 females (58.69%) and 38 males (41.31%), in a metropolitan city in Western India to determine their perceptions about simulation training. The mean age of the female and male respondents was 20.87 +/- 1.49 years and 20.95 +/- 1.63 years, respectively, without significant gender difference (Z=0.240; p=0.810). A significantly higher number of female respondents opined that simulation would be a useful additional learning tool (Z=3.170; p=0.001); would make the subject more interesting (Z=2.437; p=0.014); that they would personally prefer simulators (Z=2.432; p=0.015) and that simulators would improve confidence and competence (Z=2.482; p=0.013). Though simulation-based training cannot replace clinical exposure, its use is growing globally with its capability to improve competence of health professionals, augment their confidence levels and reduce intrinsic risks to patients. The hands-on aspect of simulation-based training provides an opportunity for repetitive practice in a low-risk environment, which can surmount the constraints of traditional training. Since high-fidelity simulators are expensive, more studies are required before adopting simulation-based medical education as a standard tool for training and assessing medical students.
... High fidelity simulators, virtual reality task trainers, animal models, and simulated patients form the components of simulation-based training programs [6,7]. This teaching and training strategy has been effectively adapted in the departments of anesthesia, emergency medicine, intensive care medicine, surgery, obstetrics, pediatrics, ophthalmology, and radiology in many institutions [8]. ...
Article
Skill acquisition with required competencies as defined by the National Medical Commission for the postgraduate surgical residents can happen in a step-wise manner from novice or advanced beginner to competent levels. This requires well-defined program-specific objectives, teaching-learning and assessment methods as per the competency-based medical education curriculum. Various modalities of teaching for the residents are adapted during the COVID pandemic to maintain the continuum of learning. In this study, we have attempted to develop, implement, and evaluate the effectiveness of acquiring laparoscopic surgical skills using advanced simulators and with large live animal in a real-life situation by a modular training approach. This skill-based program was developed and implemented for final year General Surgery postgraduate residents of Yenepoya Medical College for training laparoscopic surgical competencies. The training was conducted at Advanced Simulation Centres of Yenepoya (Deemed to be University), Mangalore, Karnataka, India. Three training modules were prepared based on the competency-based medical education curriculum for incremental training with advanced simulators and large live animals in a real-life situation which included the sessions on briefing, scenarios, simulations, hands-on activities, debriefing, feedback, and assessment methods. Assessment after the modular training showed statistically significant improvement in their scores, and they scaled up their skill acquisition ladder after each module. The residents and faculty felt that integration from different specialties has increased their confidence levels and communication skills, exploring team dynamics with 1:1 mentorship to make them competent emphasizing the effectiveness of simulation-based training even during the pandemic.
... Este ambiente controlado y supervisado se integra como una instancia complementaria al trabajo con pacientes reales de forma estandarizada, reproducible y segura. [1][2][3][4][5][6][7][8][9] El campo de la simulación pediátrica ha crecido rápidamente, tanto como intervención educativa como foco de investigación. 1 Asimismo, la bibliografía sobre experiencias con simulación ha mostrado un crecimiento exponencial. 10 Numerosos trabajos describen el diseño y la implementación de centros de simulación médica, 6,11 en especialidades internistas, quirúrgicas y también en pediatría 9,12,13 rescatando la aceptación por parte de alumnos y docentes y la posibilidad de aplicar conocimientos teóricos y desarrollar habilidades y razonamiento crítico. ...
Article
Full-text available
La investigación sobre el uso de simulación como estrategia educativa en los postgrados está en aumento. Las particularidades de los pacientes pediátricos justifican el desarrollo de conocimiento específico. Se llevó a cabo un estudio aleatorizado y controlado para evaluar la eficacia de una intervención educativa para entrenamiento en habilidades clínicas. Treinta y ocho pediatras en formación participaron en forma voluntaria de un programa en el que recibieron de manera aleatorizada una capacitación y posterior evaluación en dos habilidades combinando escenarios de procedimientos y de habilidades de comunicación. Dos evaluadores independientes calificaron el desempeño pre y postintervención mediante listas de cotejo y otorgaron calificación considerando el puntaje global y los errores graves cometidos. Se observó una mejora significativa en el desempeño luego de un periodo de lavado de dos meses. La presencia de controles permitió relacionar el desempeño al entrenamiento. Se encontraron diferencias significativas en las habilidades procedimentales y una mejoría tanto en las calificaciones, como en los errores graves de los participantes. Las habilidades de consejería reportaron una mejoría marcada en ambos grupos
Article
Objective Currently available 3D modelling and printing techniques allow for creation of patient-specific models based on 3D medical imaging data. We hypothesized that a low-cost, patient-specific, cardiac CT-based phantom, created using desktop 3D printing and casting had comparable image quality, accuracy and usability as an existing commercially available echocardiographic phantom. Design blinded comparative study Setting simulation laboratory at a single academic institution. Participants voluntary cardiac anesthesiologists at a single academic institution. Interventions stage one of the study consisted of an on-line questionnaire where a set of basic TEE views obtained from the 3D printed phantom and commercial phantom were presented to participants who had to identify the views and evaluate their fidelity to clinical images on a Likert scale. In stage two, participants performed an unblinded basic TEE examination on both phantoms. Measurements and main results the time needed to acquire each basic view was recorded. Overall usability of the phantoms was assessed through a questionnaire. The participants could recognize most of the views. Fidelity ratings for both phantoms were similar (p< 0.05) with the exception of mid-esopahegal 2 Chamber view that was found better on the 3D printed phantom. The time required to obtain the views was shorter for the 3D printed phantom although not statistically significant for most views. The overall user experience was better for the 3D phantom for all categories examined (p< 0.05). Conclusions The study suggests that a 3D printed TEE phantom is comparable to the commercially available one with good usability.
Article
Aims and method: The authors designed and delivered simulation training to improve the confidence and competence of junior doctors beginning work in psychiatry. Junior doctors completed various simulated psychiatry scenarios while receiving personalised feedback and teaching from their peers in online or socially distanced settings. Learners rated their confidence in psychiatry skills pre- and post-session, and Wilcoxon signed-rank tests were conducted to detect statistically significant differences. Qualitative feedback was analysed thematically. Results: Twenty-one junior doctors attended the training. There were statistically significant (P < 0.05) improvements in trainee confidence across all psychiatry skills tested. The most enjoyable aspects of the session included its 'interactivity', relevance to clinical practice, and 'realistic' and 'interesting' simulated scenarios. Clinical implications: Near-peer simulation teaching, delivered both in person and online, is effective at improving junior doctors' confidence in psychiatry. Delivering this training during placement induction could help to ensure adequate preparation of, and support for, new doctors.
Article
Purpose of the review: Caesarean sections are the most commonly performed procedure globally. Simulation-based training for caesarean sections can provide healthcare practitioners a safe and controlled environment to develop this life-saving skill. We systematically reviewed the use of simulation-based training for caesarean section and its effectiveness. Embase, Pubmed, Scopus and Web of Science were searched from inception to June 2019, without language restriction, for studies that included methods of simulation for caesarean section. Studies were selected and data extracted in duplicate. Synthesis analysed common themes on simulation-based training strategies. Recent findings: There were 19 relevant studies including the following simulation-based methods: simulators (high and low fidelity), scenario-based drills training, e-learning and combinations. A common theme was simulation for rare events such as perimortem caesarean, impacted foetal head and uterine rupture. Combination studies appeared to provide a more comprehensive training experience. Studies rarely adequately assessed the educational or clinical effectiveness of the simulation methods. Summary: There are different types of simulator models and manikins available for caesarean section training. Simulation-based training may improve technical skills and nontechnical skills, in a risk-free environment. More research is needed into simulation training effectiveness and its efficient incorporation into practice for improving outcomes.
Article
Training focused on recognizing when a medical procedure has not been implemented effectively may reduce preventable battlefield deaths. Although important research has been conducted about a range of error recovery training strategies, few studies have been conducted in the context of training for high stakes, dynamic domains such as combat medic training. We conducted a literature review to examine how error recovery training has been designed in other contexts, with the intent of abstracting recommendations for designing error recovery training to support military personnel providing emergency field medicine. Implications for combat medic training include: 1) a focus on error management rather than error avoidance, 2) a didactic training component may support training engagement and mental model development, 3) an experiential component may be designed to support perceptual skill development and anomaly detection, and 4) feedback should focus on allowing learners to make errors and encouraging them to learn from errors.
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Souba Rethinasamy, & Joseph Ramanair. (2020). Teaching and learning during "Old Normal" and "New Normal": Justifications, modifications, and lessons learnt. InSIGHT Teaching Learning Bulletin, 31, 45-49. (ISSN: 1823 2396) Teaching, learning and assessment activities are crucial part of a course delivery in educational institutions. While face-to-face (F2F) teaching remains as an important component of teaching and learning, blended and online learning have grown progressively over the past few years and become an essential part of educational institutions around the globe. In 2020 the need to deliver courses fully online was suddenly amplified by the movement control measures implemented due to the COVID-19 pandemic. The pandemic has forced the courses which were taught F2F or in a blended manner, to be taught fully online. This sole online teaching approach requires some significant changes to not only the course delivery but also every aspect of teaching and learning.
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Background: Evidence-based medicine seeks to improve medical education, which requires high competency levels in various clinical skills such as examination of patients and execution of clinical techniques on patients by integrating skill and simulation-based teaching and learning as supplementary to traditional methods of bedside clinical teaching. Hence, a safely prepared and controlled environment with trained interdisciplinary teams is very essential in providing such effective medical education to students as well as health-care professionals. The ongoing skill and simulation center project aims to provide teaching, training, and learning in various clinical procedures for both medical students and clinicians. Materials and methods: The project management cycle framework was used which included the phases of planning, designing, training, and implementation. Having picked the model for the proposed skill and simulation center, that is, redefining medical education with skill and simulation-based teaching, training, and learning, it was decided to establish this skill and simulation center. Results: The functional skill and simulation center unit with the state-of-the-art infrastructure along with a trained multidisciplinary team was achieved. There are also academic programs, which include the demonstration of various clinical and surgical skills and workshops on simulation-based medical education. Conclusion: It was possible to establish a comprehensive skill and simulation center and achieve best practices in medical education by optimal investment in infrastructure and improving the available human resources. Detailed planning is required, across a variety of domains. We hope our experiences shared in this article will help other medical colleges and hospitals across the region, both nationally and globally, toward establishing similar educational facilities.
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The HEALTH Passport: Helping everyone achieve longterm health. A medical student programme for prevention of long term conditions and promoting behavioural change
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Introduction Simulation offers radiography students the possibility to experiment with Computed Tomography (CT) in a way not possible in clinical practice. The aim of this work was to test a newly developed simulator ‘CTSim’ for effectiveness in teaching and learning. Methods The simulator was tested in two phases. The first phase used a test-retest methodology with two groups, a group that experienced a Simulation based learning intervention and one which did not. The second phase subsequently tested for changes when the same intervention was introduced as part of an existing CT training module. Results Phase 1 demonstrated statistically significant improvement of mean scores from 58% to 68% (P < .05) for students who experienced the intervention against no change in scores for the control group. Phase 2 saw mean scores improve statistically significantly in a teaching module from 66% to 73% (P < .05) following the application of the intervention as an active learning component. Conclusion The use of the CTSim simulator had a demonstrable effect on student learning when used as an active learning component in CT teaching. Implications for practice Simulation tools have a place in enhancing teaching and learning in terms of effectiveness and also introduce variety in the medium by which this is done.
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zet Amaç: Tıp eğitiminde öğrencilerin bilgi ve tutum yanında psikomotor becerileri öğrenmeleri ve uygulamaları önemli bir gereklilikdir. Hümanistik eğitim anlayışına göre girişimsel ve girişimsel olmayan becerilerin manken ve maketler üzerinde deneyerek öğrenilmesi belirli bir uygulama kapasitesine ulaştıktan sonra gerçek hasta üzerinde işlemlerin yapılması uygundur. İKÇÜ Tıp Fakültesi'nde program geliştirme çalışmaları kapsamında mesleksel beceriler dersleri yeniden yapılandırılmış ve sınıf gruplara ayrılarak küçük gruplarda tüm öğrencilerin beceriyi en az bir kez deneyimleyerek uygulayabileceği bir model oluşturulmuştur. Bu araştırmada tıp fakültesi öğrencilerinin mesleksel beceriler eğitimlerine yönelik değerlendirmeleri ve küçük gruplarda manken ve maketlerle eğitim gören dönem.1 ile büyük gruplarda eğitim gören dönem.2 tıp öğrencilerinin mesleksel beceriler eğitimlerine yönelik değerlendirmeleri arasında fark olup olmadığının saptanması amaçlanmaktadır. Yöntem: Çalışma kesitsel, analitik tiptedir. 2018-2019 eğitim öğretim yılında dönem.1 ve dönem.2'de eğitim gören öğrencilere ulaşılmıştır. Araştırmacılar tarafından geliştirilen değerlendirme formu veri toplama aracı olarak kullanılmıştır. Form 25 madde ve beş alt boyuttan oluşmaktadır. Form; eğitim, aktivite, doküman ve malzeme, eğitmenler, organizasyon ve eğitimin yararlılığı alt boyutlarından oluşmakta ve beşli likert ölçeği ile değerlendirilmektedir. Bulgular: Çalışmaya 326 gönüllü öğrenci katılmıştır. Öğrencilerin 167'si birinci sınıf, 159'u ikinci sınıftır ve ulaşım oranı %85.11'tir. 172'si erkek öğrencidir. Örneklem yeterliliği açısından Kaiser-Meyer-Olkin (KMO) değeri 0.92, Barlett testi sonucu X²:4800.295, p:0.000 hesaplanmıştır. Formun güvenirliğinin belirlenmesinde cronbach alpha katsayısı kullanılmış ve formun geneli için 0.937 olarak hesaplanmıştır. Formun beş alt boyutu olan eğitim, aktivite, doküman ve malzeme, eğitmenler, organizasyon, eğitimin yararlılığı için hesaplanan cronbach alpha güvenirlik değerleri ise sırasıyla 0.816, 0.654, 0.904, 0.802, 0.839'dir. Eğitim, materyal, eğiticiler, organizasyon ve eğitimin yararı başlıklarının tümünde dönem.1 öğrencilerinin dönem.2 öğrencilerine göre memnun oldukları, daha yüksek puan verdikleri saptanmıştır. Başlıklar cinsiyete göre karşılaştırıldığında fark bulunmamıştır. Küçük gruplarda eğitimin yürütülmesini yararlı bulduklarını ifade etmişlerdir. Eğitmenlerin konulara hazırlıklı ve hâkim olduğunu ifade etmişlerdir. Organizasyon ve yararlılık konularında olumlu geribildirim vermişlerdir. Sonuç: Dönem.1 ve dönem.2 öğrencileri mesleksel beceri eğitiminin gerekli ve yararlı olduğunu düşündükleri saptanmıştır. Küçük gruplarda ve manken, maketlerle eğitimin yararlı olduğu sonucuna varılmıştır. Anahtar Kelimeler: Küçük grup eğitimi, mesleksel beceriler, tıp eğitimi. Summary Objectives: In medical education, it is an important requirement for students to learn and apply psychomotor skills besides knowledge and attitude. According to the humanistic education approach, it is appropriate to conduct interventions on real patients after learning interventional and non-interventional skills by learning on models and manikins. Within the scope of program development studies at IKCU Faculty of Medicine, vocational skills courses were restructured and a model was created in small groups where all students could practice the skill at least once. In this study, it was aimed to determine whether there is a difference between the evaluations of medical faculty students for vocational skills training and the evaluations of vocational skills training of term.1 medical students who study with models and models in small groups and term.2 students who are educated in large groups. Methods: The study is cross-sectional and analytical. In 2018-2019 academic year, students studying in term 1 and term 2 were reached.The evaluation form developed by the researchers was used as a data collection tool.
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The role of performance assessment in outcomebased education is discussed emphasizing the relationship and interplay between these two related paradigms. Issues of the relevancy of assessment to student learning are highlighted in the context of outcome-based education.The importance of defining assessment premises and the role of institutions in defining their educational philosophy as it pertains to student learning and assessment is also presented. A brief description of implementation guidelines of assessment programs in outcome-based education are presented indicating the key features of such programs.
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This paper explores assessment innovations which have a system-wide effect on medical education and the medical profession. Important assessment approaches such as the objective structured clinical examination (OSCE), the portfolio, and hi-tech simulations are examples of reform-driven developments. A detailed account is provided on assessment areas that require further developments. The identified areas reflect current thinking in the Centre for Medical Education, University of Dundee Medical School.The assessment innovations are being developed alongside the implementation of the outcome-based curriculum. Areas that require extensive work are: assessment of progression towards defined outcomes, assessment of integrated abilities, assessment of different forms of medical knowledge, assessment of on-the-job learning, learning through assessment, assessment of error management and assessment of portfolio evidence. The identified areas for further assessment development are discussed and where appropriate a theoretical framework is provided.
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The science of virtual reality provides an entirely new opportunity in the area of simulation of surgical skills using computers for training, evaluation, and eventually certification. A taxonomy of the types of simulators is proposed based upon the level of complexity of the task which is being simulated. These tasks are precision placement, simple manipulation, complex manipulation, and integrated procedure. Representative simulators in each category are illustrated and discussed in the context of their contribution to the education and training of a surgeon. The importance of a curriculum is to give content to the role of simulators as another advanced tool for education. Simulators must be integrated into a comprehensive curriculum and not considered as a stand-alone system. The current accomplishments as well as challenges are discussed.
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Background Surgical skills are required by a wide range of health care professionals. Tasks range from simple wound closure to highly complex diagnostic and therapeutic procedures. Technical expertise, although essential, is only one component of a complex picture. By emphasising the importance of knowledge and attitudes, this article aims to locate the acquisition of surgical skills within a wider educational framework. Simulators Simulators can provide safe, realistic learning environments for repeated practice, underpinned by feedback and objective metrics of performance. Using a simple classification of simulators into model-based, computer-based or hybrid, this paper summarises the current state of the art and describes recent technological developments. Advances in computing have led to the establishment of precision placement and simple manipulation simulators within health care education, while complex manipulation and integrated procedure simulators are still in the development phase. Evaluation Tension often exists between the design and evaluation of surgical simulations. A lack of high quality published data is compounded by the difficulties of conducting longitudinal studies in such a fast-moving field. The implications of this tension are discussed. The wider context The emphasis is now shifting from the technology of simulation towards partnership with education and clinical practice. This highlights the need for an integrated learning framework, where knowledge can be acquired alongside technical skills and not in isolation from them. Recent work on situated learning underlines the potential for simulation to feed into and enrich everyday clinical practice.
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Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.
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Context: Changes in medical training and culture have reduced the acceptability of the traditional apprenticeship style training in medicine and influenced the growth of clinical skills training. Simulation is an educational technique that allows interactive, and at times immersive, activity by recreating all or part of a clinical experience without exposing patients to the associated risks. The number and range of commercially available technologies used in simulation for education of health care professionals is growing exponentially. These range from simple part-task training models to highly sophisticated computer driven models. Aim: This paper will review the range of currently available simulators and the educational processes that underpin simulation training. The use of different levels of simulation in a continuum of training will be discussed. Although simulation is relatively new to medicine, simulators have been used extensively for training and assessment in many other domains, most notably the aviation industry. Some parallels and differences will be highlighted.
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Realistic medical simulation has expanded worldwide over the last decade. Such technology is playing an increasing role in medical education not merely because simulator sessions are enjoyable, but because they can provide an enhanced environment for experiential learning and reflective thought. High-fidelity patient simulators allow students of all levels to "practice" medicine without risk, providing a natural framework for the integration of basic and clinical science in a safe environment. Often described as "flight simulation for doctors," the rationale, utility, and range of medical simulations have been described elsewhere, yet the challenges of integrating this technology into the medical school curriculum have received little attention. The authors report how Harvard Medical School established an on-campus simulator program for students in 2001, building on the work of the Center for Medical Simulation in Boston. As an overarching structure for the process, faculty and residents developed a simulator-based "medical education service"-like any other medical teaching service, but designed exclusively to help students learn on the simulator alongside a clinician-mentor, on demand. Initial evaluations among both preclinical and clinical students suggest that simulation is highly accepted and increasingly demanded. For some learners, simulation may allow complex information to be understood and retained more efficiently than can occur with traditional methods. Moreover, the process outlined here suggests that simulation can be integrated into existing curricula of almost any medical school or teaching hospital in an efficient and cost-effective manner.
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Human error and system failures continue to play a substantial role in adverse outcomes in health care. Anaesthesia crisis resource management addresses many patient safety issues by teaching behavioural skills for critical events but it has not been systematically utilized to teach experienced faculty. An anaesthesia crisis resource management course was created for the faculty of our medical school's anaesthesia teaching programmes. The course objectives were to understand and improve participants' proficiency in crisis resource management (CRM) skills and to learn skills for debriefing residents after critical events. Through surveys, measurement objectives assessed acceptance, utility and need for recurrent training immediately post-course. These were measured again approximately 1 year later along with self-perceived changes in the management of difficult or critical events. The highly rated course was well received in terms of overall course quality, realism, debriefings and didactic presentation. Course usefulness, CRM principles, debriefing skills and communication were highly rated immediately post-course and 1 year later. Approximately half of the faculty staff reported a difficult or critical event following the course; of nine self-reported CRM performance criteria surveyed all claimed improvement in their CRM non-technical skills. A unique and highly rated anaesthesia faculty course was created; participation made the faculty staff eligible for malpractice premium reductions. Self-reported CRM behaviours in participants' most significant difficult or critical events indicated an improvement in performance. These data provide indirect evidence supporting the contention that this type of training should be more widely promoted, although more definitive measures of improved outcomes are needed.
Multidisciplinary, multimodality medical simulation center—the Israeli model
  • A Ziv
  • H Berkenstadt
ZIV, A. & BERKENSTADT, H. (2004) Multidisciplinary, multimodality medical simulation center—the Israeli model, in: W. DUNN (Ed.) Simulators in Critical Care Medicine and Beyond (Des Plaines, USA, Society for Critical Care Medicine (SCCM) Press).
Med Teach Downloaded from informahealthcare.com by UB Kiel on 10/28/14 For personal use only The impact of aviation-based teamwork training on the attitudes of health-care professionals
  • A Ziv
A. Ziv et al. 198 Med Teach Downloaded from informahealthcare.com by UB Kiel on 10/28/14 For personal use only. GROGAN, E.L., STILES, R.A., FRANCE, D.J., SPEROFF, T., MORRIS, J.A JR, NIXON, B., GAFFNEY, F.A., SEDDON, R. & PINSON, C.W. (2004) The impact of aviation-based teamwork training on the attitudes of health-care professionals, Journal of the American College of Surgeons, 199, pp. 843–848.
Refocusing the role of simulation in medical education: training reflective practitioners
  • E F Dannefer
  • L C Henson
DANNEFER, E.F. & HENSON, L.C. (2004) Refocusing the role of simulation in medical education: training reflective practitioners, in: W. DUNN (Ed.) Simulators in Critical Care Medicine and Beyond (Des Plaines, USA, Society for Critical Care Medicine (SCCM) Press).