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Current state of simulation based learning and training in healthcare education

Because of the different interpretations of the term ‘simulation’ and ‘simulation based learning and training’ we first want to show different opinions providing an overview of the current state of simulation based learning and training in healthcare education.

This chapter introduces a short definition of key terms related to the SBL and SBT.

Simulations have been used as early as 1910 as a means to train both persons and teams to reduce errors and improve safety (Fowlkes et al. 1998). Commercial aviation and the military have invested heavily in the use of simulation-based training because it offers a realistic, safe, cost-effective, and flexible environment in which to learn the requisite competences for the job. (Salas et al. 1998)

Simulation in medicine is now enabling new ways of teaching and learning. Through simulations healthcare workers can learn by practicing skills taught and experiencing mistakes before interacting with an actual patient. A number of areas within the healthcare industry are currently using simulation-based training to help individuals and teams improve patient safety. (Salas et al. 2005) Simulation for the purposes of training is a representation of a task or working environment that can be used for practice activities (Hays/Singer 1989). Throughout the Harvard medical institutions, simulation-based training offers creative ways to test new ideas and teach and reinforce old ones (Berry/Cooper 2006).

Gaba (2004) stresses that simulation should be interpreted as a strategy – not a technology – to mirror, anticipate, or amplify real situations with guided experiences in a fully interactive way. However the simulator replicates a task environment with sufficient realism to serve a desired purpose (ibid).

Simulation-based training is a method or strategy of training that involves the use of several scientific, theory-based approaches to training, and includes information, demonstration, and practice-based methods. (Salas et al, 2006) It is an approach to training that seeks to accelerate the development of expertise by systematically designing opportunities to practice that result in the desired learning. (Salas and Rosen, 2008)

According to Salas et al. (2005) the key components of simulation-based training are as follows:

  • performance history/skill inventory,
  • tasks/competences,
  • training objectives,
  • events/exercises,
  • measures/metrics,
  • performance diagnosis, and
  • feedback and debrief.

Following Aukstakalnis et al. (2008) simulation-based learning is a social process of learning of practices that involves building connections:

  1. connections among what is being learned and what is important to the actor ,
  2. connections among what is being learned and those situations in which it is applied.

Learning corresponds to an incremental process of acquisition of new knowledge pieces and learning of a new knowledge structure. Simulation learning serves as a bridge between classroom learning and real-life clinical experience. Using simulation technologies in true-to-life medical settings, learners are free to build on their current knowledge base and develop important clinical skills before they work with real patients (Aukstakalnis et al. 2008).

Following Aukstakalnis et al. (2008), the general knowledge acquisition process can be divided into three categories of learning goals:

  1. to know the theory and methods;
  2. to know the theory and methods and be able to use them in standard situations;
  3. to know the theory and methods and be able to use them in unknown situations.

The first category can be (more or less) considered as content-centred approach. The second category of knowledge acquisition implicates enabling problem-oriented decisions in standard situations. The latter one includes more complex simulation models, which enable a user to create more purposeful space of actions. Aukstakalnis et al. (2008) stress that teachers of all courses they implement three categories of learning goals noted, that use of simulation environment in the practice mode and in the assessment mode is a very convenient and helps motivating student.

Role of simulation can be described as a bundle of two aspects:

a)      a teaching strategy with a goal to explore the role of high fidelity simulation in healthcare education in relation to real clinical experience, to measure learning process using simulation based environment:

-          Impact on competence,

-          Impact on patient care,

-          Impact on organization

b)      a competence assessment tool to measure learning outcomes.

There is a wide array of simulation types that can be used to train teams (e.g. Medical Emergency Teams) in healthcare. (Bellomo 2003; Beaubien 2004) Simulations can range from low-fidelity role playing exercises (e.g. an event/scenario is re-enacted) to part task trainers (e.g. training of endotracheal intubators) to high fidelity full-motion simulations (e.g. trainees conduct a realistic surgical procedure including pre-brief, task completion, and debrief) (Salas et al. 2006)

Simulation-based training provides opportunities for trainees to develop requisite competences through practice in a simulated environment that is representative of actual operational conditions; trainees receive feedback related to specific events that occur during training (Oser et al. 1999). The healthcare community can gain significantly from using simulation-based training to reduce errors and improve patient safety when it is designed and delivered appropriately. (Salas et al. 2005)

Following Berry/Cooper (2006) simulation-based training is dependent upon the fact-based scenarios that are played out by the cast of real participants and artificial patients. Together, they provide an experience that helps physicians, nurses, and students:

  • acquire the procedural skills of medicine without “practicing” on patients and then allow the practice of those skills to maintain them;
  • rehearse the rare events, the equivalent of an engine failure event for a pilot in the flight simulator;
  • behave and communicate more effectively as part of a team, particularly in a crisis;
  • safely try out new and sometimes dangerous ideas and equipment;
  • record their learning experience with the benefit of replay and reflection; and
  • assess their performance more objectively than is now done in purely clinical settings (a provocative idea, but one that is needed).

Developing SIMBASE Impact Assessment Model (IAM) we will follow the vision of Gaba (2004) who describes simulation as a strategy – not a technology – to mirror, anticipate, or amplify real situations with guided experiences in a fully interactive way.