Healthcare Simulation: A Key to the Future of Medical Education – A Review

Abstract

Aim Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education. Purpose To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides. Conclusion Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.

Physical Realism of Simulation Training for Health Care in Low- and Middle-Income Countries—A Systematic Review

“…The associated resources and costs may prohibit high physical realism simulation training in some LMIC settings. 26,27 If implementation of high physical realism simulation was to be prioritized in these settings, it would likely come at the expense of other important health care educational interventions in these low-resource settings. This should be balanced against the benefits of improving patient outcomes with potentially little cost and lower resources if low physical realism models are used.…”

“…Given the gaps in opportunities present in LMIC settings, it is important to consider the value of training equity over physical realism. The associated resources and costs may prohibit high physical realism simulation training in some LMIC settings 26,27 . If implementation of high physical realism simulation was to be prioritized in these settings, it would likely come at the expense of other important health care educational interventions in these low-resource settings.…”

“…18 Both high and low physical realism groups of rhomboid flap skills had similar posttraining results and were better than didactic-only (control: 13.82 ± 1.11; low: 24.42 ± 1.11 and 24.58 ± 1.24; high: 24.42 ± 1.50 and 24.5 ± 1.24; P < 0.05 between intervention groups; P > 0.05 intervention vs. control). 19 One study looking at virtual reality versus standard mannequin training for fiber optic intubation showed that plateaus in the learning curves were achieved more swiftly after 19 (95% confidence interval, [15][16][17][18][19][20][21][22][23][24][25][26] practice sessions in the intervention group as opposed to 24 (95% confidence interval, 20-32) in the control group. No significant difference was found between the groups in procedure time [13.7 (6.6) vs. 11.9 (4.1) secs, t =1.101, P = 0.278] or global rating scale [3.9 (0.4) vs. 3.8 (0.4), t = 0.791, P = 0.433].…”

Onward to better surgery – the critical need for improved ex vivo testing and training methods

“…Ex vivo simulation (i.e., phantoms) have demonstrated roles in: anatomic simulation; device testing; invasive and non-invasive procedural training; imager testing and calibration; inter-device comparison; and results validation. [5][6][7][8][9] The benefits of simulating complex systems with potential for catastrophic failure are widely known in many fields, perhaps most notably in aviation where accidents continue to decline over time and the Federal Aviation Administration (FAA) boasts a stellar-and continuously improving-safety record. 10 Despite the recognized benefits of medical simulation, there remains hesitancy on the part of funding agencies and regulators to assign value to results obtained using medical phantoms, with in vivo animal or human testing remaining the gold standard to justify funding and/or regulatory approval.…”

Simulation Based Inter-Professional Education – Integrating Theory, Practice and Healthcare Professionals

“…So attitude towards simulation need to be changed in order to implement it. 6 To design cost effective low and medium fidelity simulators content experts and simulation analyst should work in collaboration. Simulation technology should be developed by consulting all stakeholders especially end users.…”