Simulation-Based Medical Education

Abstract

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.

Simulation-based otolaryngology – head and neck surgery boot camp: ‘how I do it’

“…1 Indeed, the aviation industry's use of simulation training in complex technical routines is a good model for medical resident training because both groups need to train their future professionals despite the inherent dangers in the environment. 2,3 Simulation enables trainees to learn procedural skills in a tailored, non-threatening, controlled environment that can provide feedback and educational experiences. [4][5][6][7][8] Much has been written about the use and efficacy of simulation in otolaryngology -head and neck surgery.…”

Role of Simulation in US Physician Licensure and Certification

“…76 The importance of simulation is evident in aviation, where commercial pilots take their first flight only after a rigorous simulation program. The extensive use of simulation in the aviation industry has not been driven by evidence, but by intuition and common sense.…”

Biomedical Simulation: Evolution, Concepts, Challenges and Future Trends

“…9 As opposed to the clinical setting, where errors must be prevented or repaired immediately to protect the patient, in a simulated environment errors may be allowed to progress, to demonstrate their implications, or to enable a quick reaction to rectify them. 10 Simulation is a learner-centered educational experience rather than a patient-centered activity. Trainees are exposed to a range of carefully designed clinical encounters, providing the opportunity for the educator to adapt the content, level of difficulty, and sequence in the curriculum, 10 in order to diagnose and bridge needs to best practices.…”

“…10 Simulation is a learner-centered educational experience rather than a patient-centered activity. Trainees are exposed to a range of carefully designed clinical encounters, providing the opportunity for the educator to adapt the content, level of difficulty, and sequence in the curriculum, 10 in order to diagnose and bridge needs to best practices.…”

“…10,19 This consists in (formal or informal) actors trained to role-play patients, for training and assessment of history taking, physical examination, and communication skills.…”