Teaching and Assessing Procedural Skills Using Simulation: Metrics and Methodology

Abstract

Simulation allows educators to develop learner-focused training and outcomes-based assessments. However, the effectiveness and validity of simulation-based training in emergency medicine (EM) requires further investigation. Teaching and testing technical skills require methods and assessment instruments that are somewhat different than those used for cognitive or team skills. Drawing from work published by other medical disciplines as well as educational, behavioral, and human factors research, the authors developed six research themes: measurement of procedural skills; development of performance standards; assessment and validation of training methods, simulator models, and assessment tools; optimization of training methods; transfer of skills learned on simulator models to patients; and prevention of skill decay over time. The article reviews relevant and established educational research methodologies and identifies gaps in our knowledge of how physicians learn procedures. The authors present questions requiring further research that, once answered, will advance understanding of simulation-based procedural training and assessment in EM.

Teaching procedures: improving “see one, do one, teach one”

“…Real-time video and audio projection allows for feedback, education, and observation. 13 These models can be prohibitively expensive to purchase, require maintenance, and are fragile.…”

The TACTIC: development and validation of the Tool for Assessing Chest Tube Insertion Competency

“…13,14 Others have demonstrated that simulated experiences are useful adjuncts to fill training gaps. [6][7][8][15][16][17] More evidence is available to suggest that simulated experiences increase procedural knowledge, skill, and behaviours and may improve patient outcomes. The educational intervention, which included both screen-based learning and hands-on learning with feedback, was carefully designed to include several important instructional design features for simulation.…”

“…[5][6][7][8][9][10] Although various different chest tube insertion task trainers exist, there is no objective and validated scoring system in the literature to assess chest tube insertion competency. Such a tool could be used to assess a practitioner's skill, identify areas for improvement, or rate on a scale for high-stakes assessment (either in the simulated or real environment).…”

Simulación clínica de alto realismo: una experiencia en el pregrado

“…Los alumnos a los que se les ofrece esta oportunidad de implicarse en la práctica deliberada y repetitiva con simulación parecen adquirir las habilidades necesarias en periodos más breves que aquellos que se exponen únicamente a las situaciones clínicas rutinarias con pacientes reales. De hecho, existe relación entre el tiempo total de exposición a actividades de simulación y los resultados de aprendizaje [11,12]. Que los estudiantes participen en escenarios simulados de alto realismo como los descritos en este trabajo, en unas cuatro o cinco ocasiones a lo largo del curso, parece un compromiso razonable entre lo ideal y lo factible.…”