Elizabeth Blodgett Horsley, Director of Simulation, The Brooklyn Hospital Center
Healthcare professionals of a certain age will recall that their early days of training generally took the form of the see-one-do-one-teach-one mantra, shadowing a more experienced provider and hoping an interesting opportunity presented itself or simply being told to read the policy/procedure manual or the requisite skills textbook and follow through as instructed. Teamwork, leadership, and communication skills might have been eluded to in a one-off lecture on their importance but the underlying expectation was we would just intuitively know how to communicate and be a member of a functioning team. Over time however, the healthcare system underwent cosmic shifts that have influenced the way healthcare professionals are learning. Shorter hospital stays, combined with in-patients who are more acutely ill plus duty hour restrictions make it difficult to find adequate clinical placements and experiences for students. Patient safety and patient engagement is at the forefront of hospital mission and visions and as such the days of it being acceptable to randomly practice on real people are rapidly and thankfully dwindling. At one time, the number of hours spent on a unit, or the volume of procedures performed accounted for relative proficiency. This myth of hours and volume being sufficient indicators of competency has been debunked. It is not the number of hours or skills one practices; it is the quality of the practice that counts. Likewise, if we expect all members of the patient care team to function as a cohesive, collaborative unit, there needs to be a more concerted effort at educating them in those skills, beyond simply giving it a passing lip service. Health professions education has to align teaching strategies with the realities of today’s healthcare system. Much of this alignment has been supported by the technology in the field of clinical simulation.
Simulation, in its broadest and simplest form refers to replication of real events for the purpose of teaching and learning. There are some incredibly creative methods of recreating realistic patient scenarios. Indeed, a vast array of innovative technologies have revolutionized the education of health professionals. Simulation technology can range from incredibly life-like trainers created to replicate a body part such as an arm for intravenous insertions, to more intensive skills such as paracentesis or central line insertion.
On a much larger scale, there are full body human simulators that can be programmed to mimic virtually any patient condition and respond to medical intervention. In the early days of clinical simulation, these patient simulators resembled a department store mannequin and were admittedly a tad creepy. In the last two years, human simulators have evolved to look and feel incredibly lifelike. Over time, these systems have evolved from having cumbersome compressors (to make the chest rise and fall to simulate breathing) and masses of wires to now systems being wireless and operated remotely. Like many iterations of a technology, there are now smaller and more cost effective systems such as a set of tablets representing a patient monitor that can be combined with static mannequin or even a real person to create scenarios that would be commonly seen in an acute care setting. There has also been a surge in the development of virtual reality modules to learn specific skill sets— endoscopy, bronchoscopy, or to be immersed in an actual setting.
Interestingly though, this technology has had an impact in decidedly non-technical ways. It may well appear that simulation is a technological advance in education that allows health care students to practice psychomotor tasks. Indeed, that is true; however, the beauty of simulation is how it has become an incredibly powerful way of teaching teamwork and communication skills. The technology of task trainers has taken an innovative turn in that perceptive entrepreneurs have combined the best features of realistic task trainers with the ability to make them wearable by a person in the role of a patient. Voila—the ability to design educational sessions that allow the learner to master the psychomotor task concurrently with patient interaction skills. The aforementioned full body human simulators have opened up huge opportunities for teaching the necessary teamwork and communication skills for high acuity events like cardiac arrest and trauma scenarios. The call has gone out across healthcare for interprofessional collaboration and simulation has proven to be an excellent platform for some meaningful educational initiatives.
These technologies have undoubtedly contributed to the training and development of health professionals. Research has emerged that demonstrates the impact of simulation-based training on a variety of outcomes such as central line infection rates or management of shoulder dystocia. The adoption of technologically enhanced simulation has forced educators to re-think previously held ideas about what makes for effective teaching. As simulation became common in many programs, it also became apparent there was a dearth of knowledge about how to effectively use it in best practices. It is not enough to have the user manual and be able to push the right buttons. There is definitely pedagogy to simulation, and as such, academic institutions and hospitals have invested in people with specialized knowledge in the field to champion simulation initiatives. The past decade has seen an absolute boom in the scholarship in the field of simulation, ranging from the effectiveness of it as a teaching strategy to best practices for educators. Simulation has gotten students out of the lecture hall, and away from PowerPoint, and put them in robust and well planned hands-on activities. Simulation is not meant to replace the traditional lecture or time spent with real patients. Simulation is an adjunct to these and the combination of all types of learning results in the best-prepared practitioners.