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Simulation Based Medical Education

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Kelly Shinkaruk

on 14 April 2014

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Transcript of Simulation Based Medical Education

Kelly Shinkaruk and Julia Hollett
Simulation Based Medical Education
Understand the theory and a brief history of SBME

Definition of Simulation
To link knowing and doing
Purpose of SBME
Simulation Based Medical Education (SBME) Theory
History of Simulation
Purpose and Types of SBME
Dimensions of SBME
Key Components to SBME activity (fidelity, deliberate practice, debriefing, mastery level)
Ongoing SBME research
Future Application of SBME
When to use SBME
Simulation Based Medical Education
Kelly Shinkaruk and Julia Hollett
"an imitation of some real thing, state of affairs, or process."
No longer sufficient
Increased trainees, decreased opportunity
Patient safety
don't want to be "trained on"
Interdisciplinary training not addressed
Apprenticeship Model
Train in safe environment
No harm to patient
Adjusted to learner level
Education comes first
in clinical setting, patient safety comes first
Repeat scenario until proficient
High cost of technology
Need for qualified instructors
Take participants and facilitators away from clinical work
Difficult to prove validity/reliability
Consider competency to be obtained
Identify learning objectives
Select correct tool - didactic/sim/etc
Consider context and setting
Develop scenario script
Include sufficient time for various sim components
Simulator set-up. Dieckmann, Miller's Anesthesia
History of Simulation
1929 - Edwin Link built the first flight simulator
1930 - 1960
Military purchases flight simulators
Laerdal begins R&D for mouth-to-mouth mannequin
Resusci-Annie is born
Cardiology patient simulator, Harvey, is born
"Simulation in Anesthesia was first demonstrated in the late 1960s when neither the technology nor the profession were ready for it."
JS Gravenstein
Gaba develops the Comprehensive Anesthesia Simulation Environment (CASE) prototype at Stanford
Gaba launches a full-scale mannequin system (CASE + Anestuesia Simulator-Recorder mathematical models + simulation technology
Visible Human Project
Minimally Invasive Surgery
Haptic Systems
The Computer
Laerdal introduces a midfidelity simulator
Categories of Simulation
No specific classification system however this is an easy way to differentiate the types of simulation
Verbal Simulation
Standardized Patients
Part Task Trainers
Laparoscopic Training Box
Computer Patient
Virtual Anesthesia Machine
Virtual Bronchoscopy
Virtual Patient
Electronic Patient
Virtual Reality
Mannequins (SimMan, etc)
Education Theories Contributing to SBME
Cognitive Learning Theory
Key to learning is the individual's cognition
Focus on internal mental processes under the learner's control
Essential components
organization of information to be learned
learner's prior knowledge
processes involved in perceiving, comprehending, and storing info

Social (Cognitive) Theory
Learning occurs when observing others
Intentionality and forethought are necessary
Learner's set personal goals and challenges
Consequences of action results in behaviour changes/motivation
positive feedback leads to a continuation of the behaviour
negative feedback deters the actions
Constructivist Theory (Experiential Learning)
Learning occurs when the learner attaches meaning to an experience or activity
Adult learners are experiential learners
Learning is an active process, "learn by doing"
SBME links knowing and doing
Simulation Based Medical Education
Who Benefits from SBME?
Sweller's Cognitive Load Theory and Simulation Fidelity
Cognitive Load Theory
proposed in 1988 to explain effect of instructional design on learning and failure to learn
working memory is limited
learning = impaired when instructional design leads to overload
Simulation assumptions
SBME results in meaningful learning
Skills can be applied to real patients
The closer to the 'real world', the better than learning
More complex skills require more complex simulators
Fidelity is the most important part of transfer of knowledge
**optimal design minimizes extraneous load and maximizes germane load**
novices - learn skills/techniques before attempting on patients
experts - maintenance of skills esp. those that are seldom used
patient safety improvement
crisis resource management
multidisciplinary/team practice
individualized learning targeted at learner level
slow down parts of scenario
Fraser et al found that simulation had a higher cognitive load compared with traditional teaching
Research needs to address ways to optimize simulation instructional design with learner needs
Fraser, K et al. Emotion, cognitive load, and learning outcomes during simulation training. Medical Education 2012: 46: 1055-1062.
Norman, G. et al. The minimal relatonship between simulator fidelity and transfer of learning. Medical Education 2012: 46: 636-647.
fi-del-i-tee, fahy-
] noun, plural fi·del·i·ties.
1. strict observance of promises, duties, etc.: a servant's fidelity.
2. loyalty: fidelity to one's country.
3. conjugal faithfulness.
4. adherence to fact or detail.
5. accuracy; exactness
: The speech was transcribed with great fidelity.

Reality vs realism
how closely does a simulation need to mimic a clinical situation?
"Both HFS and LFS learning resulted in consistent improvements in performance in comparisons with no-intervention control groups. However, nearly all the studies showed no significant advantage of HFS over LFS with average differences ranging from 1% to 2%."

Norman, G. et al. The minimal relatonship between simulator fidelity and transfer of learning. Medical Education 2012: 46: 636-647.
Physical Mode
aspects of simulation that measure physical and chemical dimensions
weight of mannequin
force needed to compress chest
duration of time from drug administration to response
Semantical Mode
concepts and relationships
can transmit information in various manners
vital signs monitor
verbal description
tactile perception
semantical recoding
syringe of water = drug
Phenomenal Mode
deals with the "experience"
emotions and beliefs
providing high phenomenal realism is the key goal for a successful simulation
Low Fidelity
High Fidelity
Let's try a low fidelity simulation!
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