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How is simulation used?
Simulation training extends from part task trainers, or procedural training to the experience of full clinical situations. Table 1 lists the range of low to high fidelity simulated experiences.
For example simulated parts of the body can be used for cannulation, catheterisation and rectal examination. Some skills are practiced in a wet lab where animal and human tissue can be used for example, for suturing. Basic (low fidelity) manikins are used for teaching basic and advanced life support. High fidelity manikin simulators with a vast number of programmed interactions and physiological responses can be used for individual or team scenario training.
High fidelity simulators also include those that are used for laparoscopic and endoscopic skills where the technology of virtual reality is employed. Some of these sophisticated
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1. Games, classroom scenarios 2. Wet labs using human or animal tissue 3. Simulated patients. Either actors or volunteers 4. Computer generated virtual reality simulators 5. Manikins and models of varying complexity. From part task trainers, such as cannulation arms to ‘complete’ bodies such Simman™ 6. Mock hospital facilities including a simulated operating theatre, emergency departments and wards. |
simulators have ‘forced feedback’ (haptic) systems which enable the learner to ‘feel’ the endoscope going around the splenic flexure.
Despite the ready availability of simulated body parts and 'kit', the integration of technical and non-technical skills is paramount in developing professional practice. In addition, to ensure patient safety, non-technical skills are an aspect of training that should be emphasised. Analyses of adverse incidents indicates that the majority of causes of errors are in the non-technical skill domain, including communication failure, team failure, poor leadership or poor decision making (Gawande et al, 2003; Mallory et al, 2003). The Scottish Clinical Simulation Centre has looked at the integration of human factors into the medical curriculum and how to access the acquisition of those skills. They have developed behavioural markers for these skills in both anaesthetic (ANTS) and surgical arena (NOTSS).
Kneebone’s research programme on the integration of technical and non-technical skills includes simulation training for rectal endoscopy which uses an endoscopy simulator with a simulated patient next to the simulator (2003). A sheet covers the patient and the trainee has to perform the task while talking and explaining to the ‘patient’ what he or she is doing.
Scenario simulation provides an excellent opportunity for interprofessional education with the ability to train real teams from work environments. In addition, predetermined healthcare groups deliver many of the skills required by patients during their care, however in the future who delivers these skills may well change. It is envisaged that simulation teaching will provide packages that any group could access and interact with other groups for relevant multidisciplinary situations.
Thinking point:
What skills do you (and other teachers) need to acquire in order to make the most of such simulation opportunities in teaching technical and non-technical skills?
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