Editor Discusses Simulation in Medical Education

In this first year of MEdSim we have highlighted changes in medical school curriculum; discussed best practices in hospitals to reduce cost and reduce infections; highlighted association goals gleaned from conferences and articles for transforming  healthcare; discussed how to measure competency and the use of simulation as an evaluation as well as teaching tool for all healthcare professionals; shared ideas for measuring effective training through the use of simulation and the rapid growth of simulation centers across the world and how to get return on investment for these centers. We have interviewed key healthcare professionals to understand the rapidly changing face of medicine and to discuss state of the art practices in their fields. Our goal is to highlight best practices in medical education and training through the use of simulation and other tools to reduce cost and improve patient safety.

From our attendance at recent meetings we have learned that some doctors are taking bold steps to ensure that medical professionals are equipped to meet the future demands of a burgeoning population while having contact hours of training reduced. Richard Reznick, M.D., the dean of Queen’s Faculty of Health Sciences, is recognized for his commitment to surgical education, simulation, research and academia. Dr. Reznick’s   research has focused on performance-based assessment, technical skill acquisition and simulation, all with the aim of improving practice.  His work in surgical assessment and simulation also led to the creation of a unique competency-based curriculum to train surgeons. Dr.Reznick is a fellow of both the Royal College of Physicians and Surgeons of Canada and the American College of Surgeons. A checklist to reduce surgical complications, he participated in developing is now being used around the world.

At the Minimally Invasive Surgical week in Boston during his presentation he announced that in January he will be accepting highly qualified high school students in his medical education program. This has been a long accepted practice in much of the world, but not in the US or Canada.

Another physician, practicing in Canada, Dr. Teodor Grantcharov, an associate professor of medicine at the University of Toronto and a surgeon specializing in minimally invasive surgery, is improving surgical outcomes through education. He and Vanessa Palter, a surgical resident   and Ph.D., candidate recently published a study showing that surgical residents who train first in a simulation lab significantly outperform colleagues who receive only standard surgical training.  The findings were published in The Annals of Surgery and compared University of Toronto surgical residents who completed a five month simulation training module to residents who received conventional surgical training. Their research proves that surgeons who train using simulation technology perform significantly better in the operating room than those who train using conventional methods. Now, as Medical Director of St Michael’s Patient Simulation Centre, he takes a leading role in training the next generation of surgeons.

Similar advancements are taking place in medical simulation centers throughout the world. These centers are training nurses, doctors, pharmacists and other healthcare professionals to equip them with the skills necessary to assure competency in their chosen fields.

In a study by Yasuharu Okuda, M.D. and others in 2009 a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education and continuing medical education found 113 articles which they included in their review. The articles demonstrated that simulation training lead to improved medical knowledge, comfort in procedures and improvements in performance during retesting and simulated scenarios. As stated by Dr. Okuda, simulation, in all its incarnations, is a tremendous tool for healthcare educators that allows students to achieve goals without patients being put at risk.

Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Dimitrios Stefanidis, M.D, Carolina Medical Center, in his article that appeared in MEdSim 1/2012, discussed the application of motor learning theory to simulator learning, important curricular elements for skill acquisition, and methods of simulator performance assessment that maximize learning and clinical skill transfer.

Using simulation in medical education provides the ability to practice, practice, and practice in a safe environment, alters the degree of difficulty in the scenario, provides instant feedback and allows individuals to achieve competency as individuals or team members and provides tangible measurable outcomes.