What is Medical Simulation Training?
Medical simulation training most often means any clinical simulation used to train medical physicians. To best comprehend how these medical simulations work, one must understand the physician’s scope of practice and specific roles and responsibilities inherent across medicine. Specifically, medical simulation focuses on training objectives such as learning how to diagnose, treat, perform surgery, and work within an interprofessional team. Further, medical simulations may employ one or several of these elements to develop and deliver situationally appropriate training.
Anyone who’s ever owned a dog knows that breed matters. A Schnauzer does not look the same as a teacup Poodle, and a Yorkshire terrier behaves differently to a German shepherd. In the same way, medical simulation does not work the same as nursing simulation or occupational therapy simulation. The difference between these various approaches to clinical simulation is guided by different objectives. These are ultimately dependent on distinct scopes of practice between healthcare disciplines.
To comprehend how healthcare simulation differs for various disciplines, one must first understand what differentiates various healthcare professions. The line of demarcation between disciplines is guided by scope of practice. Simply put, a scope of practice describes the “procedures, actions, and processes” allowed to be performed by a particular type of healthcare provider. For example, a physician can diagnose illnesses and prescribe treatments, whereas a registered nurse is responsible for administering ordered treatments. These fundamentally different responsibilities lead to the development of different kinds of clinical simulation training.
The precise details of this scope are typically outlined by whichever state or country is issuing the provider’s license. In the United States, there may be some regional variation between states, which is important when considering the specific type of clinical simulation being delivered. For example, some states allow nurse practitioners to practice independently without physician oversight, while others do not.
Viewing Medical Simulation Through the Lens of Scope of Practice: Medical simulation is guided by the broadest scope of practice possible. This is the full ability to diagnose illnesses, prescribe treatments, perform surgical procedures, and delegate actions to the interprofessional team. In light of this, medical simulation training should be tailored to the development of skills in these areas.
Diagnosing Illness: Before knowing how to treat an illness, a physician must first become aware of how to make a proper diagnosis. This is a complex responsibility due to the knowledge needed in areas of human physiology, pathology, psychology, and the interconnected nature of all three. The processes that physicians use to apply knowledge gained in all of these domains and presumptively arrive at a diagnosis is called “forming a differential.” This includes a thorough patient assessment, a strong understanding of all possible pathological options, deductive reasoning, and a determination of additional knowledge needed to make different diagnoses.
In this context, medical simulation is used to apply cerebral information to a patient scenario. Early in a physician’s training, this may be as simple as being presented with a patient who has only a few complaints and no co-morbidities, thus limiting the complexity of diagnostic options. For instance, a learner might arrive at an asthma diagnosis when presented with clear-cut symptoms of wheezing and shortness of breath when exposed to triggers like pollen or dust. As the physician progresses in skill and area of specialty, they will benefit from clinical simulation scenarios that require them to diagnose complex, rare, or easy-to-miss disorders with multiple potential causes.
Prescribing Treatments: When a physician has developed strong skills in diagnosing illnesses, they might be tempted to assume follow-up treatment will be simple. To the contrary, learning how to prescribe appropriate treatments requires an understanding of pharmacology, non-pharmacological therapies, surgical options, illness subtypes, changes in the world of research, and what is most appropriate given the patient’s socioeconomic status.
Medical simulation can be used under these circumstances to give the physician the opportunity to treat a patient, then show the end result of whatever regimen was chosen. For example, a doctor may be required to choose between various medications for a patient who is critically coding as a result of an acute disorder.
Surgical Procedures: In the United States, medical physicians are the only discipline able to perform the act of surgery on a patient. This involves cutting into a patient’s body to remove diseased tissue or otherwise change existing physiological structures. Since these procedures typically involve a high level of risk, surgeons often experience many simulated surgeries before ever performing a real one. This allows the provider to practice the simultaneous management of sterile procedure, precise technique, proficiency with various tools, and working with the surgical team. In surgery, there is no replacement for practice, so surgical simulation is a great way to obtain experience in a manner that doesn’t risk harming patients.
Delegating to the Team: While all healthcare professions practice working as part of a team, physicians have the unique role of top-level coordination of care for all the various disciplines that may interact with their patient. This requires in-depth knowledge of the healthcare system in which they operate. Here, medical simulation is primarily focused on interprofessional education (IPE) aspects of practice and the nuances of working as a team member. As such, these scenarios may include healthcare clinicians from many backgrounds, such as nursing, respiratory therapy, social work, or other allied health professions.
Given that the different types of medical simulation can be distinctly categorized, components of these clinical simulations are often combined. Depending on the learner’s or professional’s objectives, they may choose to employ one or several of these types of clinical simulation. As in the case with dogs, “breed matters” across healthcare simulation too.
Nathan Costiuc, MSN, APRN, FNP-BC, is a Nurse Practitioner and Healthcare Simulation Educator. He began his career delivering clinical simulation to nursing students, quickly realizing the industry’s potential to impact modern training for all healthcare professionals. In navigating better ways to deliver clinical simulation, Costiuc entered into the world of virtual reality, and now works as a Clinical Education Specialist for Oxford Medical Simulation. His passion is in using innovative methods and emerging technologies to reduce medical error, solve practical problems, and improve patient care. He also actively works with disabled veterans in the clinical setting.