November 26, 2013By Lance Baily

A Black Belt in Simulation: What Can Healthcare Education Learn From Martial Arts?

At the age of 10 my father took me to my first Tae Kwon Do class. I had no idea that day would began a seven year commitment to becoming a 2nd degree Black Belt in the Korean-based martial arts form taught by 7th Degree Black Belt Master Don Wortman. From three to six times a week for seven years I would put on the white uniform and take hour after hour of hands-on training. As opposed to Judo wrestling or Akido’s throwing, Tae Kwon Do is a martial arts form that focuses a great deal on balance while keeping opponents at a distance primarily through kicks, leg sweeps and blocks. Understand that physical demonstration was always inherently apart of the instruction, and that any lecture based demonstration included the instructors movement as example. Martial Arts, like dancing, can not be fully learned via powerpoint while sitting in a classroom. While the mind was learning, the body itself was obviously the instrument of skills performance.

Creating Muscle Memory From Repetition

For the first fifteen minutes of our class, the instructor would warm up the students in stationary drills that stretched our muscles. Pushups, stretches and then jumping jacks would lead into stationary blocks, kicks and punches. Instructors would correct punching technique and stance while walking around the students, very much like nursing instructors do during clinical skills practice. Next, the learners would all run the to back of the dojo and begin movement drills where they would practice the same skills they just performed while moving across the floor. Again, Tae Kwon Do is about keeping opponents ideally at kicking-distance and so being able to move while performing skills was the next evolution of the performance. From here, the day would continue with either hand to hand defensive skills or practicing form combinations which demonstrated anywhere from 5 to 50 specific movements within a set path. All of these training segments required students to practice the movement into the unoccupied air around them, without dynamic opponent engagements – which came later. How does that help?

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From this training breakdown, consider the number of times I threw a spinning back kick during these classes. Lets average me at about 50 back-kicks a class, four classes a week, 50 weeks a year, for seven years. That is literally 70,000 spinning back kicks! So what does that mean in our context of medical simulation? Let’s dig deeper into my experience of the art form:

Around the age of 16 I achieved my black belt status and was immediately asked to teach other students.  While at first I was teaching about 10 children per class from the ages of 5 to 15, I was quickly promoted by the lead instructor to teach classes of 200 adults all of whom were older than myself. One day, a very much younger but prominent student of mine became frustrated with the repetitive nature of the classes, citing boredom of the “same old thing” as being “unchallenging”.

I asked the younger student if he had ever been in a real fight to which he replied “no”. After reminding him its best to keep it that way, I told him about the one time I had to defend myself while at high school. A fellow student roughly my size stood face-to-face and without warning pushed me very hard with both his hands raised for more. In mere milliseconds and without thinking I spun around and performed a spinning back-kick which landed squarely into his exposed abdomen. My opponent flew backwards into the air, crashed into the wall and slid to the ground holding his stomach.

Before I knew what had happened the fight was already over, with the lesson experienced that in a real situation, there is no time to “think of the next move”. I reminded my younger student that we train our bodies day after day with the muscle memory of specific movements so that our body automatically responds to the unknown situation before us. 70,000 spinning kicks means that when I needed it, the body acted out what it was most able to do. Of course, while repetition of movement gives martial arts trainees the ability to react without hesitation, sparring is necessary to practice those skill combinations through simulated combat.

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Martial Arts Training is Always Simulation-Based

Most classes would end with sparring sessions where students of like-size and skill would dawn protective gear and combine all previous skills into live-action engagements with their opponent. This was a great way to critique students to bring all previous skill experiences together while refining movement against a live opponent, something which can obviously only be trained with another individual. Reacting to your opponent, connecting blows, body positioning, and blocking best experienced and learned through simulated sparring matches.

Thus, to train in martial arts is to train through simulation. For obvious reasons students are not going outside half-way through a class to start a real fight with whoever passes by the dojo, nor are students only practicing moves against an invisible make-believe opponent made entirely of painted air. Other students wearing protective gear safely provide an opportunity to simulate movements of a living and moving opponent. In most cases, the greatest lesson students could learn during the sparring match was to remain calm – to not rush in. This is difficult to teach all levels of learners as nothing creates stress like someone trying to kick you in your head!

So always we encouraged patience and defensive mindsets, which ultimately empowered students to maintain situational awareness of their surroundings. As offensive strikes are always a risk, student attacks were only rewarded if they were efficient expenditures of energy, maximizing damage while minimizing effort. This learned patience to maintain situational awareness is where we can see the most powerful implications to healthcare.

Medical Simulation is Healthcare Training

In healthcare, a lecture on starting CPR after recognizing tunnel vision of teammates seems very simple for students to grasp. But like when fighting a real opponent, high stakes stressful situations bring intense adrenaline which will hijack normal operating thought protocols. So theoretically understanding adrenaline is one thing, but experiencing and dealing with it first hand is entirely another. Thus to draw a parallel to the benefits of simulated sparring in martial arts, advancements in healthcare education technology allow students and professionals to now better accomplish two things:

1) Build muscle memory for high-use skill sets through repetition of action. (This includes behavioral and cognitive skill sets).
2) Safely train for the unknown by engaging in medical simulation scenarios designed to lift up a learner’s directly applicable experience.

Imagine tomorrow’s healthcare professionals after having completed 70,000 low-fidelity task trainer IV starts, 70,000 TEAMSTEPPS communication engagements, or 70,000 high-fidelity simulated patient assessments. Anyone who thinks simulation may still fall by the wayside within the future of healthcare training is missing the point. No matter if cognitive, behavioral or technical – simulated training provides for faster responses with higher quality in any field.

Interested in reading further? Check out our articles on the lessons learned from the use of simulation in the aviation industry and/or scuba diving industry!

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