Simulation Training in Healthcare

Simulation Training in Healthcare is an educational method that includes a range of realistic and immersive replicas of clinical practice, policy, scenarios, tasks, and equipment. Healthcare simulation training has a number of purposes. This includes but is not limited to: education, assessment, research, latent safety threat identification, environmental testing and integration of policy and procedure into the healthcare environment.

Also known as “Healthcare Simulation” “Medical Simulation” or “Clinical Simulation”, Simulation training in healthcare allows for knowledge, skill and attitude acquisition of healthcare staff in a safe and low risk environment. Simulation training in healthcare is an educational philosophy and method which aims to be able to replace experiences with patients. Simulation training in healthcare can be used by individuals right through to complete teams who respond to a crisis as they would in a real clinical case.

Simulation training in healthcare can be used by a variety of different modalities. These modalities include but are not limited to: virtual patient encounters, standardized person/patient, static manikin/skills trainer, high fidelity manikin, escape rooms and screen based serious games. Simulation training in healthcare allows for individuals and teams to be able to practice: procedures, team based skills, communication, leadership and the management of complexities of crisis situations.


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Benefits of Simulation Training in Healthcare

Simulation training in healthcare allows learners to be able to practice for real life clinical events prior to occurrence on a patient in clinical care. This means that healthcare staff are able to be exposed to cases and complexities around these prior to completion on a real patient. This means that latent safety threats and knowledge gaps of clinical staff are able to be picked up early and reduce the risk to patients in clinical environments.

Up to one in every four deaths in hospitals can be attributed to error by healthcare teams in the United States of America currently. Medical error is hugely impactful on morbidity and mortality of users of the healthcare system the world over. Simulation training in healthcare allows for healthcare staff to practice and hone skills for rare events that otherwise would not be able to be practiced prior to on a real patient.


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Simulation training in healthcare is a powerful educational experience to assist healthcare professionals at all levels be able to reflect on their clinical and team work skills to be able to achieve higher competence and safer care. Simulation training in healthcare also provides healthcare organizations the opportunities to improve their system and clinical outcomes. Most medical errors are system based and in order to reduce medical errors a focus on system improvement rather than individual blame is required.

History of Simulation Training in Healthcare

Healthcare education of clinical staff historically took on a ‘see one, do one, teach one’ approach for education, experience and progression of staff. This process meant that patients had inexperienced healthcare staff practice on them with increased risk of poor outcomes. The danger and risk of harm with use of this method of staff education has become more unacceptable.

Simulation training in healthcare can be traced back to the late 1960s and early 1970s. Researchers from the University of Miami developed Harvey, the Cardiology Patient manikin, which in today’s terms would be considered a hybrid simulator which was in between a skills trainer and high fidelity manikin.

In the 1980s, Dr David Gaba assisted to develop and implement high fidelity manikins into simulation training in healthcare for anaesthesiology trainees. At the time these techniques gave opportunities for healthcare teams to repeat clinical and team practice in a safe learning environment. Gaba was a key component of the development of simulation training in healthcare at this time and of the importance placed on debriefing to reinforce learning and improve clinical practice.

Today, high fidelity manikins are available that are able to breathe, dilate pupils and present with a very similar clinical assessment to a real patient. Most current manikins are also wireless and are incredibly close to what a real patient presents as. Healthcare simulation task trainers for procedures are also available. The development and use of virtual reality simulation with technology based products has skyrocketed in popularity and interest amongst the healthcare simulation community.

Types of Simulation Training

There are three main parts or domains in which simulation training in healthcare can be utilized:

  • Manikins or task trainers can be used by individuals or teams to practice technical procedures, clinical skills or team based training.
  • Standardized patients or persons can be used as actors in place of a patient to teach clinical skills. Standardized persons can be hybrid and also involve wearable manikins to increase fidelity. Standardized persons are able to give a more lifelike experience and enable healthcare staff to practice communication skills.
  • Simulation based technology is used for team or individual training in a virtual based environment. This may be screen, VR or other technology based simulation training.

As with all simulation training in healthcare arguably the most important element of healthcare simulation is the debrief segment after the education session. Debrief allows clinical simulation participants to be able to reflect on their performance as an individual and team member to alter future practice. Careful consideration must be given as to the appropriate level of clinical simulation to be provided to the learners. Simulation training in healthcare teams need to ensure that an appropriate learning theory, methodology and pedagogy is followed to ensure learner and facilitator safety.

Principles of Simulation Training in Healthcare

The primary use for simulated training in healthcare is to give learners the opportunity to practice and also instill deliberate clinical practice. Simulation training in healthcare allows healthcare staff a safe environment to make mistakes without harm to patients. Reflection in debrief and for even years after a healthcare simulation scenario enables learners an experience to reflect on and improve care for patients.

Individuals can practice procedural based skills such as intubation or central line insertion on low cost skills trainers at a slower pace with support from an instructor. The use of a task trainer means that healthcare professionals are able to take their time and allow for muscle memory retention in a new skill. This allows users to refine fine motor skills and also acquire haptics and sensations associated with particular procedures.

Once baseline clinical and procedural skills are acquired by clinical staff members then there is a readiness and requirement for more complex team training events in healthcare simulation. Team training in clinical simulation allows for all team members to work together and to practice clinical decisions, communication and leadership skills. Team training in clinical simulation is much more resource intensive, however the outcomes and adaptations to clinical practice can be length of career impactful. Crisis situation clinical simulation scenarios performed in-situ allow for acquisition of complex team based skills in a clinical environment followed by a debrief to enable reflection.



Debrief and Faculty Simulation Training in Healthcare

Debrief is arguably the most important element of simulation training in healthcare. Clinical simulation participants need to explore and reflect on their clinical simulation scenario experience in a safe and non judgmental environment. There is a great importance for highly skilled and trained debriefers in clinical simulation scenarios to ensure that healthcare simulation participants are not damaged by their experience in the clinical simulation.

Debrief in the healthcare simulation environment comes in many methodologies. However the debrief process is undertaken, the debrief should be learner-focused and on a foundation of strong psychological safety. Debrief in clinical simulation should be conversational, bidirectional, interactive, non judgmental and reflective. With a high standard of training in debrief, no matter what debrief philosophy or system is used, the learner should emerge with understanding and empowerment for alterations to clinical and team based practices.

There are a number of forms of debriefing in the healthcare simulation environment. Some examples include: Promoting Excellence and Reflective Learning in Simulation (PEARLS); Team-Guided team self-correction, Advocacy-Inquiry, Systemic-constructivist (TeamGAINS); Defusing, discovering, and deepening (3D); Gather, Analyze, and Summarize (GAS). Clinical simulation learners and faculty members should share a mental model which has an underlying assumption that everyone wants to learn and improve their current knowledge base.

Reference:

  • Aggarwal R, Mytton OT, Derbrew M, et al. Training and simulation for patient safety. BMJ Quality & Safety 2010;19:i34-i43.

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