By: Serena Zaccagnini

Simulations in medical training are a realistic cross-disciplinary method of training and feedback. In simulation-based learning learners can repeatedly practice and review tasks in lifelike circumstances using physical or virtual reality models to identify and understand the factors that affect systems and the problems that can arise. Simulation-based medical education (SMBE) allows students the chance to refine their skills in a safe and controlled environment where they can increase their skills and reduce their margins of error. SMBE creates a safe and controlled environment that exposes trainees to dangerous conditions.

The State of Medical Education

Research by Jones, Passos-Neto and Braghiroli indicates that, despite advances in technology, teaching strategies and learning theories, it is not uncommon for medical students to be taught with decades-old syllabi. The current model of medical training has been in use for at least a hundred years, but a developing movement for patient safety has forced institutes to revise the medical education system.

Several external factors are driving the movement for medical education reform:

• Increased awareness of information overload and stress on medical students.
• Recognition of the need for students to be effective junior doctors after undergraduate studies, not during residency; students are often ill-prepared for their roles.
• The need for continuing education for higher specialist training, coupled with the drive to revalidate.
• New interest in outcomes-based education, focusing on the student’s ability to perform what they have learned, rather than the typical goal-based education, which focuses on student satisfaction.

Some institutions have already adopted simulations for use in examinations. For example, Scalese, Obeso and Issenberg indicate that the Royal College of Physicians and Surgeons in Canada uses simulations with computers and mannequins alongside patient participants in their Internal Medicine certification exams.

Simulations, Past and Present

Any person attempting to determine the origins of simulation-based education would find themselves mired in information dating back millennia. While the first dedicated use of simulations in medical training took place in the USA in the 1960s, use of simulations in medical training can be found across cultures and ancient civilizations. In the past, these simulations used active participants or mannequins as the test subject. Over the last several decades, the educational tools shifted from the real-world to the virtual.

A Shift toward the Virtual

Medical education is one of many disciplines experiencing a significant increase in the use of simulation technology for teaching and assessment. From the military and aviation industries training pilots on flight simulators to construction workers training on virtual cranes, simulation-based education has seen a boom in trust and satisfaction.

The shift to virtual education for medicine follows the trends of society. Many medical students and practitioners have adapted their methods to better fit the 21^st century:

• Many medical students view lectures online or listen via podcasts.
• Residents consult information stored in Personal Digital Assistants (PDAs) to make patient management more efficient.
• Practitioners can receive continuing education credits by attending teleconferences.

Much of the movement toward simulations occurred in the 1980s and 1990s, when sophisticated computers and software capable of reproducing and mimicking physiologic responses and feedback were produced. The first wave of simulated patients combined a Macintosh computer with a mannequin and waveform generator to mimic a patient during anaesthesia. Specialties such as anesthesiology, critical care and emergency medicine have long been at the forefront of the push toward SMBE.

Technological innovations have paved the way for a wide range of simulators that can facilitate and supplement learning in numerous medical disciplines.

The Limits of SMBE

Primary concerns regarding simulation use in medicine involve cost, efficiency and simulation quality.

• Cost: The best medical simulations are available at considerable costs. Machines require maintenance and updating, which continually adds to the initial purchase price.
• Efficiency: Incorporating time into current medical curriculums is problematic and would require the medical curriculum to be updated. Dedicated and exclusive resources are seldom available. For simulations, an instructor-to-learner ratio of 1:3 or 1:4 is ideal, where the current ratio is between 1:10 and 1:15.
• Simulation Quality: Human systems are complicated and varied, thus models and instruments can never completely mimic each iteration. Poorly designed simulations can inhibit learning, such as causing students to neglect checking for physical signs because they are absent in the simulation. Participants will naturally approach simulations differently than they would real life. Students will either be hypervigilant or negligent.

Long-term studies must be conducted to analyse the effects of SMBE on patient care and general effectiveness as a teaching tool. It is only after the impact of SMBE has been evaluated that simulations can begin to replace all outdated teaching materials.

Where To, Next?

The current model of medical education has changed little over the last hundred years, but an increase in demand for experienced doctors has pushed educational institutions to reconsider the system. Simulation on its own cannot guarantee learning, but it is a game-changer.

Future studies should be conducted regarding the effects of SMBE on improving patient outcome. Without strong evidence, a field as costly and vital as medical education cannot be altered with any severity. At best, simulations will be a periphery in medical education and training. The potential growth for SMBE alongside technological advances is unmeasurable and may be the key to training medical professionals in the future. However, institutions and practitioners must analyse the current education system and the validity of SMBE research to determine if the jump can be made now or later.

The shift toward heavy technology use is unavoidable; medical professionals, as other professions, have started to rely on computer- and cloud-based materials to improve their patient care. What remains to be seen is if they will fully accept this paradigm shift and trust simulations to train the next generation of doctors.

Resources

Bradley, Paul. “The History of Simulation in Medical Education and Possible Future Directions.” Medical Education 40, no. 3 (March 2006): 254-62. doi:10.1111/j.1365-2929.2006.02394.x.

James, John T. “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care.” Journal of Patient Safety 9, no. 3 (September 2013): 122-28. doi:10.1097/PTS.0b013e3182948a69.

Jones, Felipe, Carlos Eduardo Passos-Neto, and Oddone Freitas Melro Braghiroli. “Simulation in Medical Education: Brief History and Methodology.” Principles and Practice of Clinical Research 1, no. 2 (July/August 2015): 56-63.

Krishnan, Divya G., Anukesh Vasu Keloth, and Shaikh Ubedulla. “Pros and Cons of Simulation in Medical Education: A Review.” International Journal of Medical and Health Research 3, no. 6 (June 2017): 84-87.

Scalese, Ross J., Vivian T. Obeso, and S. Barry Issenberg. “Simulation Technology for Skills Training and Competency Assessment in Medical Education.” Journal of General Internal Medicine 23, no. Suppl 1 (January 2008): 46-49. doi: 10.1007/s11606-007-0283-4.

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Serena Zaccagnini is a student at Seneca College in Toronto, Ontario studying Technical Communication. She is looking forward to a career in the Technical Communication field. I have a Specialized Honours Bachelor of Arts in English and Professional Writing with emphasis on Digital and Institutional Communication from York University. In my spare time, I enjoy reading and baking.

By Minyu Anna Philip

A classroom or an office is a blend of personalities. Just as educators develop preferences for methods to teach, learners develop preferences for a specific way of learning. As we set out to instruct, it is our responsibility to build up methodologies to effectively communicate to our unique audience. Every instructional method comes with its own advantages and disadvantages. The type of learner and the level of knowledge they possess are two essential considerations when designing any instructional plan. The physical settings of the teaching space and the materials available also play an important role in the selection of an instructional method. A novice would have to be taught from scratch whereas what a subject matter expert probably needs to learn is probably a new perspective of approaching a problem. Any instructional method requires a level of preparation by the educator and sometimes, from the learners. However, one scenario or subject could be taught in several different ways and here you shall see different types of effective instructional methods.

Role Playing

In role playing, learners take the role of another person to understand what it is like to be in their shoes.

The preparations required for this activity are that the educator defines the problem situation and provides clear instructions, topics and roles.

This activity helps to introduce the scenario dramatically. It enables the learners to assume the roles of others and thus appreciate another point of view. It is also an excellent method of practicing their skills in a practical environment and helps them to explore real-time solutions for problems.

The activity could be time-consuming to set up and execute and it could make a few of the learners self-conscious.

Games

Games introduce active participation to learners in a team-building activity.

The groundwork of game-building activities includes choosing relevant games that can be reasonably expected to achieve the learning objectives. The educator must introduce the game, provide clear, thorough directions and make the objectives known beforehand. It is important that the atmosphere is friendly and pinpointing of losers is avoided so that the confidence of the participants is not shaken. The educator must be able to handle all kinds of situations and not take sides or be partial.

The advantages of this activity are that learners are usually challenged by and interested in games. It brings about a fun and stimulating experience and improves team-building activities.

The disadvantages of having games as an activity are that it could be demotivating for non-competitive learners. It could also instill a feeling of shortage of skill as compared to the more competitive and talented learners. If the focus is on who wins the game rather than the activity itself, it might discourage creativity.

Group discussion

The class is divided into groups and a topic is given to each group to be discussed.

This activity requires the educator to decide on a purpose for each group. It is also necessary to invigilate the group so that the learners do not deviate from the topic in discussion.

The advantage of this activity is that it allows an active participation from everyone in the group. The learners might feel more comfortable sharing in a smaller group as opposed to a larger group.

The disadvantage in this activity is that a few students might dominate and it might not be as effective when there are a lot of students in one group.

Debates

Learners form two groups take different sides of a topic and debate on the pros and cons on a specific topic.

The preparation required for this activity is to come up with a topic that will not create a scene that the educator might not be able to moderate.

The advantages of this activity are similar to having a group discussion. This activity also includes a smaller group and enables active participation. The learners feel more comfortable expressing their thoughts regarding a subject knowing that there are others to support it. This, in turn, encourages team spirit.

The disadvantage of having a debate is that there could be an argument that gets out of hand.

Surveys

Learners prepare questionnaires, online or on paper, and collect information. The educator could also prepare a questionnaire and make the learners fill it out, then form a discussion based on the output.

This activity requires careful thought about the various topics on which a survey could be conducted. It also demands research by the educators to prepare handouts for the students.

The advantages include the possible use of social media to get survey input, encouragement of reflective observation, analysis of direct feedback from the audience and active experimentation.

A disadvantage is that this activity is time-consuming. The learners might be required to go to a variety of audiences to obtain an accurate analysis which can be physically taxing as well.

Service learning

Learners volunteer to provide meaningful help to the community thereby learning from practical experiences.

The preparation for this activity is for the learners to find an area of genuine interest. They might have to travel, ask difficult questions and help those in need. This might require prior counseling before setting out on their course of activity.

The advantages of this activity are getting a first-hand experience of being in the field of work and a sense of giving back to society. It also encourages reflective observation and active interaction with the audience.

The disadvantage is that this could be time-consuming and could cause mental and physical challenges to the learner.

Conclusion

Learners come from different backgrounds, with varying capabilities and areas of interests. It might be difficult to find a method that suits all the learners in an equal way. Having a healthy assortment of instructions and teaching methodologies ensure that all the learners are benefitted.

References

• Bob Kizlik, http://www.adprima.com/teachmeth2.htm, 2018.
• https://www.langevin.com/train/bin/postcards/50_instructional_methods.pdf, 2009.
• Cruikshank, Bainer and Metcal, https://people.uwplatt.edu/~steck/Petrina%20Text/Chapter%204.pdf, 1999..
  

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  Minyu Anna Philip is a student in the Technical Communications program at Seneca College, Toronto. Prior to this, she completed her Engineering degree in Electronics and Communications and had a short work stint as a Programmer Analyst. She then learned about the field of Technical Writing and secured a job at Lionbridge Technologies as a Technical Writer. After this, she decided to get a formal education in Technical Writing and is now enjoying the course at Seneca. She is excited about starting her work placement in Trapeze North America.