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3 Arten, wie Simulationen Ihre Lehrbemühungen beschleunigen

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How can simulation-based training accelerate student learning?

Medicine traditionally relies on a “see one, do one” approach to learning and experience. In this context, didactic learning tends to be limited to the process of imparting knowledge. Simulation-based learning picks up where didactic leaves off. Simulation makes didactic knowledge come alive in a setting designed to mimic real clinical encounters and lifelike experiences where clinicians can refine their individual and team skills well before ever touching a real patient.

Here are three ways the effective use of medical simulation can fast-track student learning:

1. Simulation increases engagement

Experts agree that an instructor’s intent should be to facilitate their desire to learn, and challenge learners to fill in gaps where their experience falls short. The ultimate goal? To turn learners into self-sufficient problem solvers.1  Simulation is ideal for this.

As an educational approach, simulation offers a framework that is both immersive and experiential. Learners who train using simulation experience a higher level of engagement and show greater personal involvement in their training versus those who only experience didactic learning.

Simulation is unique in that it fits all types of learning styles, so it becomes this multi-modal learning environment. Students take far more away from that than eight hours in a classroom.

Dr. Amar Patel of WakeMed Health & Hospitals

A growing body of evidence shows that clinical skills acquired via simulation transfer directly to improved patient care and better outcomes. When paired with deliberate practice, simulation-based education is found to be superior to traditional clinical education for a wide range of skills acquisition.2

One such study indicates that simulation promotes engagement in several ways:

  • Flow:
    Students were absorbed in the task at hand.
  • Interest:
    Students demonstrated interest as evidenced by enjoyment, active discussion, and humor.
  • Relevance:
    Simulations were relevant, in terms of situational clinical practice, exam preparation, and obtaining feedback on clinical decisions.3

2. Simulation maximizes retention

Learners and providers who use simulation have higher retention rates versus exclusively didactic forms of learning.  “Simulation helps students build mental models, which is so important in healthcare,” according to Jennifer McCarthy, EMT-P, an associate professor at Bergen Community College in Paramus, NJ. “Faculty interact with them to build an effective model, so when students are under stress they can draw on that experience.”

Having the opportunity to go through an experience allows people to have that ah-ha moment when they begin to see things differently.

Dr. Sharon Griswold-Theodorson, Professor of Emergency Medicine at Drexel University College of Medicine

Research confirms the importance of hands-on practice for skills retention.4 In a 2010 study, 100% of graduate nurses said that simulation facilitated learning through experience without risk to the patient, and gave them confidence in emergency situations.5

In simulation-based team training for obstetric clinicians, 30% of participants said their team’s overall performance showed significant improvement. Further, 90% agreed that their response to critical events improved.6

A longitudinal study of internal medicine residents found that Advanced Cardiac Life Support (ACLS) skills acquired via a simulation-based education program did not decay significantly over a 14-month period. These findings are in sharp contrast with baseline data indicating that graduating residents without simulator training showed 17% poorer performance on average, despite three years of patient care and completion of two ACLS courses.7

100% Graduate Nurses now confident in emergencies
90% OB Clinicians responded better to critical events
17% Experienced residents without simulation training performed 17% poorer in ACLS

 3. Simulation ensures learning is transfered to the job

Learners and providers who use simulation, especially in situ, are associated with a higher rate of skill application at the bedside.

Evidence shows that clinical skills acquired in medical simulation laboratory settings transfer directly to improved patient care practices and better patient outcomes. For example, simulation was found to be superior to traditional clinical education for acquisition of a wide range of medical skills, including: advanced cardiac life support, laparoscopic surgery, cardiac auscultation, hemodialysis catheter insertion, thoracentesis, and central venous catheter insertion.8

A recent study found that in situ simulation as an interdisciplinary team training methodology reduced perinatal morbidity. The findings indicated that a process shift occurred in the hospital being trained with in situ simulation, resulting in an improvement of 37% in perinatal morbidity.9

Dr. Robert Anderson, assistant professor at the Northern Ontario School of Medicine, sees simulation as having a tremendous impact on learning outcomes. “You can challenge the way students look at things and make mistakes in essentially a consequence-free environment.” 10

Summary

“Does simulation work? You bet it works,” says Dr. Thomas Talbot, medical director, USC Institute for Creative Technologies at the University of Southern California. “It’s sort of a play version of a real life-situation where someone could have a good outcome or a poor outcome. We let users have that experience in a safe environment so they’re free to make mistakes and learn from them.”

Factors such as competition for clinical sites, limited opportunities for high-quality clinical experiences, a renewed focus on patient safety, and evolving reimbursement strategies have combined to recast medical simulation from “nice to have” to a must-have for effective medical education and training. If you’re not using simulation today, perhaps it’s time to explore how simulation can add to your training efforts.

References
1. Bruner, Jerome S. 1966. Toward a Theory of Instruction. Cambridge MA: Harvard University Press, pp. 49–53
2. McGaghie, W. C., Issenberg, S. B., Petrusa, E. R., & Scalese, R. J. (2010). A critical review of simulation-based medical education research: 2003–2009. Medical education, 44(1), 50-63. 
3. McCoy, L., Pettit, R. K., Lewis, J. H., Allgood, J. A., Bay, C., & Schwartz, F. N. (2016). Evaluating medical student engagement during virtual patient simulations: a sequential, mixed methods study. BMC Medical Education, 16(1), 1.
4. Oermann, M. H., Kardong-Edgren, S. E., & Odom-Maryon, T. (2011). Effects of monthly practice on nursing students’ CPR psychomotor skill performance. Resuscitation, 82(4), 447-453.
5. Ackermann, A. D., Kenny, G., & Walker, C. (2007). Simulator programs for new nurses’ orientation: A retention strategy. Journal for Nurses in Professional Development, 23(3), 136-139.
6. Gardner, R., Walzer, T. B., Simon, R., & Raemer, D. B. (2008). Obstetric simulation as a risk control strategy: course design and evaluation. Simulation in Healthcare, 3(2), 119-127.
7. Wayne, D. B., Siddall, V. J., Butter, J., Fudala, M. J., Wade, L. D., Feinglass, J., & McGaghie, W. C. (2006). A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills. Academic Medicine, 81(10), S9-S12.
8. McGaghie, W. C., Issenberg, S. B., Petrusa, E. R., & Scalese, R. J. (2010). A critical review of simulation-based medical education research: 2003–2009. Medical education, 44(1), 50-63.
9. Riley, W., Davis, S., Miller, K., Hansen, H., Sainfort, F., Sweet, R. Didactic and Simulation Nontechnical Skills Team Training to Improve Perinatal Patient Outcomes in a Community Hospital. The Joint Commission Journal on Quality and Patient Safety, Volume 37, Number 8, August 2011, pp. 357-364(8).
10. Cohen, E. R., Feinglass, J., Barsuk, J. H., Barnard, C., O’Donnell, A., McGaghie, W. C., & Wayne, D. B. (2010). Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Simulation in healthcare, 5(2), 98-102.