Overview

What is simulation?

Simulation is a method to produce an experience without going through the actual event and it has been adapted for healthcare training purposes to simulate real patient encounters or other hypothetical clinical scenarios. It’s a platform where learners can learn by doing, reflecting on, assimilating lessons, and incorporating them into everyday practice.

There are many different modalities of how simulation can be delivered; some examples include task trainers, mannequins or patient simulators, standardized patients, screen-based environments, and simulated healthcare environments. Simulation does not necessarily even need to be physical and can involve engaging learners in imaginary activities such as facilitated mental simulations.

The scope of simulation also ranges greatly from the focused practice of a particular technical skill (eg. intubation) to a communication exercise with a standardized patient (eg. breaking bad news). The scale can involve a single patient encounter to triaging multiple victims of a major disaster in a less controlled environment with many interprofessional learners playing a role in a novel type of “mega sim”.

Simulation has clear value as a training tool and adjunct in modern healthcare education. It can be applied to physicians and other healthcare professionals of all levels. However, it is important to note that while simulation can complement or be combined with other learning methods, it cannot and should not replace real patient-care experiences to meet learning goals.

Why should simulation be used for learning?

Improved clinical training and transfer of skills to real world clinical settings
Simulated tasks are reproducible and can be standardized for training and assessment
Improved patient safety by allowing trainees to first practice their skills in low-stakes, simulated environments without the risk of harm to real patients
Allow learners to experience failure and to recognize when they are approaching the limits of their knowledge and skills– and to help bridge those gaps
Provide opportunities for support and guidance to junior learners, which may not always be possible in real clinical settings or events
Simulated exposure to uncommon or rare cases (eg. MH) to develop more prepared clinicians
Create tasks that would otherwise be impossible due to limited resources or materials
Interprofessional learning that promotes a more collaborative and team-based delivery of care

What is the evidence behind simulation?

Research on outcomes from simulation-based healthcare training, like much of literature pertaining to medical education, is limited and varies widely in methodological rigor and focus. A meta-analysis published in JAMA (Cook et al.) showed that simulation training, compared to no intervention, was associated with better learning outcomes; in particular, large effects were shown for knowledge, skills, and behaviours, while effects for patient-related outcomes were smaller but still moderate.

Similarly, a BEME systematic review (Isenberg et al.) showed that high-fidelity simulations are educationally effective and elucidated features that lead to the most effective learning: providing feedback, repetitive practice, curriculum integration, range of difficulty, and being adaptable noted as some of the most important.

Despite evidence of simulation showing an improvement in knowledge, technical, and non-technical skills, there remains a lack of concrete evidence on effectiveness in improving patient outcomes. Further research in this field is certainly needed.

References

So HY, Chen PP, Wong GKC, Chan TTN. Simulation in Medical Education. Journal of the Royal College of Physicians of Edinburgh. 2019;49(1):52-57.

Bradley P. The history of simulation in medical education and possible future directions. Med Educ. 2006;40(3):254-262.

McGaghie WC, Siddall VJ, Mazmanian PE, Myers J; American College of Chest Physicians Health and Science Policy Committee. Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009;135(3 Suppl):62S-68S.

Cook DA, Hatala R, Brydges R, et al. Technology-Enhanced Simulation for Health Professions Education: A Systematic Review and Meta-analysis. JAMA. 2011;306(9):978–988.

Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10-28.