How to Teach Using Simulation in Healthcare

By Mike Davis, Jacky Hanson, Mike Dickinson and 2 more

How to Teach Using Simulation in Healthcare provides an ideal introduction and easy-to-use guide to simulation in medical education.  Written by a team of experienced medical educators, this practical text – packed full of case examples and tips – is underpinned by the theory of simulation in education, and explores how to integrate simulation into teaching.   

Key topics include: 

• Use of low, medium and high fidelity equipment
• Issues of simulation mapping and scenario design
• Role of human factors
• Formative and summative assessment
• New social media and technologies
• Detailed explorations of some examples of simulation.

How to Teach Using Simulation in Healthcare is invaluable reading for all healthcare professionals interested and involved in the origins, theoretical underpinnings, and design implications of the use of simulation in medical education.

• Language: English
• Publisher: Wiley
• Release date: Jul 26, 2017
• ISBN: 9781119130734

Mike Davis

Mike Davis (1946–2022) was the author of City of Quartz as well as Dead Cities and The Monster at Our Door, co-editor of Evil Paradises, and co-editor—with Kelly Mayhew and Jim Miller—of Under the Perfect Sun (The New Press).

Book preview

Preface

Professor David Gaba, one of the pioneers of simulation training in healthcare, observed in 1992, ‘… no industry in which human lives depend on the skilled performance of responsible operators has waited for unequivocal proof of the benefits of simulation before embracing it’. Fortunately, the evidence to support this worthy sentiment now exists in abundance and simulation training for healthcare professionals is in widespread use.

The key educational theory underpinning the value of simulation training, experiential learning, is far from a new concept, having been espoused in ancient times by both Confucius and Aristotle but more recently by David A. Kolb whose experiential learning cycle might have been specifically designed with medical simulation in mind. Even without an understanding of these formal educational principles, however, it is surely self‐evident that training doctors, nurses and allied health professionals in a safe and supportive learning environment where they can practise without the risk of doing any harm is a good idea – a view supported by data collected from patients and carers. The authors cover experiential learning and allied theories in a complete chapter of this book and helpfully point the reader to additional, more in‐depth texts on these subjects.

I do not know anyone involved in simulation training who does not feel a profound sense of reward and enjoyment in supporting learning in this environment, but it is not easy. This book highlights very well the importance of fastidious design of learning outcomes, careful preparation of the scenarios, tools and technology and, most importantly, focused training in debriefing skills for faculty members. A core tenet of experiential learning is the requirement for reflective practice which is most effective when supported by facilitators experienced in the use of what John Heron, in his Six‐Category Intervention Analysis, would call ‘authoritative and facilitative interventions’ – learning outcomes can so easily be jeopardised by the inexperienced debriefer.

We were, of course, using simulation in medicine long before the advent of the technological advances which now support this training so effectively and I very well remember practising the siting of epidurals using a simple orange to give that distinctive feel of loss of resistance. However, colleagues in the world of engineering and computer technology have opened up a world of novel, cost‐effective and highly portable solutions to support simulation training both in our education centres and in real clinical settings. None of this training would be possible without the support of the resourceful and inventive simulation technologists in our centres. These are the invaluable team members who configure the AV systems to support debriefing, programme a vast array of bespoke scenarios, reconfigure and repair increasingly complex technologies and design innovative solutions to produce bleeding into drains or the appearance of third‐degree burns on actors and mannikins. We now have apps for iPhones and Android, wireless mannikins and e‐learning platforms which provide extraordinary flexibility in the development of innovative learning opportunities, all of which are explored and signposted in this book.

The overarching purpose of simulation education is the transfer of training received to the clinical workplace, i.e. to take the new or enhanced skills back to the ward or operating theatre to improve the safety and care of our patients. No practitioner of simulation‐based education would ever say that simulation is the answer to all the challenges we face in medical education but it is a very powerful adjunct to clinical apprenticeship and deserves to be a cornerstone in the education of healthcare professionals from all backgrounds. Simulation training can support the development of competencies in both technical and non‐technical skills and plays a vital part in enhancing the teamworking skills so essential in the management of clinical crises. There is now clear evidence that regular crisis resource management training incorporating simulation for multidisciplinary teams in healthcare improves safety‐critical behaviours and, crucially, patient outcomes, and Chapter 10 provides constructive direction in the most effective use of simulation for safety training.

This book has been written by authors with a combined experience of over 50 years in simulation training for healthcare professionals. They have put together a text that concisely covers all the aspects of the successful design and organisation of simulation training, from the construction of scenarios and use of the huge variety of technology to support simulation‐based education to the design and operation of a simulation centre. How to Teach Using Simulation in Healthcare joins the inventory of similar ‘How to’ titles from Wiley at an opportune moment when time for training healthcare professionals is being compressed, as never before, by competing demands for service delivery. This concise and pragmatic publication will be a welcome support and useful reference for experienced and novice educators in healthcare who are using simulation to train healthcare professionals and I look forward to many future editions.

Helen Higham MBChB, FRCA, SFHEA

Consultant Anaesthetist, Oxford University Hospitals NHS Foundation Trust

Senior Clinical Research Fellow and Director of OxSTaR, University of Oxford

President, ASPiH (2014–2017)

April 2017

Chapter 1

Introduction

Simulation has become a major component of medical education in recent years and it is increasingly widely researched and supported by societies (e.g. ASPiH) and journals (e.g. BMJ‐STEL) as well as more mainstream organisations with an interest in medical education (e.g. AMEE, ASME, AoME).

The purpose of this book is to provide the relative newcomer to simulation education with an exploration of some of the basic principles of theory and practice. Chapter 2 explores a brief history of medical education and the way in which simulation has made an impact. Chapter 3 examines some of the contributions of relevant adult education theory to its ongoing development. Remaining chapters from 4 to 11 have a much more practical orientation befitting a How to … book, and address some specific issues in terms of planning and presentation of simulation sessions, the importance of formative and summative assessment (including feedback), as well as providing examples of good practice from a variety of settings.

In many respects, it is difficult to anticipate the future of simulation, particularly as it responds to technological developments (mannikins,¹ computers, software, etc.) and new thinking about approaches to managing a simulated event – everything from ‘flipping the classroom’ and the use of new media (see Chapter 12) to further thinking about the process of providing debrief and feedback based on a more rigorous exploration and analysis of experience.

As well as the excitement of rising to the challenge of new technology, making best use of all resources is explored in Chapter 13 which examines the process of commissioning a dedicated simulation resource. Chapter 14 looks at the human aspect of that process and explores the route to developing expertise in managing the learning environment through faculty training.

Chapter 15 explores (albeit only in outline and with a somewhat cloudy crystal ball) some direction of travel and supports a willingness to engage with new possibilities as they emerge from changes in technology and orientation as well as learner expectations.

We conclude with a short annotated bibliography describing books that the team of authors have learned from over the years.

This book is largely the product of work initiated and sustained over a number of years at Lancashire Teaching Hospitals NHS Foundation Trust (hereafter LTHTR) at Royal Preston Hospital, where many of the writers and editors work or have worked in the Lancashire Simulation Centre. We would like to thank all learners and contributors to the programmes described in this book, for their feedback and active participation in the various programmes, and our shared understanding of the processes. Specifically, we would like to thank the following.

Anil Hormis, MBChB FCARCSI AFICM, Consultant in Anaesthesia, Critical Care and Pre‐hospital Emergency Medicine, Rotherham NHS Foundation Trust, for critical reading.

Karl Thies, MD FRCA DEAA FERC, Consultant Anaesthetist and Pre‐hospital Emergency Medicine, Birmingham Children’s Hospital, who advised on the European Trauma Course section in Chapter 11.

University of Manchester undergraduates, 2008 onwards.

University of Manchester SIFT funding.

Colleagues at Blackpool Teaching Hospitals NHS Foundation Trust.

Christine Davis and Steven Pettit gave helpful comments and corrections.

Additionally, those colleagues who have contributed to the varied programmes offered by the Simulation Centre.

Finally, we acknowledge the support of the LTHTR Workforce and Education Directorate for continued funding and support.

Needless to say, all errors of omission and commission are the responsibility of the editors.

Mike Davis

Jacky Hanson

Mike Dickinson

Lorna Lees

Mark Pimblett

Note

1 We anguished for some time about the spelling of this word and decided on mannikin simply because it was closest to its Dutch sixteenth-century origins.

Chapter 2

Simulation‐based medical education (SBME): some specifics

Learning outcomes

By the end of this chapter, you will recognise some of the drivers behind the development of SBME and some key characteristics of provision.

Some history

Medical education in the UK has changed significantly over the past two decades. It was initially grounded in basic sciences and clinical theory and this knowledge learned from textbooks was then applied through practice on patients.

Originally, medicine was learned from texts by Galen and Hippocrates written more than 2000 years ago. Knowledge was gained from these specific texts which defined someone as a doctor. This knowledge could include philosophy and astrology and only those who could read Latin had any chance of becoming a physician, accepted by the London College of Physicians. This provided the main concept that knowledge learned is the mainstay and the practice of medicine came afterwards. Until the development of the apothecary, anyone who learned by apprenticeship was dismissed as incompetent (Nutton & Porter, 1995). It was in the seventeenth and eighteenth centuries that chemistry and botany were introduced. Boerhaave developed bedside teachings and Hunter introduced anatomy dissection to aid learning (Reinarz, 2005). A licence was awarded by individual universities and the Royal Colleges in London and Edinburgh.

Medical regulation developed with the Medical Act of 1858, when the General Medical Council (GMC) was established to determine what constituted appropriate education for a doctor. The curriculum was the basic sciences, humanities and clinical studies initially, over 2 years. The Medical Act of 1886 stated that a graduate needed ‘the knowledge and skills requisite for the efficient practice of medicine, surgery and midwifery’ (MacAlister, 1906). It was Flexner’s reports of 1910 and 1912 that sealed the curriculum structure of preclinical and clinical years over a 5‐year period (Cooke et al., 2006). This was only removed from the Medical Act in the revisions of 1973 and 1983 (Cavenagh et al., 2011).

The knowledge of medicine expanded, and throughout the twentieth century there have been concerns that the curriculum was overloaded and students were not able to apply themselves or be ready for unsupervised clinical practice. Sir George Pickering (1978) suggested the need to provide a curriculum that allows the student to be able to weigh up evidence and reach a decision, and found that students wanted their teachers to know how to teach. Medicine had expanded so much that research was more important than being taught how to teach. In 1993 the GMC published the report Tomorrow’s Doctors, which recommended reducing the factual knowledge by producing a core curriculum and developing special study modules, which enabled students to develop critical thinking and reasoning. The authors accepted that these ideas had been proposed before, but there were a number of developments which provided the catalyst for these reforms, including publications in the British Journal of Medical Education, documentaries on television and the appointment of educators to medical schools. Prior to this, very few people teaching medicine had any educational qualifications (Cavenagh et al., 2011).

Jacky Hanson writes of her own student days:

In my experience as a medical student in the 1980s, very few of my preclinical or clinical lecturers appeared to have any formal education in teaching. The majority of teaching on the wards was by humiliation, but there were some good teachers who stood out with a natural ability. As a qualified doctor, I distinctly recall myself and a female colleague being called Tweedle Dumb and Tweedle Dee by a senior surgeon who was teaching us on the postgraduate Fellowship of the Royal College of Surgeons