Clinical Simulation
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Introduction
Most education occurs in real clinical care, though simulation and role play are used in increasing roles to teach principles and allow practice.
Funny cartoon (external link)
Role Play
Role play occurs when people act out a clinical situation. Often the teacher, or an actor, take on the role of the patient, while the learner plays the clinician.
Actual clinicial encounters provide powerful material for role plays.
Open role plays see the patient narrative flowing from the clinician's past experience, while a structured role sees the story unfolding in specific ways to cover specific teaching points.
Role play can be used to improve on specific aspects of their history and physical exam, especially with challenging patient types (eg anxiety, personality disorders, etc).
Role play can be anxiety-provoking for learners, but if is introduced properly, can rapidly represent a safe place for learning and experimentation. It also allows for immediate feedback.
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Basic Procedural Skills
Lynagh et al. [26] concluded that skills laboratory training enhances procedural skills performance as assessed by simulation, though compared to standard or no training.
It appears that skills sessions can be taught by either faculty or med students (Weyerich et al, 2009).
This effect can be demonstrated regardless of whether the preceding skills laboratory training is lead by faculty staff or by trained medical students that serve as peer teachers [30], [31]. Yet, the transfer of procedural skills acquired in skills laboratories to actual clinical practice remains the subject of an ongoing discussion.
Resources and References
Biese KJ et al. 2009. Using screen-based simulation to improve performance during pediatric resuscitation. Acad Emerg Med. 16 Suppl 2:S71-5.
Individual case simulation online can improve knowledge and confidence, though not performance in scenario-based skills assessment (Biese et al, 2009).
Harder BN. 2010. Use of simulation in teaching and learning in health sciences: a systematic review. Nurs Educ. 49(1):23-8
Littlewood KE, Shilling AM, Stemland CJ, Wright EB, Kirk MA. 2012. High-fidelity simulation is superior to case-based discussion in teaching the management of shock. Med Teach. Nov 5. [Epub ahead of print]
Okuda Y, Bryson EO, DeMaria S Jr, Jacobson L, Quinones J, Shen B, Levine AI. 2009. The utility of simulation in medical education: what is the evidence? Mt Sinai J Med. 76(4):330-43.
McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003–2009. Med Educ 2010; 44: 50–63
Tan SC, Marlow N, Field J, Altree M, Babidge W, Hewett P, Maddern GJ. 2012. Surg Endosc. A randomized crossover trial examining low- versus high-fidelity simulation in basic laparoscopic skills training. 26(11):3207-14.
- doesn't really seem to make a difference.
Weyrich P, Celebi N, Schrauth M, Moltner A, Lammerding-Koppel M, et al. 2009. Peer-assisted versus faculty staff-led skills laboratory training: a randomised controlled trial. Med Educ 43: 113–120.
Roy KM, Miller MP, Schmidt K, Sagy M. 2011. Pediatric residents experience a significant decline in their response capabilities to simulated life-threatening events as their training frequency in cardiopulmonary resuscitation decreases. Pediatr Crit Care Med. 12(3):e141-4.
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