Is simulation training evolution or revolution?

James Tomlinson, a simulation fellow in surgery, argues that we need to look outside the medical world to enhance our understanding and utilisation of simulation training

A recent PubMed search for ‘simulation training’ produced more than 17,000 results - a huge number for what is a new area. Some argue that simulation training can increase the efficiency of learning, improve patient outcomes, and reduce healthcare costs.¹ I would argue that simulation training is more about evolution than revolution.

Firstly, recent research on laparoscopic skill simulation found that although metrics can be improved with independent practice, the role of an expert coach in developing clinically relevant skills is of key importance.² For simulation to be effective it would need expert faculty to feedback: this would require senior clinicians being away from clinical duties, which would have implications for time and costs for hospitals. 

Further work is required to establish what approach should be taken to maximise the educational benefit of simulation. Many current simulators, especially those within surgery, focus on the reproduction of entire procedures rather than the skills that are needed to perform those procedures. This is significant because commercial interests are increasingly driving the acquirement of a large amount of equipment rather than the educational need for it. 

Trainees are relied upon to provide patient care on a day-to-day basis and removing them from the clinical environment to train in a lab creates a barrier between doctors and their patients. 

We cannot expect trainees to engage in simulation training during non-working hours without it having a significant impact on their work-life balance and potential implications for their mental and physical wellbeing. Shifting the burden of simulated training on to unpaid time is wholly unacceptable. 

There is a very real risk that simulation training is perceived to be an educational revolution that will improve training. If simulation is to be used effectively in medical training it requires significant commitment from trainers. 

There are important lessons to be learned from educational psychology work in sport and music where the role of deliberate practice has been studied for many years, and there is little point in reinventing the wheel by repeating this work. 

Simulation offers the opportunity to hone our skills, but we must look outside the medical world if we are to maximise its full potential. 

James Tomlinson is a leadership fellow (simulation) HEYH, ST8 orthopaedics. 

References

1. Cohen ER et al, Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Simul Healthc. Apr; 5(2):98-102 (2010)
2. Ericsson K A et al, The role of deliberate practice in the acquisition of expert performance. Psychological Review 100 (3):363-406 (1993)