Simulation in Medical Education

Simulation is an interactive educational tool that is increasingly used in medical education, and there is mounting evidence to support its role in improving knowledge, behaviours, as well as skill outcomes. Simulation is not a technology but a technique, which aims at mimicking or magnifying a real experience that is performed under supervision and guidance from a professional educator in a fully interactive manner. Equipment and facilities often dominate the discussion when taking about simulation-based education; however, effective learning using simulation as a methodology usually involves facilitators as well as simulated patients. Using simulation to improve safety will require full integration of its applications into the routine structures and practices of healthcare. Various leading forces and enactment mechanisms are required to drive simulation forward. By itself, simulation does not guarantee learning, but within the proper environment, it is a tool of paramount importance for modern curricula oriented by the adult learning theory. The future of simulation in healthcare depends on the commitment and creativity of the healthcare simulation community to see that improved patient safety using this tool becomes a reality. This chapter will discuss the art and science of simulated learning, the simulation fidelity continuum (low to high, multimode) and how it can be tailored to the learner’s needs. It will also discuss using simulation for assessment, how to design an effective simulation-based medical education activity as well as approach to evaluation of a simulation learning activity. It will expand to include curriculum integration and simulated learning in rheumatology and then will conclude with future directions of simulation-based education.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic €32.70 /Month

Buy Now

Price includes VAT (France)

eBook EUR 93.08 Price includes VAT (France)

Softcover Book EUR 116.04 Price includes VAT (France)

Hardcover Book EUR 158.24 Price includes VAT (France)

Tax calculation will be finalised at checkout

Purchases are for personal use only

References

  1. Oxford English Dictionary. www.oed.com. Accessed 29 Mar 2018.
  2. Datta R, Upadhyay K, Jaideep C. Simulation and its role in medical education. Med J Armed Forces India. 2012;68(2):167–72. ArticlePubMedGoogle Scholar
  3. Akaike M, Fukutomi M, Nagamune M, Fujimoto A, Tsuji A, Ishida K, et al. Simulation-based medical education in clinical skills laboratory. J Med Investig JMI. 2012;59(1–2):28–35. ArticleGoogle Scholar
  4. Dieckmann P, Ringsed C. Pedagogy in simulation-based training in healthcare. Chapter (4). In: Forrest K, Mckimm J, Edgar S, editors. Essential simulation in clinical education. Wiley; 2013. pp. 43–58. Google Scholar
  5. Abela JC. Adult learning theories and medical education: a review. Malta Med J. 2009;21(1):11–8. Google Scholar
  6. Kaufman DM. Applying educational theory in practice. BMJ Br Med J. 2003;326(7382):213–6. ArticleGoogle Scholar
  7. Dreyfus H, Dreyfus S. Mind over machine: the power of human intuition and expertise in the era of the computer. Oxford: Basil Blackwell; 1986. Google Scholar
  8. Vaihinger H. The philosophy of AS if. Abingdon: Routledge; 2000. Google Scholar
  9. Dieckman P. Simulation settings for learning in acute medical care. In: Dieckman P, editor. Using simulations for education, training and research. Lengerich: Pabst. p. 40–138. Google Scholar
  10. Diekman P, Manser T, Wehner T, Rall M. Reality and fiction cues in medical patient simulation, an interview study with anesthesiologists. J Cogn Eng Decis Making. 2007;1:148–68. ArticleGoogle Scholar
  11. Tekian A, McGuire C, McGaghie W. Innovative simulations for assessing professional competence: from paper-and-pencil to virtual reality. University of Illinois at Chicago, Department of Medical Education; 1999. Google Scholar
  12. Maran NJ, Glavin RJ. Low- to high-fidelity simulation – a continuum of medical education? Med Educ. 2003;37(Suppl. 1):22–8. ArticleGoogle Scholar
  13. Norcini JJ, McKinley DW. Assessment methods in medical education. Teach Teach Educ. 2007;23(3):239–50. ArticleGoogle Scholar
  14. Kneebonee R, Kidd J, Nestel D, Asvall S, Paraskeva P, Darzi A. (2002)An innovative model for teaching and learning clinical procedures. Med Educ. 2002;36:628–34. ArticleGoogle Scholar
  15. Kneebone RL, Kidd J, Nestel D, Barnet A, Lo B, King R, Yang GZ, Brown R. Blurring the boundaries: scenario-based simulation in a clinical setting. Med Educ. 2005;39:580–7. ArticleCASGoogle Scholar
  16. Kneebone R. Simulation and transformational change: the paradox of expertise. Acad Med. 2009;84:954–7. ArticleGoogle Scholar
  17. Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol. 2002;167(3):1243–7. ArticleGoogle Scholar
  18. Lee KHK, Grantham H, Boyd R. Comparison of high- and low-fidelity mannequins for clinical performance assessment. Emerg Med Australas. 2008;20(6):508–14. Google Scholar
  19. De Giovanni D, Roberts T, Norman G. Relative effectiveness of high- versus low-fidelity simulation in learning heart sounds. Med Educ. 2009;43(7):661–8. ArticleGoogle Scholar
  20. Scerbo MWP, Schmidt EAM, Bliss JPP. Comparison of a virtual reality simulator and simulated limbs for phlebotomy training. J Infus Nurs. 2006;29(4):214–24. ArticleGoogle Scholar
  21. Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott TJ. Training for shoulder dystocia: a trial of simulation using low-fidelity and high-fidelity mannequins. Obstet Gynecol. 2006;108(6):1477–85. ArticleGoogle Scholar
  22. Grady J, Kehrer R, Trusty C, Entin E, Entin E, Brunye T. Learning nursing procedures: the influence of simulator fidelity and student gender on teaching effectiveness. J Nurs Educ. 2008;47(9):403–8. ArticleGoogle Scholar
  23. Rodgers DLE, Securro SJE, Pauley RDE. The effect of high-fidelity simulation on educational outcomes in an advanced cardiovascular life support course. Simul Healthc E J Soc Simul Healthc Winter. 2009;4(4):200–6. ArticleGoogle Scholar
  24. Munshi F, Lababidi H, Alyousef S. Low- versus high-fidelity simulations in teaching and assessing clinical skills. J Taibah Univ Med Sci. 2015;10(1):12–5. Google Scholar
  25. Smallman HS, John MS. Naive realism: misplaced faith in realistic displays. Ergon Des Q Hum Factors Appl. 2005;13(3):6–13. ArticleGoogle Scholar
  26. Issenberg B, 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):10e28. Google Scholar
  27. Rudolph JWP, Simon RE, Raemer DBP. Which reality matters? Questions on the path to high engagement in healthcare simulation. Simul Healthc E J Soc Simul Healthc Fall. 2007;2(3):161e163. Google Scholar
  28. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, MacAulay C, Mancini ME. Training and simulation for patient safety. Qual Saf Health Care. 2010;19(Suppl 2):i34–43. ArticleGoogle Scholar
  29. Grober ED, Hamstra SJ, Wanzel KR, Reznick RK, Matsumoto ED, Sidhu RS, et al. The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures. Ann Surg. 2004;240(2):374–81. ArticlePubMedGoogle Scholar
  30. Steigerwald SN, Park J, Hardy KM, Gillman LM, Vergis AS. Does laparoscopic simulation predict intraoperative performance? A comparison between the fundamentals of laparoscopic surgery and LapVR evaluation metrics. Am J Surg. 2014; https://doi.org/10.1016/j.amjsurg.2014.08.031. pii: S0002-9610(14)00526-1 ArticleGoogle Scholar
  31. Tan SC, Marlow N, Field J, Altree M, Babidge W, Hewett P, Maddern GJ. A randomized crossover trial examining lowversus high-fidelity simulation in basic laparoscopic skills training. Surg Endosc. 2012;26(11):3207e3214. https://doi.org/10.1007/s00464-012-2326-0.ArticleGoogle Scholar
  32. Curran V, Fleet L, White S, Bessell C, Deshpandey A, Drover A, Hayward M, Valcour J. A randomized controlled study of manikin simulator fidelity on neonatal resuscitation program learning outcomes. Adv Health Sci Educ Theory Pract. 2015;20(1):205–18. ArticleGoogle Scholar
  33. Merchant DC. Does high-fidelity simulation improve clinical outcomes? J Nurses Staff Dev. 2012;28(1):E1–8. [quiz E9–10] ArticleGoogle Scholar
  34. 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. ArticlePubMedGoogle Scholar
  35. Vaughan V III. The patient management problem as an evaluative instrument. Pediatr Rev. 1979;1(3):67–76. ArticleGoogle Scholar
  36. Epstein RM, Hundert EM. Defining and assessing professional competence. J Am Med Assoc. 2002;287(2):226–35. ArticleGoogle Scholar
  37. High-stakes test. Education reform. https://www.edglossary.org/high-stakes-testing/. Accessed on 30th Mar 2018.
  38. Gale T, Roberts M. Assessment. Chapter 5. In: Forrest K, Mckimm J, Edgar S, editors. Essential simulation in clinical education. Willey; 2013. pp. 43–58. Google Scholar
  39. Schuwirth LW, van der Vleuten CP. The use of clinical simulations in assessment. Med Educ. 2003;37(Suppl. 1):65–71. ArticlePubMedGoogle Scholar
  40. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65:S63–7. ArticleCASGoogle Scholar
  41. Ker J, Bradley P. Simulation in medical education. Edinburgh: Association for the Study of Medical Education; 2007. Google Scholar
  42. Smith AF, Greaves JD. Beyond competence: defining and promoting excellence in anaesthesia. Anaesthesia. 2010;65:184–91. ArticleCASGoogle Scholar
  43. Postgraduate Medical education and training board. Developing and maintain an assessment system – a PMETB guide to good practice. London: PMETB; 2007. Google Scholar
  44. Epstein RM. Assessment in medical education. NEJM. 2007;356:387–96. ArticleCASGoogle Scholar
  45. Gaba D. The future vision of simulation in health care. Qual Saf Health Care. 2004;13(Suppl 1):i2–i10. ArticlePubMedGoogle Scholar
  46. Weller JM, Bloch M, Young S. Evaluation of high fidelity patient simulator in assessment of performance of anaesthetics. Br J Anaesthesia. 2003;90:43–7. ArticleCASGoogle Scholar
  47. Johnson KB, Syroid ND, Drews FA. Part task and variable priority training in first-year anaesthesia resident education: a combined didactic and simulation-based approach to improve management of adverse airway and respiratory events. Anesthesiology. 2008;108:831–40. ArticleGoogle Scholar
  48. Baxendale B, Coffey F, Buttery A. The roles of faculty and simulated patients in simulation. Chapter 6. In: Forrest K, Mckimm J, Edgar S, editors. Essential simulation in clinical education. Willey; 2013. pp. 87–110. Google Scholar
  49. Barrows H. An overview of the uses of standardized patients for teaching and evaluating clinical skill. Acad Med. 1993;68:443–53. ArticleCASGoogle Scholar
  50. Ziv A, Small SD, Wolpe PR. Patient safety and simulation-based medical education. Med Teach. 2000;22(5):489–95. ArticleGoogle Scholar
  51. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003;78:783–8. ArticleGoogle Scholar
  52. Pazin Filho A, Romano MMD. Simulacao: aspectos conceituais. Rev Fac Med Ribeirao Preto. 2007;40(2):167–70. Google Scholar
  53. Jones F, Passos-Neto CE, Braghiroli OF. Simulation in medical education: brief history and methodology. Princ Pract Clin Res. 2015;2(1):56–63. Google Scholar
  54. Decker S. Integrating guided reflection into simulated learning experiences. In: Jeffries PR, editor. Simulation in nursing: from conceptualization to evolution. New York: National League for Nursing; 2007. p. 73–85. Google Scholar
  55. Dismukes RK, Gaba DM, Howard SK. So many roads: facilitated debriefing in healthcare. Simul Healthc. 2006;1(1):23–5. ArticleGoogle Scholar
  56. Fanning R, Gaba D. The role of debriefing in simulation-based learning. Soc Simul Healthc. 2007;2(2):115–25. ArticleGoogle Scholar
  57. Rudolph JW, Simon R, Dufresne RL, Raemer DB. There’s no such thing as “non-judgmental” debriefing: a theory and method for debriefing with good judgment. Simul Healthc. 2006;I(I):49–55. ArticleGoogle Scholar
  58. Cho SJ. Debriefing in pediatrics. Korean J Pediatr. 2015;58(2):47–51. ArticlePubMedGoogle Scholar
  59. Couper K, Perkins GD. Debriefing after resuscitation. Curr Opin Crit Care [Internet]. 2013;19(3):188–94. ArticleGoogle Scholar
  60. Clay AS, Que L, Petrusa ER, Sebastian M, Govert J. Debriefing in the intensive care unit: a feedback tool to facilitate bedside teaching. Crit Care Med. 2007;35(3):738–54. ArticleGoogle Scholar
  61. Norman G, Muzzin L, Williams R, Swanson D. Simulation in health sciences education. J Instr Dev. 1985;8(1):11–7. ArticleGoogle Scholar
  62. Miller R. Psychological considerations in the design of training equipment. Report no. WADC-TR-54-563, AD 71202. Wright Patterson Air Force BAse, OH; Wright Air Development Center. Wright-Patterson Air Force Base; 1954. Google Scholar
  63. Yachemetz T, Matthews LR. Clinical simulation terminology within the context of respiratory therapy education: a discussion paper. Can J Respir Ther. 2008;44(4):29. Google Scholar
  64. Ebel R, Frisbie D. Essentials of educational measurement. 5th ed. Englewood: Prentice Hall College Div; 1991. Google Scholar
  65. Teodor PG, Vanessa NP. Simulation in surgical education. Can Med Assoc J. 2010;182(11):1191. ArticleGoogle Scholar
  66. Bates R. A critical analysis of evaluation practice: the Kirkpatrick model and the principle of beneficence. Eval Program Plann. 2004;27(3):341–7. ArticleGoogle Scholar
  67. Kyle RR, Murray WB. Clinical simulation: operations, engineering, and management. Burlington: Academic; 2008. Google Scholar
  68. Issenberg SB. The scope of simulation-based health care education. Simul Healthc. 2006;1:203–8. ArticleGoogle Scholar
  69. Issenberg SB, Mcgaghie WC, Petrusa ER, Gordon DJ, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27:10–28. ArticleGoogle Scholar
  70. Motola I, Devine LA, Chung HS, Sullivan JE, Barry Issenberg S. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Med Teach. 2013;35(10):e1511–30. ArticleGoogle Scholar
  71. Monrad SU, Zeller JL, Craig CL, DiPonio LA. Musculoskeletal education in US medical schools: lessons from the past and suggestions for the future. Curr Rev Musculoskelet Med. 2011;4:91–8. ArticlePubMedGoogle Scholar
  72. Sabanathan A, Fent G, Purva M. OP0279 developing and running a rheumatology emergency simulation course. Ann Rheum Dis. 2016;75:163–4. ArticleGoogle Scholar
  73. Sabanathan A, Purva M, Helliwell P, Thurairajah T, Fernando X, Prakash A. Can you simulate gout teaching? Rheumatology. 2015;54(suppl 1):i147. Google Scholar
  74. El Miedany Y, El Gaafary M, Youssef S, Almedany S, Palmer D. Using simulation in clinical education: psoriasis area and severity index (PASI) score assessment. Curr Rheumatol Rev. 2016;12(3):195–201. ArticleGoogle Scholar
  75. Russell A, Beresniak A, Bessette L, et al. Cost-effectiveness modeling of abatacept versus other biologic agents in dmards and anti-tnf inadequate responders for the management of moderate to severe rheumatoid arthritis. Clin Rheumatol. 2009;28:403–12. ArticleGoogle Scholar
  76. Saraux A, Gossec L, Goupille P, et al. Cost-effectiveness modelling of biological treatment sequences in moderate to severe rheumatoid arthritis in France. Rheumatology (Oxford). 2010;49:733–40. ArticleGoogle Scholar
  77. Cimmino MA, Leardini G, Salaffi F, et al. Assessing the cost-effectiveness of biologic agents for the management of moderate-to-severe rheumatoid arthritis in anti-TNF inadequate responders in Italy: a modelling approach. Clin Exp Rheumatol. 2011;29:633–41. CASGoogle Scholar
  78. Beresniak A, Ariza-Ariza R, Garciallorente JF, Ramirez-Arellano A, Dupont D. Modelling cost-effectiveness of biologic treatments based on disease activity scores for the management of rheumatoid arthritis in Spain. Int J Inflamm. 2011;2011:727634. ArticleGoogle Scholar
  79. Puolakka K, Blåfield H, Kauppi M, et al. Cost-effectiveness modelling of sequential biologic strategies for the treatment of moderate to severe rheumatoid arthritis in Finland. Open Rheumatol J. 2012;6:38–43. ArticleCASPubMedGoogle Scholar
  80. El Miedany Y, El Gaafary M, Youssef S, et al. OP0312 simulated teaching in rheumatology: assessment of an interactive e-learning postgraduate rheumatology teaching module. Ann Rheum Dis. 2015;74:191. ArticleGoogle Scholar
  81. Joorabchi B, Devries JM. Evaluation of clinical competence: the gap between expectation and performance. Pediatrics. 1996;97:179–84. CASGoogle Scholar
  82. Mangione S, Nieman LZ. Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency. JAMA. 1997;278:717–22. ArticleCASGoogle Scholar
  83. Lypson ML, Frohna JG, Gruppen LD, Woolliscroft JO. Assessing residents’ competencies at baseline: identifying the gaps. Acad Med. 2004;79:564–70. ArticleGoogle Scholar
  84. Friedman Z, Siddiqui N, Katznelson R, Devito I, Davies S. Experience is not enough: repeated breaches in epidural anesthesia aseptic technique by novice operators despite improved skill. Anesthesiology. 2008;108:914–20. ArticleGoogle Scholar
  85. Bell RH Jr, Biester TW, Tabuenca A, Rhodes RS, Cofer JB, Britt LD, Lewis FR. Operative experience of residents in US general surgery programs: a gap between expectation and experience. Ann Surg. 2009;249:719–24. ArticleGoogle Scholar
  86. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011;86:706–11. ArticlePubMedGoogle Scholar
  87. Birnbach DJ, Salas E. Can medical simulation and team training reduce errors in labor and delivery? Anesthesiol Clin. 2008;26:159–68. ArticleGoogle Scholar
  88. Kuehster CR, Hall CD. Simulation: learning from mistakes while building communication and teamwork. J Nurses Staff Dev. 2010;26:123–7. ArticleGoogle Scholar
  89. Salas E, Diazgranados D, Weaver SJ, King H. Does team training work? Principles for health care. Acad Emerg Med. 2008;15:1002–9. ArticleGoogle Scholar
  90. McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefanidis D. Evaluating the impact of simulation on translational patient outcomes. Simul Healthc. 2011a;6:S42–7. ArticlePubMedGoogle Scholar
  91. Ziv A, Rubin O, Sidi A, Berkenstadt H. Credentialing and certifying with simulation. Anesthesiol Clin. 2007;25:261–9. ArticleGoogle Scholar
  92. Steadman RH, Huang YM. Simulation for quality assurance in training, credentialing and maintenance of certification. Best Pract Res Clin Anaesthesiol. 2012;26:3–15. ArticleGoogle Scholar
  93. Holmboe E, Rizzolo MA, Sachdeva AK, Rosenberg M, Ziv A. Simulation-based assessment and the regulation of healthcare professionals. Simul Healthc. 2011;6:S58–62. ArticleGoogle Scholar
  94. Buyske J. The role of simulation in certification. Surg Clin N Am. 2010;90:619–21. ArticleGoogle Scholar
  95. Ben-Menachem E, Ezri T, Ziv A, Sidi A, Brill S, Berkenstadt H. Objective structured clinical examination-based assessment of regional anesthesia skills: the Israeli National Board examination in anesthesiology experience. Anesth Analg. 2011;112:242–5. ArticleGoogle Scholar
  96. Levine AI, Schwartz AD, Bryson EO, Demaria S Jr. Role of simulation in U.S. physician licensure and certification. Mt Sinai J Med. 2012;79:140–53. ArticleGoogle Scholar
  97. Issenberg SB, Chung HS, Devine LA. Patient safety training simulations based on competency criteria of the Accreditation Council for Graduate Medical Education. Mt Sinai J Med. 2011a;78:842–53. ArticleGoogle Scholar
  98. McGaghie WC. Research opportunities in simulation-based medical education using deliberate practice. Acad Emerg Med. 2008;15:995–1001. ArticleGoogle Scholar
  99. McGaghie WC. Medical education research as translational science. Sci Transl Med. 2010b;2:19cm8.1–3. ArticleGoogle Scholar

Author information

Authors and Affiliations

  1. King’s College London, Darent Valley Hospital, Dartford, Kent, UK Yasser El Miedany
  2. Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt Yasser El Miedany
  1. Yasser El Miedany
You can also search for this author in PubMed Google Scholar

Rights and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Cite this chapter

El Miedany, Y. (2019). Simulation in Medical Education. In: Rheumatology Teaching. Springer, Cham. https://doi.org/10.1007/978-3-319-98213-7_14

Download citation

Share this chapter

Anyone you share the following link with will be able to read this content:

Get shareable link

Sorry, a shareable link is not currently available for this article.

Copy to clipboard

Provided by the Springer Nature SharedIt content-sharing initiative