The Value of Simulation in

HealthCare Education

Akain Dissanayaka
 What is simulation?

Simulation is the act of imitating a real

object, incident or procedure.

Simulation is a person, device or set of

conditions which present evaluation
problems realistically. The student
responds to the problems as they would
under natural circumstances.
 Simulation education is....
“A method to teach the application of critical
thinking skills, communication and team
interactions”.
(Nehring and Lashley, 2004)
“When scenario-based teaching is introduced
it provides a key role in ‘training responses to
high-risk, low-frequency clinical events”.
(Nunn, 2004)
“Clinical skills relevant to clinical practice can
be taught and successfully mastered by
trainees in a risk-free learning environment
where errors can be allowed to occur”.
(Paparella et al, 2004)
Use of simulation education
qSimulation is valuable
when ‘on-the-job’
training is expensive or
risky
q
qSimulation has been
adopted for training
where consequences
of error expose many
people to risk or the
cost of error is high, for
example:
ØAerospace
ØHealthcare
ØMilitary
ØNuclear power
plants

 RETENTION
qTeach Others90% Collaborative Simulations
qLearn By Doing75% Simulations
qDiscussion Groups 50% Web Seminars, chat
qDemonstration30% Animation
qAudio Visual 20% PowerPoint Slides
qLecture 5% Streaming media

Source: Andersen Consulting

(http://www.andersonconsultinggroup.com/)
 Simulation varieties
qStandardized Patients
qImprovised Technology
qScreen Based Simulation
qTask Trainers
qLow/Mid/High Fidelity Mannequins
qVirtual Reality
 Common Simulators
qCase Scenarios with role playing

Lower Cost
qComputerized Case Scenarios
qProgrammed Patient Training
qSurgical “Box” Trainer
qMannequin based Simulation— SimMan™ (Laerdal) or
METI HPS (SimMan3G, SimBaby)
qAnesthesia OR Simulations
qVR Surgical Simulations—

Higher Cost
qMIST-VR, ES3, GI Mentor, etc
qHigh-Fidelity Endovascular Simulators
qFlight Simulators for Airline Industry
 THE MULTIPLE GOALS OF THE
SIMULATION TRAINING INCLUDE

qPromote patient safety through realistic simulated training.

qEnhance efficiency and competency of providers.
qIncrease communication, teamwork and critical thinking skills
with Crisis Resource Management (CRM) training.
qIncrease confidence and skill levels in medical treatment for
deploying medical personnel.
qProvide cutting-edge Graduate Medical Education training for
residents in multiple specialties.
qRe-establish skills for returning providers Host Advanced
Cardiac Life Support, Advanced Trauma Life Support, Pediatric
Advanced Life Support, Trauma Nursing Core Course, and
Emergency Nursing Pediatric Course training programs.
qTake the training to sites within the hospital and clinics, as well
as off-site
 Advantages of simulation training
qDetermine what you want qProvide feedback
to assess. qGive opportunities for
qDesign a simulation that repetitive practice
provokes this qIntegrate simulation
into overall curriculum
performance. qProvide increasing
qObserve/record the levels of difficulty
performance. qProvide clinical
qAnalyze the performance variation in scenarios
using some type of rubric: qControl environment
checklist, etc. qProvide individual and
team learning
qDebriefing, feedback and qDefine outcomes and
teaching. benchmarks
 Literature review
 Evidence supports the use of simulation in healthcare
education to be an effective teaching strategy to assess
and strengthen the skills and competences in
healthcare Simulation as a teaching method is complex,
multifaceted and challenging.
 Simulation becomes an essential component of
education, training, assessment and maintenance of
professional certification throughout healthcare
q Simulation training has a positive impact on inter-
professional training and could be effective in
reducing medical error
q It allows participants to focus on skills, organisation and
problem solving within a team, rather than individually
learning facts in isolation



 §DeVita, M. A., Schaefer, J. L,. Wang, H. & Dongilli, T. (2005)
Improving medical emergency team (MET) performance using
a novel curriculum and a computerized human patient

simulator. Quality and Safety in Health Care, 14, 326-331
 §Ker, J., Mole, L. & Bradley, P. (2003) Early introduction to inter-
professional learning: a simulated ward environment. Medical
Education, 37, 248-255
§Shapiro, M. J., Morey, J. C., Small, S. D., Langford, C. J.
Kaylor, C. J., Jagminas, l., Suner, S., Salisbury, L., Simon, R. &
Jay, G. D. (2004) Simulation based teamwork training for
emergency department staff: does it improve clinical team
performance when added to an existing didactic teamwork
curriculum? Quality and Safety in Health Care, 13, 417-421

qShowed simulated-training improved inter-professional team

performance and patient safety
qResults indicate students felt the Simulated Clinical
Experience to be an effective teaching method
Bremner, M. N., Aduddell, K., Bennett, D. N. &


VanGeest, J. B. (2006) The Use of Human Patient

Simulators: Best Practices With Novice Nursing
Students. Nurse Educator, 31(4), 170-174.


Schoening, A. M., Sittner, B. J. & Todd, M. J. (2006).



Simulated Clinical Experience: Nursing Students’

Perceptions and the Educators’ Role. Nurse
Educator, 31(6), 253-258.


q Proved simulated clinical experiences improved

confidence and competence in nursing students
and prepare them for real practice.
qQualitative data analysis showed students’ found
simulation a positive experience.
q61% felt the experience gave them increased
confidence

Shepherd, I. A., Kelly, C. M., Skene, F. M. & White, K. T. (2007). Enhancing


Graduate Nurses’ Health Assessment Knowledge and Skills Using Low-

Fidelity Adult Human Simulation. Simulation in Healthcare, 2(1), 16-24.


Alinier, G., Hunt, B., Gordon, R. & Harwood, C. (2006) Effectiveness of



intermediate-fidelity simulation training technology in undergraduate nursing

education.
Journal of Advanced Nursing, 54(3), 350-369


Jefferies, P. R., Woolf, S. & Linde, B. (2003) Technology-based vs. Traditional



Instruction: A Comparison of Two Methods for Teaching the Skill of

Performing a 12-Lead ECG. Nursing Education Perspectives, 24(2), 70-74


q These researchers showed that simulation based trainings

are more effective than traditional teaching strategies in
healthcare education.
q This evaluates combination of simulation training and a
relevant educational framework offers a significant
alternative over traditional teaching methods in preparing
new health professionals to the practice.

q Mixed Simulations, Physical Simulations, Standardized
Patients, Virtual Humans and Virtual Simulations

 Current Simulation Scenarios

Thousands of clinicians, educators,
administrators, and managers have
benefited from simulation training programs.
These cover a range of healthcare areas,
including anaesthesia, emergency
medicine, intensive care, labor and delivery,
pain service, radiology, surgery, code, EMS
and transport teams, and crisis
management response in many domains.
In conclusion, researches show the use of simulation in
healthcare education to be an effective teaching strategy to
assess and strengthen the skills and competences in medical
practice. Simulated clinical scenarios provide a realistic safe
learning environment that more closely represents clinical
care, beneficial to both graduate and undergraduate student
in the transition from theory-to-practice. Improve team
performance managing the ‘at-risk’ patient with the potential
to improve patient outcome and reduce medical errors.
In comparison with traditional teaching methods, simulation
appears to be more effective in developing and refining
clinical skills along with non-technical skills such as
communication, clinical analysing, decision-making and inter-
professional teamwork training. Used within an educational
framework with learning objectives relating to clinical
objectives, simulation can become essential to healthcare
studies and continual professional development of health
professionals.
 Future of simulation training
 However, using simulation as a teaching method is
complex, multifaceted and challenging. Facilitators’
need to be appropriately trained and have
adequate resources to design, develop and plan
simulation training. Further research studies
should focus on measuring the impact simulation
training has on clinical practice and patient
outcomes to validate its use. Healthcare education
and practice have to embrace the use of simulation
training and support its use in order to continue to
advance.

http://news.icanhascheezburger.com/2009/07/07/political-pictures-
simulators-realistic/
 References
 Bristol Medical Simulation Centre (2010) Simulation (Online) Available at: http://www.bmsc.co.uk/ ,
(Accessed on 15/11/2010)
 CAE( 2010) Healthcare(WWW) http://www.cae.com/en/healthcare/resource.centre.asp, (Accessed on
14/11/2010 )
 e-Learning for Healthcare(2010), Healthcare(WWW)Available at : http://e-lfh.org.uk/index.html,
(Accessed on 15/11/2010)
 Laschinger, S., Medves, J., Pulling, C., McGraw, D. R., Waytuck, B., Harrison, M. B. and Gambeta, K. (2008),
Effectiveness of simulation on health profession students' knowledge, skills, confidence and
satisfaction. International Journal of Evidence-Based Healthcare,Vol: 6, pp:  278–302
 McGuire, F. (2007) Simulation in Healthcare, in Handbook of Simulation: Principles, Methodology,
Advances, Applications, and Practice (ed J. Banks), John Wiley & Sons, Inc., Hoboken, NJ, USA. 
 Nehring, W. M., & Lashley, F. R. (2004). Using of the patient simulator in nursing education. Annual
Review of Nursing Education. Vol.2, 163-181.
 Nunn, A. (2004). Almost the real thing. Nursing Management, 11(7), 7 14-18.
 OMNI Architects (2010) Medical Simulation(WWW) available at:
http://www.omniarch-ny.com/index.php? section=institute-for-medical-simulation#2slideShow1,
(Accessed on 14/11/2010)
 Paparella D, Galeone A, Venneri MT, Coviello M, Scrascia G, Marraudino N, et al. (2006)Activation of
the coagulation system during coronary artery bypass grafting operation. comparison between on
pump and off pump techniques. J Thorac Cardiovasc Surg.,vol,131:290-29
 The Society for Simulation in Healthcare(2010)(WWW) available at:
http://www.ssih.org/SSIH/ssih/Home/ Default.aspx , (Accessed on 15/11/2010)
 http://www.sesam-web.org/centers/bristol/
 http://www.gaumard.com/  


Thank you !