Research in simulation based health professions education: Building houses or making bricks?

Adam Dubrowski, PhD Learning and Research Institutes

Wilson Centre Department of Paediatrics, UofT

Chaos in the Brickyard

Applying the Scientific Method and underpinning research methodology to generate evidence that will be used to build simulation based education programs.

General Aim

• Models of Medical Education •  Introduction to Simulation • Working Model • Components of Simulation

–  Simulators –  Educators – Organization

•  Future Directions

Outline

Apprenticeship Model

Trainer

Trainee

Patie

nt C

are

Shift in responsibility

Ashley, 2000

Apprenticeship Model

Trainer

Trainee

Patie

nt C

are

Gap

Ashley, 2000

Apprenticeship Model

Trainer

Trainee

Patie

nt C

are

More people die in a given year as a result of medical errors ( 44,000) than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).

"To Err is Human, Building a Safety Health System" (2000).

Apprenticeship Model

Trainer

Trainee

Patie

nt C

are

Simulation

Simulation Based Education

Learn faster Remember longer

Be safer

The replication of a task or an event for the purpose of

education and/or assessment.

Simulation Based Education

Simulation Based Education

Working model

Dubrowski, A., Brydges, R., Satterthwaite, L., Xeroulis, G., Classe, R. American Journal of Surgery. in press.

Busy Environment: Multitasking

Simulation Based Education

Technical Performance

Communication

Environment

Clinical Knowledge

Attentional capacity threshold

Additional Learning

Simulation Based Education

Simulation Based Education

Technical Performance

Communication

Environment

Clinical Knowledge

Additional Learning

Attentional capacity threshold

Simulation Based Education

Technical Performance

Communication

Environment

Clinical Knowledge

Additional Learning

Attentional capacity threshold

Simulation Based Education

Technical Performance

Communication

Environment

Clinical Knowledge

Additional Learning

Attentional capacity threshold

Simulation Based Education

Technical Performance

Communication

Environment

Clinical Knowledge

Additional Learning

Attentional capacity threshold

Simulation Based Education

Evidence

Kurahashi et al. Surgery. 2010

Study 1: Does it work?

Can simulation based training help in pre-training?

Practice Skills Test

Written Test

1 week rest

Study 1: Does it work?

Skills Test: Expert Opinion

0 5

10 15 20 25

Written Test: Score

0 5

10 15 20 25

Trained Novice Novice

Trained Novice Novice

Study 1: Does it work?

simulation performance improves

Study 1: Does it work?

learning enables

Study 1: Does it work?

simulation

Simulation Based Education

How to use it?

Simulation Based Education

Components

Simulators Educators Organization

Simulators Information Flow Framework

Brydges et al., Am J Surg. 2007, Sidhu et al., J Vasc Surg. 2007

Study 2: Realism

Brydges et al., Am J Surg. 2007, Sidhu et al., J Vasc Surg. 2007

High fidelity

Animal model

Low fidelity

Study 2: Realism

Brydges et al., Am J Surg. 2007, Sidhu et al., J Vasc Surg. 2007

Expe

rt O

pini

on

0 5

10 15 20 25

Senior

0 5

10 15 20 25

Novice

Synthetic Cadaver Ex

pert

Opi

nion

Pre-training baseline

Synthetic Cadaver

Study 2: Realism

simulation appropriate models requires

Study 3: Educators Errors in learning

Xeroulis et al., Surgery. 2007

Study 3: Educators

Xeroulis et al., Surgery. 2007

Expe

rt O

pini

on

0

5

10

15

20

25

Post-training Retention

1 month Pre-training baseline

Errors allowed Errors not allowed Independent learning

Study 3: Educators

simulation educated educators requires

Organization

Moulton et al., Ann Surg. 2007

Optimal schedules

Study 4: Organization

Moulton et al., Ann Surg. 2007

1 2 3 4

1 hour block

1 month

1 2 3 4

1 hour block

1 week rest

1 month

distributed practice

massed practice

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

R

R

Transfer

Study 4: Organization

Moulton et al., Ann Surg. 2007

distributed massed

Expe

rt O

pini

on

30

20

10

0 Pre-test

Microsurgical drill

Post-test

Rat

Transfer

Study 4: Organization

simulation effective curricula requires

Summary of Results

simulation appropriate models requires

simulation educated educators requires

simulation effective curricula requires

Implications

Trainer

Trainee

Patie

nt C

are

Medical Education = Evidence Based Education

Future

Technology

Future Directions

Mechanisms

Future Directions

Conclusions

CellSociety

End

adam.dubrowski@sickkids.ca http://www.slideshare.net/adam.dubrowski/dubrowski-bricks