Dubrowski final 1
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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
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