While myriad forces are changing the face of contemporary healthcare, one could argue that nothing will change the way medicine is practiced, more than current advances in technology. Indeed, technology is changing the entire world at a remarkable rate – with mobile phones, music players, emails, databases, laptop computers, and tablets transforming the way we work, play, and relax.
Despite this, it is generally acknowledged that the adoption of technology in healthcare is slow and disparate. The Healthcare Industries Task Force, for example, has described the National Health Service as “a late and slow adopter of technology.” This is not that surprising, given the large costs and investments often involved – but a reassessment of attitudes needs to take place.
In 1834, the London Times described the stethoscope in the following manner:
That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; because its hue and character are foreign and opposed to all our habits and associations.
Even today, we still tend to treat new technologies with restraint; a menace to time-honoured – if imperfect – ways of doing things. But in essence, such items are simply there to make life easier. To reassess, healthcare professionals must look at the ways technology can benefit their patients, colleagues, and themselves. After more than fifteen years of my own involvement in the field of simulation based learning, I felt it was time to reflect on the field’s progression.
Simulation-based medical training essentially involves learning with items or machines – instead of the patient. A simple example would be teaching students to handle needles, and sutures using a pig’s foot or a piece of simulated skin. A more complex example is the use of the famous Resusci Anne, a resuscitation manikin, to teach a partial task such as chest compressions and positive pressure ventilation. Today, computerized full-body manikins are considered the mainstay of simulation-training; they aim to represent patients, their signs, and symptoms.
Confucius made the case for the utility of simulation some 2,500 years ago, by observing that real experience, however profound in nature, was always tinged with risk. He further suggested that rehearsal was one of the best methods of learning:
By three methods we may learn wisdom: first, by reflection, which is noblest; second, by imitation, which is easiest; and third by experience, which is the bitterest.
It would appear, therefore, that the concepts supporting the value of simulation are nothing new. The only thing that’s changed is the technology underpinning such practices.
Over the last decade, simulation has moved from being an emergent and disruptive educational innovation, to a mainstream element of most healthcare curricula. Whilst manikins have been widely available for practices such as CPR and airway management training, over the last decade – new simulators have been produced that are unprecedented in their functionality. New features reproduced many, but not all, of the signs seen in deteriorating patents. It became possible to interface them to commercial physiological monitors, anaesthesia machines, ventilators, and even cardiac defibrillators. Consequently, it became feasible to recreate most medical emergencies with acceptable realism.
Despite the feast of newer, increasingly sophisticated simulators and training aids, the adoption of such devices was not all smooth sailing. Funding was hard to come by (as initial investments were principally for hardware and buildings), and provision for educators was often missing from business plans. Universities could not exist without paid academics, but hospital-based training was frequently unfunded or buried within nonclinical time. Some simulation centres became starved of funding to implement and develop courses, improve their teaching skills, and train the next generation of educators.
One of the more obvious reasons why simulation-technology was characterised by a large trough after its initial adoption was the failure to develop strong partnerships with academic educators at an early stage. It is now common to hear of clinicians undertaking formal university-based education degrees, or more recently, medical education with simulation training. However, the early days of simulation-based education were populated by enthusiasts who were self-taught or learned from others in this new field – relatively isolated from the broader medical profession.
Notwithstanding these difficulties, the benefits of simulation in medical training are easy to see. Clearly, it is self-evident that traditional medical education was (and still can be) lacking in many ways. Thinking back to my own medical internship fills me with some horror. The phrase ‘patient safety’ was never heard. Not only did I feel completely unprepared for my first year in a teaching hospital, I remember being mostly fearful of sick patients and accepting that on several occasions, I was probably contributing to their demise. At a personal level, this was not unexpected after several years of varying degrees of intimidation by clinical teachers. Internship was a new phase of trial-and-error care, and I often looked back at my own medical education and wondered why it did not prepare us better. Like many before me, I made a promise that I would try to be a better teacher than some who taught me.
As Dr William Mayo (one of the seven founders of the Mayo Clinic), stated more than ninety years ago, “There is no excuse today for the surgeon to learn on the patient.” With the rise of new, simulation-based technologies, this is now truer than ever. Clinical simulation training and assessment encompasses a range of tools, such as task trainers, virtual reality simulators, standardized patients, virtual patients, and computerized full-body manikins. As with any tool however, the effectiveness of simulation technology depends on how it is used. Those of us who have experienced both traditional and simulation-based learning, know that there’s a place for both. There is no going back, and it is imperative to actively foster the next generation of simulation champions, as well as the technology they rely on. Anything less is doing an injustice to future healthcare practitioners – and their patients.
Featured Image Credit: GlideScope practice by AllieKF. CC BY-SA 2.0 via Flickr.
Great piece Richard. Couldn’t agree more.
This is a great article and a great summary Richard – many thanks
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