Why Simulation Works

Why is simulation revolutionizing the training of medical students? Here are some of the key benefits:

Simulation allows repetitive practice without risk to patients.
Nearly every aspiring practitioner of a difficult skill learns through repetitive cycles of trial and error — a kid practicing free throws; a woodworker in the shop; a law student in moot court. Not quite so with doctors.

Residents do “practice” on living patients, of course, but without the ability to try and try again in pursuit of proficiency. With medical simulators, residents can practice the broad range of procedures as often as they or their instructors wish, and with no cost to human patients.

Simulation allows standardization in medical training and assessment.
Pamela Andreatta, Ed.D., assistant professor of medical education and director of the Clinical Simulation Center, explains how she describes the advantages of simulation to medical educators who know only the apprentice model of resident training:

“If someone were to ask me, ‘How do you know this works?’ I would ask them, ‘How do you know your way works?’ They would say, ‘Patient outcomes.’ But we can’t tie training objectives to patient outcomes because there are too many uncontrolled variables.”

She means that one patient may die even if a resident performs perfectly, while another patient may do well despite significant errors on the resident’s part.

Pamela Andreatta in the Clinical Simulation Center Photo: Martin Vloet

Then, too, no two residents ever really receive the same training, because no two residents deal with the same cases. So it’s hard to assess their acquisition of standard skills. It’s also hard to judge whether one resident is more skilled than another.

With simulation, educators can ensure that every resident confronts the same problems and tasks. They receive immediate feedback on what they did well or poorly, then try again immediately, based on what they’ve just learned.

Andreatta gives this example: “To this day, most of the chest-tube curricula are a see-one, do-one, teach-one kind of thing. A resident will watch somebody else do one, go in and mimic them, then teach somebody else to do it. So it’s all verbal. There’s no set curriculum. There are no set criteria for performance at each step. If we do that in the simulation center, we can do a task analysis where we go step-by-step and identify exactly what they do each step of the way; then identify how it should be done, to what criteria.”

Simulation allows educators to set standard levels of performance.
Standard performance levels can be established for essential skills. Then residents can be trained to meet those standards. In surgery, for example, a resident would be required to reach a certain level of performance in both basic and comprehensive skills ranging from knot-tying, with and without instruments, to the handling of laparoscopic instruments to the completion of an endovascular procedure.

Andreatta is now collaborating with physicians to set standards in surgery, family medicine, urology, emergency medicine, pediatrics, and obstetrics/gynecology. Such standards are expected to be developed nationally, too — and may soon be required for the accreditation of medical schools.

Simulation enables physicians to “warm up” for treating human patients.
Not only residents but also highly experienced physicians are spending time in the Clinical Simulation Center. The highly realistic scenarios and instruments allow them to get the feel of instruments and anatomy before they go to work on human patients.

Before long, it may be possible to scan the anatomy of an actual patient who is about to receive treatment, then convert that data into a computerized scenario that exactly replicates what the physician will see when the procedure gets underway. With that simulated scenario on a computer screen, the physician will then be able to rehearse the treatment ahead of the actual event.

“It’s definitely a realistic goal,” Andreatta says, “and we’re certainly moving in that direction.”

—James Tobin

Also:

Reality Check

What’s It Like to Use the Simulators?