Simulation Standards

From WickedSim

A crying need for standardisation

About forty years ago, aviation simulation was in a similar state to current Medical Simulation. Even if a company had just spent twenty million dollars on a new simulator, there was no assurance that the swanky new machine would perform acceptably like a real aircraft, nor was there a high likelihood that if you went to the 'identical' simulator down the road that the two would be similar in performance!

Through the attempts of remarkable people like Ray Page the aviation industry has overcome that hurdle. How can we achieve similar results in Medical simulation? This topic is under discussion.

Assessing Competence

Simulation shows great promise where one wishes to assess competence, but clearly competence should be assessed against some sort of benchmark. Here standardisation again rears its head. Recently in the field of anaesthesia (in particular) more and more emphasis has been placed on formative assessment (ongoing, episodic assessment during the course of training) as opposed to summative assessment (for example, a big, traumatic exam at the end of training).

In addition, it has been realised that the naive old viewpoint that someone is competent after they've once been assessed as competent is neither valid nor acceptable. Having initials after your name is no measure of current ability. We therefore require ongoing assessment and credentialing in Medicine, particularly in high-risk areas such as obstetrics, surgery and anaesthesia. Appropriately standardised simulation is one possible way to assess things, and may be the only way of assessing handling of uncommon events.

The recent academic medical literature has been enthusiastic about the use of simulation in assessing competence. See for example the following articles from 2007 alone:

• Credentialing and certifying with simulation. Anesthesiol Clin. 2007 Jun;25(2):261-9 Ziv A, et al.
• Simulation applications for human factors and systems evaluation Anesthesiol Clin. 2007 Jun;25(2):237-59. Small SD.
• The use of standardized patients to evaluate family medicine resident decision making Fam Med. 2007 Apr;39(4):261-5 Terry R et al. (This article is particularly interesting as it shows how a 'simulated patient' can be incorporated into everyday practice).
• The use of simulation in emergency medicine: a research agenda. Acad Emerg Med. 2007 Apr;14(4):353-63. Bond WF et al.
• Anaesthetists' management of oxygen pipeline failure: room for improvement Anaesthesia. 2007 Feb;62(2):122-6 Weller J et al.