Talk:A gentle introduction to simulation
From WickedSim
I saw this on the main page and took the liberty of turning it into a link. This is definitely a topic that needs an entry due to the vast numbers of educational centers out there that are interested in simulation, but just don't know where to begin. In fact, I'm not even sure where to begin an article like this so I thought I'd start a discussion on it instead. The article should be comprehensive, but not overwhelming. It should be technical and medical enough to be useful, but be general enough so that it can be understood by administrators, technicians, doctors, students, and anyone passing by wondering what we're talking about. So here's a few thoughts on what we should include:
- A brief history of medical simulation
- Major companies providing medical simulation supplies
- Links to simulation societies (particularly medical simulation, but the whole sim field is fairly non-specialized at the moment)
- Any sort of resource useful for starting up a simulation center
- Possibly a list of centers with contacts willing to provide some one on one advice, tours, etc..?
- Statistics about medical simulation (this is especially useful for getting funds and convincing 'non-believers')
- Conferences involved in simulation (same as the sim societies comment)
Some of these things could have their own separate page in the wiki since they are big enough to be articles in themselves. Feel free to brainstorm about what should be in here, or start writing a page for this topic if you have material for it.
Aurelmihai 11:07, 22 March 2007 (EDT)
Hi Aurel, good for you, I like your list. I agree that a lot of the topics you mention can be farmed out as links after a brief mention.
My feeling is that the gentle intro should give just the briefest note as to what simulation is, and then concentrate more on the philosophy --- the 'why' of simulation
I'm talking about:
- the central importance of crew-resource management and interpersonal factors;
- the need for standardisation (can't emphasise this too much);
- where medical simulation is at present (just starting up)!
Johanvs 19:45, 25 March 2007 (EDT)
Looking at wikipedia as a reference, it appears that there's no entry on medical simulation, but there is an entry on simulated (standardized) patients and there are entries on simulation of other sorts. If we're looking to define medical simulation through its history and original intent, it seems that modern medical simulation has grown out of standardized patients. Mechanical simulators simply take standardized patients a step forward, both in terms of standardization, because the mechanical simulator can be programmed to repeat a scenario precisely, and in terms realism, because they have the potiental to simulate all aspects of human physiology and pathophysiology even if they are far from that point right now. Also in terms of realism, they allow the learner to do more than they could do on a standardized patient. Theoretically any procedure could be performed on a mannequin.
Simulation seems to provide a great benefit to training in other fields, providing a repeatable, standardized scenario for a student. It gives instructors a way to rate students objectively and ideally can be methodically refined to provide a student with exactly the skills he needs in the most efficient way. More standardization is certainly better because it creates more credible results - a standardized curriculum and testing, a platform for research studies, etc.. I think this is what you mean by standardization.
That leaves the crew-resource management aspect, which I'm not entirely clear on. Where I work, teamwork is a secondary emphasis. We focus more on teaching skills and teamwork is absorbed as a side-effect. More often than not, we encourage students not to give overt hints to one another because we are focusing on one learner at a time with the others there to support and observe. We do this because each student must eventually be able to do each skill independently. In any case, I'm sure we could both (all? I don't see anyone else contributing..) write a novel describing simulation, its importance/uses, and its current state as we see it, but ideally we need a definitive source to give the article some weight, otherwise it's just our opinions.
Aurelmihai 11:22, 27 March 2007 (EDT)
It occurred to me that by standardization you and others might be talking about a 'standard mannequin' whose parts can be interchanged easily. If that is the case, you must be careful to specify that the standard must be specified by an independent society in no way associated with anyone producing these mannequins. The society ought to be open to all to join so that a free discussion of features and standards can take place, and the standards ought to be a par that companies must meet in order to be branded a standard, certified mannequin, but the standard should in no way limit the creativity of companies in producing new and innovative mannequin designs, nor should the standard restrict mannequins to using certain patented parts/processes. If these standards just develop on their own it could be disastrous. Imagine METI 10 years from now having no competition and being the standard for mannequin technology. It's like comparing IEEE with Microsoft. IEEE sets electronics standards, but doesn't actually make any products. Microsoft sets the OS standard and makes the product, so the consumer is effectively taken out of the process. You get whatever the producer wants to give you, and the producer will create new releases for the sole purpose of making money off you. Also, prices will remain as high or higher than they already are because the market is monopolized by one overwhelming producer, while quality will remain low or slip lower because you have no alternative for standardized parts. This is a direction I hope medical simulation does not take so we need to be careful what we wish for in terms of standardization.
12:36, 28 March 2007 (EDT)
I largely agree with what you've said. Perhaps I should clarify here and there:
- I agree that those who set the standards should not be able to take off their 'standardiser' hat and say "And by the way, I have something to sell you ..." The Micro$oft problem illustrates this well.
- Hardware standardisation is indeed desirable, but it pales into insignificance besides standardisation of 'software' constructs, particularly models.
- For example, there are multiple models of the cardiovascular system, and of the respiratory system, ranging from the simple to the irrationally complex (fifty compartments arbitrarily plucked out of the air). Wouldn't it be nice if we could say "Today we will be using cardiovascular model 3.1.4 bis. We know that it has the following advantages, and the following limitations (list goes here). With this as a basis, we'll be using the following pharmacokinetic and pharmacodynamic models, which have previously been verified in the following situations. And hey, these will all give the same responses on the following simulators, yippee!!"
- At present we have the problem that even if we run the same model on the same simulator repeatedly (a good example is METI) we have no guarantee that we will get the same response!! We have a long way to go.
- I think that even bigger than the above is the need to develop and characterise crew resource management, and examine human factors. To my mind, technical aspects of what the individual does in medical simulation, particularly in the operating theatre setting, are far less important than the dynamics of human interaction, and the system within which they are placed. A lot of medical error is system error, and I believe about 90% of our energies should be focussed on looking at this, rather than 'mere' technical aspects.
Johanvs 19:31, 28 March 2007 (EDT)
Well, I was editing the page to put some of our thoughts into writing when the page took what I had written up to then, saved it, and wouldn't let me save anything more. It was giving me a server not found error so I'll try again tomorrow. -Aurel
Hi Aurel, that's a bit odd. Please let me know if it recurs. We've had some problems with our current host and will almost certainly change to a new one within the next month. The problems however have been about enabling image uploads for everyone, and not server errors. Hmm.
BTW, external links are within single square brackets, internal ones in double square brackets. Also in internal links you use a pipe to separate the name from the tag, while in external links you simply leave a space after the URL. I didn't make this clear on the help page. Sorry. Will update that page later.
Johanvs 20:25, 29 March 2007 (EDT)
Ok, I'll make sure to use the right links from now on and I fixed the links I had used in this article. As for the error, what's even stranger is that I got it down to one particular set of text that would cause a server error whenever I input it. In fact, I can't even put that piece of text in here to show you, but I'll email it to you.
Anyway regarding the article, I thought I'd start it off with what's up there now. I'll get together some links to add to it next week. Feel free to add and alter it as you see fit. I'm especially curious to see what you'd put up for crew resource management.
Aurelmihai 09:34, 30 March 2007 (EDT)
My 2 cents
Part task trainers are essentially that - training people in tasks like cannulation and beyond. Noting that medical students still cannulate each other and insert nasogastric tubes on each other. (Hopefully that wonderful tradition of eating the ox eye has disappeared though!)
Full body mannequins (from a full body Resusi Annie to the METi HPS) although they can be utilised to teach tasks, they are more appropriate to "train the team or crew resource management" in terms of allocating different tasks to different people on the same mannequin. Here in lies the rub...
In "real" life we do both, and it is that interaction of watching someone else fumble the cannulation, and those time delays that I want to merge in my simulation training.
I have to admit the only sentance here that "made" me want to contribute to this was Aurel's comment of ""We focus more on teaching skills and teamwork is absorbed as a side-effect. More often than not, we encourage students not to give overt hints to one another because we are focusing on one learner at a time with the others there to support and observe."" Just what sort of teamwork message is being absorbed as a side effect of this ACTIVELY discouraging teaching of a fellow team member? --Lara 01:45, 31 March 2007 (EDT)
I've never heard of eating an ox eye, so I imagine that's no longer happening! Regarding your points on teamwork, I agree that it makes sense to use a full body mannequin to teach crew resource management and I'd encourage you to alter or add to any part of what I've written to make that clear. I'd do it myself, but I don't have experience with how that works except that it sounds good. And I do agree, the message we send probably isn't ideal, but there are other factors to consider. Picture the following situation.
You have three residents in for a simulation session, one for each of the three years in our residency program. Suppose our first year resident is terribly inexperienced and doesn't study very much, our second year is a top student, and our third year means well, but fumbles a lot. First year steps up for his scenario with the other two as support. It's a simple case, but he doesn't know where to begin. After fumbling around for a minute and watching the patient deteriorate, second year drops a huge hint and gives the case away. First year finishes the case within 5 minutes. Second year comes up and does a stellar job without any help. Third year comes up. He has a scenario encouraging teamwork. He delegates tasks to both of the other residents. As the scenario progresses, second year is doing his task well and third year is floundering so second year gives a hand.
First year got nothing out of that scenario. Second year did well. Third year started well, but couldn't finish it on his own. Now imagine they're all attendings. Scary, huh? First year will probably kill somebody even if a group is helping him. He's completely incompetent and can't figure out anything on his own. Second year is fine. He's probably even developed the leadership skills to take him further than he would have otherwise because he's had to help so many of his classmates along the way. Third year is a great team player, but can't do the job on his own if he has to. So that's the key to it: being accountable for your skills and actions. I'd love to be able to see both teamwork and personal accountability taught, but I'm not sure I see how to get both. In any group setting, there are those who will use the group to shield themselves from any real work. Ideally, every member in the group should know what needs to be done and work seamlessly to achieve that end, but unfortunately it doesn't happen that way. What we hope to achieve is a system where everyone knows exactly what needs to be done in any scenario and can do it on their own, and when they have assistance they'll hopefully know what to do with it.
Again, please edit the entry as you see fit. I only wrote it that way to start us off somewhere, not to write the definitive version of what medical simulation is. By the way, I hear that our curriculum is changing for the coming year so we may get a more teamwork built in to it!
Aurelmihai 12:45, 2 April 2007 (EDT)
---
Hi Aurel
I've added a bit about CRM. Comments/criticisms are welcome.
Johanvs 05:58, 3 April 2007 (EDT)
Consider the SSIH definition of simulation [1]
210.55.20.102 15:56, 2 August 2007 (EDT)
