Medical simulation
In the past, its main purpose was to train medical professionals to reduce errors during surgery, prescription, crisis interventions, and general practice.
With the help of a UCSD School of Medicine student, Computer Gaming World reported that a Surgeon (1986) for the Apple Macintosh very accurately simulated operating on an aortic aneurysm.
The key elements in the design of a simulation center are building form, room usage, and technology.
It may include incorporating aspects of the environment not essential in simulation activities, but that play a big role in patient safety.
The CHSOS certification endeavors to standardize and authenticate the minimum competencies to be demonstrated by simulation center operations specialists.
[13] The origins of debriefing can be traced back to the military, whereby upon return from a mission or war game exercise, participants were asked to gather as a group and recount what had happened.
The aim is to reduce stress, accelerate normal recovery, and assist in both the cognitive and emotional processing of the experience.
[1] More specific descriptions of debriefing can be found, such as the following in relation to debriefing in healthcare simulations, described by Cheng et al. (2014): "...a discussion between two or more individuals in which aspects of a performance are explored and analysed with the aim of gaining insights that impact the quality of future clinical practice".
This guide may be virtual in nature, such as prompts from a computer program, or may be physically present, in the form of an instructor or teacher.
[30] The point of the description phase is to identify the impact of the experience, gain insights into what mattered to the participants throughout the simulation, and to establish a shared mental model of the events which occurred.
[34][25][17] A debate in the healthcare simulation community exists regarding the exploration of feelings in the descriptive phase.
One camp believes that the descriptive phase should allow an opportunity for participants to "blow off steam," and release any tension which may have accumulated during the simulation scenario in order for learners to continue the debrief and subsequent reflection without pent-up emotion.
[25][34][26] Others believe that the "venting" phase is not necessary and may explicitly make this statement in their debriefing models, or simply omit any reference to emotions or feelings at all.
[26] This is the phase in which the bulk of the time of debriefing is spent, with a focus on participant performance, rationales, and frames.
However, performance can often be a difficult topic to broach with participants, as criticism or constructive feedback often incur negative feelings.
[33][34][31][26] Advocacy-inquiry consists of pairing "an assertion, observation, or statement" (advocacy), together with a question (inquiry), in order to elicit the mental frameworks – or schema – of both the facilitator and the participants.
[33][34][32][31] Participants are asked to move any newly acquired insights or knowledge gained throughout the simulation experience forward to their daily activities or thought processes.
Common questions posed, or statements made, by a facilitator during this phase include: Note that the summary here is not always in terms of re-stating the major points which were visited throughout the simulation and debrief, but more so emphasize the greatest impact of learning.
[1] The method of debriefing chosen should align with learning objectives through evaluation of three points: performance domain – cognitive, technical, or behavioral; evidence for rationale – yes/no; and estimated length of time to address – short, moderate, or long.
[33][1] It can be challenging for the novice facilitator to adapt to emergent learning objectives, as the subsequent discussion may be purely exploratory in nature with no defined outcome.
In such situations, the facilitator and participants must be flexible and move on to the next objective, and follow-up with the debriefing of the emergent outcome at a later time.
Complex cases usually involve heightened emotions, interdependent processes, and require more time spent debriefing.
The location of the debriefing is ideally somewhere comfortable and conducive to conversation and reflection, where chairs can be maneuvered and manipulated.
Establishing psychological safety and a safe learning environment is of utmost importance within both the simulation and the debriefing period.
[35]: 340 It is recommended that establishing safety begin in the pre-brief phase[35] by alerting participants to the "basic assumption."
According to a study conducted by Bjorn Hoffman, to find the level of efficiency of simulation based medical training in a hi-tech health care setting, "simulation's ability to address skillful device handling as well as purposive aspects of technology provides a potential for effective and efficient learning.
"[39] More positive information is found in the article entitled, "The role of medical simulation: an overview," by Kevin Kunkler.
According to the Institute of Medicine, 44,000 to 98,000 deaths annually are recorded due primarily to medical mistakes during treatment.
[43] A near 5% representation of deaths primarily related to medical mistakes is simply unacceptable in the world of medicine.
The use of high-fidelity simulation for health professional education is strongly recommended by the WHO because it leads to greater acquisition, retention, and transfer of technical and non-technical skills.
