In this post, Dr Kristina Pollock, a Clinician Teacher at the Royal (Dick) School of Veterinary Studies, explains how simulation based teaching is a highly effective form of research-led teaching…
Simulation is a method or technique that is employed to produce an experience without going through the real event. It also provides opportunities that are not available in real event learning and creates a safety container for error and reflection.
Simulation based teaching is directly related to research-led teaching in that it allows the study and evaluation of a hypothesis in a safe environment under controlled circumstances. It can facilitate the study of rare situations, otherwise difficult or unethical to evaluate in real life, that can be replicated in the simulation environment whilst ensuring the safety of students and simulation participants (Lame, 2018).
Simulation as a training method was first developed in the aviation industry where it was clearly quite costly if errors occurred “on the job” rather than in a safe practice environment where skills could be honed ahead of the high stakes real life situation. It was quickly adopted by anaesthetists for the same reason and has now become a cornerstone of medical education. The UK has highest number of advanced medical simulation centres in Europe, and the NHS is regarded as a global leader in simulation based medical education. Simulation also features as a core learning tool in veterinary medical education. One of the challenges faced in the veterinary sector compared to the human medical field, is the lack of availability of high fidelity manikins.
There is strong evidence of the benefits of simulation based medical education (SBME). Uniquely, the learner has the opportunity to practise an activity without compromising patient safety in a safe environment (Weller et al., 2012). Rather than being used to simply introduce a learner to a new skill, simulation – when repeated multiple times – can lead to eventual mastery of the skill (Motola et al., 2013; Issenberg et al., 2005). It has been shown that repetitive practice of a skill in a focused domain is associated with improved skill performance (Ericsson, 2004).
SBME works particularly well for teaching procedures and allowing experience of emergency situations that occur infrequently, but are potentially dangerous or even life-threatening (Aggarwal et al., 2010). Improved patient outcomes have been proven in human medical education for a number of common technical procedures such as cardiorespiratory arrest. Simulation facilitates delivery of many curriculum requirements using case studies and role-play situations (Beaubien, 2004). Peer assisted learning also works well using this teaching method.
My experience of teaching veterinary undergraduates clinical skills using simulation is that it enhances the effectiveness of teaching procedures while deepening understanding and awareness of the importance of non-technical skills, such as communication and ‘human factors’ that arise in pet medial care delivery.
A simulation teaching exercise follows a well-defined structure. First, the students are given a briefing of the task or scenario. Boundaries around confidentiality and psychological safety are established. The simulation experience follows. Finally, the exercise concludes with a debrief between the teacher(s) and student(s). The debrief is where the magic happens! Students are asked to assess their individual performance. This is followed by constructive feedback from the teacher and a set of future learning objectives, based on the feedback, are created by the student. Students are required to reflect on the whole experience and the evidence suggests that this is when deep and impactful learning occurs.
At the Royal (Dick) School of Veterinary Studies we have been fortunate enough to purchase the only advanced canine manikin currently available commercially. It has an integrated software system allowing manipulation of the manikin by an external observer in response to actions taken by students during the simulation exercise. This will allow us to teach veterinary clinical skills using immersive (also called high fidelity) simulation scenarios, dramatically enhancing the learner experience and the range of skills we can teach using simulation. As I write this, it is on an airplane literally winging it’s way to us!
This coming year, we will be teaching our final year vet students basic and advanced CPR using immersive simulation. We are currently developing an immersive simulation veterinary clinical skills lab within our clinical skills teaching space and writing new software for patient triage, emergency patient stabilisation and anaesthesia teaching. We are delighted to have the opportunity to introduce this teaching methodology in novel and exciting ways within the veterinary medical field, and I will keep you posted on how it goes as we train our first cohort of students using immersive simulation in early 2020.
Aggarwal, R., Mytton, O. T., Derbrew, M., Hananel, D., Heydenburg, M., Issenberg, B., MacAulay, C., Mancini, M. E., Morimoto, T., Soper, N., Ziv, A. & Reznick, R. (2010). Training and simulation for patient safety. Quality & Safety in Health Care. 19 Suppl 2, i34–43. DOI: 10.1136/qshc.2009.038562
Beaubien, J. M. (2004). The use of simulation for training teamwork skills in health care: how low can you go? Quality & Safety in Health Care. 13 Suppl 1, i51–i56. doi: 10.1136/qshc.2004.009845
Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine: Journal of the Association of American Medical Colleges. 79 Suppl 10, S70–81. DOI: 10.1097/00001888-200410001-00022
Issenberg, S. B., McGaghie, W. C., Petrusa, E. R., Lee Gordon, D. & Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher. 27 (1), 10–28.DOI: 10.1080/01421590500046924
Lamé, G. and Dixon-Woods, M. (2018). Using clinical simulation to study how to improve quality and safety in healthcare. BMJ Simulation and Technology Enhanced Learning. Published Online First: 29 September 2018. doi: 10.1136/bmjstel-2018-000370)
Motola, I., Devine, L. A., Chung, H. S., Sullivan,J. E. & Issenberg, S. B. (2013). Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Medical Teacher. 35 (10), e1511–1530. DOI: 10.3109/0142159X.2013.818632
Weller, J.M. (2004). Simulation in undergraduate medical education: Bridging the gap between theory and practice. Medical Education, (38), pp. 32–8. doi: 10.1111/j.1365-2923.2004.01739x