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“I hear and I forget. I see and I remember. I do and I understand.”
-Confucius
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OBJECTIVES
Identify basic similarities and differences in simulation with different levels of learners.
Identify foundational issues that unify all levels of learners.
Recognize elements of simulation that might affect the learner population and outcomes.
Understand how simulation can be used to bridge the gap between different types of clinicians from academia to practice.
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Simulation foundations and theories largely remain constant while simulation applications are evolving. Simulation has numerous uses in healthcare affecting resilience and reliability, from education and training to process improvement at the individual, team, and system level to improve patient safety, prevent adverse events, and deliver quality and safe patient care (Page, Fairbanks, & Gaba, 2018). Simulation is an educational methodology used to provide learning with patient safety in mind. It is simply no longer necessary to attempt a procedure for the first time on an actual patient when there is a means to practice repeatedly in simulation (Brazil, Purdy, & Bajaj, 2019; Finkelman & Kenner, 2009). Simulation can assure that the learner experiences a specific type of event, whether it is an individual onboarding assessment or an interprofessional simulation of a rare event such as a code or postpartum hemorrhage—without jeopardizing patient safety. In the clinical environment, learners might not often experience rare events; simulation can deliver important and critical standardized learning experiences.
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Simulation should be managed and utilized based on the different types and levels of learners. The targeted population of learner, as well as the learning objective, will drive the type of simulation needed. Simulation debriefing methodologies, scenario types, checklists/metrics, and outcomes may vary depending on whether the learner is a novice or experienced or a member of an interprofessional team. Typically, with novice learners, learning occurs in the moment during debriefing. With an experienced team of clinicians, learning is most robust during periods of reflected self-discovery. High, intermediate, or low levels of facilitation may be used in debriefing to guide learners to obtain the best experience (Bauchat & Seropian, 2020; Fanning & Gaba, 2007).
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Many simulation activities—regardless of learner type or level—begin with the evaluation or acquisition of motor skills. According to one theory of motor skill acquisition, new learners must think through and perform actions step by step before they can perform in a more rote and fluid fashion, and certainly before adding complexity (Fitts & Posner, 1967). To ensure a new graduate is competent in motor skills, tasks must be repeated over and over, often following a checklist or procedural guideline, like the example shown in Figure 8.1.
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For learners who have relevant experience, the simulation team must validate the learner's ability to ...