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“Simulation technology and pedagogy have advanced dramatically in recent years and have the potential to improve health professionals’ competency and safe practice.”
-Amitai Ziv, Stephen D. Small, and Paul Root Wolpe
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OBJECTIVES
Discuss how simulation can be used to promote safety in all aspects of healthcare.
Examine how simulation can be used to inform quality-improvement mechanisms at all levels of the healthcare system.
Show how simulation can be used to document evidence of performance skills in healthcare practices.
Demonstrate how simulation can be used to reduce risks associated with healthcare for patients and providers.
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A key tenet for healthcare providers is, “First do no harm.” Although modern clinicians might consider the earliest healing methods to be a form of sorcery by today's technology and genome-driven clinical techniques, at their root, all healthcare practices still depend on human performance and are, therefore, susceptible to human error. Human imperfection will likely remain in perpetuity; however, it is possible to limit errors and associated adverse effects on patients, their families, and practitioners themselves. Most healthcare professionals learned through apprenticeships under the tutelage of more experienced clinicians. The apprentice method enables students to learn clinical procedures, techniques, reasoning, and decision-making by observing, and subsequently performing, these behaviors while providing patient care. This method has numerous strengths. Its inherent weakness, however, is the lack of adequate opportunities for repetition and deliberate practice, both of which are so essential for developing psychomotor skills. Instead, the learner may receive subjective observations about performance, often in the absence of performance standards and a lack of preceptor training in teaching and performance assessment. The result is wide variability in the quality of training and, therefore, variability in the quality of clinical performance, with the potential to adversely affect patient care.
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Simulation affects safety in a number of different healthcare situations. Most commonly, simulation is seen as an enabler of patient safety. However, there are other domains in which simulation can foster safety, including clinician safety and environmental safety.
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Singular reliance on the apprentice-training model of clinical instruction places patients at greater risk for a potential adverse event. Consider the likelihood that a learner will take more time to assess and treat a patient than a professional provider would. Although this delay might not have an adverse effect in many clinical situations, it inconveniences patients and endangers those with clinical situations that are time dependent. For example, a patient presenting with signs and symptoms of a thrombotic stroke requires quick assessment, diagnosis, and administration of potentially lifesaving drugs such as tissue plasminogen activator. However, this patient faces several obstacles to securing optimal care, including timely admission to the emergency department, rapid triage assessment and diagnosis of a potential stroke patient, quick and accurate intravenous (IV) access placement, prompt evaluation by the attending physicians, and accurate treatment protocols ...