Roads less traveled: understanding the “why” in simulation as an integrated continuing professional development activity

Abstract

BackgroundThe simulation community has experienced significant advances, strengthening the case for the use of simulation in medical education toward improving patient outcomes. However, an underlying assumption particularly regarding utilization of simulation by those who are in practice, is that simulation will be selected as a continuing professional development (CPD) strategy. Exploring reasons for choices of educational formats, particularly regarding simulation, is poorly integrated into CPD research.DiscussionDespite significant advances the scientific simulation community has been slow to produce evidence regarding why practitioners may be reserved in engaging in simulation or not. Using examples from related education contexts the author attempts to bridge simulation science, CPD and less commonly used theoretical frameworks to address this issue. The author argues that theoretical perspectives that recognize the use of simulation for CPD as a socio-personal process and/or a personal or group issue (e.g., theories of intelligence, self-determination theory, theory of planned behavior, social identity theory) and that are conceptually distinct from educational mechanisms/ provision are necessary to advance simulation use in CPD contexts.ConclusionGiven the close relationship practicing clinicians have to patient outcomes a new imperative may be to focus on the theoretical and practical links informing simulation use for CPD at the level of the individual and individual-among-professional groups. The simulation community may therefore need to engage in research that attempts to further uncover and address underlying issues of “why” clinicians integrate simulation as CPD activities or not.

Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians

“…There is a clear need for specific and complementary research questions centered on physicians' engagement in simulation for CPD. 28 Further research to optimize effectiveness and demonstrate the utility of simulation for CPD certainly has a role, such as examining technological advances (eg, mixed reality) or new techniques. However, doing so will be insufficient to increase physicians' engagement in simulation-based CPD, unless additional attention is directed toward the growing list of suggested explanations (other than effectiveness skepticism) for why simulation is poorly integrated in CPD.…”

“…With only four studies to draw on and several incentive-based studies on which loose inferences can be made, additional theory informed research is necessary. 28…”

“…To date, examination of these factors remains limited. 28 Broadening the kinds of research questions asked, by leveraging varied theoretical or conceptual frameworks, may provide meaningful insights into the underlying mechanisms that shape physician behaviors related to CPD. Some useful examples can be found in the CPD and simulation medical education literature.…”

“…27 Several theoretical frameworks (eg, implicit theories of intelligence, self-determination theory, theory of planned behavior, and identity theory) have been suggested as needed ways to broadly examine simulation based CPD. 28 Doing so may provide researchers with opportunities to investigate clinician's engagement of simulation for CPD in a number of ways. Gathering, reviewing, and summarizing the existing evidence on clinician's perspectives on simulation-based CPD may afford a better understanding of the "relationship" certified physicians entertain with simulation-based CPD (value attributed and why, reasons for engaging or not, inauspicious educational structures, etc.)…”

Recasting Assessment in Continuing Professional Development as a Person-Focused Activity

“…For example, attending to the social conditions of "appraisal" on practicing clinicians 54,55 or what assessment designs can mean for the person and subsequent implications 7,8 (eg, how simulation-based assessment can create feelings of apprehension about the discovery of areas of incompetence). 56 It may be necessary to take a broader approach in CPD and understand how people engage with assessments and the effects assessments have on that connection augmenting research that focuses on systems, utility, or quality.…”