The Use of Simulation in the Development of Individual Cognitive Expertise in Emergency Medicine

Abstract

This consensus group from the 2008 Academic Emergency Medicine Consensus Conference, ''The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise,'' held in Washington, DC, May 28, 2008, focused on the use of simulation for the development of individual expertise in emergency medicine (EM). Methodologically sound qualitative and quantitative research will be needed to illuminate, refine, and test hypotheses in this area. The discussion focused around six primary topics: the use of simulation to study the behavior of experts, improving the overall competence of clinicians in the shortest time possible, optimizing teaching strategies within the simulation environment, using simulation to diagnose and remediate performance problems, and transferring learning to the real-world environment. Continued collaboration between academic communities that include medicine, cognitive psychology, and education will be required to answer these questions. ACADEMIC EMERGENCY MEDICINE 2008; 15:1037-1045 ª 2008 by the Society for Academic Emergency MedicineKeywords: simulation, cognitive, expertise, deliberate practice, competence, remediation E ducation in the specialty of emergency medicine (EM) covers the spectrum of learning, from simple knowledge acquisition to making complex decisions about the value of information.1 As such, it involves many teaching and learning strategies, of which simulation is just one possibility. Questions remain as to the best means of using simulation to achieve greater expertise. The discussion at the consensus conference was structured around a series of questions for future research pertaining to the use of simulation to further acquisition of expertise. This article aims to frame research questions surrounding this topic that are of highest priority and to discuss research techniques that may be applied to their solution.This discussion, in terms of both the literature cited and the breakout group members, draws from leaders in EM, cognitive psychology and education. It creates a plan for translational work from principles that have been tested in the psychological laboratory and others developed in educational theory to the simulation laboratory environment, including virtual or computerbased simulation. The underlying psychological and educational principles and assumptions will be explained within each section to the extent needed for clarity.We begin with the presumption that the relative youth of simulation training techniques in medicine leaves room for high-quality descriptive studies. Such studies should use good observational tools and be aimed at developing future hypotheses when such hypothesis testing is needed. 2 We also acknowledge the potentially bidirectional nature of translational research. That is, successful individuals or teams of EM

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