The Utility of Simulation in Medical Education: What Is the Evidence?

Abstract

Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes.

Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula

“…Over the past 20 years, simulation-based medical education (SBME) has become a frequently used asset in undergraduate medical education [36]. The benefits of SBME are well known, but most importantly, is its ability to provide medical students with repeatable clinical experiences that avoid patient harm [37].…”

Simulation-based medical education in clinical skills laboratory

“…The benefit of SBME is that simulation training offers both learners and patients a safe environment for practice and error (3,5). A public magazine of University of Texas Houston Medical School introduced the message "No patients were harmed in the making of this physician" by Darla Brown as a slogan of a new skills laboratory (17).…”

Role of Simulation in US Physician Licensure and Certification

“…Although simulation-based education and evaluation are used extensively for specialty-specific residency training, 40 only 2 specialty boards, anesthesiology and surgery, have required their use for primary certification, and few have adopted or required its use for MOC activities. Currently, only the American Board of Anesthesiology (ABA) requires participation in a simulation-based educational course for recertification.…”