With the Simulation Summit fast approaching – November 8 to 9 in Vancouver, Canada – I thought it would be a good time to look at some key papers from the last 12 months on simulation in medical education.
#1. Sawyer T, A Sierocka-Castaneda, D Chan, B Berg, M Lustik, M Thompson. The effectiveness of video-assisted debriefing versus oral debriefing alone at improving neonatal resuscitation performance: a randomized trial. Simulation Healthcare. 7(4):213-21.
This RCT compared oral debriefing v. video-assisted debriefing, controlling for debriefing content and time on task. Blinded scoring of group performance on a subsequent scenario used a validated score. Both groups improved from scenario 1 to 2 without difference in scores between groups.
My $0.02: Looking past the methodology issues (sample size and potential type II error, contamination from clinical experience, the list continues but let’s not beat this study to death…), this is another study suggesting that fancy bells and whistles (i.e. video recording) add to the costs of education without contributing to the bottom line – learning!
#2. Norman G, K Dore, L Grierson. The minimal relationship between simulation fidelity and transfer of learning. Medical Education. 46(7): 636-647.
This narrative review (i.e. idiosyncratically selective – i.e. papers the authors found without describing the search strategy – i.e. a search strategy that is potentially biased and unsystematic) asks the increasingly economically-driven question – does high-fidelity simulation result in better performance outcomes than low-fidelity simulation? Reviewing 18 studies, the authors divide fidelity into: visual/tactile authenticity (i.e. is the simulation realistic to touch and feel); and psychological fidelity (i.e. does the simulation contain criticlal elements to mimic specific behaviours required of the task).
Compared to “nothing” high-fidelity simulation shows gains in performance and transfer to real patient care. (But this has been also show in systematic reviews. See here and here When compared to low fidelity simulation, the more resource-intensive high fidelity simulation has modest or limited benefit.
My $0.02: (I need to be careful here – the authors are colleagues!) The key instructional benefits of simulation are deliberate practice and mastery learning. Another colleague at McMaster has shown that a styrofoam cup and 2 McDonald straws are equivalent to an expensive (>$4000 CDN) high-fidelity simulator to teach urologists how to perform ureteroscopy.
It isn’t visual/tactile authenticity that improves learning via simulation, rather it is learning each step in sequence (mastery) and receiving feedback on repeated performance (deliberate practice) that is key.
So, how hard is it to get time in your simulation centre? Are you evaluating your current simulation budget and considering low-fi alternatives? Or, do certain competencies require high-fidelity simulation (e.g. crisis resource management)?
PS: Check back here in a few months when we’ll talk about a preferred nomenclature to low v. high fidelity. A friend’s paper is embargoed, so nothing from me until the publication date.
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