Training and elearning

Simulation and elearning: the ideal partnership?

Advances in technology have led to opportunities for different methods of teaching and training. This paper explores the combination of two of these new technology-based educational methods: anatomical simulation and screen-based learning.

Simulation in all its forms is now well established in medical education. A wide range of techniques and equipment is in use. Various classification models have been used to structure this field, the simplest dividing simulation into its anatomical and screen-based forms.

Anatomical simulation

Anatomical simulation uses models or dummies of human anatomy — at their most simple, synthetic arms for training in blood or venous cannulation. ‘Part-task trainers’ such as these are commonplace in all clinical-skills laboratories. More complex models, or mannequins, meanwhile, can simulate a complete human (pictured) and have advanced greatly in complexity in recent years. At the top end of the spectrum, ‘high-fidelity’ mannequins are computer driven and can exhibit realistic clinical signs and symptoms. Their response to treatment can also be very realistic and occur in real time.

Over the last decade a growing number of centres have used high-fidelity mannequins for teaching training.1 The most elaborate use of these mannequins is what is called high-fidelity platform simulation. Here the mannequin is placed in a realistic setting — for example an operating theatre — and surrounded by real equipment and people.

The manage­ment of the medical problem is then carried out under the typical pressures found in reality, otherwise known as ‘immersion simulation’. The expectation is that participants will perform at least to some degree as they would in real life. These ‘scenarios’, as they are called, are filmed and watched by the trainers and colleagues of the participants. After the scenario is finished the group meets to discuss and reflect on all aspects of what happened.

It is generally agreed that the delivery of successful healthcare in the acute setting requires a combination of sound medical and technical knowledge with a range of behavioural skills such as communication, time management and leadership. All these issues can be tackled using this form of simulation training.2

Efficacy of anatomical training

Though this method is not yet scientifically validated (the validation process being by definition highly complex and difficult), the large body of feedback gleaned through face validation has been hugely positive. Despite the relatively high costs of this type of training and the limit on the number of students that can realistically be trained at any one time, an increasing number of resources are being directed towards this approach, though with educational budgets increasingly limited, this may not always be possible.

Screen-based training

As the sophistication of computer software has developed, so has the complexity of screen-based learning material. Interactive screen-based teaching modules are now common in medical curricula, many with an element of simulation. With the increasing availability of the Internet, these modules are flooding the educational market under the umbrella of elearning. There are obvious advantages of this method in terms of the easy access to a massive body of material, but its content and quality, however, is sometimes open to question.

Though the elearning experience is very much under the control of the user — a positive thing in many respects — this kind of individual experience may have a down side. Medical educationalists worry that the inevitable endpoint could be the loss of the collegiate structure to medical education. The experience of group learning is thought to be an important part of the educational experience. In fact healthcare professionals, more than most, require the development of social skills learnt through interaction with colleagues.

Elearning modules are now being developed that are based on high-fidelity platform simulation.3 These modules provide an interactive experience where the user can examine both medical and technical knowledge as well as aspects of social interaction and behaviour.

The educational experience is obviously different from that of the immersion simulations described above, but in terms of cost effectiveness there may be clear advantages.

There is clearly potential for students to review their own participation in simulation courses and therefore be able to further reflect on their experience.

In summary, the scope for elearning in medical education looks set to expand rapidly, and simulation has an important role to play in this. It is therefore vital that the educational community strives to validate both these modalities and thus ensures that vital resources are not misdirected.

Dr Kevin Haire is Director of Medical Simulation at the Chelsea & Westminster Hospital.

References

1. McFerich J. A structured literature review on the use of high fidelity patient simulators for teaching in emergency medicine. Emerg Med J 2006; 23(7): 509–11.
2. Gaba DM, Howard SK, Fish KJ, Smith BE, Sowb YA. Simulation-based training in anaesthesia crisis resource management (ACRM): a decade of experience. Simulation Gaming 2001; 32: 175–93.
3. British Medical Journal Learning Foundation Programme.
   www.bmjlearning.com/foundation/index.htm