Training and Assessment of Trauma Management: The Role of Simulation-Based Medical Education
Section snippets
Simulation-based medical education
Simulation-based medical education (SBME) is a rapidly growing field in the training of health professional and medical teams [1], [2]. Important driving forces for the integration of SBME in formal curriculum and evaluation include, among others
Demands to minimize risks to patients by optimizing the use of simulation-based training that avoids exposing patients to unnecessary risk [3]
Demands by animals' rights movements to avoid the use of live animals for training health care providers [4]
Simulated patients
Objective Structured Clinical Examination using standardized simulated patients is a widely used model of medical education [1], [2]. Using this tool, trainees are trained and evaluated on their ability to a take patient history, perform a physical examination, communicate with the patient, and suggest appropriate treatment options. This simulation modality is used widely by medical and nursing schools and by medical boards worldwide, including the National Board of Medical Examiners in the
Skills training
The use of task training simulators for the teaching of technical skills has become common in many fields of medicine, and demonstrates a reasonably good transfer of skills from models to humans [16], [17], [18], [19]. In the training of trauma care, various skills trainers are used for teaching novices trauma-related procedures like chest drain insertion, cricothyroidotomy, and focused abdominal sonography for trauma (FAST). The emergency insertion of a chest drain for tension pneumothorax or
Computerized patient simulators
Computerized patient simulators, based on a mannequin connected to a physiologic monitor and run by a computerized system located in the relevant clinical environment, can be programmed for diverse clinical scenarios and can permit a safe and reproducible training environment. This type of simulation-based training requires physicians to identify problems and provide solutions, as if it were a real emergency situation (ie, infuse fluids, perform orotracheal intubation, or insert a thorax
Team training
One of the major applications of SBME in the training of trauma management is its use in team training. Although surgical, anesthesiology, and emergency medicine trainees receive feedback on their technical performance from their trainers, they rarely receive feedback on their nontechnical or team skills. The importance of nontechnical skills is highlighted by data from aviation, demonstrating that 70% of errors have human causes and that a large number of errors are a result of failures in
Web-based teaching
In any modality of SBME, it is useful to provide participants with associated theoretic material in advance of their simulation-based training, to achieve a more homogeneous group by triggering prior knowledge, and stressing important learning points [11]. One of the options is to use web-based teaching tools, such as the “HighLearn” [57], to facilitate learning the cognitive knowledge relevant for training, while incorporating tasks and examinations for the trainees.
Practical aspects
SBME is used increasingly for training medical personnel in trauma care. It is important to recognize the broad spectrum of simulation modalities and devices and to use simulation in a cost-effective manner, while recognizing the SBME's limitations and adjusting the training program and the simulation tools to the target population and the educational goals. Simulation technologies should supplement, not replace, the traditional methods of teaching cognitive knowledge. For example
The cognitive
Summary
Simulation-based medical simulation offers a safe and “mistake-forgiving” environment to teach and train medical professionals. The diverse range of medical simulation modalities enables trainees to acquire and practice an array of tasks and skills. SBME offers the field of trauma training multiple opportunities to enhance the effectiveness of the education provided in this challenging domain. Further research is needed to better learn the role of simulation-based learning in trauma management
References (57)
- et al.
A comprehensive examination for senior surgical residents
Am J Surg
(2000) - et al.
Evaluation of high fidelity patient simulator in assessment of performance of anaesthetists
Br J Anaesth
(2003) - et al.
Clinical impact of advanced trauma life support
Am J Emerg Med
(2004) - et al.
Comparison of performance two years after the old and new (interactive) ATLS courses
J Surg Res
(2001) - et al.
Assessment of technical skills transfer from the bench training model to the human model
Am J Surg
(1999) - et al.
A valid method of laparoscopic simulation training and competence assessment
J Surg Res
(2003) - et al.
Analysis of tube thoracostomy performed by pulmonologists at a teaching hospital
Chest
(1997) - et al.
Prehospital cricothyroidotomy by physicians
Am J Emerg Med
(1997) - et al.
Trauma mannequin assessment of management skills of surgical residents after advanced trauma life support training
J Surg Res
(2000) - et al.
Does training on an anaesthesia simulator lead to improvement in performance?
Br J Anaesth
(1994)