Training and Assessment of Trauma Management: The Role of Simulation-Based Medical Education

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Simulation-based medical education (SBME) 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. In this article, the authors describe the possible roles of simulated patients, skills trainers, computerized patient simulators, and web-based teaching in trauma training, and describe some practical aspects of using simulation for trauma training.

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)

  • M.A. Olympio et al.

    Failure of simulation training to change residents' management of oesophageal intubation

    Br J Anaesth

    (2003)
  • V. Chopra et al.

    Reported significant observations during anaesthesia: a prospective analysis over an 18-month period

    Br J Anaesth

    (1992)
  • R.S. Holzman et al.

    Anesthesia crisis resource management: real-life simulation training in operating room crises

    J Clin Anesth

    (1995)
  • G. Fletcher et al.

    Anaesthetists' Non-Technical Skills (ANTS): evaluation of a behavioural marker system

    Br J Anaesth

    (2003)
  • S.B. Issenberg et al.

    Simulation technology for health care professional skills training and assessment

    JAMA

    (1999)
  • A. Ziv et al.

    Patient safety and simulation based medical education

    Med Teach

    (2000)
  • Committee on Quality of Health Care in America, Institute of Medicine To err is human: building a safer health system....
  • C. Cohen

    The case for the use of animals in biomedical research

    N Engl J Med

    (1986)
  • The Israel National Institute for Health Policy and Health Services Research

    Curriculum for medical schools towards the 21st century

    (2002)
  • R.L. Helmreich et al.

    Anaesthetic simulation and lessons to be learned from aviation

    Can J Anaesth

    (1997)
  • Ende J. Feedback in clinical medical education. JAMA...
  • L. Rooks et al.

    A primary care preceptorship for first-year medical students coordinated by an area health education center program: a six-year review

    Acad Med

    (2001)
  • H.T. Østergaard et al.

    Implementation of team training in medical education in Denmark

    Qual Saf Health Care

    (2004)
  • M.A. Papadakis

    The step 2 clinical skills examination

    N Engl J Med

    (2004)
  • J. Ali et al.

    Comparison of performance of interns completing the old (1993) and new interactive (1997) Advanced Trauma Life Support courses

    J Trauma

    (1999)
  • D. Ost et al.

    Assessment of a bronchoscopy simulator

    Am J Respir Crit Care Med

    (2001)
  • T.P. Grantcharov et al.

    Randomized clinical trial of virtual reality simulation for laparoscopic skills training

    Br J Surg

    (2004)
  • B.D. Eaton et al.

    Animal cadaveric models for advanced trauma life support training

    Ann R Coll Surg Engl

    (1990)
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