Introduction

Simulation is the act of mimicking a real object,

event or process.”

“Simulation is a person, device or set of

conditions which present evaluation problems
authentically. The student responds to the
problems as they would under natural
circumstances.”
 Introduction
Characteristics
Cues and consequences are like reality
Situations can be complex
Fidelity (exactness of duplication) is not perfect
Feedback to users questions, decisions, and actions.
Harvey
 Introduction
Why is simulation important in medical education?

Problems with clinical teaching

New technologies for diagnosis/treatment
Assessing professional competence
Medical errors and patient safety
Deliberate practice
 Available Simulation Equipment
Standardized Patients
Improvised Technology
Screen Based Simulation
Task Trainers
Low/Mid/High Fidelity Mannequins
Virtual Reality
 Standardized Patients
Individuals trained to portray specific illness or
behavior in a realistic and consistent manner for the
purposes of teaching or assessment.
Used in classroom setting, or without knowledge in
clinical setting
Especially useful to teach and assess communications
and professionalism competencies in a standardized
method.
 Standardized Patients
Initially started in the 1980’s
Now - Association of Standardized Patient Educators
http://www.aspeducators.org/sp_info.htm
Required Clinical Skills testing for all students
USMLE Part II CS exam

Univ of South Florida standardized patient

 Standardized Patients
Strengths
Can consistently reproduce clinical scenario for
standardized testing of learners
Ability to assess rare conditions not otherwise reliably
seen
Patients trained to provide objective & accurate feedback
Can use in real settings (arrive at office/ED as ‘real’
patient for realistic environment)
 Standardized Patients
Weaknesses
Little research on effectiveness
Most studies are from preclinical medical school
education
Few studies done with residents or practitioners
and nearly all have small numbers (15-50)
Cost to pay & time to teach standardized patients
Quality of experience heavily dependent upon
training of the patient and scenarios developed
 Improvised Technology
Models made of easily available items
Closely mimic human tissue
Allow for near replica of actual procedural steps
Generally used for instruction of procedures
Commonly used examples
Slab of ribs to teach insertion of chest tubes
Pigs feet or head for suturing practice
Other examples in the literature
Jello for vascular model
Lasagna for split skin graft harvesting
Animal Models
 Examples – Vascular model

A = Sock skin
B = Film canister for support
C = Foam curler connective tissue
D = Straw vessel
 Screen Based Simulation
Laerdal Microsim
www.Anesoft.com
ACLS
Critical Care
Anesthesia
Sedation
Neonatal
 Task Trainers
Devices designed to simulate a specific task or
procedure.
Examples:
Lap simulator
Bronch simulator
“Traumaman”
Artificial knee
Task Trainers
 Task Trainers
Strengths
High fidelity, good research on efficacy, may have self
guided teaching, metrics available

Weaknesses
Poor haptics on most machines, expensive, focus on
single task, not integrated into complete patient care
 Low Fidelity Mannequins
Examples
●
 Mid Fidelity Mannequins
Relatively new class of mannequins, often used for
training.
Features:
Active airways – ETT, LMA, Combitube
Breathing/pulses, rhythms
Basic procedures – pacing, defibrillation
Some automated response and programmed
scenarios
 Mid Fidelity Mannequins
Strengths:
Active airways, somewhat interactive, moderate cost,
moderate portability
Weaknesses:
Semiskilled instructor, limited advanced procedures
(lines, chest tubes)
Features
 High Fidelity Mannequins
Strengths
Many dynamic responses, preprogrammed
scenarios, widest variety of procedures, most
immersive.

Weaknesses
Cost, procedures are not very realistic, reliability, lack
of portability, significant instructor training required.
 High Fidelity Mannequins
Strengths
Many dynamic responses, preprogrammed scenarios, widest
variety of procedures, most immersive.

Weaknesses
Cost, procedures are not very realistic, reliability, lack of
portability, significant instructor training required.
 Virtual Reality
Advanced form of human-computer interaction
Allow humans to work in the computer’s world
Environment understandable to us
Four necessary components
Software
Hardware
Input devices
Output devises
Input and Output devices
 Virtual Reality
Types of VR applicable to medicine
Immersive VR
Desktop VR
Pseudo-VR
Augmented reality
Immersive VR
Desktop VR
Pseudo-VR
Augmented Reality
 Best Teaching Practices
Screen based teaching with feedback is better than self
study.
Comparing simulation to other teaching modalities
demonstrates some slight advantages.
Simulation can be an effective replacement for live practice
for some skills.
Learner centered teaching with simulation.
Cheap may be as good as expensive.
Team behavior can be effected by focused simulation
experiences.
Innovative use of two new technologies helps to engage
learners in a large group setting.
Task trainers appear to be a valid method for assessing
procedural competence.
Multiple simulated encounters are needed to accurately
assess resident abilities.
 Best Teaching Practices
Orientation
Introduction to session
Expectations
What is real/what is not
Self assessment
Debriefing
Evaluation

There are many aspects of human knowledge/skills/attitudes

to assess and the correct tool must be used for each one.

”Softer” competencies like professionalism can be assessed

with the aid of simulation technology.
 How To Best Use Simulation
Provide feedback
Give opportunities for repetitive practice
Integrate simulation into overall curriculum
Provide increasing levels of difficulty
Provide clinical variation in scenarios
Control environment
Provide individual and team learning
Define outcomes and benchmarks
 Best Assessment Practices
●Determine what you want to assess.
●Design a simulation that provokes this performance.

●Observe/record the performance.

●Analyze the performance using some type of rubric: checklist, GAS,

etc.
●Debriefing, feedback and teaching.
 Summary

Simulation is one tool

(new, expensive and exciting)
in our educational repertoire.
(Similar to lecture, case discussion, skill lab, MCQ, SP,
etc.)
 Summary
Provide feedback
Give opportunities for
repetitive practice
Integrate simulation into
overall curriculum
Provide increasing levels of
difficulty
Provide clinical variation in
scenarios
Control environment
Provide individual and team
learning
Define outcomes and
benchmarks
Determine what you want to
assess.
Design a simulation that
provokes this performance.
Observe/record the
performance.
Analyze the performance
using some type of rubric:
checklist etc.
Debriefing, feedback and
teaching.
Making Simulation Business Relevant
• Framework from the
‘Engineering
Manager’s S urvival
G uide’ eBook
• Early Findings from
the ‘Measuring the
Value of S imulation’
Study

42
1/28/14

The Engineering Manager’s Survival Guide

– Five Trends Shaping

Modern Engineering
– Five Initiatives for Today’s
Engineering Manager
– Six Technology Categories
to Enable Initiatives
Five Trends Shaping Modern Engineering

Profitable Growth and Engineering

Staffing
The Visibility Mandate for
Engineering Operations
The Expanding Role of the Modern
Engineer
The Increasing Volatility of
Engineering Work
The Coming War for Engineering
Talent

44
 Five Initiatives for Today’s Engineering
Manager

Agile Product Development

Processes
Engineering Knowledge
Management
Just in Time Engineering
Right the First Time Principle
Talent Management Strategy

45
Six Technology Categories to Enable
Initiatives
Design and Simulation
Engineering Collaboration
Engineering Guidance
Product Lifecycle
Management
Talent Management
3D Visualization

46
Mapping Trends to Initiatives

Trends
Profitable Growth and Engineering Staffing

The Visibility Mandate for Engineering

Operations
The Expanding Role of the Modern Engineer

The Increasing Volatility of Engineering Work

The Coming War for Engineering Talent

Initiatives
Agile Product Development Processes

Engineering Knowledge Management

Just in Time Engineering Practices

The Right the First Time Principle

Talent Management Strategy

Mapping Initiatives to Technology

Initiatives
Agile Product Development Processes

Engineering Knowledge Management

Just in Time Engineering Practices

The Right the First Time

Principle
Talent Management
Strategy

Technolog y C ateg ories

Design and Simulation

Engineering Collaboration

Engineering Guidance

Product Lifecycle
Management
Talent Management

3D Visualization
Early Findings
 Measuring the Value of Simulation Study

• About the research study

– Survey-based study
– Statistics will be used to publish an info-graphic
research report, made available to participants
• Includes questions on how simulation is valued
as well as organizational characteristics
• Early findings

50
Question #1: In which of the following aspects of product
development does your organization use simulation?

Larger orgs concentrated on

front end with simulation

Smallest orgs aren’t using

simulation as much

51
Question #2: Simulation is used in which of the
following activities in your organization?

66%
63%
48%

52
Question #3: Which of the following simulation
advantages are realized by your organization?

Have metrics been formally defined and tracked as a way to measure the
value of simulation? 38% YES

53
Question #4: Which of the following simulation
advantages are realized by your organization?

54
Question #5: Which of the following best describes the attitude of your
organization’s leadership towards simulation.

55
Question #6: Simulations are used to validate designs before next
steps such as prototyping, testing or design release

56
Question #7: Simulation results affect and
influence design decisions

57
 Question #8: Simulation generates design alternatives or
improvements through optimizations or design of experiments

58
 Takeaways from Early Findings
• Biggest cited advantage @ product performance. BE
CAREFUL. Quantify it.
• Understand how sim affects your company’s business
model (contract or prospective).
• Bigger orgs should consider using sim more broadly.
Smaller orgs should use sim more consistently.
• Orgs that see sim as essential use them more frequently in
testing / prototyping and apply them EVERY TIME.

59
THANK YOU