Okay, admit it, this title will be challenging for some. Although the converse of the question is what some of the naysayers say about simulation. What’s the real deal? The real deal is learning from real patients is an invaluable part of the healthcare education experience. At the risk of alienating some we must think of the real patient experience as a “tool” in the educational toolbox. But there are many tools in the toolbox!
We must also recognize the value of learning in the simulated environment as an additional tool in the toolbox. When we have many different tools by which to complete a goal, going through the risks and benefits of each will help us make the proper decisions to allow us to proceed with the most efficiency and effectiveness in our educational endeavors.
When I observe aspects of examples of learning in the clinical environment I become easily frustrated with seeing examples of colossal amounts of time wasted while waiting for some nugget of education to randomly appear in the clinical environment. Paramedic and nursing students working in the clinical environment that are changing bed linens over and over again are clearly being used as a service to someone and not functioning in a capacity that is enhancing their clinical learning. Similarly interns that may be on a specialty care service that are dictating their 30th discharge summary of the month are probably being used more in a service capacity than one in an environment that enhances their education.
Some of the advantages of simulation include being able to structure the learning environment so that the time can be accounted for in a more robust fashion that helps to ensure that valuable learning opportunities are presented, encountered or participated in. Additionally the ability to do and re-do exist in the simulated environment, where as in most cases this is not possible in the actual clinical care environment. This is important to enhance and create programs of mastery learning with incorporated deliberate practice. And this applies whether we are talking about individual expertise or that of groups of people working on collaborative goals in team training environment. Additionally, in many simulation program designs there is much closer oversight of what a learner or groups of learners is/are accomplishing in the simulated environment when compared to the oversight that occurs in most clinical learning environments.
Please don’t misunderstand; I am not trying to diminish the value of learning on real patients in the clinical environment. I am merely stating that there are pros and cons, limitations and capabilities of all different modalities of learning as we bring people along the journey of what it takes to become a practicing healthcare professional. It is one that is complex that requires multiple repetitions from different vantage points, perspectives, as well as opportunities for learning. Carefully evaluating those opportunities, the resources that are available in a given program are important concepts to ensure that we continue to improve the health care education for creating tomorrow’s healthcare providers.
Those who are in the capacity of creating new curriculum or revamping and revising old, would do well to think broadly about the needs of the learner, the level of learner and what would be optimal exposure to create the most efficient and effective learning at that point in time. We need to begin to challenge the existing status quo so that we can truly move forward in revising healthcare education to continue to allow people to achieve excellence.
Beautifully said! Thank you, Dr. Phrampus!
Should we begin by asking what scaffold do they need for each step along the way? What specific learning experiences do learners need to reach certain competencies? Have I failed this thinking process before when I have thrown learners into challenging simulations that they struggled? OR have I contributed to their self-awareness and activated them to pursue? These are questions I believe we will need to answer through program evaluation and sharing research that answers these questions. As a profession, we will have to do a better job at publishing specifics within and about our educational program evaluation and research. Thanks for stimulating great conversation Paul Phrampus!
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