Those of us in the simulation community know well that when used appropriately and effectively simulation allows for amazing learning and contributes to students and providers of healthcare improving the craft. We also know there is very little published literature that conclusively demonstrates the “right way to do it”.
Yet in the scholarly literature there is still a struggle to define best practices and ways to move forward. I believe it is becoming a rate limiting step in helping people get started, grow and flourish in the development of simulation efforts.
I believe that part of the struggle is a diversity of the mission of various simulation programs ranging from entry level students to practicing professionals, varying foci on individualized learning incompetence, versus and/or team working communications training etc. Part of the challenges in these types of scholarly endeavors people try to describe a “one-size-fits-all“ approach to the solution of best practices. To me, this seems ridiculous when you consider the depths and breadth of possibilities for simulation in healthcare.
I believe another barrier (and FINALLY, the real point of this blog post 🙂 is trying to overly theorize everything that goes on with simulation and shooting down scholarly efforts to publish and disseminate successes in simulation based on some missing link to some often-esoteric deep theory in learning. While I believe that attachments to learning theory are important, I think it is ridiculous to think that every decision, best practice and policy in simulation, or experimental design, needs to reach back and betide to some learning theory to be effective.
As I have the good fortune to review a significant number simulation papers it is concerning to me to see many of my fellow reviewers shredding people’s efforts based on ties to learning theories, as well as their own interpretations on how simulation should be conducted. They have decided by reading the literature that is out there (of which there is very little, if any, conclusive arguments on best practices) has become a standard.
My most recent example is that of a paper I reviewed of a manuscript describing an experimental design looking at conducting simulation one way with a certain technology and comparing it to conducting the simulation another way without the technology. The authors then went on to report the resulting differences. As long as the testing circumstances are clearly articulated, along with the intentions and limitations, this is the type of literature the needs to appear for the simulation community to evaluate and digest, and build upon.
Time after time after time more recently I am seeing arguments steeped in theory attachments that seem to indicate this type of experimental testing is irrelevant, or worse yet inappropriate. There is a time and place for theoretical underpinnings and separately there is a time and place for attempting to move things forward with good solid implementation studies.
The theory wonks are holding up the valuable dissemination of information that could assist simulation efforts moving forward. Such information is crucial to assist us collectively to advance the community of practice of healthcare simulation forward to help improve healthcare globally. There is a time to theorize and a time to get work done.
While I invite the theorist to postulate new and better ways to do things based on their philosophies, let those in the operational world, tell their stories of successes and opportunities as they are discovered.
Or perhaps it is time that we develop a forum or publication of high quality, that provides a better vehicle for dissemination of such information.
So…… in the mean time….. beware of the theory wonks. Try not to let them deter from your efforts to not only move your own simulation investigations forward, but to be able to disseminate and share them with the rest of the world!
All too often it is easy to be stuck in a mindset which can create tunnel vision. One of those time frames in the simulation world can come from an overall short-sightedness, into the usefulness, power, wisdom and change that can result from well-run simulation efforts. Many people have heard the adage “with simulation is within the debriefing that all the learning occurs.” While phrases like this are meant to underscore the importance of the debriefing following a simulation if they are taken too literally they can result in a lack of recognition of total value of the simulation program investments and contributions.
