Simulation training brings on the light-bulb moments

Students in a lab setting

Risk-free, hands-on practice crucial to medical education

By Keri Sweetman

Late one night in anesthesia resident Kristin Radtke's second year, she found herself responding to a complicated emergency call for a patient in respiratory distress. One glance told her that the situation- an unco-operative patient in recovery from recent surgery, with some serious medical complications-would be far more complex than the straightforward cases she'd encountered in textbooks.

Recalling that day, Radtke credits her simulation training in crisis resource management (CRM) for helping her manage a dynamic and dangerous situation. "Simulation practice in remaining calm and slowing down the mind, situational awareness, using material and human resources, communicating and decisiveness are the things that saved the day for me," she says.

Neil Gibson, Director of Simulation in the Faculty of Medicine & Dentistry until the end of 2018, has seen first-hand the power of crisis resource management training, where residents must simulate an operation while instructors add increasingly unpredictable and complicated factors. "We start with something relatively simple, then push people out of their comfort zone," he explains, "then do a facilitated debriefing, dissecting communication skills, crisis management skills and leadership."

Simulation isn't just about crisis training. Fairly early in medical school, students encounter basic task training with simulators for one-to-one procedures such as starting an IV or using an ultrasound machine. Every August before students head out for clinical placements, they take a two- week "link block" using simulation to polish their basic-task skills. There's also a move to involve more simulation in medical examination procedures, augmenting multiple choice, written and oral exams.

Applying clinical reasoning to learning scenarios

The radiation therapy clinical learning suite at the Cross Cancer Institute boasts an OSCE-informed linear accelerator, a procedure room and the audiovisual components required to record students' learning so they can be given informative feedback by instructors.

"The students absolutely love it," says Susan Fawcett, Director, Radiation Therapy program. "It's where everything comes together and where their 'aha' moments begin to happen. This is where the rubber meets the road. The students take everything they have learned in their theoretical courses and put it all together in the simulated environment."

What's new?

"We're going through a generational shift with respect to technology and how we approach medical education," Gibson says, "so it's no longer just the early adopters. Academic faculty, no longer just clinical faculty, are beginning to realize it needs to be part of their academic careers." To serve that need, Gibson is collaborating with Alberta Health Services to adapt existing AHS training modules into faculty development courses in simulation. His long- term plan involves working with IDEAS office Director Carol Hodgson to create a professional simulation certification for faculty and residents.