Practice makes perfect

Incorporating simulation into teaching and learning is part of a culture change

Judith Chrystal - 07 March 2017

The use of simulation in medical education is becoming engrained in the culture of how physicians learn, and the Department of Pediatrics is embracing the teaching technique in some innovative ways. While MD students and residents have many opportunities to interact with real patients, it's not always safe to practise all skills with them - nor does the opportunity to learn about less common scenarios present itself often enough for the learner to become proficient.

Dr. Jonathan Duff, pediatric critical care specialist and residency program director, sees local interest in simulation as part of a growing worldwide trend in medical teaching and learning. "It's no longer okay just to be competent - we want people to get to a level of mastery," he says. "We're hoping to make it part of the culture of pediatrics." And Duff has already been recognized as a bright light in this, receiving of the certificate of merit from the Canadian Association of Medical Education (CAME) for his commitment.

Simulation can take many forms, from learning to place an IV line into an orange or a plastic arm, to working with a standardized patient actor, or being in a crisis scenario with a realistic mannequin. Duff believes that learning to manage a crisis, work with a team, and improve communication and leadership skills are some of the things for which the technique is best suited. He emphasizes that, "The idea of simulation is that you need to be able to practise your skills, you can't just hear about something in a lecture or read about it in a textbook." With simulation, learners can practise over and over again - and receive valuable feedback in the process.

Most simulation is still in a classroom or workshop setting, but Duff has recently begun to provide just-in-time training in the pediatric intensive care unit with on-the-spot simulations that day to prepare the on-call overnight team for an anticipated scenario with a real patient. "The increase in confidence level is huge, because we can walk into a situation and say, 'I've done this before, and I've seen this before'."

For all the benefits realized, finding the time and space to set up and implement simulation can be a challenge. "I think acquiring and managing the resources is our biggest limitation," says Duff. "That's why we need to do the research and show if it's better than the way we are teaching it now - or, show that it doesn't work for some things and we'll put our energy elsewhere."

National and international research from the last few years is showing that simulation is better for learning in certain contexts and there is even data to suggest that the use of simulation versus traditional teaching is improving patient outcomes. Duff is currently leading two research projects (using simulation for high-stakes OSCE exams and traditional CPR instruction) and is involved in an international pediatric simulation research collaborative (INSPIRE) with over 50 countries that studies all facets of the technique.

This article comes from the 2015 Department of Pediatrics Annual Report.