Biomedical Engineering Reference
In-Depth Information
retained more efficiently than would be the case
with traditional teaching methods [3].
Incorporating crisis resource management
(CRM) may enable the students to consol-
idate knowledge, behaviors, interactions with
colleagues, attitudes and skills to achieve an
improved understanding of the significance of their
performance in general, and in particular, how
their performance impacts on patient safety and the
quality of healthcare they provide. A video-assisted
reflective process powerfully reinforces learning.
Crisis resource management courses demonstrate
the value of simulation in bridging the gap between
“knowing” and “doing” and keeping the focus on
patient safety [24-26].
to patient morbidity and simply preparing and
using airway equipment when indicated [31]. The
literature has supported the fact that students'
clinical experiences correlate with their level of
confidence in practical application of that experi-
ence. Hands-on clinical experience was found to
be the most important variable in building confi-
dence during patient encounters [31,32]. Fincher
and Lewis [33] support the relationship between
self-acknowledged competence and the frequency
of performing a given task or exercise. Due to
concerns of patient safety, students cannot be given
the freedom to manage a critically ill patient.
High-fidelity patient simulation offers an ideal
venue for replication of critical events that can
be managed without risk or harm to a patient by
using scenarios that are pre-programmed, may be
repeated, and videotaped in realistic re-creations
of dynamic clinical settings such in the commu-
nity setting, within a helicopter, ambulance, the
operating room, critical care unit, or emergency
department (Figures 20.5 and 20.6). Simulation
technology therefore presents educators with the
opportunity to assess students' performances using
standardized cases and to determine whether the
educational objectives set out in the curriculum
are being matched by performance in a clinical
setting. A more detailed analysis of the trainee's
performance, beyond simply the proper execu-
tion and completion of the CRM principles can
be beneficial for improving the student's under-
standing of patient care principles; fostering reflec-
tive learning through self-analysis of leadership
style and skills including cooperation and interac-
tion with peers, subordinates, and superiors; and
making appropriate personnel adjustments neces-
sary for optimum delivery of medical care within
a chaotic environment.
Further, many of the recognized shortfalls (e.g.,
knowledge deficits or decision making failures)
uncovered during simulation training may be a
useful focus for research in this new modality
of medical education [17,21,34]. This is partic-
ularly true as simulation based validation, certi-
fication, or privilege-based assessment increases
in frequency and acceptance in the medical
community.
20.7 Moulage vs. Mannequin Training
Training students in a simulated environment
without actual patients is a potential method of
teaching new skills and improving patient safety
[27]. In its current format, disaster and bioter-
rorism training (and testing) relies heavily on actors
as patients (moulage). The realism of a moulage
environment is limited by replication of acute
physiological alterations in a patient actor (i.e.,
diminished breath sounds, wheezing, tachycardia,
weak pulses [27]. Little literature is available to
answer the effectiveness question of “moulage” vs
mannequin simulator for training. Previous studies
have suggested that simulators could potentially
improve trauma training [28-30]. Lee et al. [27]
found that the clinical effectiveness of the simu-
lator was equal and in several areas, superior,
to patient actors in a trauma assessment training
testing format.
20.8 Medical Professionals: Little
Things Mean a Lot
Simple tasks can be erroneously performed,
forgotten, or neglected by the novice as well
as the experienced care provider. Calling for
help, performing a history/physical examina-
tion, confirming or even checking vital signs
before instituting aggressive treatment, discontin-
uing medications that are obviously contributing
