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Faking It

By Jock Hoffman, CRICO

Related to: Communication, Emergency Medicine, Obstetrics, Surgery, Teamwork Training


The original simulation mannequin—Resusci Anne, who debuted in CPR classes almost 50 years ago—now shares the training stage with dozens of more life-like mannequins in more realistic settings. With skilled instructors running authentic scenarios, simulation-based medical training has passed from a curiosity to a training necessity. Medical students, residents, and attending physicians are able to try new equipment, learn new techniques, practice new (or rusty) procedures, make mistakes, and learn from those mistakes, with no risk to patients or providers.

Allegations of inadequate technical skill are made in about one-third of all claims filed against CRICO-insured providers over the past 10 years—and in 43 percent of cases naming a surgeon. With more than $105 million in incurred losses at stake, CRICO/RMF and the Harvard medical community are working to reduce errors that might be prevented through simulation-based training and practice. Indeed, simulation has become a mainstream component of medical skills development and retention.

Harvard Medical School and numerous other U.S. and foreign academic institutions have whole-heartedly adopted simulation-based training, not only for technical mastery, but also for improving teamwork and leadership skills. As mandates, requirements, and accreditation drive demand, the competition for training resources, equipment, and expertise will, no doubt, accelerate. Accrediting organizations and professional societies are also jumping aboard: ACGME, the American College of Surgeons, and the Society for Simulation in Healthcare are leading the push for setting standards or establishing accreditation processes for simulation-based training.

Our Recommendation

Does it work? Hard evidence that simulation improves patient outcomes and/or reduces adverse events is not available…yet. We think that what seems intuitive about simulation-based training (i.e., practice improves performance) will be borne out with statistical credibility. In the meantime, more important than “does it work?” is which program will work for you?

Simulation is employed in many forms and environments, everything from two individuals sitting in chairs role playing to a multi-station high-tech surgery skills center. But the scripts, computers, and patient mannequins are only the props. Truly effective simulation-based training is dependent upon the fact-based scenarios played out by a cast of real participants (except for the artificial patient).

Harvard Medical School and its affiliated institutions offer a broad range of simulation-based programs and skills training centers across multiple locations, disciplines, and curricula. We encourage you to seek out a program that simulates what you actually experience (or expect) in your day-to-day practice, one that will enable you to learn and hone the skills—technical or cognitive—that you will need in order to provide safe and effective patient care.

Additional Materials

Vozenilek J, Huff S, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med.2004;11(11):1149-54.

Patow CA. Advancing medical education and patient safety through simulation learning. Patient Safety & Quality Healthcare. March/April 2005.

July 1, 2007
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