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Using Simulation-Based Education to Improve Residents’ Clinical Decision Making Skills in Developing Countries

Yıl 2016, Cilt: 10 Sayı: 2, 96 - 104, 14.06.2016
https://doi.org/10.5455/tjfmpc.215600

Öz

Background: Recently, a significant increase occured in the use of medical simulation technology for teaching and assessment. Improved patient safety during medical education has driven simulation-based education (SBE), particularly in resident education. Although many countries have integrated SBE into their undergraduate programs, some developing countries, including Turkey, have been slow to apply SBE into their graduate programs. We propose a review of existing examples of SBE used which may promote the implementation of similar curricula in developing countries. Methods: To derive a representative sample of relevant curricula, we performed a web-based literature review using the search terms “simulation” and (“ graduate, resident”) and (“clinical decision-making” or „„clinical reasoning”) and “training‟‟. Results: Of the 83 original articles, ten resulting articles were relevant to SBE used to support residents‟ clinical decision-making in six clinical areas. We summarize the ten curricula and discuss them in the context of three primary considerations (course administration, content development, and assessment program evaluation) so they may be applied in similar graduate curricula in Turkey and others.Conclusions: It is obvious that simulation-based education offers benefits. In particular, graduate-level training programs used to support clinical decision-making are critical to the development of competent physicians around the world.

Kaynakça

  • Laschinger S, Medves J, Pulling C, McGraw DR, Waytuck B, Harrison MB, et al. Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction. Int J Evid Based Healthc 2008 Sep;6(3):278–302.
  • Scalese RJ, Obeso VT, Issenberg SB. Simulation technology for skills training and competency assessment in medical education. J Gen Intern Med 2008 Jan;23(1): 46–49.
  • Gordon J. Fostering students’ personal and professional development in medicine: a new framework for PPD. Med Educ 2003 Apr;37(4):341–9.
  • Boshuizen H, Schmidt HG. On the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices. Cog Sci 1992;16(2):153–184.
  • Kramer AW, Jansen JJ, Zuithoff P, Tan LH, Grol LP, van der Vleuten C.P.M. Predictive validity of a written knowledge test of skills for an OSCE in postgraduate training for general practice. Med Educ 2002 Sep;36 (9):36:812–9.
  • Eckleberry-Hunt J, Tucciarone J. The Challenges and Opportunities of Teaching ‘‘Generation Y’’. J Grad Med Educ 2011 Dec;3(4):458-61.
  • Monaco M, Martin M. The millennial student: A new generation of learners. Athletic Train Educ J 2007;2(Apr– Jun):42–46.
  • Twenge JM . Generational changes and their impact in the classroom: teaching generation me. Med Educ 2009 May;43(5):398–405.
  • Croasdale M. Med schools adjusting to millennial students: Educators look for ways to build on new scholars’ perceived strengths in technology, optimism and team-building. Am Med News 2008 Jan.
  • Sandars J, Morrison C. What is the net generation? The challenge for future medical education. Med Teach 2007 Mar;29(2-3):85–88.
  • Kuh GD. What we're learning about student engagement from NSSE: Benchmarks for effective educational practices, change. The Magazine of Higher Learning 2003;35(2):24-32.
  • Mıdık Ö, Kartal M. Simulation based medical education. Marmara Medical Journal 2010;23(3):389–399.
  • DiLullo C, McGee P, Kriebel RM. Demystifying the millennial student: A reassessment in measures of character and engagement in professional education. Anat Sci Educ 2011 July-August;4(4):214-26.
  • Weimer M. Millennial students: They aren’t all the same. The Teaching Professor 2012;26:3-8.
  • Irby DM, Cooke M, O'Brien BC. Calls for reform of medical education by the Carnegie Foundation for the advancement of teaching: 1910 and 2010. Acad Med 2010 Feb;85(2):220–7.
  • Rodriguez-Paz JM, Kennedy M, Salas E, Wu AW, Sexton JB, Hunt EA, et al. Beyond "see one, do one, teach one": toward a different training paradigm. Qual Saf Health Care 2009 Feb;18(1):63-8.
  • Gordon JA, Hayden EM, Ahmed RA, Pawlowski JB, Khoury KN, Oriol NE. Early bedside care during preclinical medical education: Can technology-enhanced patient simulation advance the flexnerian ideal? Acad Med 2010 Feb;85(2):370–377.
  • http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexner_Report.pdf. erişim tarihi: 20.11.2009
  • Tatar M , Kanavos P. Health care reform in Turkey. Health Policy Developments , Eurohealth 2006;12(1):20–22.
  • McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Med Educ 2014 Apr;48(4):375-85.
  • Gordon JA. The human patient simulator: acceptance and efficacy as a teaching tool for students. Medical Readiness Trainer Team. Acad Med 2000 May;75(2):522.
  • McGregor CA, Paton C, Thomson C, Chandratilake M, Scott H. Preparing medical students for clinical decision making: a pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention. Med Teach 2012;34(7):508-17.
  • Ziv A, Wolpe PR, Small SD, Glick S. Simulation based medical education: an ethical imperative. Acad Med 2003 Aug;78(8):783–8.
  • Okuda Y, Bryson EO, DeMaria S Jr, Jacobson L, Quinones J, Shen B, et al. The utility of simulation in medical education: what is the evidence. Mt Sinai J Med 2009 Aug;76(4):330–43.
  • Shafer S, Rooney D, Schumacher R, Chapman R, House J. Neonatal lumbar punctures: bridging the clinical gap. MedEdPortal Publications 2013.
  • Levine AI, Swartz MH. Standardized patients: the "other" simulation. J Crit Care 2008 Jun;23(2):179-84.
  • Grall KH, Stoneking LR, DeLuca LA, Waterbrook AL, Pritchard TG, Denninghoff KR. An innovative longitudinal curriculum to increase emergency medicine residents' exposure to rarely encountered and technically challenging procedures. Adv Med Educ Pract 2014 Jul 17;5:229-36.
  • Lee MO, Brown LL, Bender J, Machan JT, Overly FL. A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation. Acad Emerg Med 2012 May;19(5):577–85.
  • Okuda Y, Godwin SA, Jacobson L, Wang E, Weingart S. SimWars. J Emerg Med 2014 Nov;47(5):586-93.
  • Mathai SK, Miloslavsky EM, Contreras-Valdes FM, Milosh-Zinkus T, Hayden EM, Gordon JA, et al. How we implemented a resident-led medical simulation curriculum in a large internal medicine residency program. Med Teach 2014 Apr;36(4):279–83.
  • Cohen ER, Barsuk JH, Moazed F, Caprio T, Didwania A, McGaghie WC, et al. Making july safer: simulation-based mastery learning during intern boot camp. Acad Med 2013 Feb;88(2):233-9.
  • Butter J, McGaghie WC, Cohen ER, Kaye M, Wayne DB. Simulation-based mastery learning improves cardiac auscultation skills in medical students. J Gen Intern Med 2010 Aug ;25(8):780–785.
  • Barsuk JH, Cohen ER, Vozenilek JA, O’Connor LM, McGaghie WC, Wayne DB. Simulation-based education with mastery learning improves paracentesis skills. J Grad Med Educ 2012 Mar;4(1):23–27.
  • Barsuk JH, Cohen ER, Caprio T, McGaghie WC, Simuni T, Wayne DB. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology 2012 Jul 10;79(2):132–137.
  • Schroedl CJ, Corbridge TC, Cohen ER, Fakhran SS, Schimmel D, McGaghie WC, et al. Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: A randomized trial. J Crit Care 2012 Apr ;27(2):219.e7–13.
  • Szmuilowicz E, Neely KJ, Sharma RK, Cohen ER, McGaghie WC, Wayne DB. Improving residents’ code status discussion skills: A randomized trial. J Palliat Med 2012 Jul;15(7):768–774.
  • Sam J, Pierse M, Al-Qahtani A, Cheng A. Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes. Paediatr Child Health 2012 Feb;17(2):e16-20.
  • Kellicut DC, Kuncir EJ, Williamson HM, Masella PC, Nielsen PE. Surgical team assessment training: improving surgical teams during deployment. Am J Surg Endosc 2014 Aug;208(2):275-83.
  • Buchholz J, Vollmer CM, Miyasaka KW, Lamarra D, Aggarwal R. Design, development and implementation of a surgical simulation pathway curriculum for biliary disease. Surg Endosc 2015 Jan;29(1):68-76.
  • SCORE| General Surgery Resident Curriculum Portal. http://www.surgicalcore.org/. erişim tarihi: 15.10.2014
  • Shamim KM, Ahmed K, Gavazzi A, Gohil R, Thomas L, Poulsen J, et al. Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity. BJU Int 2013 Mar;111(3):518-23.
  • Kurdak H, Altintas D, Doran F. Medical education in Turkey: past to future. Med Teach 2008;30(8):768-73.
  • World Federation for Medical Education(WFME) and the Foundation For Advancement of International Medical education and Research (FAIMER). https://search.wdoms.org/. erişim tarihi:23.09.2015
  • Türk Tabibler Birliği Mezuniyet Öncesi Tıp Eğitimi Raporu 2010;51-52. http://www.ttb.org.tr/kutuphane/mote_2010.pdf
  • McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011 June;86(6):706–11.
  • McMahon GT, Monaghan C, Falchuk K, Gordon JA, Alexander EK. A simulator-based curriculum
  • to promote comparative and reflective analysis in an internal medicine clerkship. Acad Med. 2005 Jan;80(1):84–89.
  • Cook DA, Hatala R, Brydges R, Zendejas B, Szostek JH, Wang AT, et al. Technology-enhanced simulation
  • for health professions education: a systematic review and meta-analysis. JAMA 2011 Sep 7;306(9):978–88.
  • Heitz C, Eyck RT, Smith M, Fitch M. Simulation in medical education: survey of the clerkship directors
  • in emergency medicine. West J Emerg Med 2011 Nov;12(4):455–460.
  • Kordowicz AG, Gough MJ. The challenges of implementing a simulation-based surgical training curriculum. Br J Surg 2014 Apr;101(5):441-3.
  • McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Translational educational research: a necessity for effective health- care improvement. Chest 2012 Nov;142(5):1097–103.

Gelişmekte Olan Ülkelerde Asistanların Klinik Karar Verme Becerilerini Geliştirmek İçin Simülasyon Temelli Eğitim Uygulaması

Yıl 2016, Cilt: 10 Sayı: 2, 96 - 104, 14.06.2016
https://doi.org/10.5455/tjfmpc.215600

Öz

Amaç: Son zamanlarda, eğitim ve değerlendirme için tıbbi simülasyon teknolojilerinin kullanımı önemli bir derecede artış göstermektedir. Tıp eğitimi sırasında hasta güvenliğinin önemli hale gelmesi özellikle asistan eğitiminde, simülasyon temelli uygulamaları harekete geçirdi. Çoğu ülkelerin mezuniyet öncesi eğitim programlarının içine simülasyon temelli uygulamalar
entegre olmasına rağmen, Türkiye‟nin de içinde olduğu bazı gelişmekte olan ülkelerin mezuniyet sonrası programlarına simülasyon temelli eğitim uygulamalarının dahil olması yavaş olmuştur. Gelişmekte olan ülkelerin benzer müfredat uygulamalarını desteklemek için, varolan simülasyon temelli eğitim örneklerinin derlenmesi amaçlanıldı. Yöntem: Müfredat ile ilgili sunulan literatür örneklerini araştırmak için “simülasyon‟‟ ve (“mezuniyet sonrası, asistan‟‟) ve (“klinik karar verme ya da klinik akıl yürütme‟‟ve “eğitim‟‟ kelimelerinden oluşan web tabanlı bir literatür taraması yapıldı.Sonuç: Altı klinik alanda, asistanların klinik karar verme becerilerini destekleyen simülasyon temelli eğitim ile ilgili 83 orijinal makaleden on tanesinin sonuçları derlenildi. Türkiye ve diğer ülkelerde benzer mezuniyet sonrası eğitim müfredatları içerisinde uygulanılabilmesi için özetlenen bu on müfredat üç temel başlıkta (kurs yönetimi, müfredat geliştirme ve ölçmedeğerlendirme programı) tartışıldı. Tartışma: Simülasyon temelli eğitimin sunduğu yararlar açıktır. Özellikle, mezuniyet sonrası eğitim programlarının kullanımı, dünyadaki klinisyenlerin yeterliliklerinin gelişimi için gerekli klinik karar verme sürecinde kritik bir öneme sahiptir.

Kaynakça

  • Laschinger S, Medves J, Pulling C, McGraw DR, Waytuck B, Harrison MB, et al. Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction. Int J Evid Based Healthc 2008 Sep;6(3):278–302.
  • Scalese RJ, Obeso VT, Issenberg SB. Simulation technology for skills training and competency assessment in medical education. J Gen Intern Med 2008 Jan;23(1): 46–49.
  • Gordon J. Fostering students’ personal and professional development in medicine: a new framework for PPD. Med Educ 2003 Apr;37(4):341–9.
  • Boshuizen H, Schmidt HG. On the role of biomedical knowledge in clinical reasoning by experts, intermediates and novices. Cog Sci 1992;16(2):153–184.
  • Kramer AW, Jansen JJ, Zuithoff P, Tan LH, Grol LP, van der Vleuten C.P.M. Predictive validity of a written knowledge test of skills for an OSCE in postgraduate training for general practice. Med Educ 2002 Sep;36 (9):36:812–9.
  • Eckleberry-Hunt J, Tucciarone J. The Challenges and Opportunities of Teaching ‘‘Generation Y’’. J Grad Med Educ 2011 Dec;3(4):458-61.
  • Monaco M, Martin M. The millennial student: A new generation of learners. Athletic Train Educ J 2007;2(Apr– Jun):42–46.
  • Twenge JM . Generational changes and their impact in the classroom: teaching generation me. Med Educ 2009 May;43(5):398–405.
  • Croasdale M. Med schools adjusting to millennial students: Educators look for ways to build on new scholars’ perceived strengths in technology, optimism and team-building. Am Med News 2008 Jan.
  • Sandars J, Morrison C. What is the net generation? The challenge for future medical education. Med Teach 2007 Mar;29(2-3):85–88.
  • Kuh GD. What we're learning about student engagement from NSSE: Benchmarks for effective educational practices, change. The Magazine of Higher Learning 2003;35(2):24-32.
  • Mıdık Ö, Kartal M. Simulation based medical education. Marmara Medical Journal 2010;23(3):389–399.
  • DiLullo C, McGee P, Kriebel RM. Demystifying the millennial student: A reassessment in measures of character and engagement in professional education. Anat Sci Educ 2011 July-August;4(4):214-26.
  • Weimer M. Millennial students: They aren’t all the same. The Teaching Professor 2012;26:3-8.
  • Irby DM, Cooke M, O'Brien BC. Calls for reform of medical education by the Carnegie Foundation for the advancement of teaching: 1910 and 2010. Acad Med 2010 Feb;85(2):220–7.
  • Rodriguez-Paz JM, Kennedy M, Salas E, Wu AW, Sexton JB, Hunt EA, et al. Beyond "see one, do one, teach one": toward a different training paradigm. Qual Saf Health Care 2009 Feb;18(1):63-8.
  • Gordon JA, Hayden EM, Ahmed RA, Pawlowski JB, Khoury KN, Oriol NE. Early bedside care during preclinical medical education: Can technology-enhanced patient simulation advance the flexnerian ideal? Acad Med 2010 Feb;85(2):370–377.
  • http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexner_Report.pdf. erişim tarihi: 20.11.2009
  • Tatar M , Kanavos P. Health care reform in Turkey. Health Policy Developments , Eurohealth 2006;12(1):20–22.
  • McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Med Educ 2014 Apr;48(4):375-85.
  • Gordon JA. The human patient simulator: acceptance and efficacy as a teaching tool for students. Medical Readiness Trainer Team. Acad Med 2000 May;75(2):522.
  • McGregor CA, Paton C, Thomson C, Chandratilake M, Scott H. Preparing medical students for clinical decision making: a pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention. Med Teach 2012;34(7):508-17.
  • Ziv A, Wolpe PR, Small SD, Glick S. Simulation based medical education: an ethical imperative. Acad Med 2003 Aug;78(8):783–8.
  • Okuda Y, Bryson EO, DeMaria S Jr, Jacobson L, Quinones J, Shen B, et al. The utility of simulation in medical education: what is the evidence. Mt Sinai J Med 2009 Aug;76(4):330–43.
  • Shafer S, Rooney D, Schumacher R, Chapman R, House J. Neonatal lumbar punctures: bridging the clinical gap. MedEdPortal Publications 2013.
  • Levine AI, Swartz MH. Standardized patients: the "other" simulation. J Crit Care 2008 Jun;23(2):179-84.
  • Grall KH, Stoneking LR, DeLuca LA, Waterbrook AL, Pritchard TG, Denninghoff KR. An innovative longitudinal curriculum to increase emergency medicine residents' exposure to rarely encountered and technically challenging procedures. Adv Med Educ Pract 2014 Jul 17;5:229-36.
  • Lee MO, Brown LL, Bender J, Machan JT, Overly FL. A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation. Acad Emerg Med 2012 May;19(5):577–85.
  • Okuda Y, Godwin SA, Jacobson L, Wang E, Weingart S. SimWars. J Emerg Med 2014 Nov;47(5):586-93.
  • Mathai SK, Miloslavsky EM, Contreras-Valdes FM, Milosh-Zinkus T, Hayden EM, Gordon JA, et al. How we implemented a resident-led medical simulation curriculum in a large internal medicine residency program. Med Teach 2014 Apr;36(4):279–83.
  • Cohen ER, Barsuk JH, Moazed F, Caprio T, Didwania A, McGaghie WC, et al. Making july safer: simulation-based mastery learning during intern boot camp. Acad Med 2013 Feb;88(2):233-9.
  • Butter J, McGaghie WC, Cohen ER, Kaye M, Wayne DB. Simulation-based mastery learning improves cardiac auscultation skills in medical students. J Gen Intern Med 2010 Aug ;25(8):780–785.
  • Barsuk JH, Cohen ER, Vozenilek JA, O’Connor LM, McGaghie WC, Wayne DB. Simulation-based education with mastery learning improves paracentesis skills. J Grad Med Educ 2012 Mar;4(1):23–27.
  • Barsuk JH, Cohen ER, Caprio T, McGaghie WC, Simuni T, Wayne DB. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology 2012 Jul 10;79(2):132–137.
  • Schroedl CJ, Corbridge TC, Cohen ER, Fakhran SS, Schimmel D, McGaghie WC, et al. Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: A randomized trial. J Crit Care 2012 Apr ;27(2):219.e7–13.
  • Szmuilowicz E, Neely KJ, Sharma RK, Cohen ER, McGaghie WC, Wayne DB. Improving residents’ code status discussion skills: A randomized trial. J Palliat Med 2012 Jul;15(7):768–774.
  • Sam J, Pierse M, Al-Qahtani A, Cheng A. Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes. Paediatr Child Health 2012 Feb;17(2):e16-20.
  • Kellicut DC, Kuncir EJ, Williamson HM, Masella PC, Nielsen PE. Surgical team assessment training: improving surgical teams during deployment. Am J Surg Endosc 2014 Aug;208(2):275-83.
  • Buchholz J, Vollmer CM, Miyasaka KW, Lamarra D, Aggarwal R. Design, development and implementation of a surgical simulation pathway curriculum for biliary disease. Surg Endosc 2015 Jan;29(1):68-76.
  • SCORE| General Surgery Resident Curriculum Portal. http://www.surgicalcore.org/. erişim tarihi: 15.10.2014
  • Shamim KM, Ahmed K, Gavazzi A, Gohil R, Thomas L, Poulsen J, et al. Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity. BJU Int 2013 Mar;111(3):518-23.
  • Kurdak H, Altintas D, Doran F. Medical education in Turkey: past to future. Med Teach 2008;30(8):768-73.
  • World Federation for Medical Education(WFME) and the Foundation For Advancement of International Medical education and Research (FAIMER). https://search.wdoms.org/. erişim tarihi:23.09.2015
  • Türk Tabibler Birliği Mezuniyet Öncesi Tıp Eğitimi Raporu 2010;51-52. http://www.ttb.org.tr/kutuphane/mote_2010.pdf
  • McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011 June;86(6):706–11.
  • McMahon GT, Monaghan C, Falchuk K, Gordon JA, Alexander EK. A simulator-based curriculum
  • to promote comparative and reflective analysis in an internal medicine clerkship. Acad Med. 2005 Jan;80(1):84–89.
  • Cook DA, Hatala R, Brydges R, Zendejas B, Szostek JH, Wang AT, et al. Technology-enhanced simulation
  • for health professions education: a systematic review and meta-analysis. JAMA 2011 Sep 7;306(9):978–88.
  • Heitz C, Eyck RT, Smith M, Fitch M. Simulation in medical education: survey of the clerkship directors
  • in emergency medicine. West J Emerg Med 2011 Nov;12(4):455–460.
  • Kordowicz AG, Gough MJ. The challenges of implementing a simulation-based surgical training curriculum. Br J Surg 2014 Apr;101(5):441-3.
  • McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Translational educational research: a necessity for effective health- care improvement. Chest 2012 Nov;142(5):1097–103.
Toplam 53 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Derleme
Yazarlar

İbrahim Başhan

James Cooke Bu kişi benim

Deborah Rooney Bu kişi benim

Yayımlanma Tarihi 14 Haziran 2016
Gönderilme Tarihi 5 Haziran 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 10 Sayı: 2

Kaynak Göster

Vancouver Başhan İ, Cooke J, Rooney D. Using Simulation-Based Education to Improve Residents’ Clinical Decision Making Skills in Developing Countries. TJFMPC. 2016;10(2):96-104.

Sağlığın ve birinci basamak bakımın anlaşılmasına ve geliştirilmesine katkıda bulunacak yeni bilgilere sahip yazarların İngilizce veya Türkçe makaleleri memnuniyetle karşılanmaktadır.