Chest
Contemporary Reviews in Critical Care MedicineSimulation Training in the ICU
Section snippets
History of Medical Simulation
Simulators were introduced in the aviation industry in the 1920s so pilots could receive standardized flight training without putting people’s lives at risk.6 The first documented use of HCS did not occur until 1960, when a group of anesthesiologists led by Peter Safar in the United States and Bjørn Lind in Norway collaborated with Norwegian toy manufacturer Åsmund Lærdal to develop Resusci Anne, a full-size manikin simulator of a pulseless dying victim.6 Soon thereafter, Sim One, a
Procedural Training
With the current emphasis on patient safety, the traditional “See one, do one, teach one” approach to procedural training has come under scrutiny. The empirical cognitive science evidence suggests that skill acquisition requires deliberate practice, a planned series of activities of increased complexity with opportunities for repetition that are guided by specific feedback to improve in a particular domain.12 Developing expertise in performing procedures requires three-dimensional understanding
Debriefing to Learn
A discussion of HCS is incomplete without emphasizing the importance of debriefing. Simulation training is based on the constructivist learning theory, which suggests learners gain knowledge and meaning on the basis of their experiences. In high-fidelity simulation scenarios with multiple learners, each participant gains different knowledge, based on their experience. This knowledge acquisition occurs not only during the simulation case but also during debriefing with feedback, which has been
Milestones in Critical Care Training
The current Accreditation Council for Graduate Medical Education (ACGME) accreditation system incorporates entrustable professional activities (EPAs) and milestones to provide meaningful trainee assessment to learners.47 EPAs are tasks that trainees are expected to perform independently on graduation while milestones are competency-based development outcomes that can be demonstrated progressively from beginning of residency or fellowship to graduation.48
Milestones and EPAs exist for all ACGME
Simulation for Health-Care System Support
A highly reliable health-care system requires a culture of safety, and leadership committed to process improvement.59 Effective QI processes for health-care systems include having clinical team members practice together, with simulation serving as an effective way to learn and rehearse so teams can prevent adverse events, or improve after their occurrence. Communication errors during handoffs between teams or at shift change are common and an area of QI focus. Simulation has successfully been
Simulation in Decision Science
Simulation has also been used in decision science to assess biases in provider choices. Serious games, simulations of real-world events, or processes designed for the purpose of solving a problem, have been used to both teach and assess provider decision-making, which can be negatively influenced by cognitive load inherent to caring for critically ill patients. Physicians randomized to different types of active serious games with structured feedback demonstrated reduction of undertriage of
Areas of Uncertainty and Future Directions
We have highlighted many benefits of simulation to ICU training (Table 4). However, the cost of the educational or performance improvements gained from simulation must be acknowledged. High-fidelity simulators are expensive and require maintenance. Dedicated simulation staff must schedule, set up, and run scenarios and aid educators who require assistance throughout the simulation process. Hiring SPs for communication programs or examinations can also be costly. Additional costs may be incurred
Acknowledgments
Financial/nonfinancial disclosures: None declared.
Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.
Other contributions: The authors thank Kelly Byrne for technical assistance with editing and formatting.
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FUNDING/SUPPORT: This work was supported in part by the National Institutes of Health Intramural Program.