Evolution of Simulation-Based Education at Michigan Medicine

Abstract

Executive summary The introduction of simulation as a training modality and performance-improvement mechanism within healthcare has caused a remarkable paradigm shift over the last 15 years. Although lecture, apprenticeship and practice-based learning continue to provide the foundational knowledge required for health professionals, simulation-based training has revolutionized the training experience by providing early procedural experience, opportunities for deliberate practice, and standardized assessment. Gone are the days of “See one. Do one. Teach one.” We are now in the era of safe and deliberate practice to competency before patient interaction. Due to the relatively brief history of simulation in health professions’ training, dramatic improvements in technology, and changing environments of care, learner needs and stakeholder expectations, predicting the future role and scope of simulation over the next 15 years presents an enormous challenge. Looking to other skills-intensive industries, such as aviation, energy, and the military, we may begin to visualize the future of skills training in health professions. Simulation centers will likely evolve over the coming decades into ‘skills commons’ where learners and full medical teams gather for initial training, repeated practice, and assessment. Simulated operating rooms will be replaced by immersive virtual reality spaces for high-risk or high intensity training, table top skills trainers replaced by a host of haptic workstations for task training, and standardized patients replaced by sophisticated simulators for exam skills training. All of these training resources could be available 24-7, offering learners the ability to practice until learning goals are mastered and assured via on-demand testing. Beyond the increased availability, higher technology and broader scope of skills available, the commons will drive a fundamental change in the culture of healthcare to one of rehearsal prior to performance, regular individual practice, deliberate planning and preparation for potential adverse events, post event debriefing, and continuous team development. As is true in any sport, both individual and team practice are essential to improve performance. Much like a baseball player taking batting practice, healthcare providers must individually practice position- or specialty-specific skills to objective targets. Just like a baseball player taking practice swings immediately before entering the batter’s box, healthcare professionals must visualize and practice the critical steps just prior to performing a procedure. Finally, Clinical Simulation Center, Department of Learning Health Sciences, Michigan Medicine and most importantly, as in any team sport, healthcare teams must repeatedly manage simulated critical events in preparation for the unexpected, especially when outcomes are dependent on team performance. Best team performance depends on individuals and teams seeking to continually improve their performance through accessing performance data (going to the film room), testing ‘new formations and plays,’ incorporating advice from coaches, and regularly utilizing safe and relevant spaces for both individual and team practice. The skills commons would act as the healthcare practice field for rapid assessment, adaptation and improvement. With effective team training, teammates change perspectives, are encouraged to adapt, and engage in team feedback, resulting in a pervasive culture of continuous improvement. The commons will also be the ideal place to leverage the broad strengths of the University to address the significant challenges within healthcare and health professions training, and to utilize simulation as a critical component of the learning health system. The ‘skills commons’ concept can guide health professions educators and system leaders to visualize a future state of simulation, not only as a modality for individual and team skills training, but as a mechanism for health system evaluation and improvement and an interprofessional hub for problem solving.