the future vision of simulation in health care
Replace or amplify the real experience with guided experience and evoke or replicate the substantive aspects of the real world in a fully interactive manner.
Various applications of simulation in health care can be classified according to 11 dimensions: the purpose and purpose of simulation activities;
Experience level of participants;
Areas of health care;
Professional discipline of students;
The type of knowledge, skill, attitude or behavior involved;
Age of simulated patients;
Technology applicable or required;
Degree of direct participation;
And feedback methods.
Using simulations to improve safety requires full integration of its applications into the routine structure and practice of healthcare.
The cost and benefits of the simulation are difficult to determine, especially for the most challenging applications, which may require long-term use.
It can be expected that the various dynamics and implementation mechanisms will drive the simulation forward, including professional associations, liability insurance companies, health care payers and the final public.
The future of the healthcare simulation depends on the commitment and ingenuity of the healthcare simulation community to ensure that the use of the tool to improve patient safety becomes a reality.
The past twenty years
Especially in the last five years.
Through a variety of applications, interest in using simulations to improve patient safety and patient care has grown rapidly.
Simulation is a technique, not a technique, to substitute or amplify a real experience with a guided experience, which is usually immersed in nature and evokes or copies the real world in a fully interactive manner
\"Immersive\" conveys the feeling that participants are immersed in a task or environment, just like the real world.
Ideal example of complete immersion (
It\'s a fiction.
This will be the \"holographic deck\" in Star Trek, where people simply cannot distinguish between simulated experiences and real life.
While this seamless immersion is not yet achievable, experience has shown that it is easy for immersion simulation participants to pause doubts and speak and act as they do in their actual work.
While this definition contains a wide range of experience activities, the term \"simulator\" used in health care generally refers to a device that presents a simulated patient (
Or part of the patient)
And interact appropriately with the actions taken by the simulation participants.
The interest in healthcare simulations is largely from long-term experience and the use of simulations in large quantities for non-
In particular, commercial aviation, nuclear power production and military-
The same as the inherent dangers and complexities of health care, but given the inherent risks, industries with very low failure rates are considered highly reliable organizations.
1-3 health care simulators are directly similar to flight simulators known to the public.
The objective of this paper is to provide a comprehensive framework for understanding the application diversity of simulation in health care, classified by 11 different dimensions;
Provide a vision of how simulation can be fully integrated into the structure and process of healthcare to radically change patient care and patient safety;
It also outlines the power and implementation mechanism of the simulation that may be released by different entities in the next 20 years.
Although from the perspective of the United States, these issues are similar worldwide.
Simulation how to improve patient safety those who are committed to developing and using Simulation in Healthcare have a shared vision for the future revolution of healthcare organizations to a large extent, simulation is a key
We seek a model in which the structure and system of health care is targeted at safety, quality, and-
Places that don\'t conflict with these goalsfor efficiency.
The current health care system in the world is not doing this (
For example, please see the report of the American Institute of Medical Research on medical error 4 and \"crossing the quality gap\" 5.
The revolution we envision involves how to educate, train and sustain people to provide safe clinical care.
At present, the health care system attaches importance to basic science education, leaving most clinical training to the relatively unsystematic apprenticeship process.
Emphasis is placed on personal knowledge and skills rather than honing the performance of the clinical team.
Once the clinician has completed the training, the level of continuing education and training required is often the lowest and unorganized.
Therefore, a fundamental part of the vision for the future is that clinicians, teams and systems should constantly conduct systematic training, rehearsal, performance evaluation and improvement in practice.
This vision has been inspired to some extent by a variety of highly reliable organizations, particularly the existing systems of commercial airlines, but has not been blindly replicated from their experience.
Needless to say, using simulation as part of the process of transforming healthcare is more complex than just trying to do simulation training on the basis of the current system.
In addition, in addition to training, simulation can also provide indirect methods to improve safety, including promoting the recruitment and retention of technicians as a lever for cultural change, as well as improving quality and risk management activities.
Simulation applications are diverse and can be classified according to 11 dimensions. future applications can be classified according to 11 dimensions, each dimension represents different attributes of simulation (fig 1).
There is a clear gradient and direction for many dimensions, although there is only absolute difference for other dimensions.
In the past 20 years, the application of simulation in health care has been very diverse. In fact, some have been used for decades, but the possible application areas have not been fully studied.
Future, extra part of 11-
It will explore the 3D \"application space\" more widely, weaving rich and complex simulation brocade in the field of health care.
The total number of unique combinations in all dimensions is very large (
In order of 511-More than 48 millionor more! )
So obviously some combinations are either redundant or irrelevant.
Download the 11 dimensions of the figureOpen simulation application in the new tabDownload powerpoint figure 1.
The part of the item marked with an asterisk is derived from miller.
44 any particular application of the simulation can be classified as a point or range in each dimension (
The diamond in the figure illustrates a specific application-
Multi-disciplinary CRM decision-making and teamwork training for ICU personnel.
Dimension 1: The most obvious application of simulation of the purpose and purpose of simulation activities is to improve the education and training of clinicians, but other purposes are also meaningful.
Education emphasizes conceptual knowledge, basic skills and an introduction to practical work.
The training emphasizes the practical tasks and work to be completed.
Simulations can be used to evaluate the performance and capabilities of individual clinicians and teams.
Standardized Patient actors6, 7 clinical skills exams have been used in high-risk exams.
When applied to invasive and hazardous treatments in healthcare, only technical simulators can support patients.
The 8-11 simulation rehearsal is now being explored as an aid to practical clinical practice, such as the surgeon or the entire surgical team who can use the simulation of a particular patient to rehearse exceptionally complex operations in advance.
The 12-14 simulator can be a powerful tool for researching and evaluating organizational practices (
Patient care agreement)
And the investigation of human factors (
For example, performance shaping factors such as fatigue 15 or user interface and operation of medical devices in a high-risk clinical setting.
In fact, experience testing of simulation-based clinical equipment availability has been used to design equipment currently sold;
Ultimately, this practice may be required by regulators before new equipment is approved.
Simulation can be a \"bottom-up\" tool to change the health care culture and make it safer by training clinicians to develop the desired \"safety culture\" practice.
3 simulation is also a meeting point for cultural change and patient safety, which can bring together experienced clinicians (
Who found simulated clinical involvement)
Health care managers and experts in human factors, organizational behavior, or institutional change.
Dimension 2: Many simulation applications in units participating in the simulation are for individuals.
These may be particularly useful for teaching knowledge and basic skills.
In other high-risk industries such as aviation, personal skills are a basic component, but at a higher organizational level, there are considerable in various forms of \"unit resource management\"CRM).
This is based on experience finding that individual performance is not sufficient to achieve optimal security.
Therefore, team training can be provided to the crew first (
Also known as \"single discipline team \")
, Consisting of multiple individuals from a single subject and then a team (
Or \"multi-disciplinary team\".
In fact, there are advantages and disadvantages in solving team cooperation problems in a single discipline approach of \"training crew team cooperation\", while solving team cooperation problems in multi-disciplinary \"joint team training\" has advantages and disadvantages.
For the best benefit, these methods can be used in a complementary manner.
The team exists in the actual \"work unit\" in the organization (
Specific intensive care units, for example)
Each of them is their own training goal.
More and more, people are increasingly interested in the simulation of experience,
Clinical staff and work units of medical institutions (
For example, for managers or executives)
22 and the whole organization (
For example in a disaster drill or a catastrophic patient care accident in response to a simulation).
Dimension 3: The level of experience simulated by the simulated participants can be applied from the \"cradle to grave\" of the clinician.
It can be used for early learners, such as children in school or non-professionals, to promote the teaching of biological sciences, to make students interested in biomedical careers, or to explain health care issues and practices.
Obviously, the main role of the simulation has always been, and will continue to be, to provide education, training and rehearsal for those who actually prepare or work to provide health care.
From their earliest level of vocational or vocational education, simulation is relevant (students)
During Apprenticeship Training (
Such as interns and resident doctors).
Although these levels have so far been the main focus of simulation training, simulation is increasingly important for the continued training of experienced personnel, among whom ,-as in aviation—
Can be applied to practicing clinicians on a regular basis (
Individual, team or organization)
Regardless of their qualifications
Z23, 24 this approach provides the accumulation of experience, which is expected to have a long-term synergy.
Dimension 4: The area of healthcare where simulation technology is applied can be applied to almost all areas of healthcare.
Most of the attention to simulation is focused on technical and procedural skills applicable to surgical, 13,25-27 obstetrics, 28,29 invasive cardiology, 30,31 and other related fields, while another bastion of the simulation is to recreate the entire patient for dynamic areas involving high-risk and invasive interventions such as anesthesia, 32-36 intensive care, 37, 38, and emergency medicine.
39-42 while simulations may be applicable in areas of image interpretation such as radiology and pathology, in which personnel can generally use archived images from real patients for training, which is not optional in other areas
When imaging is combined with invasive intervention, simulation is clearly beneficial.
In many fields, simulation technology is used to solve the problem.
Technical skills to communicate with patients and colleagues, or to solve problems such as ethics or hospice care.
Dimension 5: The health care discipline of the people participating in the simulation is applicable to all disciplines of health care, not just doctors.
As a result, the simulation technology is being used for nurses, and ultimately for technicians, assistants, and even clerical personnel, especially when conducting training as a team or work unit.
Simulation is also not limited to clinical personnel.
It may also target managers, executives, hospital trustees, regulators and lawmakers.
For these groups, simulations can communicate the complexity of clinical work and can be used to exercise and explore organizational practices in clinical institutions at multiple levels.
Dimension 6: Types of knowledge, skills, attitudes, or behaviors involved in simulation can be used to help learners acquire new knowledge and better understand conceptual relationships and dynamics.
Today, physiological simulations allow students to observe changes in cardiovascular and respiratory functions over time and respond to interventions --
In essence, make textbooks, charts, and charts \"vivid \".
\"The next step is to acquire the skills that accompany the knowledge.
Get some skills immediately from concept knowledge (
Heart auscultation, etc)
Other activities involving complex mental movements (
Basic Surgical techniques).
Isolated skills must be combined into a new layer of clinical practice.
For example, an understanding of the general surgical concept cannot be combined solely with the basic techniques of anatomy and suture or instrument operation to create a competent laparoscopic surgeon.
Basic skills must be combined with actual clinical techniques, and for this process simulation may have considerable capabilities, especially since it can easily provide even uncommon anatomical or clinical manifestations
In the current health care system, for most of the invasive procedure novices engaged in a task, it is often the first to perform this task for real patients, although under a certain degree of supervision.
They climb the learning curve and work on patients with different levels of guidance.
Simulation provides a possibility for novices to practice extensively before starting to work as a supervised \"apprentice in a real patient.
\"In this and other ways, the simulation is applied to clinicians throughout their career to support lifelong learning.
It can be used to refresh the skills of programs that are not executed frequently.
In addition, knowledge, skills and practices honed as individuals must be linked to effective team work with different clinical teams, which in turn must operate safely in the work unit and in larger organizations.
3, 45-47 will require a permanent rehearsal of the response to challenging events, as the team or organization must deal with them as a coherent unit.
Dimension 7: Up to now, most of the simulator and simulation applications have been targeted at adult patients and clinical activities related to adult medicine.
This reflects, to some extent, the challenge of building fully interactive human models and coaches for small patients.
In fact, however, the simulation is applicable to patients of almost all types and ages, from \"cradle to grave\" as well.
\"Simulations can be particularly useful for pediatric patients and clinical activities, as the physiological reserve of newborns and infants is smaller than that of most adults.
The 48, 49 fully interactive pediatric patient simulator will be launched soon, and virtual reality technology will eventually make it easier to provide a variety of simulated pediatric clinical activities.
Dimension 8: to achieve these goals, simulate the various technologies applicable or required (
Technology is not included)
Will be related to simulation.
Oral simulation (
Standardized Patient actors50-52 does not require any technology, but can effectively evoke or reproduce challenging clinical situations.
Very low technology.
Even a fruit or a simple doll.
Skin and muscles can be represented in the initial training of some manual tasks.
Even some aspects of complex tasks and experience can be recreated even if the technical content is low.
For example, some education and training on teamwork can be done through role play, video analysis, or simple mannequin exercises.
In the end, however, learn and practice complex manual skills (
Such as surgery, cardiac catheter)
, Or dynamic management of life-threatening clinical conditions including hazardous or harmful interventions (
Such as intubation or defibrillation)
, Can only be done completely using any animal-
This becomes very difficult due to the cost and problems of animal rights --
Or the technical means to recreate the patient and clinical environment.
From relatively simple multimedia to different kinds of parts, the simulation technology is different.
Simulator task trainer. A part-
Task Trainer is a device that copies limited aspects of a task but does not provide an integrated experience.
The \"Patient Simulator\" is a system that presents fully interactive patients and appropriate clinical working environments in one of the following ways: in actual physical reality, a patient human model is used (
\"Simulator based on human body model \")
On the computer screen only (
Using virtual reality (VR;
Virtual reality simulator)
Presents parts or all of the patient and environment to the user through two or three dimensional visual and audio representation, with or without touch (haptics)
Create a more \"immersive\" experience.
Screen-based simulators can be considered as very limited virtual reality simulators.
In addition, a VR device that copies a specific program (
Such as laparoscopic surgery)
Using replicas of the actual tools in a fully interactive manner, also known as simulators, although they do not show complete patients.
Dimension 9: simulate certain types of simulations at the sites involved-
Someone who uses a video, computer program, or network-
You can use your own personal computer to do it in the privacy of your learner\'s home or office.
More advanced screen-based simulators may require more powerful computer facilities in the medical library. Part-
Task Trainers and virtual reality simulators are best used in specialized skill labs.
Human model-based simulations can also be used in skill labs, although more complex reproduction of actual clinical tasks requires a dedicated patient simulation center, the center has a fully equipped copy of the clinical space or the ability to bring the simulator into the actual working environment (
Compared with clinical simulation in a dedicated center, clinical simulation on site has advantages and disadvantages.
For example, the use of the actual site can train the entire unit and all its personnel, procedures and equipment.
On the other hand, the availability of actual clinical sites is limited at best, and simulation activities may distract attention from real patient care work.
The dedicated simulation center is a more controllable and usable environment that can document meetings more fully without distracting real activity.
For large-scale simulation (
Such as disaster drills)
The whole organization becomes a place for training.
Video conferencing and advanced networking even allow advanced types of simulations remotely (
See dimension 10 below).
For example, real-time collaborative use of virtual reality surgical simulators has been shown, even in places thousands of miles apart.
Dimension 10: the degree of direct participation in simulating most simulations-
Even screen-based simulators or partstask trainers—
Originally conceived as a highly interactive event, direct \"on-site\" participation.
However, not all learning needs direct participation.
For example, some learning can be done only by watching simulations involving others, because one can easily imagine standing in the position of the participants.
The next step is to involve the remote audience in the simulation itself or debriefing what happened.
Some centers have been using video conferencing for simulation exercises including the incidence and mortality sessions.
54. since the simulator can be suspended, restarted, or otherwise controlled, the remote audience can easily get more information from the field participants, debate the appropriate course of action, and discuss with people in the simulator how to proceed best.
Dimension 11: The feedback method accompanying the simulation is like in real life, one can learn a lot from the experience itself without any additional feedback.
For most complex simulations, specific feedback is provided to maximize learning.
On a screen-based simulator or virtual reality system, the simulator itself can provide feedback on participants\' behavior or decisions, 55 particularly for manual tasks that are easy to describe clear performance metrics.
More often, human tutors provide feedback for simulations.
This can be as simple as having the instructor look at the records of previous courses that the learner has completed individually.
For many target populations and applications, instructors provide real-time guidance and feedback to participants during the simulation process.
Here, the ability to start, pause, and restart the simulation is also valuable.
For the most complex use of simulation, especially when training relatively experienced personnel, the typical form of feedback is
Analog debriefing sessions that often use audio
Video of the scene.
By the end of the scenario, experienced people can apply their collective skills without interruption, but then allow them to see and discuss the strengths and weaknesses of their actions, decisions and actions.
The simulation is fully integrated into the health care system, and from all 11 aspects, the simulation is clearly applicable in many aspects of the entire health care system.
Only by fully integrating the relevant applications into the daily structure of health care can the major revolution brought about by simulation be realized.
With such embedded simulation, it will not become \"additional\" as it is today \";
This will be part of the daily work environment.
As part of achieving many learning goals, students will expect to participate in the simulation.
Clinical students (
Residents, for example)
They usually receive intensive simulation training on the days they perform clinical work.
The concentration and case significance that may be caused by the use of the simulation should be far from making up for the relative loss of the actual case experience.
This becomes more important as the number of hours worked by trainees decreases (
Significant in Europe, smaller in the United States).
Experienced clinicians will spend a day in the simulator on a regular basis rather than their usual clinical pursuits.
Continuing education will be transformed into lifelong learning embedded in the care system, not entirely at the discretion, time or cost of the individual practitioner.
In the area of health care, unlike experience in other high-reliability industries, simulation may never replace training in the apprenticeship system for real patient supervision work.
Unlike aircraft or nuclear power plants, we do not design and build humans.
We also did not receive the official instruction manual!
Compared to other high-risk activities using simulations, patient care is inherently more complex and requires more human empathy and connections.
Simulations will be used for activities that are most appropriate, especially dangerous, involving unusual or rare situations, or experiencing activities that learn the most valuable.
Finding the right combination of traditional learning, simulated learning and practical patient care experiences is an important challenge.
Another revolutionary feature of simulation support is that, in many cases, training can be conducted not only within a fixed duration or number of cases, skills and behavior can also be performed at specific standard competency levels in key aspects of knowledge.
56, 57 establishing these competency standards in all aspects of health care will be a challenge, but simulation is an important component for the Study of establishing assessment and standard-setting methods, and provide the same case of test ability for different personnel and teams.
Most standard level competency assessments will be conducted in a form that will be conducted for trainees and experienced personnel.
Nevertheless, a key aspect of highly reliable organizations is that they ensure that individuals, staff, teams and work units play a role at the level of competence shown.
Therefore, the use of simulation for high-risk testing will ultimately be a feature of simulation vision.
The cost varies greatly across all 11 dimensions to achieve simulation for various applications.
The cost depends to a large extent on the combination of the target group, the simulated purpose, and the technology used.
It also depends on how educational and clinical organizations successfully restructure their work structures to incorporate simulation-based learning.
Some forms of simulation are cheap and distributed (
For example, screen-based or web-based simulations and partstask trainers).
Low cost is particularly important for early task and skill learners, because in this case, the likelihood of regular availability and repeated practice is the most valuable.
Where simulation training replaces existing training (
As an alternative to animal labs, for example)
Relative costs will also be relatively low.
At the highest end-
Provide new training sessions to experienced clinical teams or work units using hi-fi scenarios
The cost may be great.
It is in these applications, however, that when comparing healthcare with other highly reliable organizations, the greatest potential for improving patient safety can be seen. Time must be set aside from clinical work for specialized training;
This can be costly because the current system does not provide specialized training time for clinical services.
However, in high reliability organizations, training is also accepted as part of the job, not as an attachment to the job, and the industry employs enough people to allow this to happen.
Benefits gained from various applications of simulation will be more difficult to measure than costs.
Security gains are hard to assess in nature, but the scale of investment is very obvious.
Some of the benefits may be direct as the performance of individuals and teams is immediately significantly improved.
This may improve the efficiency of care and reduce errors, thus offsetting the cost of training based on simulation.
Many benefits may depend on cumulative synergies over the long term.
This creates the phenomenon of \"chicken and egg.
\"Only when simulation is applied consistently over a long period of time can long-term benefits be obvious (
This could be the case with the airline).
However, most health care institutions are cautious about the commitment to long-term implementation, and there is no clear evidence that its application is justified.
However, the current system of education, training and maintenance of proficiency has never been rigorously tested in itself to determine whether it has achieved the established goals;
A high-level review of the performance of the healthcare industry 4, 5 indicates that it does not.
Organizations without high reliability have data equivalent to randomized clinical trials that demonstrate the benefits of simulation training, although individuals and teams have been using and regularly evaluating for decades in actual work and simulation
58, 59 health care pioneer centers began to make a leap forward in long-term application without proof of absolute benefit.
A bigger leap may be needed in the future.
In addition, benefiting from intensive training also requires a full reinforcement of the principles taught in the real world.
Various potential benefits and costs of final simulation
Perceived \"business case\"
Will be 11-in a different way-
3D simulation space.
Business cases in different regions and countries will also be very different, with different types of drivers, payment systems and economic strength.
Motivation and implementation mechanism stability 1 provides a detailed account of the various social entities and the motivation that may attract them to advance the vision described above.
It also summarizes the different implementation mechanisms that each entity may use.
Similarly, since different countries, regions and countries will have different health care system structures, the relevance or strength of these entities will be greatly different, and their drive and implementation strategies will be greatly different.
It is possible to mix drivers and implementation mechanisms in any region.
This may be especially true in an environment where the United States lacks a single health care payer and the government\'s regulatory system is decentralized.
View this table: view the inlineView pop-up table 1 driving the two possible histories of driving forces and implementation mechanisms that fully integrate simulations into health care from 2025, and see all these possibilities imagine, this year is 2025, and consider how future historians view the history of healthcare simulation.
Two possible histories are outlined: one is the successful realization of the above vision;
On the other hand, although there is an early commitment and enthusiasm for the application of simulation in healthcare, this vision only achieves small fragments.
Optimistic view of 2025: At the beginning of the 21st century, the simulation was successfully integrated into the entire healthcare structure, and various driving forces were combined to realize the simulation vision embedded in the healthcare structure.
The first campaign was initiated by medical and nursing educators and clinical faculty, first translated through various departments, hospitals and specialized schools, and then translated by professional associations, program certification review committees, and professional board.
Although hesitant at first, progress has been stable since 2004.
Institute of Medical simulation (SMS)
The American and European Society of Medical Simulation (SESAM)
Provide technical and political leadership for mock communities * individual schools, training programmes and hospitals, and systematic mock training in certain areas and disciplines.
The typical goal is for students and trainees (
Residents, for example)
Despite continuing education for experienced personnel, the hospital has also begun training specific work units.
Various professional organizations around the world take the lead in issuing simulation training and encourage other professional associations to follow suit.
In some cases, they take action because the evidence base provides strong proof of the benefits of a particular application for a particular type of simulation;
However, in many other cases, given the high surface effectiveness of the simulation method used, it is difficult to conduct a clear study of its success, and there is limited evidence of action by institutions and organizations, and continued discontent with traditional methods.
In particular, they believe that the long-term cumulative effect of the application simulation will produce important synergies over a long period of time.
For example, a famous university has opened a revolutionary and well-received new professional school in which, doctors, nurses, and associated health personnel are in the classroom together and eventually conduct joint clinical training in the ward.
\"In the end, the experience of those who used the simulation early convinced those who were waiting for further information, even if the formal evidence was limited.
The public is an important driver.
Security is fundamentally a political issue.
Compared with the many threats faced by the people of the world, the security of health care
Or in commercial aviation.
Compared with famine, disease and war, it is of little significance.
In industrialized countries, however, as the public has long demanded near-perfect aviation safety, they have begun to demand equal progress in medical safety.
By 2010, due to the persistent occurrence of highly open death or brain injury cases related to major errors by clinicians and organizations, the public was fully aware of how accidental the training and evaluation of clinicians was.
They are asking for changes that will bring health care together with other industries.
This trend has been caught by medical accident lawyers (
In countries where litigation is common)
Who has developed a new theory of negligence based on the inability of health care institutions to ensure the safety of patients, to be free from the wrong chain of accident evolution, and even to systematically ensure the capacity of personnel.
The medical institution turned to simulation as a means to address this challenge, and liability insurance companies in turn provided incentives (
Simulation and post-event suppression (
Denial of insurance)
For those who did not adopt it.
Ultimately, government regulators and NGOs
Government Certification Authority (
For example, the Joint Commission for Accreditation of Healthcare Organizations-JCAHO—
Hospitals in the United States)
Systematize these changes.
Similarly, they provided incentives for conducting mock training in the first place, but ultimately required that such training be used as a standard.
Medical device regulators, such as the US Food and Drug Administration, first encourage and request the submission of simulation data as part of the device approval process.
This is especially important for testing the availability of devices, especially in the user interface of diagnostic and therapeutic devices.
Pessimistic view of 2025: Although promised early in the 21 st century that the failure of the simulation was frustrating, there was great interest in reforming health care services, in particular, the way in which personnel and systems are prepared and sustained in terms of knowledge ability, skills and behaviour.
Simulation is highly touted to provide an advantage in solving these problems, in part because of its obvious (Unconfirmed though)
Success in a highly reliable organization.
The academic work of the past 20 years has provided tempting advice for simulation to become an effective tool.
Supporters provide a vision for the future of the integrated use of simulations for individuals, staff, teams, work units and organizations, as part of the healthcare revolution.
The initial excitement turned into \"the storm in the Teapot \".
\"In 2025, the simulation is still used intermittently in some areas of health care, especially for students and trainees, but it has never been widely used, it has almost zero impact on the actual delivery of care.
Thanks to several historical factors.
It turns out that the public is more interested in the cost of access to care and care than in the quality or safety of care.
According to the inference of \"Wildavsky medical Gold act\" 60, they want to \"save money on other people\'s health care\" while still looking forward to the highest results for themselves or their families.
As a result, they have not asked to invest in safer care and for better training for clinicians or teams.
Serious adverse consequences of preventable
Although still surprisingly frequent
It is not common for any patient.
In addition, they even insisted on using the simulation in large numbers, partly because of difficulties in reforming the clinical work system to match what was taught.
It turns out that the culture and structure embedded is very resistant to change.
Research has shown that simulation training is actually better for improving certain skills, but not all.
The simulation of complex team behavior is not enough, and the goal is only changed once.
Long-term multi-center studies and randomized controlled trials have never been funded.
No one is willing to pay the extra cost, even if it is a handful of applications that have proven to be beneficial, and is not willing to invest in analog systems and continuous applications to achieve lasting improvements.
In fact, training continues to play a secondary role in the irresistible need for clinical services.
Because of this, a few centers that bravely tried to fully integrate simulation training in different dimensions went bankrupt.
Professional associations, professional committees, certification bodies and regulatory bodies have failed to take action, even if there is evidence of moderate interest.
For the profession, reform training and practice run counter to the requirement to pay for care.
The existing practitioners are cautious about the new requirements and strongly oppose the mandatory simulation training program.
Hospitals and training programmes also oppose them because they are reluctant to bear the costs and difficulties of fully reorganizing the training system.
In addition, the attempt to integrate the simulation is involved in a turf battle between different health care disciplines, professions and between different certification and regulatory agencies.
Text Box 1: key information on the training and evaluation of the health care personnel system should be the main priority of the health care system.
Simulation has many applications classified by 11 dimensions.
Simulation Training applies not only to individuals, but more importantly to crew members, teams, work units and organizations.
Simulation will be an important \"bottom-up\" tool to create and maintain a culture of security and to promote changes in working procedures and systems.
Simulation will facilitate standard-based competency-driven clinical training and practice.
Simulation-based training costs can vary greatly depending on the details of the application.
The benefits of simulation applications can be difficult to measure, especially those that may involve long-term cumulative effects.
The main drivers of the simulation vision include the public, liability insurance companies, professional associations, accredited organizations and government regulators.
In some well-known cases, poor training and skills lead to a clinical disaster, which makes simulation training attractive to risk managers and insurance companies.
However, there are also a small number of medical accident cases claiming that negative or wrong simulation training is the cause of negligence.
Most of these allegations have been rejected or successfully defended by the court, but there are still a few allegations that persist, causing huge monetary losses to the simulation center.
Insurance at the simulation center has become expensive and difficult to obtain, and medical accident insurance companies have canceled the discounts they used to offer for simulation training.
Starting from 2004: what history will pass?
One thing to guess about future history is that real history will almost certainly be different from any of these extremes, and intermediate results are most likely.
In addition, depending on the unique local features of different regions, different regions may end in different middle positions.
The simulation of health care is almost near the end of 20 years of steady development, which may put it in the \"end of the beginning\" phase (
Quote from Churchill.
The fate of simulation as a means of revolutionary change in healthcare is approaching the \"tipping point\" 61, which will strongly resolve the year in one direction in these alternative histories over the next 10 years, although it will take ten years to fully evolve.
The simulation community must use the simulation tool to promote the vision of improving patient safety to the public and to the implementing agencies.
The simulation community must also play a core leadership role in setting standards for simulators, courses and simulation centers.
While we may never have clear evidence of simulation benefits comparable to multiple randomized clinical trials, we should collect evidence as much as possible, in the absence of Iron evidence, be forthright on our way forward.
The current generation of leaders in healthcare and healthcare simulation will be a key role in determining the actual course of future history.
As the grateful man said: \"A page of history will be neatly engraved on the stone.
The future is here. we are the future. we depend on ourselves. ” (
1982 from \"Throwing Stones; Lyrics, John P. Barlow;
Bob will, music.
Played by the Grateful Dead).
Text box 2: integrate different types of simulations into further research and development areas of different dimensions of the application, purpose, and target population.
Evaluate the impact or benefits of simulation-based training in all aspects.
Develop applications for participating units larger than the clinical team (
Complete work unit, full medical institution).
Use Simulations to establish benchmarks and standards for competency-based performance evaluation.
Use simulation to study basic aspects of human performance in health care.
If possible, use simulations to test the availability of medical devices and patient care processes before the early prototype phase and deployment.
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Org and SESAM on Www. uni-mainz.
On November 1942, after the Second Battle of El Alamein, Churchill said: \"This is not the end now.
This is not even the beginning of the end.
But this may be the end of the beginning.