1. The different uses of simulation:
From education to product testing
Adam Dubrowski, PhD
Learning and Research Institutes
Wilson Centre
Department of Paediatrics, UofT
3. Chaos in the Brickyard
Forscher, BK. Chaos in the Brickyard.
Science. 1963 Oct 18; 142(3590): 339.
4. Applying the Scientific Method and
underpinning research methodology to
generate evidence that will be used to build
simulation based education programs.
General Aim
5. • Models of Medical Education
• Introduction to Simulation
• Working Model
• Components of Simulation
– Simulators
– Educators
– Organization
• Future Directions
Outline
8. Apprenticeship Model
Trainer
Trainee
PatientCare
More people die in a given year as a result of medical
errors ( 44,000) than from motor vehicle accidents
(43,458), breast cancer (42,297), or AIDS (16,516).
"To Err is Human, Building a Safety Health System" (2000).
13. Dubrowski, A., Brydges, R., Satterthwaite, L., Xeroulis, G., Classe, R.
American Journal of Surgery. in press.
Busy Environment: Multitasking
Simulation Based Education
35. Study 4: Organization
Moulton et al., Ann Surg. 2007
1 2 3 4
1 hour
block
1 month
1 2 3 4
1 hour block
1 week
rest
1 month
distributed practice
massed practice
1 2 3 41 2 3 41 2 3 41 2 3 41 2 3 4
T
T
Transfer
36. Study 4: Organization
Moulton et al., Ann Surg. 2007
distributed
massed
ExpertOpinion
30
20
10
0
Pre-test
Microsurgical drill
Post-test
Rat
Transfer
48. PGY 1-5 Gen Surgery residents
Knot tying: surface (easy) and depth (difficult)
Assessed with expert-based (GRS) and computer-
based (motion analysis device) assessments
Brydges et al., J Am Coll Surg. 2008
Assessment of Performance
49. T
T
T
T T T
T T T
T
400
200
100
0
5
4
3
2
1
0
T T
T
T T
T T T TT
1000
800
600
400
200
0
T
T
T
T T
Surgical Volume
Expert-basedComputer-based
1 2 3 4 5
Depth
Surface
Brydges et al., J Am Coll Surg. 2008
Assessment of Performance
57. Building Skills, Changing
Practice: Simulator Training
for Hand Hygiene Protocols
Canadian Institutes of Health Research
Partnerships for Health System Improvement
A. McGeer, MA. Beduz, A. Dubrowski
Assessment of Learning
58. Purpose
• Current models of
knowledge delivery about
proper hand hygiene rely
on didactic session
• Transfer to practice is low
Assessment of Learning
66. • No transfer of
knowledge
• No changes in
performance, no
learning
• Ineffective education
and not transfer to
practice
PurposeAssessment of Learning
Being trained as a kinesiologyst and neuroscientist the general aim of my research is to apply the scientific method and the underpinning research methodology to generate evidence which can then be used to build simulation augmented education programs
I will do this by first introducing the past med education models that are rooted in the principles of apprenticeshipNext I will introduce SimulationAfter that I will present samples of research that look at the optimization of various components of Simulation. Specifically, I will look at evidence that can help us decide what simulators to use, how we should train the teachers or educators, and how the courses which utilize simulation should be organized.Finally I will talk about a few possible future direction
For that I will use anon-going study that looked at the use of simulation for the adherence of hand hygiene protocols
What we normally want to know is wehther our programs impact learning of skills, which then lead to change in behavour, which can be measured in the clinical setting. This is what is known as transfer to practice. However,
Typically what we assess is whether the learning happened based on what the learners know. When we don’t see transfer to practice, we cannot say whether this failure is due to ineffective education or transfer to practice mechanisms. Using simualtion ….
… for assessments ofcompetnacy and proficiency at a skill can help us in the understanding of the low transfer to practice phenomenon.
