Ziv Amitai, Ben-David Shaul, Ziv Margalit
Israel Center for Medical Simulation (MSR), Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Med Teach. 2005 May;27(3):193-9. doi: 10.1080/01421590500126718.
Medical professionals and educators recognize that Simulation Based Medical Education (SBME) can contribute considerably to improving medical care by boosting medical professionals' performance and enhancing patient safety. A central characteristic of SBME is its unique approach to making (and learning from) mistakes, which is regarded as a powerful educational experience and as an opportunity for professional improvement. The basic assumption underlying SBME is that increased practice in learning from mistakes and in error management in a simulated environment will reduce occurrences of errors in real life and will provide professionals with the correct attitude and skills to cope competently with those mistakes that could not be prevented. The main message of the present paper is that this assumption, which serves as the driving force of SBME, should also serve as a starting point for critical thinking and questioning regarding the multiple aspects and components of SBME. These questions, in turn, should lead to empirical research that will provide feedback concerning changes that may be necessary in order to attain the goal of improving medical professionals' performance. Based on such research, SBME will be held accountable for its outcomes, i.e. whether its educational techniques indeed result in decreased occurrence of errors or not, and whether the ability to cope with the errors that do occur is significantly improved. The first of three issues that were addressed concerns individuals' experience of performing mistakes. It is suggested that in order to benefit fully from the experience of performing mistakes in a simulated context, medical educators should create a balance between the emotional load associated with the experience and the professional lessons that can be learned. Furthermore, research should focus on the long-term effects of the experience in changing professionals' attitudes and behaviour. The second question concerned the contribution of the different components of the educational experience to creating the desired changes in professionals' performance. Analysis of the teaching and learning involved in each stage of the educational event should serve as the basis for research that aims at identifying the unique contribution and efficiency of each element, and defining the essential core activities of a simulated experience. Finally, the need to define a newly emerging profession-SBME educator-was addressed. The professional qualifications are, clearly, multidisciplinary and should be based on the growing experience of medical educators in training students and professionals. Defining the profession is essential in order to create academic environments in which professionals will be trained to develop and implement new programmes, accompanied by research and assessment.
医学专业人士和教育工作者认识到，基于模拟的医学教育（SBME）通过提高医学专业人员的表现和增强患者安全，能够对改善医疗护理做出重大贡献。SBME的一个核心特征是其对待犯错（以及从错误中学习）的独特方式，这被视为一种强大的教育体验以及专业提升的机会。SBME的基本假设是，在模拟环境中增加从错误中学习和进行错误管理的实践，将减少现实生活中的错误发生，并为专业人员提供正确的态度和技能，以有效应对那些无法预防的错误。本文的主要观点是，这个作为SBME驱动力的假设，也应成为对SBME的多个方面和组成部分进行批判性思考和质疑的起点。反过来，这些问题应引发实证研究，以提供有关为实现提高医学专业人员表现这一目标可能需要的变革的反馈。基于此类研究，SBME将对其结果负责，即其教育技术是否确实导致错误发生率降低，以及应对实际发生的错误的能力是否得到显著提高。所探讨的三个问题中的第一个涉及个人犯错的体验。有人建议，为了在模拟情境中充分从犯错体验中受益，医学教育工作者应在与该体验相关的情感负担和可学到的专业教训之间创造平衡。此外，研究应关注该体验在改变专业人员态度和行为方面的长期影响。第二个问题涉及教育体验的不同组成部分对在专业人员表现方面产生预期变化的贡献。对教育活动每个阶段所涉及的教学和学习进行分析，应作为旨在确定每个要素的独特贡献和效率，并界定模拟体验的基本核心活动的研究基础。最后，探讨了定义一个新兴职业——SBME教育工作者的必要性。显然，专业资格是多学科的，应基于医学教育工作者在培训学生和专业人员方面不断增长的经验。定义该职业对于创建学术环境至关重要，在这种环境中，专业人员将接受培训以开发和实施新计划，并伴有研究和评估。
