Okuda Yasuharu, Bryson Ethan O, DeMaria Samuel, Jacobson Lisa, Quinones Joshua, Shen Bing, Levine Adam I
Department of Emergency Medicine and Medical Education, Mount Sinai School of Medicine, New York, NY, USA.
Mt Sinai J Med. 2009 Aug;76(4):330-43. doi: 10.1002/msj.20127.
Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes.
医学院校和住院医师培训项目目前正面临教学模式的转变。医学信息和研究数量的不断增加，使得医学教育难以在课程设置上与时俱进。随着患者越来越担心学生和住院医师在他们身上“练习”，临床医学越来越注重患者安全和质量，而不是床边教学和教育。教育工作者通过重组课程、开展小组讨论以及增加自主学习和独立研究来应对这些挑战。然而，课堂与临床环境之间仍然存在脱节。许多学生觉得他们在病史采集、体格检查、诊断和管理方面的训练不足。医学模拟已被提议作为一种弥合这一教育差距的技术。本文回顾了模拟在医学教育中效用的证据。我们在MEDLINE数据库中搜索了与教育中的模拟相关的原创文章和综述文章，关键词包括模拟、人体模型模拟器、部分任务模拟器、毕业后医学教育、本科医学教育和继续医学教育。与本科医学教育、毕业后医学教育和继续医学教育相关的文章被用于该综述。本综述纳入了113篇文章。基于模拟的培训在模拟研究的两个领域被证明能带来临床改善。在腹腔镜手术模拟器上接受培训的住院医师在手术室的操作表现有所提高。另一项研究表明，在模拟器上接受培训的住院医师比那些接受心脏骤停患者标准培训的住院医师更有可能遵守高级心脏生命支持协议。在医学培训的其他领域，模拟已被证明能提高医学知识、操作舒适度，并在模拟场景的重新测试中提高表现。模拟也被证明是评估学习者以及教授团队合作和沟通等主题的可靠工具。只有少数研究表明使用模拟进行培训能直接改善临床结果。多项研究证明了模拟在本科和毕业后医学教育水平的基础科学和临床知识教学、操作技能、团队合作、沟通以及评估方面的有效性。随着模拟在医学院校和住院医师教育中越来越普遍，需要更多研究来确定模拟培训是否能改善患者结局。
