Sørensen Jette Led, Østergaard Doris, LeBlanc Vicki, Ottesen Bent, Konge Lars, Dieckmann Peter, Van der Vleuten Cees
Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark.
Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, 2730, Herlev, Denmark.
BMC Med Educ. 2017 Jan 21;17(1):20. doi: 10.1186/s12909-016-0838-3.
Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design of SBME and the advantage and disadvantage of the different simulation settings, such as training in simulation-centres, in-house simulations in hospital departments, announced or unannounced in situ simulations.
Non-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence individual or team learning. However, hospital department-based simulations, such as in-house simulation and in situ simulation, lead to a gain in organisational learning. To our knowledge no studies have compared announced and unannounced in situ simulation. The literature suggests some improved organisational learning from unannounced in situ simulation; however, unannounced in situ simulation was also found to be challenging to plan and conduct, and more stressful among participants. The importance of setting, context and fidelity are discussed. Based on the current limited research we suggest that choice of setting for simulations does not seem to influence individual and team learning. Department-based local simulation, such as simulation in-house and especially in situ simulation, leads to gains in organisational learning. The overall objectives of simulation-based education and factors such as feasibility can help determine choice of simulation setting.
基于模拟的医学教育（SBME）传统上是在模拟中心进行的场外模拟。一些医院科室也利用为模拟而设立的内部培训室提供场外模拟，这些活动被称为内部培训。内部培训设施可以是医院科室的一部分，在一定程度上类似于模拟中心，但技术设备通常较少。过去十年引入的现场模拟主要包括团队活动，在医疗专业人员自己的工作环境中的患者护理单元进行。因此，这种模拟与实际工作环境的有意融合意味着现场模拟将模拟带入实际工作环境，并在人们工作的地方提供培训。现场模拟可以是预告的或未预告的，后者也称为演练。本文介绍并讨论了SBME的设计以及不同模拟环境（如模拟中心培训、医院科室内部模拟、预告或未预告的现场模拟）的优缺点。
非随机研究认为，现场模拟在教育目的方面比其他类型的模拟环境更有效。相反，现有的少数比较研究，无论是随机的还是回顾性的，都表明环境的选择似乎不会影响个人或团队学习。然而，基于医院科室的模拟，如内部模拟和现场模拟，会带来组织学习的提升。据我们所知，没有研究比较过预告和未预告的现场模拟。文献表明，未预告的现场模拟能在一定程度上改善组织学习；然而，也发现未预告的现场模拟在计划和实施方面具有挑战性，并且参与者压力更大。文中讨论了环境、背景和逼真度的重要性。基于目前有限的研究，我们认为模拟环境的选择似乎不会影响个人和团队学习。基于科室的局部模拟，如内部模拟，尤其是现场模拟，会带来组织学习的提升。基于模拟的教育的总体目标以及可行性等因素有助于确定模拟环境的选择。
