Kneebone Roger L
1Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
2Centre for Engagement and Simulation Science (ICCESS), Academic Surgery (3rd Floor), Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH UK.
Adv Simul (Lond). 2016 Sep 29;1:27. doi: 10.1186/s41077-016-0028-8. eCollection 2016.
Simulation is firmly established as a mainstay of clinical education, and extensive research has demonstrated its value. Current practice uses inanimate simulators (with a range of complexity, sophistication and cost) to address the patient 'as body' and trained actors or lay people (Simulated Patients) to address the patient 'as person'. These approaches are often separate.Healthcare simulation to date has been largely for the training and assessment of clinical 'insiders', simulating current practices. A close coupling with the clinical world restricts access to the facilities and practices of simulation, often excluding patients, families and publics. Yet such perspectives are an essential component of clinical practice.
This paper argues that simulation offers opportunities to move outside a clinical 'insider' frame and create connections with other individuals and groups. Simulation becomes a bridge between experts whose worlds do not usually intersect, inviting an exchange of insights around embodied practices-the 'doing' of medicine-without jeopardising the safety of actual patients.Healthcare practice and education take place within a clinical frame that often conceals parallels with other domains of expert practice. Valuable insights emerge by viewing clinical practice not only as the application of medical science but also as performance and craftsmanship.Such connections require a redefinition of simulation. Its essence is not expensive elaborate facilities. Developments such as hybrid, distributed and sequential simulation offer examples of how simulation can combine 'patient as body' with 'patient as person' at relatively low cost, democratising simulation and exerting traction beyond the clinical sphere.The essence of simulation is a purposeful design, based on an active process of from an originary world, of what is criterial and - in another setting for a particular purpose or audience. This may be done within traditional simulation centres, or outside in local communities, public spaces or arts and performance venues.
Simulation has established a central role in clinical education but usually focuses on learning to do things as they are already done. Imaginatively designed, simulation offers untapped potential for deep engagement with patients, publics and experts outside medicine.
模拟已牢固确立为临床教育的支柱，广泛的研究已证明其价值。当前的做法是使用无生命模拟器（具有一系列复杂性、精密性和成本）来处理“作为身体的”患者，并使用受过训练的演员或外行人（模拟患者）来处理“作为人的”患者。这些方法通常是分开的。迄今为止，医疗保健模拟主要用于临床“业内人士”的培训和评估，模拟当前的做法。与临床世界的紧密结合限制了对模拟设施和做法的使用，通常将患者、家属和公众排除在外。然而，这些观点是临床实践的重要组成部分。
本文认为，模拟提供了走出临床“业内人士”框架并与其他个人和群体建立联系的机会。模拟成为通常互不相交的专家世界之间的桥梁，促使围绕具体实践——医学的“实践”——交流见解，而不会危及实际患者的安全。医疗保健实践和教育发生在一个临床框架内，这个框架常常掩盖了与其他专家实践领域的相似之处。通过不仅将临床实践视为医学科学的应用，还视为表演和技艺，能产生有价值的见解。这种联系需要对模拟进行重新定义。其本质不是昂贵复杂的设施。混合、分布式和顺序模拟等发展提供了示例，说明模拟如何能以相对较低的成本将“作为身体的”患者与“作为人的”患者结合起来，使模拟民主化，并在临床领域之外产生影响。模拟的本质是基于一个从原始世界出发的积极过程，针对特定目的或受众，在另一种环境中对什么是标准的进行有目的的设计。这可以在传统模拟中心内完成，也可以在当地社区、公共场所或艺术及表演场所之外完成。
模拟在临床教育中已确立核心地位，但通常侧重于学习按已有的方式做事。经过富有想象力的设计，模拟为深入接触医学之外的患者、公众和专家提供了尚未开发的潜力。
