Department of Psychiatry at Yale School of Medicine, New Haven, CT, 06519, USA.
The Harris Center for Mental Health and IDD, Houston, TX, 77092, USA.
BMC Med Educ. 2022 Jul 30;22(1):584. doi: 10.1186/s12909-022-03627-w.
Health system science (HSS) encompasses both core and cross-cutting domains that emphasize the complex interplay of care delivery, finances, teamwork, and clinical practice that impact care quality and safety in health care. Although HSS skills are required during residency training for physicians, current HSS didactics have less emphasis on hands-on practice and experiential learning. Medical simulation can allow for experiential participation and reflection in a controlled environment. Our goal was to develop and pilot three simulation scenarios as part of an educational module for resident physicians that incorporated core and cross-cutting HSS domains. METHODS: Each scenario included a brief didactic, an interactive simulation in small-group breakout rooms, and a structured debriefing. The case scenario topics consisted of educational leadership, quality and safety, and implementation science. Learners from four residency programs (psychiatry, emergency medicine, orthopedics, ophthalmology) participated January - March 2021.
A total of 95 resident physicians received our curricular module, and nearly all (95%) participants who completed a post-session survey reported perceived learning gains. Emotional reactions to the session were positive especially regarding the interactive role-play format. Recommendations for improvement included participation from non-physician professions and tailoring of scenarios for specific disciplines/role. Knowledge transfer included use of multiple stakeholder perspectives and effective negotiation by considering power/social structures.
The simulation-based scenarios can be feasibly applied for learner groups across different residency training programs. Simulations were conducted in a virtual learning environment, but future work can include in-person and actor-based simulations to further enhance emotional reactions and the reality of the case scenarios.
健康系统科学（HSS）涵盖核心和跨领域，强调医疗保健中护理提供、财务、团队合作和临床实践的复杂相互作用，这些因素会影响护理质量和安全性。尽管 HSS 技能是医生住院医师培训所必需的，但目前的 HSS 课程较少强调实践操作和体验式学习。医疗模拟可以在受控环境中实现体验式参与和反思。我们的目标是开发并试点三个模拟场景，作为纳入核心和跨领域 HSS 领域的住院医师教育模块的一部分。
每个场景都包括简短的教学、在小组休息室进行的互动模拟以及结构化的讨论。案例场景主题包括教育领导力、质量和安全以及实施科学。来自四个住院医师培训项目（精神病学、急诊医学、骨科、眼科）的学习者于 2021 年 1 月至 3 月参加了该课程。
共有 95 名住院医师接受了我们的课程模块，几乎所有（95%）完成课后调查的参与者都报告说有学习收获。对课程的情绪反应是积极的，特别是对互动角色扮演格式。改进的建议包括非医师专业人员的参与和针对特定学科/角色的场景定制。知识转移包括考虑权力/社会结构，从多个利益相关者的角度进行有效谈判。
基于模拟的场景可以为不同住院医师培训项目的学习者群体灵活应用。模拟是在虚拟学习环境中进行的，但未来的工作可以包括现场和基于演员的模拟，以进一步增强情感反应和案例场景的真实性。
