Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

BACKGROUND Simulation technology is widely used in undergraduate and graduate medical education as well as for personnel training and evaluation in other healthcare professions. Simulation provides safe and effective opportunities for learners at all levels to practice and acquire clinical skills needed for patient care. A growing body of research evidence documents the utility of simulation technology for educating healthcare professionals. However, simulation has not been widely endorsed or used for continuing medical education (CME). METHODS This article reviews and evaluates evidence from studies on simulation technology in undergraduate and graduate medical education and addresses its implications for CME. RESULTS The Agency for Healthcare Research and Quality Evidence Report suggests that simulation training is effective, especially for psychomotor and communication skills, but that the strength of the evidence is low. In another review, the Best Evidence Medical Education collaboration supported the use of simulation technology, focusing on high-fidelity medical simulations under specific conditions. Other studies enumerate best practices that include mastery learning, deliberate practice, and recognition and attention to cultural barriers within the medical profession that present obstacles to wider use of this technology. CONCLUSIONS Simulation technology is a powerful tool for the education of physicians and other healthcare professionals at all levels. Its educational effectiveness depends on informed use for trainees, including providing feedback, engaging learners in deliberate practice, integrating simulation into an overall curriculum, as well as on the instruction and competence of faculty in its use. Medical simulation complements, but does not replace, educational activities based on real patient-care experiences.

[1]  J. Barsuk,et al.  Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. , 2008, Chest.

[2]  Subcommittees 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2005 .

[3]  Peter W. Airasian,et al.  Mastery Learning: Theory and Practice , 1971 .

[4]  R. Cummins ACLS provider manual , 2004 .

[5]  Robert Fletcher,et al.  Systematic Review: The Relationship between Clinical Experience and Quality of Health Care , 2005, Annals of Internal Medicine.

[6]  Edbert B. Hsu,et al.  Challenges in Systematic Reviews of Educational Intervention Studies , 2005, Annals of Internal Medicine.

[7]  H. Colt,et al.  Virtual reality bronchoscopy simulation: a revolution in procedural training. , 2001, Chest.

[8]  David Murray,et al.  Reliability and Validity of a Simulation-based Acute Care Skills Assessment for Medical Students and Residents , 2003, Anesthesiology.

[9]  J. Shatzer,et al.  Use of "Standardized Examinees" to Screen for Standardized-Patient Scoring Bias in a Clinical Skills Examination , 2005, Teaching and learning in medicine.

[10]  J. Feinglass,et al.  Graduating internal medicine residents’ self-assessment and performance of advanced cardiac life support skills , 2006, Medical teacher.

[11]  門倉 光隆,et al.  Colt HG, Crawford SW, Galbraith O., Virtual reality bronchoscopy simulation : a revolution in procedual training., Chest., 2001, 120, 1333-1339 , 2003 .

[12]  Lisa E. Dahill,et al.  Educating Clergy: Teaching Practices and Pastoral Imagination , 2005 .

[13]  N. Charness,et al.  Expert Performance Its Structure and Acquisition , 2002 .

[14]  K. A. Ericsson,et al.  The Road To Excellence: The Acquisition of Expert Performance in the Arts and Sciences, Sports, and Games , 1996 .

[15]  William C McGaghie,et al.  A Longitudinal Study of Internal Medicine Residents’ Retention of Advanced Cardiac Life Support Skills , 2006, Academic medicine : journal of the Association of American Medical Colleges.

[16]  E. Petrusa Clinical Performance Assessments , 2002 .

[17]  A. P. Craig,et al.  Time and Learning , 2000, On Learning.

[18]  S Barry Issenberg,et al.  The scope of simulation-based healthcare education. , 2006, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[19]  J. Shatzer,et al.  Performance of “standardized examinees” in a standardized‐patient examination of clinical skills , 1997, Academic medicine : journal of the Association of American Medical Colleges.

[20]  K. A. Ericsson,et al.  Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[21]  John R Boulet,et al.  A Simulation-Based Acute Skills Performance Assessment for Anesthesia Training , 2005, Anesthesia and analgesia.

[22]  J. Barsuk,et al.  Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice. , 2008, Journal of hospital medicine.

[23]  K. A. Ericsson,et al.  An expert‐performance perspective of research on medical expertise: the study of clinical performance , 2007, Medical education.

[24]  W. McGaghie,et al.  Development and evaluation of high-fidelity simulation case scenarios for pediatric resident education. , 2007, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[25]  A. Darzi,et al.  Assessing procedural skills in context: exploring the feasibility of an Integrated Procedural Performance Instrument (IPPI) , 2006, Medical education.

[26]  A. Ziv,et al.  Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review , 2005, Medical teacher.

[27]  I. R. Hart,et al.  BEME Guide No. 1: Best Evidence Medical Education. , 1999, Medical teacher.

[28]  I. Olkin,et al.  Improving the quality of reports of meta‐analyses of randomised controlled trials: the QUOROM statement , 2000, Revista espanola de salud publica.

[29]  William C McGaghie,et al.  Effect of practice on standardised learning outcomes in simulation‐based medical education , 2006, Medical education.

[30]  Susan Eastwood,et al.  Mejora de la calidad de los informes de los metaanálisis de los ensayos clínicos controlados: el acuerdo QUOROM , 2000 .

[31]  J. Feinglass,et al.  Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice , 2006, Journal of General Internal Medicine.

[32]  William C. McGaghie,et al.  Assessing Knowledge and Skills in the Health Professions: A Continuum of Simulation Fidelity , 1999 .

[33]  J. Boulet,et al.  Psychometric Challenges of Using Simulations for High-Stakes Assessment , 2007 .

[34]  W. McGaghie,et al.  Competency-Based Curriculum Development in Medical Education , 1978 .

[35]  J. Woodhouse,et al.  Acute Care Skills in Anesthesia Practice: A Simulation-based Resident Performance Assessment , 2004, Anesthesiology.

[36]  McGaghie Wc,et al.  Innovative Simulations for Assessing Professional Competence , 1999 .

[37]  M F Brillinger,et al.  Helping Adults Learn , 1990, Journal of human lactation : official journal of International Lactation Consultant Association.

[38]  W. McGaghie,et al.  Development of Multimedia Computer-Based Measures of Clinical Skills in Bedside Cardiology , 2000 .

[39]  William C. McGaghie,et al.  Simulation-Based Training of Internal Medicine Residents in Advanced Cardiac Life Support Protocols: A Randomized Trial , 2005, Teaching and learning in medicine.

[40]  A. Haghighat,et al.  Performance of A 3 MCNP™ for Calculation of 3-D Neutron Flux Distribution in a BWR Core Shroud , 2001 .

[41]  B. Spivey Continuing medical education in the United States: Why it needs reform and how we propose to accomplish it , 2005, The Journal of continuing education in the health professions.

[42]  Barbara G. Kanki,et al.  Cockpit Resource Management , 1993 .

[43]  Mary-Jo DelVecchio Good American Medicine: The Quest for Competence , 1995 .

[44]  W. McGaghie,et al.  Simulation technology for health care professional skills training and assessment. , 1999, JAMA.

[45]  Robert J. Crutcher,et al.  The role of deliberate practice in the acquisition of expert performance. , 1993 .

[46]  G. Loyd,et al.  Practical Health Care Simulations , 2004 .

[47]  William C. McGaghie,et al.  Effectiveness of a Cardiology Review Course for Internal Medicine Residents Using Simulation Technology and Deliberate Practice , 2002, Teaching and learning in medicine.

[48]  R. Neumar,et al.  Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2010, Circulation.

[49]  William C McGaghie,et al.  Comparison of Two Standard-setting Methods for Advanced Cardiac Life Support Training , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[50]  Janet Grant,et al.  Best Evidence Medical Education , 2000, Advances in health sciences education : theory and practice.

[51]  Todd Dorman,et al.  Effectiveness of continuing medical education. , 2007, Evidence report/technology assessment.

[52]  John R Boulet,et al.  Performance of Residents and Anesthesiologists in a Simulation-based Skill Assessment , 2007, Anesthesiology.

[53]  L. Nieman,et al.  Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency. , 1997, JAMA.

[54]  David S. Cordray,et al.  Treatment Strength and Integrity: Models and Methods. , 2006 .

[55]  F. Bradley The hospital as a college. , 1957, Medical times.

[56]  C. Pugh,et al.  Fundamentals of Educational Research Using Clinical Simulation , 2008 .

[57]  Roslyn F Schneider,et al.  Competency in chest radiography. A comparison of medical students, residents, and fellows. , 2005, Journal of general internal medicine.

[58]  E. Salas,et al.  Team performance assessment and measurement , 1997 .