How Does Simulation Based Education Impact Patient Safety?
International Day of Education
The International Day of Education highlights the role of education globally and promotes accessible education for everyone as a human right. To learn more about the International Day of Education follow the link: https://unpartnerships.un.org/events/international-day-education.
To celebrate the International Day of Education this year, we are reflecting on Simulation-Based Education (SBE) within healthcare and how it contributes to patient safety.
Simulation-Based Education
Having initially been demonstrated within the aviation industry (Oman et al., 2023), SBE has been adopted within healthcare education and training. Clinical SBE began several decades ago (Nehring and Lashley, 2009) and has continued to successfully grow rapidly, providing learners with the opportunity to put their knowledge and skills into practice within a psychologically safe environment. Effective SBE includes a debrief following on from the simulated exercises. Research outlines that the debrief has been identified as a key component of impactful SBE (Jaye et al., 2015), with the simulated scenarios acing as a catalyst for further reflection, conversation and sharing of experiences and ideas.
There are a range of techniques used within SBE:
- Forum theatre: Participants observe a complete simulated scenario play out in front of them, followed by a group reflection. The scenario is then run again, giving participants the opportunity to pause the scenario at multiple points and change the behaviours of one of the simulated characters in an attempt to improve the outcome.
- Fishbowl Simulation: Participants are given a scenario and task and interact with simulated characters whilst their peers observe the interaction and completion of the task. This is followed by a facilitated debrief in which participants are able to explore alternative methods, obtain feedback, discuss learning objectives, reflect and share ideas.
- Observational simulation: Participants observe a simulated scenario which is then followed by a facilitated debrief in which participants are able to explore alternative methods, discuss learning objectives, reflect and share ideas.
- Monologues: Participants observe whilst a simulated character delivers a monologue which may include the character’s reflections, experiences or feelings. This is then followed by a facilitated debrief in which participants are able to explore alternative methods, discuss learning objectives, reflect and share ideas.
How Simulation-Based Education Impacts on Patient Safety
SBE has been shown to have a wide range of benefits, many of which in turn, impact on patient safety. Some of these benefits are outlined below:
Participant Skills and Knowledge
SBE enhances participant skills (Issenberg et al., 1999) through practice, reflection and feedback and can be utilised within a broad range of skills, spanning both technical skills, such as performing procedures and examinations but also non-technical skills, such as leadership, communication skills, teamwork or prioritisation (Pearson and McLafferty, 2011). Enhancement of the skills and knowledge of clinical staff will result in an increase in patient safety.
Participant Confidence
Simulation training is valuable with regards to participant confidence, as highlighted by Alrashidi et al., 2023. By providing participants with the opportunity to practise a new skill in a simulated setting in which there will be no safety implications, participants can build their confidence to the point at which they feel safe to use the skills in a non-simulated environment.
Participant Teamwork
Teamwork skills are often a key focus and improve through the use of simulation training (Gilfoyle et al., 2017). Dependent on the participant group this can be on both an intra-professional and interprofessional basis. Whilst these skills can be practised within the simulation scenarios, the debrief period also provides the opportunity to share differing points of view within the team which can enhance teamwork.
Participant Mental Health, Burnout and Sick Leave
Medical and allied healthcare staff face high levels of mental health concerns and burnout, with the recent General Medical Council (GMC) report, “The State of Medical Education and Practice in the UK Workplace Experience 2024” stating, “a third of doctors are struggling and feel unable to cope.” Staff burnout impacts negatively on patient safety (Garcia et al., 2019). Simulation training has been found to have beneficial effects on anxiety, stress and burnout amongst some staff groups (Couarraze et al., 2023) and could also act as a protective factor against sick leave (Schram et al., 2023)
References:
Alrashidi, N., Pasay An, E., Alrashedi, M. S., Alqarni, A. S., Gonzales, F., Bassuni, E. M., Pangket, P., Estadilla, L., Benjamin, L. S., & Ahmed, K. E. (2023). Effects of simulation in improving the self-confidence of student nurses in clinical practice: a systematic review. BMC medical education, 23(1), 815. https://doi.org/10.1186/s12909-023-04793-1
Couarraze, S., Jean, M. S., Decormeille, G., Cerfon, C. H. H., Minville, V., Fourcade, O., & Geeraerts, T. (2023). Short term effects of simulation training on stress, anxiety and burnout in critical care health professionals: before and after study. Clinical Simulation in Nursing, 75, 25–32. https://doi.org/10.1016/j.ecns.2022.12.001
Garcia, C. L., Abreu, L. C., Ramos, J. L. S., Castro, C. F. D., Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina (Kaunas, Lithuania), 55(9), 553. https://doi.org/10.3390/medicina55090553
General Medical Council. (2024). The State of Medical Education and Practice in the UK Workplace experience 2024. https://www.gmc-uk.org/-/media/documents/somep-workplace-report-2024-full-report_pdf-107930713.pdf
Gilfoyle, E., Koot, D. A., Annear, J. C., Bhanji, F., Cheng, A., Duff, J. P., Grant, V. J., St George-Hyslop, C. E., Delaloye, N. J., Kotsakis, A., McCoy, C. D., Ramsay, C. E., Weiss, M. J., Gottesman, R. D., & Teams4Kids Investigators and the Canadian Critical Care Trials Group (2017). Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 18(2), e62–e69. https://doi.org/10.1097/PCC.0000000000001025
Issenberg, S. B., McGaghie, W. C., Hart, I. R., Mayer, J. W., Felner, J. M., Petrusa, E. R., Waugh, R. A., Brown, D. D., Safford, R. R., Gessner, I. H., Gordon, D. L., & Ewy, G. A. (1999). Simulation technology for health care professional skills training and assessment. JAMA, 282(9), 861–866. https://doi.org/10.1001/jama.282.9.861
Jaye, P., Thomas, L., & Reedy, G. (2015). ‘The Diamond’: a structure for simulation debrief. The clinical teacher, 12(3), 171–175. https://doi.org/10.1111/tct.12300
LaVelle, B. A., & McLaughlin, J. J. (2008). Simulation-Based Education Improves Patient Safety in Ambulatory Care. In K. Henriksen (Eds.) et. al., Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Agency for Healthcare Research and Quality (US).
Nehring, W. M., & Lashley, F. R. (2009). Nursing Simulation: A Review of the Past 40 Years. Simulation & Gaming, 40(4), 528-552. https://doi.org/10.1177/1046878109332282
Oman, S. P., Magdi, Y., & Simon, L. V. (2023). Past Present and Future of Simulation in Internal Medicine. In StatPearls. StatPearls Publishing.
Pearson, E., & McLafferty, I. (2011). The use of simulation as a learning approach to non-technical skills awareness in final year student nurses. Nurse education in practice, 11(6), 399–405. https://doi.org/10.1016/j.nepr.2011.03.023
Schram, A., Jensen, H. I., Gamborg, M., Lindhard, M., Rölfing, J., Kjaergaard-Andersen, G., Bie, M., & Jensen, R. D. (2023). Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites. BMJ open, 13(10), e076163. https://doi.org/10.1136/bmjopen-2023-076163
United Nations. 24 January 2025 International Day of Education. https://unpartnerships.un.org/events/international-day-education