Back in the 1960s, the aviation industry introduced simulators to train pilots. The idea was to put trainees in a high tech simulation model of a cockpit, throw everything possible at them and see how they do. If they made mistakes, no one suffered, — least of all passengers on an aircraft. Today, even with the horrors of 9/11 and the recent Air France crash in Toronto, air travel remains the safest mode of transportation.
What about health care? This too can be a life and death business, and the safety record isn’t good. In fact, this industry suffers the equivalent of a plane crash every day, which means that more than 150,000 people needlessly die each year in North America alone because of medical error. If there was a major plane crash every day, all stops would be pulled out to see what was wrong. But not in health care. This – deaths due to medical error – has been the industry’s best kept secret.
Aviation used technology to train its professionals and improve its safety record. We in health care must do the same. How can we use simulator education for health professionals? Just as physicians use technology for diagnosis, we can use technology to assess the ability of a health care student or professional to perform critical tasks. Instead of requiring student health care professionals to practice on real people, we can use a simulator – just like they do with aspiring airline pilots.
Extending the use of simulation is the driver of a new paradigm for clinical education.. Leading Toronto hospitals, like St. Michael’s, Mount Sinai and Sunnybrook, are using simulation technology to ensure that tomorrow’s professionals can meet the task when they work with people. The Michener Institute for Applied Health Sciences, Canada’s only post-secondary institution that exclusively trains for careers in allied health professions, has used simulators for years to prepare the technical skills of students. Now it’s planning to extend simulation education in curriculum to enhance inter-professional skills (i.e., team collaboration, communications, crisis management).
At Michener, we still focus on skills development for allied health care professions. But in the future we will reinforce these skills in a clinical context with health care students from other professions to simulate the team environment in health care. Thus, students will work in simulated situations that mirror the reality of clinical practice before working with patients and before they progress into their clinical placements.
The context for this is that health care education is at a crossroads. The challenge for academic institutions is to work with their clinical partners to revamp clinical education. Academics and clinicians must not get stuck in the quagmire of the historic “apprenticeship model” of preparation for health care delivery. Instead, they must find innovative teaching and learning models.
Why the need for such a change? Health care educators should be asking themselves whether their students are ready for their clinical rotation and, ultimately, for practice. Faculty must be confident that students can demonstrate the necessary expertise to progress into clinical rotations.
With human resource shortages and increased workloads in clinical environments, it’s clear that faculty in educational institutions must assume more responsibility. That’s why Michener is optimizing the preparation of its students before they proceed into their clinical education rotation, by extending simulation education and assessment opportunities.
The present clinical education model may, in fact, be compounding HR shortages in health care. The number of students Michener can accommodate in any program is directly related to the availability of clinical education sites. At a time when we face HR shortages, the number of new graduates we can prepare is restricted. To address the looming shortages, we must find ways to maximize the clinical education experience. This may mean shifting the onus of responsibility for supporting students’ clinical learning away from clinical sites and back into the educational institution.
We must be clear about which competencies are best addressed in a real clinical setting and which may be taught and reinforced in a simulated clinical environment. Research will help determine the time required to reach competency, while curriculum redesign will ensure that clinical education rotations focus on competencies that can’t be replicated by simulation. There is no science to the present model of 42 weeks for clinical education; the time blocked for clinical education is more often a factor of tradition.
We have an opportunity to rethink our academic model. We can realign the curriculum to make it consistent with current educational theory and give faculty, sites and students the opportunity to build the “best experience/best education” model to carry us forward. This just happens to be the slogan at Michener. The idea is to design curriculum so students are active in learning.
Historically, health care curriculum has been designed in disciplinary silos. Students learn their discipline content, apply this knowledge in laboratory settings and proceed into clinical education environments. Not until the clinical education rotation do they apply their discipline-specific expertise with other health care professions. Inter-professional education (IPE) ensures that students learn and apply skills like collaboration, communications, problem analysis and patient care with other people from different disciplines – physicians, nurses, allied health professionals – to simulate real-life experience.
Moving away from these professional silos that are now so prevalent in health care will, hopefully, contribute to the reduction of medical errors.
Curriculum must also be designed to provide simulated learning opportunities that optimize student learning. This will shift some of the burden from the clinical environment to the educators and respond to student requests for more “hands on” learning opportunities. For the current academic year, all programs at Michener will:
Use a computerized curriculum design system.
Map curriculum against professional competencies, Michener core capabilities and IPE competencies.
Work with clinical partners to shift the focus of responsibility for clinical education from external clinical sites to an internal, Michener-simulated environment and reduce external clinical education time by up to 50 per cent.
Integrate problem-based, inter-professional simulation learning into the curriculum to replace the reduced clinical time.
Train faculty to improve the assessment of students’ clinical skills.
Evaluate student readiness to proceed into clinical environments before allowing students to engage in active patient care.
No pilot flies until the instructor is certain air travel safety isn’t compromised. So too will we ensure that no student will deliver patient care without careful assessment in a simulated situation.
Mary Preece (MPreece@michener.ca) is Vice President of Academic Affairs at The Michener Institute for Applied Health Sciences.