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© Borgis - Postępy Nauk Medycznych 4/2018, s. 217-220 | DOI: 10.25121/PNM.2018.31.4.217
*Malgorzata Perlak1, Adam Ubych1, Kamil Barglik1, Mateusz Benesz1, Katarzyna Stawicka1, 2, Seweryn Krol3, Michal Stasiowski3, 4, Witold Lukas1
Practical aspects of the use of medical simulation in the teaching of medical and communication skills
Praktyczne aspekty wykorzystania symulacji medycznej w nauczaniu kompetencji medycznych i komunikacyjnych
1Center of Didactics and Medical Simulation, Medical University of Silesia, Poland
2Department of Propedeutics and Obstetrics, Faculty of Health Sciences, Medical University of Silesia in Katowice, Poland
3Clinical Department of Anaesthesiology and Intensive Care, St. Barbara Provincial Specialist Hospital No. 5 in Sosnowiec, Poland
4Clinical Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
Streszczenie
Proces nauczania polega na dostarczeniu wiedzy, tak aby uczący się znał i wiedział, jak wykonać daną czynność. Symulacja to sztuczne odtwarzanie właściwości danego zjawiska za pomocą jego modelu. Na dzień dzisiejszy wiele ośrodków – uczelni medycznych, klinik czy też organizacji zajmujących się kształceniem kadr medycznych – korzysta z metod i technik symulacji medycznej.
Symulacja to sztuczne odtwarzanie właściwości danego zjawiska za pomocą jego modelu. Liczne organizacje, uczelnie medyczne i kliniki zajmujące się kształceniem kadr medycznych korzystają z metod symulacji medycznej. Wykorzystanie symulacji medycznej w procesie nauczania kadr medycznych ma na celu optymalizację efektów kształcenia.
Profesjonalne przygotowanie symulacji medycznej jest uznaną formą kształcenia, prowadzącą do lepszego efektu edukacyjnego w porównaniu do techniki klasycznej – pod warunkiem, że spełnione zostały jednocześnie wszystkie wymagania zawarte w ośmiu etapach przygotowania i przeprowadzenia symulacji medycznej.
Summary
The teaching process is based on providing knowledge so that a learner knows and has an ability to perform a given activity. Simulation is the artificial reproduction of the characteristics of a given phenomenon, using its model as a point of reference. Nowadays, many centers – medical universities, clinics or other organizations involved in the education of medical staff use methods and techniques of medical simulation.
Simulation is an artificial reproduction of the properties of a given phenomenon by means of its model. Currently, numerous organizations, medical colleges and clinics involved in the process of training of medical staff employ the methods and techniques of medical simulation. The utility of medical simulation in the process of teaching of medical treatment providers aims to optimize the educational results.
Professional preparation of a medical simulation is an appropriate form of training, which leads to improvement of educational effects as compared to conventional method, on condition that all the requirements of the eight stages of preparation and conduct of medical simulation are met simultaneously.
INTRODUCTION
The guiding idea introduced by Confucius: “Tell me and I will forget. Show me and I may remember. Involve me and I will understand” (1), confirms the accuracy of adult learning. The most effective way of acquiring and consolidating knowledge is based on active participation of the participants in a given process, as opposed to listening to or to passive mechanical acquisition of knowledge and understanding of the presented content.
Active forms of teaching include role-performance, playing audio/video recordings, case studies and working with a simulated patient or an advanced simulator (2, 3). All the methods mentioned prior are applied to the teaching process of medical staff as they allow them to develop integral medical skills, clinical communication and teamwork (3, 4). Medical simulation occupies a special place among the above mentioned methods.
Simulation is defined as the artificial reproduction of the characteristics of a given phenomenon by means of using its model – a simulator – in order to improve knowledge and gain the ability to solve problems in practice (5). At present, medical colleges use medical simulation methods and techniques (6, 7). Certified training courses for international organizations, i.e. the European Resuscitation Council (ERC) and the American Heart Association (AHA), are largely based on the simulation form (8) during practical classes.
The aim of this overview paper is to present the principles governing the teaching process that uses medical simulation, as well as to provide practical information for individuals working with the use of the method of medical simulation.
SIMULATION AS A TEACHING METHOD
The analysis of the learning process, i.e. the development of professional competences, shows that in contrast to all available and currently used teaching methods, only simulation allows for practical examination of students’ skills, which consequently leads to achieving maximum efficiency of the teaching process (fig. 1) (9, 10). A medical simulation is different from a conventional teaching method (based on the transfer of knowledge during lectures or seminars). In the process of teaching by means of simulation, participants take an active part in the scenario, i.e. in the simulated medical event. The role of the patient is played by an advanced medical simulator and the participants become a medical team: for example, a hospital staff or a medical rescue team (12). The simulation scenario takes about 10-15 minutes and focuses on a specific event (traffic accident, exacerbation of a specific disease entity).
Fig. 1. Levels of evaluation
After the completion of the simulation session, the whole situation is analyzed both in medical and communication terms. In comparison with other types of activities, instead of analyzing the patient’s imagined medical condition, discussing and planning the procedure, the participants act as in the case of an event under real medical conditions. All procedures, from taking a medical history of a patient to the implementation of advanced medical procedures, have to be carried out in real time. As a rule, the teacher/simulation trainer should not be present in the simulation room when the scenario is performed. Thanks to audio-video systems, actions of the team can be observed. Moreover, the teacher/simulation trainer can communicate with the team, for example, using the patient’s voice. The participants have to rely on their own without external support.
A simulator, for example, the Human Patient Simulator HPS, Simman 3G, is used during the simulation session. It offers the possibility of examining individual reflexes, symptoms (respiratory murmurs, heart rate, reaction of the pupils to light, etc.) and has the function of performing medical procedures (advanced airway irritation, defibrillation, injection, etc.) (11).
The student’s working environment with the simulated patient has to faithfully reflect real work environment, that is the rooms in which they will work in the future. The simulation room is usually equipped with the same tools which one may see in the real hospital rooms.
The student acquires knowledge how to use the medical equipment and perform actions in the surrounding environment in simulated conditions while learning about handling of medical equipment, its distribution and functioning.
The learning process is about providing knowledge so that the learner knows how to perform the given activity. One should pay attention to the fact that passing knowledge is not enough since it should be consolidated and put it into practice by the student.
The learner has to have the opportunity to be shown how the medical procedure is performed in order to perform a given activity (under the supervision of the teacher) independently. A medical simulation offers all these possibilities (12, 13). However, the method has to be applied properly in order to produce the desired results in the form of satisfied, confident and well-educated medical experts. Moreover, the instructor should remember about eight stages of preparing and conducting medical simulation in a professional manner and which is aimed at achieving a pre-set didactic goal.
The first important step is to define the target audience precisely and adapt the scenario to capabilities of the students. There should be no “one-size-fits-all” scenario due to the diversity of level of knowledge and experience of the students, as the learning objectives and therefore the complexity of the scenario will be different for each group of participants.
Setting the target precisely is the second meaningful stage which should be based on reliable sources. The assumed educational results are included in: the syllabuses of a given subject, contemporary literature or guidelines published by scientific societies. Each simulation should have a clearly stated objective, as conducting a simulation that focuses on too many elements may not be effective. The simulation should include one of the two learning objectives described within the three areas: knowledge, skills and social competences.
The next step refers to making effort to get the participants acquainted with requirements they will have to meet during the simulation. It is important that the students know the material in advance in order to prepare for the simulation classes. Outlining an area of knowledge which should be remembered becomes essential for successful simulation activities. Under no circumstances should a simulation be an unannounced test of knowledge after which a participant may get a critical feedback.

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Piśmiennictwo
1. https://pl.wikiquote.org/wiki/Konfucjusz.
2. Knowles MS, Holton EF, Swanson RA: Edukacja dorosłych. Wyd. Naukowe PWN, Warszawa 2009.
3. Wallin CJ, Meurling L, Hedman L et al.: Target-focused medical emergency team training using a human patient simulator: effects on behavior and attitude. Med Educ 2007; 41(2): 173-180.
4. DeLorenzo RA, Abbott CA: Effectiveness of an adult learning, self-directed model compared with traditional lecture-based teaching methods in out of hospital training. Acad Emerg Med 2004; 11: 33-37.
5. http://ecmo.pl/symulacje-ecmo1/symulacje-wysokiej-wierno%C5%9Bci.
6. Stasiowski MJ, Majzel G, Perlak M et al.: Ocena porównawcza wpływu kształcenia studentów V roku medycyny (kierunku lekarskiego) metodą klasyczną oraz symulacją na skuteczność leczenia ostrego bólu pourazowej w symulacji medycznej. Anestezjol Ratow 2017; 11(4): 374-384.
7. http://ckp.wim.mil.pl/30-aktualnoscipasek/188-nasze-szkolenia.
8. http://www.prc.krakow.pl/szkolenia.html, http://www.heart.org/HEARTORG/.
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10. International Association for Communication in Healthcare: https://www.each.eu/ (dostęp z dnia: 1.02.2018).
11. http://www.lmp.pl/index.php/Symulacja_Medyczna.html.
12. Wang EE, Vozenilek JA: Addressing the Systems-based Practice Core Competency. A Simulation-based Curriculum. Acad Emerg Med 2005; 12(12): 1191-1194.
13. Gaba DM: The future vision of simulation in health care. Qual Saf Health Care 2004; 13(suppl. 1): i2-i10.
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15. Rudolph JW, Simon R, Raemer DB, Eppich WJ: Debriefing as Formative Assessment: Closing Performance Gaps in Medical Education. Acad Emerg Med 2008; 15: 1-7.
16. Czekajlo M, Dąbrowski M, Dąbrowska A et al.: Symulacja medyczna jako profesjonalne narzędzie wpływające na bezpieczeństwo pacjenta wykorzystywane w procesie nauczania. Pol Merk Lek 2015; 38(228): 360-363.
17. Jaye P, Thomas L, Reedy G: The Diamond: a structure for simulation debrief. Clin Teach 2015; 12(3): 171-175.
otrzymano: 2018-07-05
zaakceptowano do druku: 2018-07-26

Adres do korespondencji:
*Malgorzata Perlak
Center of Didactics and Medical Simulation Medical University of Silesia in Katowice
8b Medyków Str., 40-752 Katowice, Poland
Phone: +48 (32) 2088772
E-mail: mperlak@sum.edu.pl

Postępy Nauk Medycznych 4/2018
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