Tolga D. Dittrich, MD
Simulation-based education (SBE) is an emerging field in medical education. Several techniques are available, such as role-playing, realistic mannequins, or virtual reality, which can be used alone or in combination with one another. The fields of application in the training of stroke physicians are manifold. They range from learning clinical treatment pathways for junior clinicians to highly specific manual skills for advanced physicians.
Evans and co-authors identified three essential components for the development of successful SBE programs: (1) fidelity (i.e., creating an authentic learning experience); (2) feedback (i.e., consolidating the simulation experience); and (3) transfer of knowledge (i.e., transferring what has been learned into clinical practice).
Fidelity is an interplay of different factors whose importance for learning success depends significantly on the complexity of the skill to be learned. These factors include psychological and engineering fidelity (e.g., realistic simulations). Some scenarios may concentrate on the realistic character of the simulation (e.g., simulation-based learning of mechanical thrombectomies), and others on the psychosocial embedding (e.g., end-of-life care decisions with the help of simulated patients).
To not only initiate desired behaviors but also to consolidate and improve what has been learned, feedback is considered essential. The suggested approach consists of a planning part (“How can feedback be incorporated effectively into the scenario?”), a briefing of the participants (“Which are the learner-generated objectives and learning needs?”), and the actual feedback within the individual parts of a scenario, as well as after completion.
The effectiveness of SBE is ultimately defined by the successful transfer of knowledge from the learner-centered scenario to the patient-centered clinical reality. On the one hand, this has to be evaluated in the short term (e.g., by course completion questionnaires); on the other hand, in the long term (e.g., by assessing the impact on measurable endpoints like door-to-needle-time).
Compared to learning specific skills through experience in the clinical setting, a benefit of SBE is that it can be tailored to the particular needs of the trainees and their level of training. In this regard, effective SBE is not necessarily expensive and provides a protected and controlled environment in which various situational approaches can be practiced.