The Great Debate: Simulation(It won’t revolutionize GME)

Brian Burkey MD, MEdCleveland Clinic Foundation

Cleveland, OH

The Present--The Perfect Storm• More physicians and

surgeons will need to trained more intensely and more quickly with less faculty and monetary resources

• “We can't solve problems by using the same kind of thinking we used when we created them.” ---A. Einstein

The Future?

• The Solution– Elements of effective reform

• GME re-engineering– Greater efficiency

» Simulation: Means of safely recreating elements of a complex clinical reality

» May play a increasing role as it is most effective where trainees need to master skills in areas of limited experience due to patient safety concerns, and time constraints

» However, there are still few simulators in otolaryngology compared to general surgery and procedural medical specialties, eg. Pulmonology

Simulation Limitations

• Opportunity cost vs. non-simulation education– Opportunity lost with NOT using alternative

resources (time, money)– Rarely is true benefit realized due to lack of

debriefing; curriculum is not developed in accordance with educational guidelines

– Simulation centers frequently are often driven by financial and productivity agendas

Simulation Limitations

• Artificial situation– Skills are learned outside of clinical context– Component skills are emphasized rather than

unified scenario; lacks teamwork/communication training

– Learner interacts with machine, not patient, and focuses on procedure

– Can lead to learners’ false sense of security, ie. routine expertise vs adaptive expertise

Simulation Limitations

• Real cost– High fidelity simulators are very expensive and

tech support is mandatory– Overall usage is low– Cannot be borne by most departments alone– Little data on cost-effectiveness and educational

value• Favors simpler models and progressive strategies, ie.

from low fidelity to higher fidelity simulators

Simulation Suggestions

• Use simulation as a one element of overall curriculum, sparingly; KISS

• Focus should be on recreation (scenarios) and not replication (simulators)

• Simulation should recreate sociocultural practice rather than focusing on acquisition of component skills only– Roger Kneebone

Current Simulation?