Medical simulation: Improving training and diagnostics to enhance patient care

Prof Dara Byrne and Dr Ann O’Shaughnessy provide an update on the RCPI’s simulation governance project

In recent years, simulation-based education has become a vital component of postgraduate medical education. This has been spurred on by improved understanding of how skills, knowledge, and behaviours are acquired, the prioritisation of patient safety and improved quality of care, and advances in the technology available to support the educational development of healthcare providers.

Simulation can be used to improve the individual, the team and the system. A translational simulation approach (irrespective of the location, modality, or content of the simulation) has been proven to support quality improvement efforts in hospitals. And what we are seeing now is increased support for simulation as a tool to address safety culture within organisations.

The RCPI has been incorporating simulation-based education into several of our programmes since 2014. We are now working to inform and implement a coordinated approach across all our training programmes through the simulation governance project.

Commencing in 2022, the project aims to develop and implement a College-wide strategy for managing the design, delivery, and evaluation of simulation-based education across all specialties. The project has gathered some momentum in consultation with stakeholders across the health service, and as we move towards implementation, we are entering into a second phase of consultation and evaluation.

Why simulation?

When used correctly simulation has been shown to improve patient outcomes. In translational simulation, education and training is directed at a specific healthcare outcome target, not just an assumption of improved system performance as a result of improved individual knowledge or skills. Some examples include: Lowered infection rates as a result of targeted training for central line insertion; reduction in perinatal asphyxia and neonatal hypoxic-ischaemic encephalopathy following team training for obstetric emergencies; and survival in cardiac arrest with a rapid cycle deliberate practice simulation approach. Improved outcomes for trauma patients, including decreased times from patient arrival to the CT scanner and to the operating room, have been reported following an in situ TeamSTEPPs educational intervention. There, targets involve individual and team knowledge and skills, but also complex, context-specific system issues.

Simulation provides opportunities for standardised clinical experiences and offers a safe environment to learn, rehearse, and practice safely. Simulation is useful for learning as an individual or within a team and can be used for mastering practical procedures as well as non-technical skills and supports a human factors approach to education and training. Interprofessional teams learning together improves psychological safety beyond the simulation event. The knowledge, skills, and attitudes learned in simulation translate out into the working environment.

Using simulation as an educational intervention to directly improve patient outcomes and as a diagnostic tool to examine error or problems is a very powerful tool for modern healthcare organisations to improve the quality of patient care.

Introducing simulation into postgraduate training programmes requires careful planning to ensure effectiveness and sustainability. The RCPI has already incorporated simulation-based education into several of its programmes. The next phase requires a coordinated approach across all our training programmes; the focus on the use of simulation needs to move from supporting the individual with procedural skill training to a team and interprofessional approach.

It is widely agreed that simulation is of significant value for hospitals and healthcare education. However, it must be better resourced. We need simulation facilities and expertise to be expanded and located on clinical sites across the country to see the system and our patients truly reap the benefits.

When used correctly simulation has been shown to improve patient outcomes

How will the simulation governance project help?

At the national level, one of the key objectives of the RCPI simulation governance project  is to ensure that the RCPI’s simulation training is aligned with the priority areas identified in the National Strategic Guide to the Implementation of Simulation on Clinical Sites (March 2022). The guide outlines priority areas for the HSE and local sites to ensure that simulation activities meet an international standard, are accessible and resourced, and become embedded within healthcare education and provision organisations.

Within the College, the project informs – and is informed by – the outcome-based education review and the mandatory teaching review, with the combined aim of improving the quality of training and assessment for all RCPI trainees.

Long-term the project will manage the design, delivery, and evaluation of simulation-based education across the specialties.

To date, the project team has developed a project charter, met with key stakeholders, including those managing and working on simulation sites across the country, and established a steering committee consisting of the faculties, institutes, and other key groups to form a steering committee. We propose to identify several clinical sites and support them to develop their simulation capabilities. This will be done in line with the national strategic guide and the national simulation office, due to be established this year, and in collaboration with site staff and management to understand current and future capabilities. This is key to ensuring the success of the implementation plan.

Over the next six months the steering committee will meet monthly to oversee and implement a governance structure and strategy for the future development and delivery of all RCPI simulation programmes. Members of the committee will attend a workshop led by Prof Dara Byrne covering the key tenets of simulation training and the current situation nationally. A series of ‘Train the Trainer’ courses are also being developed for people intending to develop new simulation programmes in the future and will be rolled out as part of the implementation plan.

Simulation-based education and the use of simulation as an educational intervention and diagnostic tool will continue to advance patient care. Ensuring that simulation activities are standardised, meet international standards and are sustainable requires considerable work in the form of strong expert leadership, faculty training, resource management, programme design and development, and quality assurances.

A coordinated approach to this across training bodies, higher education institutes, healthcare organisations, and healthcare professions is now required to ensure success.

The RCPI simulation governance project is led by Prof Dara Byrne and Dr Ann O’Shaughnessy.

References available on request