Simulation in

medical education: Where are we?

Tachawan Jirativanont, MD

Faculty of Medicine Siriraj Hospital, Mahidol University

Who we are

Simulation educator

Our roles are facilitating, guiding and motivating learners through the simulated environment.

Our journey 1997: CPR center

2011: Siriraj Training and Education Center for Clinical Skills (SiTEC)

2012: Siriraj Medical Simulation Center for Education and Training (SiMSET)

The effective use of

simulation needs…

Mastery

learning

Deliberate

practice

Effective

feedback

Curriculum integration

Range of

difficulty Individualize

d learning AMEE guide No. 82

What does our curriculum look like?

Classroom instruction

Small group

teaching: PBL, bedside teaching,

simulation

Clinical experience

Self study

Steps to curriculum development

01 Problem identification

and needs analysis

02 Setting goals

and

objective

03 Educational

strategies

consideration

04 Implementation

05 Evaluation

and

feedback

• Anesthesia: Crisis management (5th year)

• Surgery : Perioperative management (4th year)

: Emergency in trauma (6th year)

• Medicine : SiM MED approach to critically ill patient (6th year)

: Cardiology (4th, 6th year)

: Emergency medicine (5th, 6th year)

• Pediatric : Pediatric acute care (6th year)

• OBGYN : Practical management in obstetrics emergencies (6th year)

• Integration : Siriraj Survive on Service; SiSOS (6th year)

Intra-curricular course: medical student

Siriraj Obstetrics & Gynaecology Simulation Center; SiOGSC

•Pig perineum workshop

•Basic and essential skills training in OBGYN

•Practical management in obstetrics emergency

Intra-curricular course: medical student

Intra-curricular course: Anesthesia resident

2015 2016 2017 2018 2019

Topic R2 R3 R2 R3 R2 R3 R2 R3 R2 R3 Neuro PBL PBL PBL PBL PBL PBL PBL PBL SIM SIM OBG PBL PBL PBL PBL PBL PBL PBL PBL SIM SIM

PED PBL PBL PBL PBL PBL PBL PBL PBL PBL SIM Organ Tx PBL PBL PBL PBL PBL PBL PBL PBL lecture lecture

Outside PBL PBL PBL PBL Bedside Trauma PBL PBL PBL PBL PBL ICU PBL PBL PBL PBL PBL PBL PBL PBL PBL

Crisis management in anesthesia

PGY 2015 2016 2017 2018 2019

1 SIM SIM ANTS ANTS ANTS

2 SIM SIM ANTS ANTS ANTS

3 SIM ANTS ANTS ANTS ANTS

ANTS: anesthetists’ nontechnical skills

Approaches to Non-technical skills/ team training

Aim of team training strategies • Increase the members’ team competencies •Give team members opportunities to gain

experience

AMEE guide No. 82

Non-technical skills training process

02

01

03

04

Need analysis

Instructional methodologies

Simulation modules implementation

Assessment and evaluation

Anesthetists’ non-technical skills (ANTS)

Lecture, activity, small group discussion

Clinical immersive simulation

Self-assessment, EPA, OSCE station

02

OCT 2013

Crisis team management: Our first train the trainer course

Positioning in the operating room

Assessment and evaluation of non-technical skills: The lesson learn

•Core concept is to improve the learners’ performance.

•Well-trained and standardization of the rater, and qualified tools are essential.

• Simulation provides an opportunity for a purposeful assessment.

• Sufficient evidence of validity in the ANTS instrument and the Ottawa GRS for the evaluation of non-technical skills in a simulated anaesthesia setting

• Both instruments differentiated the non-technical skills of PGY-1 from PGY-3 residents.

Final words:

• Simulation is a teaching method … no need to wait for a simulation center.

• The big step is to integrated simulation into the curriculum.

• The future direction of simulation must include non-technical skills training.