In high-tech world, low-cost simulation can advance resident training

Simulation exercises can help strengthen resident skill acquisition and competency assessment, but certain exercises—especially those intended to closely mirror realistic clinical settings—can be costly to implement. That’s why authors of a perspective piece in the Journal of Graduate Medical Education recommend cost-effective ways to simulate clinical events in training.

“While high-fidelity simulation is costly and may not be available in smaller institutions, low-fidelity simulation can provide similar experiences and fill assessment gaps with fewer resources,” authors of the perspective said. 

This form of simulation replicates clinical case scenarios in controlled situations and “has been demonstrated to be superior to traditional classroom didactics in teaching medical procedures, and has been used in a broad range of skill acquisition and maintenance, mastery learning, and team training activities,” the authors noted.

To keep simulation costs low, authors of the perspective recommend that programs embed simulation exercises in realistic contexts to help enhance the experience.

Some effective low-fidelity simulations include:

• Scripted case scenarios. For instance, a scenario could follow a patient handoff that results in incorrect medication administration and a subsequent adverse effect. This method can help build patient care, quality and safety competencies. “Residents can demonstrate how to correct the handoffs, use conflict resolution methods and strategies for disclosure of adverse effects/medical errors to patients, while addressing multiple competency domains and milestones,” perspective authors said.
• Inexpensive props. For instance, altered cardboard or plastic eyeglasses can simulate visual loss from glaucoma, macular degeneration and retinopathy, allowing residents to experience the profound effects of vision loss on everyday tasks like reading pill bottles.
• Alternative hands-on practice. For instance, surgical residents can hone their suturing techniques using pigs’ feet or inexpensive synthetic skin.

For programs that are interested in developing cost-efficient simulation for resident training, authors of the perspective piece give these recommendations:

• Start by identifying “high-stakes performance tasks” that may be linked to educational gaps. Once programs have identified the performance areas in which trainees may need to improve, they should “link [these tasks] to milestone and/or Clinical Learning Environment review areas,” the authors wrote. 
• Search online or at national meetings for existing resources—cases, tasks or assessment tools—that may offer simulation scenarios or activities to help fill these educational gaps. For instance, programs can scan peer-reviewed articles on MedEDPORTAL or in specialized journals like Simulation in Healthcare.   
• Adopt or adapt these simulation activities as they fit the program’s needs. Programs also can create new activities based on their own research and findings.  
• Run pilot simulation and evaluate the activities. Programs can “pilot and debrief the simulation on a small scale, using other trainees as observers/raters,” the authors wrote.  
• Obtain support from key leadership. This support will help especially if programs are interested in identifying future allies in the field to help offer resources that will advance their simulation exercises. 
• Run an additional pilot simulation and “provide milestone-linked performance data to learners and their Clinical Competency Committee.” This data can help educators determine trustworthy metrics for simulation performance assessments, according to perspective authors.

For more low-cost simulation exercises and tips on how to implement program simulation on a long-term basis, review the perspective piece.