Simulation reframed

Background Simulation is firmly established as a mainstay of clinical education, and extensive research has demonstrated its value. Current practice uses inanimate simulators (with a range of complexity, sophistication and cost) to address the patient ‘as body’ and trained actors or lay people (Simulated Patients) to address the patient ‘as person’. These approaches are often separate. Healthcare simulation to date has been largely for the training and assessment of clinical ‘insiders’, simulating current practices. A close coupling with the clinical world restricts access to the facilities and practices of simulation, often excluding patients, families and publics. Yet such perspectives are an essential component of clinical practice. Main body This paper argues that simulation offers opportunities to move outside a clinical ‘insider’ frame and create connections with other individuals and groups. Simulation becomes a bridge between experts whose worlds do not usually intersect, inviting an exchange of insights around embodied practices—the ‘doing’ of medicine—without jeopardising the safety of actual patients. Healthcare practice and education take place within a clinical frame that often conceals parallels with other domains of expert practice. Valuable insights emerge by viewing clinical practice not only as the application of medical science but also as performance and craftsmanship. Such connections require a redefinition of simulation. Its essence is not expensive elaborate facilities. Developments such as hybrid, distributed and sequential simulation offer examples of how simulation can combine ‘patient as body’ with ‘patient as person’ at relatively low cost, democratising simulation and exerting traction beyond the clinical sphere. The essence of simulation is a purposeful design, based on an active process of selection from an originary world, abstraction of what is criterial and re-presentation in another setting for a particular purpose or audience. This may be done within traditional simulation centres, or outside in local communities, public spaces or arts and performance venues. Conclusions Simulation has established a central role in clinical education but usually focuses on learning to do things as they are already done. Imaginatively designed, simulation offers untapped potential for deep engagement with patients, publics and experts outside medicine

Regaining creativity in science: insights from conversation

The 'early modern' (Renaissance) workshop was predicated on the idea that informal, open-ended cooperation enables participants to experience difference and develop new insights, which can lead to new ways of thinking and doing. This paper presents the insights that emerged from a conversation event that brought wide-ranging voices together from different domains in science, and across the arts and industry, to consider science leadership as we look to the future in a time of interlocking crises. The core theme identified was a need to regain creativity in science; in the methods of scientific endeavours, in the way science is produced and communicated, and in how science is experienced in society. Three key challenges for re-establishing a culture of creativity in science emerged: (i) how scientists communicate what science is and what it is for, (ii) what scientists value, and (iii) how scientists create and co-create science with and for society. Furthermore, the value of open-ended and ongoing conversation between different perspectives as a means of achieving this culture was identified and demonstrated

A surgical team simulation to improve teamwork and communication across two continents: ViSIOT™ proof-of-concept study

Background: Team communication in operating rooms is problematic worldwide, and can negatively impact patient safety. Although initiatives such as the World Health Organization’s Surgical Safety Checklist have been introduced to improve communication, patient safety continues to be compromised globally, warranting the development of new interventions. Video-based social science methods have contributed to the study of communication in UK ORs through actual observations of surgical teams in practice. Drawing on this, the authors have developed a surgical team simulation-training model (ViSIOT™). A proof-of-concept study was conducted in the UK and USA to assess if the ViSIOT™ simulation-training has applicability and acceptability beyond the UK. Methods: ViSIOT™ training was conducted at two simulation centers in the UK and USA over a 10-month period. All surgical team participants completed a questionnaire (that assessed design, education, satisfaction and self-confidence in relation to the training). Descriptive and inferential statistics were performed for the quantitative data and thematic analysis was conducted for the qualitative data. Results: There was strong agreement from all participants in terms of their perception of the course across all sub-sections measured. Nine themes from the qualitative data were identified. The two countries shared most themes, however, some emerged that were unique to each country. Conclusions: Practical developments in the course design, technology and recruitment were identified. Evidence of the course applicability in the USA provides further affirmation of the universal need for team communication training within ORs. Further studies are required to assess its effectiveness in improving communication in OR practice

Key challenges in simulated patient programs: An international comparative case study

<p>Abstract</p> <p>Background</p> <p>The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance.</p> <p>Methods</p> <p>We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources.</p> <p>Results</p> <p>Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments.</p> <p>Conclusion</p> <p>This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely.</p

Blind alleys and dead ends: researching innovation in late twentieth-century surgery

This article examines the fortunes of one particular surgical innovation in the treatment of gallstones in the late 20th century; the percutaneous cholecystolithotomy (PCCL). This was an experimental procedure which was trialled and developed in the early days of minimally invasive surgery and one which fairly rapidly fell out of favour. Using diverse research methods from textual analysis to oral history to re-enactment, the authors explore the rise and fall of the PCCL demonstrating that such apparent failures are as crucial a part of innovation histories as the triumphs and have much light to shed on the development of surgery more generally.</jats:p

Space: Potential locations to conduct full-scale simulation-based education

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