[The following notes were generated by Sandra Haudek, PhD.]
The Spring 2022 IAMSE Webinar Seminar Series, titled “To infinity and Beyond: Expanding the scope of Basic Sciences in Meeting Accreditation standards” opened on Thursday March 3, 2022. This series continues to explore how basic science education can be leveraged for student success. It expanded upon the traditional roles of basic sciences and ventured into unexplored areas: What is the role of basic science education in (1) interprofessional training, (2) social sciences curricula, (3) service-learning, (4) pre-clerkship integration, (5) and self-directed learning? These domains are cornerstones of medical education and closely align with accreditation elements for the LCME, COCA, and other accreditation bodies within the health professions. The first session in the series was titled “Developing IPE Utilizing Current Simulation Approaches” [IPE = interprofessional education] and was presented by Dr. Brian Mann, EdD, MS, PA-C, Chief of Simulation Operations for Philadelphia College of Osteopathic Medicine. During this session, Dr. Mann explained current terminology used in medical simulation, explained the different technologies used in medical simulation, and presented a curricular process linking simulations to accreditation standards.
Dr. Mann started with emphasizing on the importance of creating objectives using the most appropriate Bloom Taxonomy action verbs, particularly when addressing foundational science content such as anatomy and physiology. Since simulation activities are applications of skills, he advised to use verbs such as analyze, create, and evaluate. He then clarified the meaning of key terms used in simulation: (1) OSCE (Objective Structured Clinical Examination) – Approach to the assessment of clinical and professional competency or performance. OCSE are often related to standardized patient or history taking, but also include task training and other applications including anatomy. (2) Simulation (SIM, a component of the Simulation Activity) – A technique that creates a situation or environment that allows a representation of a real event for the purpose of practicing, evaluating, testing, or just understanding of an action in a safe environment. Simulation needs expert pedagogy from novice to expert level. Evaluations may be part of a simulation. (3)Simulation (SIM) Activity – A set of actions including initiation (pre-briefing), simulation, and debriefing including assessment. One simulation opportunity may include different activities. (4) Standardized Patient – Very well trained actors who simulate an actual patient (cannot be distinguished from real patients), including body language, anxiety and metal state levels, give limited information, emotionally personality skills. Actors may also provide assessment and verbal feedback to students. (5) High Fidelity Simulator – Mannequins who can mimic high-level human body functions, such as heart and lung sounds, blood pressure, urinating, bleeding, and swelling. (6) Task Trainer – Devises to train elements or procedures, such as starting an IV, performing CPR, suturing, and phlebotomy. Dr. Mann finished this part of his presentation with showing pictures of different simulation settings, explaining that some rooms are set up to manage communication and team work skills rather than clinical skills. He concluded that high fidelity simulator and task trainer models lend themselves to cover foundational science content, only limited by imagination. He also emphasized on the importance of diversity including actors and mannequins of different skin colors, ethnicities, gender, and ages.
Dr. Mann continued with highlighting that simulation activities provide valuable teaching experiences also for foundational sciences. He stressed on the importance of generating goals and objectives that are specific and simple, appropriate for the student’s level. All content should be familiar to students before the simulation activity. He recommended a backwards approach to curriculum design starting from the schools educational learning objectives, to course objectives, so session objectives. IPE competencies should also address competencies required for the particular program by their accrediting body (e.g., from the American Psychological Association) and the four IPE core (sub)-competencies from 2016 as listed: Values and ethics, roles and responsibilities, interprofessional communication (between different groups, families, healthcare professionals), teams and teamwork. If schools collaborate with schools in other countries, those international IPE components should be also addressed. For instance, in Canada one needs to include role clarification, patient/client/family/community-centered care, team functioning, collaborative leadership, interprofessional communication, and interprofessional conflict resolution.
Dr. Mann then provided an example of a learning theory used in medical simulation: Kolb’s Experiential Learning Theory. This theory includes a concrete experience (the simulation experience), reflective observation (debriefing), abstract conceptualization (evaluate each task), and active experimentation (repeat simulation activity ~3 weeks later). Another theory he mentioned but not discussed is the cognitive load theory. He then explored how simulation can be used to develop IPE activities. He encouraged the audience that this is really up to individuals what content or topic they want to address, from clinical situations, to psychological & physiological cases, to foundational sciences, as long as they align to the school’s competencies. The most effective way to integrate simulating is to make sure there is spaced repetition, small amounts of content at a time, and knowledge is covered before application. The biggest challenges are the different schedules between different programs and schools.
The presentation lasted about 40 minutes. During the ensuing 15 min, many questions were discussed: How often do you do simulation during pre-clerkship years and in which courses (2-3 times per semester)? How are OSCEs used for assessment (formative exam in middle, summative at end of semester; emphasis on spaced repetition throughout the semester)? How long is a simulation activity and how many students attend (logistics are difficult but manageable)? Which foundational sciences topics are mostly addressed (physiology is the easiest one, anatomy is easy as well, pathology can also be brought in e.g., taking a biopsy)? What if learners are on different levels (it is hard to make sure all learners from different programs are on the same level – may need a “retraining component”)? How important is debriefing (very important; allow learners to make mistakes and provide chances to do better next time)?