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Using simulated patient encounters, even if their primary role is to cement and supplement basic science concepts, may relieve some of that anxiety. Using Computer Simulation to Teach Basic Science There are some benefits of using computer models to teach basic science: 1. Original experiments can be recreated more easily —Classic experiments, such as the original experimental work by Starling [ 23 ], are relatively easy to construct and provide the opportunity for students to follow the same path of discovery. Some measurements or interventions are easier to demonstrate with simulation than in vivo —Pulmonary venous pressure or ventricular volume is technically very difficult to determine due to the constraints of measurement within a living organism.

Measuring cell membrane voltages is difficult due to the sensitivity of equipment to ambient noise and is realistically impossible during a busy lab class. These phenomena are relatively easy to demonstrate with simulation as no environmental noise is present in the simulated screen-based environment.

This is especially true for more complex interventions. A single experiment can be performed several times with each sequence measuring different variables in quick succession. A simulation can be reset —Animal organs have a limited lifespan ex vivo , and any experimental error is likely to necessitate a fresh preparation.

The ease with which a computer simulation can be restarted gives the educator more flexibility to allow students to commit mistakes and take the results to their conclusion. Virtual organs can be studied in situ —Studying the heart or lungs as isolated organs belies the fact that their function depends on their environment in these examples, the vascular system. Giving epinephrine to an isolated heart would increase the heart rate and force of contraction.

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However, giving epinephrine to a heart in situ would also increase the afterload which in turn affects the heart work, coronary perfusion, and cardiac output and has an effect of contracting plasma volume and thereby increasing the preload as well. Entirely virtual systems can be low cost —Although designing the computer program can be expensive, the marginal cost is thereafter very small as the program can be shared globally. This is in contrast to vivisection, with high marginal and running costs which can be shared via teleconference only partially if at all.

Best Practices in Preclinical Simulation Whereas simulation in clinical years, especially simulation related to acquisition of procedural skills, has been studied extensively, simulation in preclinical education has not. However, there have been similar themes that run across these accounts and provide a useful framework for discussion of simulation in basic science education. Complement of Lecture-Based Material In all reports, the simulator is used to enhance, rather than teach, the primary material.

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The simulated cases should be designed to enhance course objectives and goals [ 24 ]. Typically, simulators require the consolidation of knowledge gained from the lecture hall, independent study, and real-life experiences of the students, who have had limited experience with clinical medicine. Much like simulation cannot replace clinical experience, simulation should not replace traditional basic science education.

It requires thoughtful placement into the curriculum, serving to enhance and exemplify teaching, but not be the primary learning modality, and is optimal when it is a mandatory, not optional, activity [ 7 ]. Expert Instructor, Defined Group Size, and Defined Timeline Most reports indicate that simulation groups function best with 1—2 expert instructors, who can both provide accurate and physiologically sound responses to student intervention and have expertise in the working of the software [ 24 , 25 ].

The cases should be managed exclusively by the students, with instructor observing closely and interjecting only to guide but not rescue the students should they become stuck or suggest an inappropriate intervention [ 24 ].

Groups should be small enough so that all students can participate and be engaged and large enough to obligate students to work as a team. Additionally, research has shown that when students are required to teach each other, and use data to solve problems, they learn more than when they are listening to lecture or are reviewing notes [ 12 ] and that students working in collaborative settings demonstrate more enthusiasm for collaborative approaches compared to students working in lecture-based settings [ 13 ].

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However, care should be taken to avoid a too large a group, because when groups become too large, students are not able to participate as well and may not be able to observe relevant changes [ 26 ]. We generally limit our mannequin-based simulation groups to ten or less.

Deliberate Practice and Individualized Learning The educational literature increasingly recognizes that for optimal performance to occur, certain criteria of deliberate practice must be met, including repetitive performance of the skill including cognitive skills and skills assessment with specific feedback [ 7 ].

Deliberate practice has been validated in clinical skills such as bedside cardiology, advanced cardiac life support, surgical skills, and invasive procedures [ 19 ]. Data on the use of deliberate practice in learning and integrating basic science knowledge are lacking, but studies have shown that students perform better on examinations when the test items are designed as clinical vignettes, suggesting that retention is improved when students are required to use basic science in a clinical context rather than as isolated facts [ 5 ].

Case-based anesthesia : clinical learning guides

Active participation by learners allows them to focus on the core concepts that they need to master and proceed at a pace that best suits them [ 7 ]. Debriefing High-quality simulation requires scheduled and thorough debriefing by a clinician or other expert teacher [ 15 ]. In a systematic review of best practices in medical education simulation, almost half of the papers reviewed listed feedback as the most critical feature of simulation [ 7 ]. In this way, the students are better prepared with an organizational foundation for their clinical years [ 24 ].

Feedback is essential to medical simulation and one of the most challenging for preceptors to master. A study comparing oral, videotape assisted, and no debriefing found that oral and videotape-assisted feedback were equally successful in improving nontechnical skills teamwork, task management, situation awareness, and decision making but that participants who had not received feedback had no improvement on a posttest [ 27 ].

Successful feedback can be videotaped, oral, or built into the simulator [ 7 ], but should include 12 evidence-based best practices, which have been adapted by McGaghie to simulation feedback Table Table Facilitators need to be trained in administering simulation and providing feedback; because simulation is often done in small group settings, multiple facilitators are required. Students Appreciate and Value Their Simulation Experiences Overall, students rate simulation experiences very highly, believing them worthwhile and recommended for future courses and other students Table When computer simulation has been applied to neurophysiology to demonstrate membrane potentials, a large majority of students believed that the program increased their understanding [ 29 ].

Almost universally, simulation improves student confidence in themselves and in the instruction they received. That alone can be a victory for educators. Simulation in Basic Science Education. Simulation Is Widely Practiced in Medical Schools Medical simulation is most often associated with clinical education; indeed, the earliest examples of medical simulation involved obstetric mannequins, and mannequins designed to teach airway and resuscitation, which have existed since the s [ 14 , 15 ].

Reproduced with permission. To some degree, simulation in preclinical education is not a new concept. Ensure that the facilitators create a supportive learning environment for debriefs.