ABSTRACT
Biomedical simulation is an effective educational complement for healthcare training, both at undergraduate and postgraduate level. It enables knowledge, skills and attitudes to be acquired in a safe, educationally orientated and efficient manner. In this context, simulation provides skills and experience that facilitate the transfer of cognitive, psychomotor and proper communication competences, thus changing behavior and attitudes, and ultimately improving patient safety. Beyond the impact on individual and team performance, simulation provides an opportunity to study organizational failures and improve system performance. Over the last decades, simulation in healthcare had a slow but steady growth, with a visible maturation in the last ten years. The simulation community must continue to provide the core leadership in developing standards. There is a need for strategies and policy development to ensure its coordinated and cost-effective implementation, applied to patient safety. This paper reviews the evolutionary movements of biomedical simulation, including a review of the Portuguese initiatives and nationwide programs. For leveling knowledge and standardize terminology, basic but essential concepts in clinical simulation, together with some considerations on assessment, validation and reliability are presented. The final sections discuss the current challenges and future initiatives and strategies, crucial for the integration of simulation programs in the greater movement toward patient safety.
A simulação biomédica é uma ferramenta educativa para a formação nas ciências da saúde, com aplicação nos vários níveis de ensino. Proporciona experiências ativas e sistemáticas de aprendizagem com o treino de conhecimentos, habilidades e atitudes, de forma segura, pedagogicamente orientada e eficiente. Neste contexto, a simulação biomédica proporciona habilidades e experiência que facilitam a transferência de competências cognitivas, psicomotoras e de comunicação, mudando assim o comportamento e atitudes, aumentando, em última instância, a segurança do doente. Para além do impacto sobre o desempenho individual e de equipa, a simulação proporciona o ambiente ideal para o estudo de falhas organizacionais e teste de melhorias nos desempenhos dos sistemas. Nas últimas décadas, a simulação na área da saúde cresceu lentamente, mas de forma constante, com um amadurecimento significativo nos últimos 10 anos. A comunidade de simulação deve continuar a liderar o estabelecimento de standards nesta área, assim como o desenvolvimento de estratégicas e políticas para assegurar a sua implementação coordenada e custo-efetiva, no aumento da segurança do doente. Este artigo apresenta os movimentos evolutivos da simulação biomédica, incluindo uma revisão das iniciativas portuguesas e programas nacionais. Para nivelar o conhecimento e padronizar a terminologia, são apresentados conceitos básicos, mas essenciais, da simulação clínica, juntamente com algumas considerações sobre avaliação, validação e fiabilidade. As seções finais discutem os desafios atuais e as iniciativas e estratégias futuras, cruciais para a integração de programas de simulação no movimento global de promoção da segurança do paciente.
Subject(s)
Leadership , Patient Safety , Patient Simulation , Forecasting , Humans , Reproducibility of ResultsABSTRACT
Obstetric emergencies are unexpected and random. The traditional model for medical training of these acute events has included lectures combined with sporadic clinical experiences, but this educational method has inherent limitations. Given the variety of manual skills that must be learned and high-risk environment, Obstetrics is uniquely suited for simulation. New technological educational tools provide an opportunity to learn and master technical skills needed in emergent situations as well as the opportunity to rehearse and learn from mistakes without risks to patients. The goals of this study are to assess which are the factors that trainees associate to human fallibility before and after clinical simulation based training; to compare the confidence level to solve emergent obstetric situations between interns and experts with up to 5 years of experience before and after training, and to determine the value that trainees give to simulation as a teaching tool on emergent events. 31 physicians participated at this course sessions. After the course, we verified changes in the factores that trainees associate to human fallibility, an increase in confidence level to solve emergent obstetric and an increase in the value that trainees give to simulation as a teaching tool.
