Does simulation mesh with human nature?

Shakespeare once suggested that humans seek out fooling. We go to the theater to be fooled and we watch magic because we are fooled by it. The most popular magicians in the world are the ones to which no one knows how the tricks are done. So, can human patient simulation draw on this human nature to be an effective and engaging learning tool?

I recently watched Alan Kay on TED and was intrigued by his new teaching techniques for math to 6 year olds using a $100 laptop. He stated, "We strive to understand ourselves to get around our flaws." I began thinking how this quote applies to health care education. Can we as practitioners really strive to understand ourselves? Do we have the opportunity to do so? And, if so, would that reduce our flaws (medical errors).

The answer to both of those questions is YES! Alan Kay listed three areas in which humans strive to understand themselves:

SENSORY

REASONING

PERSPECTIVE

So what does this have to do with simulation? Well, keep reading!

Sensory: Humans use sensory input to organize data for better understanding. The trouble with medical and nursing education is that the novice practitioner is not exposed to real sensory stimuli in a complex environment. In steps Simulation! TUH DUH. (Magician Joke). Simulation provides a tool to emulate sensory experiences in a safe environment, out of the realm of patient endangerment, and can give context to a young practitioners learning.

In short, simulation gives experiences to the inexperienced. It allows for one to self reflect on actions taken in stress full situations, and then debrief (see below) the flaws and achievements that occurred!

Reasoning: Humans use reasoning to organize and sift through data. Math and logic are examples of way the human race organizes data to make decisions in life. Medical and nursing schools strive to inject logic and reasoning, and math I might add, into the students. We all talk about critical thinking, and problem solving ability, but do we really provide the context in which this learning and skill perfection can take place. Multiple choice tests and written case studies help, but can they then apply it to the real world?

Simulation allows the student to integrate logic into the context of patient care. That is what we want right? A doctor or nurse who can recall information at the right time, and then apply it to the need task or skill with the proper rationale. Using simulation to set up real events allows us to do this, IN REAL TIME. Students are given the ability to practice logic and reasoning in a controlled environment and then debrief (see below).

Perspective: This is where learning and flaw identification come to a head. Humans reflect back on lived experiences in order to identify areas for improvement or change. Think about the last time you went to a bad restaurant. If i mentioned for you and I go eat there tonight what would you think? Most likely you are going to recall the taste and smell of the food, the long wait, or the poor service. This perspective will then inform your current decision.

So where does the New Grad Nurse or Intern get the perspective on a critically ill patient with a low blood pressure and stab wound? They struggle to think back to reading page 2433 in Lewis text on Med Surg nursing and what that damn table said about bleeding. Simulation changes that. Simulation provides the experience they can draw on.

The other aspect of perspective is how we self reflect. After simulation is the debriefing. This is the time when the facilitator guides the students to identify the flaws of the previous events. As the student thinks back on his or her lived experience they are able to connect their personality traits, problem solving ability, and critical thinking skills and identify ways to improve practice. This is done without ever touching a patient.


So are we building a safer health care system using simulation? YES. Does the use of simulation mesh with how humans identify errors and process information? I will tell you, it sure as Hell beats reading a PowerPoint! As we as a community continue to perfect the use of simulation i can only see improvements in the care of our patients! What an exciting time to be a practitioner!

RESOURCES

Alan Kay (Watch Alan Kay's talk on TED.com)
TED (http://www.ted.com/)