Does Simulation Improve Patient Safety?: Self-Efficacy, Competence, Operational Performance, and Patient Safety
Section snippets
Health care as a high-hazard industry
Health care, especially the complex hospital care required to treat serious diseases, falls into the category of a high-hazard industry like aviation, chemical manufacturing, nuclear power generation, and the military. Intensive research has gone into improving safety in these high-hazard industries. The two most dominant theories for understanding accidents in high-hazard industries are the Normal Accidents Theory and the High Reliability Organization Theory [7], [8], [9].
The Normal Accidents
Does simulation improve patient safety?
To answer the question of whether simulation improves patient safety, we will use a conceptual framework based on Miller's [22] four levels of medical skill assessment [23] and Issenberg's system for classifying effectiveness of learning [6]. Our framework consists of four key elements: self-efficacy, competence, operational performance, and patient outcome.
Future directions
Although the number of simulation centers built in the United States and other countries is increasing, many physicians remain unfamiliar with them because they have not had time to use them or because the nearest center is too far away [45]. Nonetheless medical simulation training for individuals and medical teams to improve patient safety will continue to increase. As it does, its effect on operational performance and patient outcome needs to be vigorously evaluated. Simulation training will
Summary
Simulation training is an essential educational strategy for health care systems to improve patient safety. The strength of simulation training, especially high-fidelity simulation, is its suitability for multidisciplinary team training. There is good evidence that simulation training improves provider and team self-efficacy and competence on manikins. There is also good evidence that procedural simulation improves operational performance. However, no evidence yet shows that simulation training
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Akira Nishisaki and Vinay Nadkarni are supported by Agency for Healthcare Research and Quality grant 1U18HS 01667801. Vinay Nadkarni is an uncompensated scientific consultant for Laerdal Medical Co. and Medical Education and Technology Inc. (METI).