Elsevier

Anesthesiology Clinics

Volume 25, Issue 2, June 2007, Pages 225-236
Anesthesiology Clinics

Does Simulation Improve Patient Safety?: Self-Efficacy, Competence, Operational Performance, and Patient Safety

https://doi.org/10.1016/j.anclin.2007.03.009 Get rights and content

Simulation training is an essential educational strategy for health care systems to improve patient safety. The strength of simulation training 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 actual operational performance in clinical settings. However, no evidence yet shows that crew resource management training through simulation, despite its promise, improves team operational performance at the bedside. Also, no evidence to date proves that simulation training actually improves patient outcome. Even so, confidence is growing in the validity of medical simulation as the training tool of the future. The use of medical simulation will continue to grow in the context of multidisciplinary team training for 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

References (49)

  • Improving Patient Safety through Simulation Research. Agency for healthcare research and quality. Available at:...
  • D.M. Gaba

    The future vision of simulation in health care

    Qual Saf Health Care

    (2004)
  • J.B. Cooper et al.

    A brief history of the development of mannequin simulators for clinical education and training

    Qual Saf Health Care

    (2004)
  • S.B. Issenberg et al.

    Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review

    Med Teach

    (2005)
  • D.M. Gaba

    Structural and organizational issues in patient safety

    Calif Manage Rev

    (2000)
  • AHRQ Patient Safety Network. A National Patient Safety Resource. Glossary. Available at:...
  • J.B. Cooper

    The role of simulation in patient safety

  • T.V. Perneger

    The Swiss cheese model of safety incidents: are there holes in the metaphor?

    BMC Health Serv Res

    (2005)
  • A.D. Slonim et al.

    Integrating the Institute of Medicine's six quality aims into pediatric critical care: relevance and applications

    Pediatr Crit Care Med

    (2005)
  • Society of Critical Care Medicine Critical Care eNewsletter. Team building. Available...
  • R.J. Brilli et al.

    Critical care delivery in the intensive care unit: defining clinical roles and the best practice model

    Crit Care Med

    (2001)
  • C.S. Burke et al.

    How to turn a team of experts into an expert medical team: guidance from the aviation and military communities

    Qual Saf Health Care

    (2004)
  • W.R. Hamman

    The complexity of team training: what we have learned from aviation and its applications to medicine

    Qual Saf Health Care

    (2004)
  • M.A. DeVita et al.

    Improving medical crisis team performance

    Crit Care Med

    (2004)
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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).

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