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Title: Simulation in medical training
Author: Gosai, Jivendra
ISNI:       0000 0004 6058 6701
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2017
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Introduction: Whilst simulating clinical scenarios for the purposes of training is not a new concept, changes to the structure of medical training and working hours, technological advance and patient safety concerns have been responsible for intense interest and development of the use of simulation based medical education in recent years. The evidence base for the use of simulation is growing, with a number of studies demonstrating both learner satisfaction and improvements in self-reported confidence, as well as improvement in professional skill and knowledge. There are fewer studies which demonstrate an objective improvement in patient outcome however. Three linked studies in simulation are presented which explore the role of simulation in contemporary postgraduate medical training. 1) Temporary pacing: The first examined the use of simulation to teach the uncommon but potentially life threatening skill of temporary transvenous pacemaker insertion to trainees in General (Internal) Medicine. This demonstrated a significant increase in procedural success and learner self-reported confidence in their ability to complete the procedure, but a significant increase in the time required to do so following a single session intervention. The benefits of confidence appeared to decay somewhat over several months, although remained well above baseline. 2) ECG interpretation: The second examined the use of a novel online electrocardiography (ECG) interpretation simulator for medical students and foundation doctors. No significant difference was demonstrated in ECG interpretation between those using the simulation package and those who underwent traditional tutorial based training. There was a non-significant trend towards preference of the tutorial method. 3) Survey of attitudes to simulation: The third surveyed trainees across the United Kingdom to determine their experience of simulation, potential to access this learning modality and attitudes towards its incorporation into their training curricula. There appears to be considerable variation by region, specialty and seniority of what is available to trainees. The majority do feel that simulation has the potential to play a positive role within training but that curriculum integration, access and appropriate facilitation are issues which need to be addressed fully to optimise the benefit. Conclusions: There is evidence to support the use of simulation as a means to increase the knowledge and skill of doctors in training, although there is less evidence of direct improvement to patient outcome as a result. Trainees themselves do perceive simulation as a valuable adjunct to learning in the clinical environment when well-integrated into the curriculum, but there are variations in the accessibility and quality of what is offered. Future work should focus on addressing these issues.
Supervisor: Gunn, J. ; Purva, M. Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available