Simulation Training in Medical Education
Today’s clinicians experienced simulation as a key part of their medical education during their training as students or doctors. Thankfully, the days of first learning new skills on real patients using the ‘see one, do one, teach one’ model are long gone.
As medicine grew more complex and technology advanced, the need to learn and practice new skills in a safe, protected environment before treating real patients increased.
Medical simulation training recreates real-life clinical scenarios, helping learners practice and master skills to improve patient safety and maintain the highest standards of care.
1. Traditional Simulation
The traditional approaches to simulation in medicine has taken many forms as considered below:
a. Standardized Patients
Actors or trained individuals portray symptoms and signs of specific medical conditions. They interact with students, helping them practice history taking, physical exams, and communication skills in a controlled environment.
This setup creates a safe space for students to make mistakes, learn, and improve their clinical skills without real-world consequences.
b. Manikin Based Simulation
Manikins are life-sized models that can range from low fidelity (showing basic surface anatomy) to high fidelity (having advanced features like palpable pulses and reactive pupils). They are the mainstay of life support course training such as Advanced Cardiac Life Support which uses CPR manikins, allowing students to practice chest compressions and airway management.
Manikin based simulations are particularly useful for practicing emergency scenarios and can be used to simulate team-based emergency care.
c. Role-playing
Students assume roles in simulated medical scenarios to practice communication and decision-making skills. In one scenario, a student plays a doctor, another a patient, and a third a concerned relative, focusing on empathetic communication.
This approach removes the need for trained patient actors and gives all students hands-on learning experience.
d. Skills Trainers
Models help students practice specific medical procedures or skills. They range from simple suture pads that mimic human skin for wound suturing to complex models simulating cesarean sections.
Skills trainers offer realistic tactile feedback, helping students develop motor skills and build confidence in performing procedures.
e. High Fidelity Task Trainers Simulation
These are more complex versions of skills trainers that are designed to simulate a portion of a complex procedure, such as a laparoscopic surgery trainer simulation, where clinicians can practice performing minimally invasive surgery guided only by video feedback.
This provides tactile motor training but also the skills of coordinating movement of instruments in 3D guided only by 2D video.
f. Hybrid Simulation
Hybrid simulation combines elements from different modalities to create a more comprehensive learning experience. It may involve a ‘patient’ wearing prosthetics to mimic medical conditions or enable procedure practice.
This approach places clinical and procedural skills in the context of a living patient, requiring students to use communication and practical skills simultaneously.
g. Computer-based simulation
These are software applications that focus on decision making by presenting a clinical scenario, allowing students to choose which investigations and treatments to perform.
These computer-based simulations are flexible and allow for self-paced learning but lack the experience of immersion. With more complex scenarios, students can revisit them to improve their decision making until they master the topic.
2. Extended Reality Simulation
Computer-based simulations marked the beginning of using technology to enhance medical education and laid the foundation for technology-enhanced learning.
In recent years, Technology Enhanced Learning has expanded rapidly, often through Extended Reality. Although these immersive technologies are often grouped together, they include distinct types outlined below.
a. Augmented Reality (AR)
AR superimposes digital information on to the real world, in the form of images, diagrams, or video. This can be overlaying anatomical information onto a patient’s body so that students can point a tablet or AR glasses at a body region and then be presented with underlying organs, muscles, or bones. This offers a dynamic and interactive way to learn the complexities of human anatomy.
b. Virtual Reality (VR)
VR immerses learners in a fully simulated environment using a motion-tracking headset, allowing them to move and interact within the virtual space.
In medical education, VR offers enormous possibilities, from simple patient scenarios to complex surgical simulations. It provides an immersive, risk-free environment where students can gain clinical experience without real-world consequences.
c. Mixed Reality (MR)
MR is a mix of both AR and VR as it places virtual objects to the real world, allowing users to interact with both simultaneously.
It can be used for surgical simulation, allowing clinicians to practice procedures on virtual organs while using real surgical instruments.
3. Comparison of extended reality simulation with traditional simulation
Many sectors, including aviation and the military, have already harnessed VR-based simulation training. In healthcare, numerous studies have shown VR’s effectiveness in training across a wide range of topics and skills.
Comparing the roles, benefits, and limitations of traditional and extended reality simulations helps us better understand the future of medical education.
a. Cost
Traditional manikins or skills trainers can be expensive, even at a basic level, but especially the high-fidelity versions. Until recently, the initial setup cost for extended reality simulation could be high, however, an increasing number of subscription-based VR training solutions running on standard commercially available headsets can be available at a fraction of the cost required to operate and maintain traditional manikin-based simulations. In the long-term, VR simulation can be cost-effective as they can simulate and repeat a multitude of scenarios without additional equipment and expense.
b. Versatility
Extended reality can offer a wide range of scenarios, from teaching basic anatomy to simulating complex team-based life support training. Software updates can be easily installed, making them adaptable to the evolving needs for medical simulation. In contrast, manikins are limited in the range of scenarios they can depict.
c. Tactile Feedback
One advantage of manikin-based simulators is the tactile feedback they provide. For procedures like CPR or intubation, sensory feedback and motor coordination are crucial. While VR and AR focus more on visual and auditory experiences, MR helps bridge the gap by adding haptic feedback.
Virtual reality still plays a key role in practical skills training, as physically performing the skill is only one part of learning. VR also teaches when and why to perform procedures, the correct steps, how to assess success, and how to identify and manage complications.
d. Space
High fidelity manikin-based simulations usually require a dedicated space, often in a purpose-built simulation center. In contrast, extended reality is more mobile and not limited to physical space or location.
e. Engagement & Immersion
Immersive technologies are more engaging for trainees and can offer a gamified approach to learning, making complex medical topics more memorable.
f. International Collaboration
Virtual reality training makes it easy to bring together a team from around the world, for example, an instructor in Norway can facilitate a team-based simulation with learners from Europe, Asia, or anywhere else in the world with wifi connection. With this comes the potential to revolutionize global healthcare education.
g. Safety & Resilience
Virtual simulations eliminate the need for face-to-face teaching. In the wake of pandemics, this advantage can reduce risk and offer resilience to training in the face of future events.
Unlike traditional simulation, VR offers an immersive experience where learners are placed within an interactive simulated environment improving their engagement and fostering experiential learning. Skillup VR medical simulation is an advanced solution that allows learners to practice critical skills such as communication, decision making and teamwork in a realistic clinical environment on demand without geographic barriers.
Harnessing the potential of VR medical training promises a future where medical simulation is more realistic, immersive, interactive, and globally accessible, to ensure that the next generation of healthcare professionals are equipped to meet the challenges and escalating complexity of evolving modern medicine.
