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Study finds significant gaps in evaluations of simulation-based training in healthcare

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Simulation-based training helps dental students develop and practise soft skills and improve their professional practice and thus increases their employability. (Image: FOTOGRIN/Shutterstock)

CAMBRIDGE, UK: A recent study examined the effectiveness of simulation-based learning in medical education in enhancing healthcare professionals’ non-technical skills. The data suggest that commonly used simulation-based learning interventions are often inadequately evaluated before their use and do not assess how effectively simulations support key competencies mandated in medical and healthcare curricula and in policy. In light of the findings, the researchers urge healthcare policymakers to improve the evaluative framework in order to help students develop much-needed competencies such as evidence-based decision-making and sensitivity towards issues pertaining to equality and diversity.

Non-technical skills, including communication, decision-making and teamwork, are highly-valued in healthcare and are usually developed by employing educational tools and methods that simulate real-life professional practice. This can include role-playing to prepare students for dealing with frightened or aggressive patients or using technology-based and mixed reality simulations to test students’ behaviour in high-pressure situations.

Dr Riikka Hofmann. (Image: Riikka Hofmann)

“My research investigates how we can help healthcare professionals develop and implement new practices. We know that traditional professional development can be helpful for individual learning, but it often does not translate into change in clinical practice,” co-author Dr Riikka Hofmann, an associate professor in the Faculty of Education at the University of Cambridge, told Dental Tribune International (DTI).

“Externally facilitated workplace development interventions can help make change happen, but they are highly resource-intensive and hence not a scalable model across whole health systems. This is where simulations come in. Simulations facilitate professional learning in a way that not only transfers knowledge but also simulates authentic workplace practices, giving participants the opportunity to practise new skills without the complexity and risks of real-world settings. Technology further enhances simulations, making them even more like the real world,” she added.

Even though novel simulation-based methods are continually being developed and are typically evaluated through academic trials, Dr Hofmann and her team noticed that there have been concerns regarding the thoroughness of these trials in assessing their potential.

Seeking to investigate the issue, the researchers analysed some of the most recent evaluations, giving higher importance to papers published between 2018 and 2020. The analysis focused on three broad non-technical skill areas, namely interprofessional teamwork, communication and decision-making. The researchers selected a total of 72 assessments of simulation-based tools that targeted these skills and examined the learning outcomes the research was trying to measure as well as the assessment instruments used.

Inconsistencies in evaluations of simulation-based training

The findings revealed major inconsistencies in outcome measures as well as significant gaps in how these studies measure the potential of simulation-based tools to develop practitioners’ non-technical competencies.

Discussing the findings, Dr Hofmann told DTI: “Two things particularly surprised us about our findings. Firstly, in terms of the outcome measures, nearly every study we analysed used a different outcome measure, thus reducing comparability. Most studies developed their own outcome measures instead of using validated instruments, and even when studies used validated instruments, they each used a different instrument.”

“Secondly, we found a significant gap in the research: whereas healthcare education curricula and policies emphasise the importance of evidence-based reasoning and inclusive healthcare practice, these two outcomes were absent from the research on simulation-based learning. Therefore, we know little about the capacity of simulation-based learning to have an impact on these important outcomes. We wish to rectify this gap in our research programme,” she added.

“Soft skills, like interprofessional communication and effective teamwork, are important for avoiding medical errors and improving patient safety”
— Dr Riikka Hofmann

Dr Hofmann further explained that the evaluations did not always precisely define what learning outcomes they expected to see, and even if the studies were technically well designed, it was often unclear what they were trying to measure.

Additionally, the findings revealed that very little attention was paid to whether new simulation-based learning tools trained professionals to use evidence in their reasoning, and none of the research examined the capacity of simulation-based training to support the enhancement of equality and diversity in the workplace.

However, Dr Hofmann noted that healthcare professionals are not to blame for the fact that some important learning outcomes were overlooked in the evaluations. Rather, she pointed to gaps in the research that tests simulations, stating that there is a need to develop a stronger conceptual model that clearly defines the non-technical skills that simulation-based learning is planned to help practise.

Importance of soft skills in dentistry

“Soft skills, like interprofessional communication and effective teamwork, are important for avoiding medical errors and improving patient safety; they are also important more broadly for developing effective and inclusive workplace practices which make good use of staffing resources while looking after staff well-being and supporting innovation.”

According to Dr Hofmann, simulations provide a great opportunity to practise communication and teamwork in a safe way without causing a risk to patients. However, she noted that evidence about what kind of simulations best support the development and application of these skills is lacking at the moment.

“The ability to effectively communicate with highly diverse patients is key in dentistry from a public health perspective, as is a greater integration of dental health services with the wider healthcare services, which in turn requires effective interprofessional communication and collaboration, often across institutional boundaries, languages and traditions,” she concluded.

The study, titled “Models and measures of learning outcomes for non-technical skills in simulation-based medical education: Findings from an integrated scoping review of research and content analysis of curricular learning objectives”, was published in the December 2021 issue of Studies in Educational Evaluation.

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