Complexity, risk and simulation in learning procedural skills
Article first published online: 26 JUL 2007
Volume 41, Issue 8, pages 808–814, August 2007
How to Cite
Kneebone, R. L., Nestel, D., Vincent, C. and Darzi, A. (2007), Complexity, risk and simulation in learning procedural skills. Medical Education, 41: 808–814. doi: 10.1111/j.1365-2923.2007.02799.x
- Issue published online: 26 JUL 2007
- Article first published online: 26 JUL 2007
- Received 14 April 2006; editorial comments to authors 10 November 2006; accepted for publication 20 March 2007
- *patient simulation;
- education, medical, graduate/*methods;
- risk assessment;
- safety management;
Background A complex chain of events underpins every clinical intervention, especially those involving invasive procedures. Safety requires high levels of awareness and vigilance. In this paper we propose a structured approach to procedural training, mapping each learner's evolving experience within a matrix of clinical risk and procedural complexity. We use a traffic light analogy to conceptualise a dynamic awareness of prevailing risk and the implications of moving between zones.
The importance of context We argue that clinical exposure can be consolidated by simulation where appropriate, ensuring that each learner gains the skills for safe care within the increasingly limited time available for training. To be effective, however, such simulation must be realistic, patient-focused, structured and grounded in an authentic clinical context. Challenge comes not only from technical difficulty but also from the need for interpersonal skills and professionalism within clinical encounters.
Patient focused simulation Many existing simulations focus on crises, so clinicians are in a heightened state of expectation that may not reflect their usual practice. We argue that simulation should also reflect commonly occurring non-crisis situations, allowing clinicians to develop an awareness of the complex events that underpin clinical encounters. We describe a patient-focused approach to simulation, using simulated patients and inanimate models within realistic scenarios, to ground experience in authentic clinical practice and bring together the complex elements that underpin clinical events.
Applications Although our argument has evolved from surgical practice and operating theatre teams, we believe it can be widely applied to the increasing number of health care professionals who perform clinical interventions.