Computer-Based Simulation Software in Medical Training and Teaching - Research Proposal Example

Computer-Based Simulation Software in Medical Training and Teaching (Optometry & Vision Science) Literature Review: Computers and information technology have pervaded into nearly every area of human activity and this is true in the case of education and training too. It is more than a decade since computer aided instruction and simulation has been used in medical instruction and training and has gradually spread to the training and teaching of many of the branches of medical science. In spite of the enthusiastic manner in which computers-assisted simulation has been embraced by the field of medical science there is still the need for studies to establish its advantages over the conventional means of training and education in various branches of medical science (Letterle, 2003). Simulation in healthcare education and training may be viewed as a rehearsal for students in their work responsibilities as health care. Rehearsal is nothing new to any professional and is part of the training for greater expertise in the carrying out of their responsibilities. Such rehearsal or simulation in the field of medicine, has two modalities, one which is non-computer-dependent like human cadavers or animal models and the other which is computer-dependent or electronic-technology-dependent to create the requisite situations or scenarios for the students to rehearse with. These models range from the simple electronic mannequins to the highly sophisticated patient interactive simulation models. Compared to certain other fields of human activity, like aviation, the use of simulation models in medical education and training is fairly new (Leach, 2005). The enthusiasm for the use of computer-based simulation software has resulted in several software applications for education and training in the field of medical education. This enthusiasm stems from two important contributions that computer-based simulation models offer in the learning process. Nestel et al (2008, p.407) point out that “educational theory highlights the importance of learning in context”. Furthermore it is essential that that this in context imparting of learning of technical, communication and other professional skills should be provided without in any way compromising on patient. Computer-based simulation models provide these two key benefits of learning in context and without compromising on patient safety (Nestel et al, 2008). In any branch of medicine providing a safe means to impart in context learning is required and so is the case with anaesthesiology. To improve clinical judgement and technical skills in anaesthesiology students, different kinds of simulation modalities are available. In the United States of America these simulation modules have been developed on the basis of the key competency requirements of anaesthesiology students as stipulated by the common programme of the Accreditation Council for Graduate Medical Education (ACGME). The efficacy of computer-based simulation to train and teach students have been established, but there is still some lingering doubt as to whether this really translates into competencies in the real world of clinical practice (Levine & Bryson, 2008). In surgery, the practice until about three decades ago has been for aspiring surgeons to be attached to experienced surgeons and watch them perform surgical operations within the operation theatre as a means of acquiring in context skills required by them. Such an educational model has proven to be deficient in modern times. There have been several driving factors that have fuelled the need to move out of traditional educational models and strive for newer and more relevant educational models. These driving forces include the dramatic technological advances in the field of surgery and the greater focus on patient safety. Among the options considered to teach students operative skills in a laboratory environment has been the use of computer-based simulation modules. Evidence emanating from studies has shown that computer-based simulation modules are effective in providing students of surgery with new and useful skills outside of the operating room environment (Scott et al, 2008). Simulation models do not help only in the imparting of knowledge and skills to students relevant to their medical branches, but also provides the added advantage of assessing the acquiring of the requisite skills in these students. This benefit of simulation models is particularly useful in certain areas medical practice like surgery or intensive care, where assessment of skills of students is not possible in the clinical environment. In case they do try to test their skills it is never independently, but under the guidance of a skilled and experienced physician. Use of simulation models allow the testing of skills acquired by the student on a totally independent basis and a more objective means of assessment of the skills in the student (Tavakal, Mohagheghi & Dennick, 2008). The possession of skills alone by an aspiring healthcare professional is not enough. There must be the confidence to use it in real life situations. Such confidence can be built only through sufficient hands on practice of different scenarios that are likely to be faced in real life situations. This hands-on experience cannot occur in the clinical environment for obvious reasons of patient safety. Simulation models of humans provide the means to this hands-on experience for students and thereby contribute to the building of confidence in students to use the skills that they possess (Seybert, Kobulinsky, McKaveney, 2008). The use of patient simulation models need not be restricted to the development of highly technical skills demanding higher competence in the student. Patient simulation models can be used in the teaching and training of any discipline in the healthcare sector, for it offers the means of development of skills of simple and routine tasks. Taking blood pressure or giving an injection is a routine practice in patient care. Yet, it needs to be done properly in the interests of patient care and patient safety. Patient simulation models allow students to be skilful in these simple and routine tasks associated with patient care (Seybert & Barton, 2007). Multi-disciplinary teams are increasingly being used for the optimal management of several emergency situations in the care of patients. Such teams become more efficient and effective, when there are the means to increase their skills to respond to the emergency situations. Teaching and training the whole team as a student body to work in unison increases their skills in responding to the emergency situations. Obviously this is not possible in real life clinical situations and the means to provide this training lies in patient simulation models in different scenarios. Simulation-models thus become useful tools in imparting knowledge and skills to improve the standards of patient care (Falcone Jr. et al, 2008). However good a tool for training and teaching is from the perspective of the educator, it is also important that tool be accepted and perceived as useful by the taught. Evidence of the views on simulation as a tool for teaching and training from the perspective of the teacher and the taught in the nursing discipline of medical science is provided by Moule et al, 2008. This study shows that mentors as well as students positively accept simulation as a teaching and training tool, since it provides scope for interdisciplinary learning that could enlarge to inter-professional applications (Moule et al, 2008). In the field of Optometry and Visual Sciences computer-based multimedia interactive software programs, like the Virtual Refractor program, have emerged to assist in the teaching and training of refraction to optometry students (Martin & Alexander, 2000). The purpose of this study is to determine the effects of the inclusion of a computer software patient simulation program Virtual Refractor (VR)) on the speed and accuracy of prescribing the power required for spectacles (refraction) for patients with short-sightedness when training first year optometry students. Methodology This study recruited twenty-four first year optometry students as participants for the study. The twenty-four participants were randomly assigned into two groups. The two groups were termed as VR group and Non-VR group. There were originally twelve students each in the two groups. Ten participants from the VR group and 11 from the Non-VR group completed the study. The participants of both the groups attended two tutorials of one hour duration each. The tutorials imparted knowledge on the principles involved in the determination of power of the spectacles (Subjective refraction) and the instruments (Phoropter) used for the determination of power of the spectacles. In addition to this the VR group was also given a tutorial of one hour duration on the use of the VR software. They were also provided with the licence to use the software program at home and practice on it. Each of the participants in the study were required to submit a two patient simulator reporters for every for four weeks. At the end of this four-week period, all participants answered a questionnaire prepared by the study team. The essential information sought in the questionnaire consisted on how long they had spent reading about the techniques on the determination of short-sightedness; how long they spent on the patient simulation software program and in their perception how prepared and confident were they to examine a patient to determine the extent of short-sightedness in the patient. The next part of the study consisted of the evaluating the efficiency and effectiveness of the participants in determining short-sightedness in an actual patient. For this purpose twenty-four actual patients, who are short-sighted were required as subjects. The degree of short-sightedness of each of these subjects was first determined subjectively by the Chief Investigator and objectively from the mean set of five readings taken with an autorefractor. Then two patients were randomly assigned to one participant from each of the two groups. A time period of forty-five minutes was provided for each student participant to determine the extent of short-sightedness in the assigned patient. At the end of the time period the determined values were collected and compared with the values determined by the Chief Investigator and the autorefractor. Two students from each group (one from VR group, and one from Non-VR group) examined the same patient. • The same pair of students examined their second patient together. • The sequence of the subjective refraction examinations were: Chief investigator validating the mean of a set of 5 readings from an autorefractor, then randomly selected either VR or Non-VR student for their first patient. Their second patient was examined in the same sequence however, the student order was changed to be the other way around (i.e. if their 1st patient sequence was Chief Investigator, then VR student, and finally Non-VR student, for their 2nd patient it will be Chief Investigator, then Non-VR student and finally VR student). This randomization change of the sequence is to minimize the possible influence of patient’s fatigue and familiarization on the result. Literary References Falcone Jr, A. R., Daugherty, M., Schweer, L., Patterson, M., Brown, L. R. & Garcia, F. V. 2008, ‘Multidisciplinary pediatric trauma team training using high-fidelity trauma simulation’, Journal of Pediatric Surgery, vol. 43, pp.1065-1071. Leach, C. D. (2005). ‘Simulation and Rehearsal’, Bulletin of the Accreditation Council for Graduate Medical Education, pp.1-6. Letterle, S. 2003, ‘Medical Education as a Science: the Quality of Evidence for Computer-assisted Instruction’, American Journal of Obstetrics & Gynecology, vol.188, pp.849-854. Levine, I. A. & Bryson O. E. 2008, ‘The use of multimodality simulation in the evaluation of physicians with suspected lapsed competence’, Journal of Critical Care, vol.23, pp. 197-202e4. Martin, T & Alexander, J. A. 2000, ‘Virtual refractor: computerised teaching of refraction’, Clinical Experiences in Optometry, vol.83, no.1, pp.37-39. Moule, P., Wilford, A., Sales, R. & Lockyer, L. 2008, ‘Student experiences and mentor views of the use of simulation for learning’, Nurse Education Today. Nestel, F. D., Black, A. S., Kneebone, L. R., Wetzel, M. C., Thomas, P., Wolfe, N. H. J. & Darzi, W. A. 2008, ‘Simulated anaesthetists in high fidelity simulations for surgical training: feasibility of a training programme for actors’, Medical Teacher, vol.30, no.4, pp.407-413. Scott, J. D., Cendan, C. J., Pugh, M. C., Minter, M. R., Dunnington, L. G. & Kozar, A. R. 2008, ‘The Changing Face of Surgical Education: Simulation as the New Paradigm’, Journal of Surgical Research, vol. 147, no.2, pp.189-193. Seybert, L. A. & Barton, M. C. 2008, ‘Simulation-Based Learning to Teach Blood Pressure Assessment to Doctor of Pharmacy Students’, American Journal of Pharmaceutical Education, vol. 71, no.3, pp.1-6. Seybert, L. A., Kobulinsky, R. L., McKaveney, P. T. 2008, ‘Innovations in Teaching: Human Patient Simulation in a Pharmacotherapy Course’ American Journal of Pharmaceutical Education, vol. 72, no.2, pp.1-8. Tavakal, M., Mohagheghi, A. M. & Dennick, R. 2008, ‘Assessing the Skills of Surgical Residents Using Simulation’, Journal of Surgical Education, vol.65, no.2, pp.77-83. Read More