Simulation: A Pathway to Providing Better Care

By Morgan Passiment

A recent symposium sponsored by the Society for Simulation in Healthcare and the National League of Nursing showcased how we can make interprofessional education in health care come alive through simulation. Over 400 people from a variety of health professions shared their experiences and engaged in small group discussions about how to leverage simulation to improve interprofessional education and patient care.

The program was packed with examples of successful applications of simulation such as onboarding staff, dealing with crisis, reducing infections, improving communication in the PICU and ED, developing cultural competence, and games for team building. The most powerful moment in the program was a video interview of students’ reactions immediately after their first interprofessional team exercise. They were energized by the challenge of having to perform; immediately recognized that role confusion and poor communication created huge stumbling blocks; and unanimously wanted to have these collaborative interactions sooner and more often in their training. Are our educational programs ready to provide these opportunities?

In 2010, the AAMC began an initiative to understand where and how simulation was integrated into medical education. We discovered  that simulation-facilitated learning permeates the education continuum, but often lacks the depth needed to effect long-term systemic change. In fact, we noted that simulation to remediate patient safety issues and create a sense of shared purpose through interprofessional education was a ripe area for development at medical schools.

We have all seen the tragic headlines: medical error results in double mastectomy, young girl dies of ruptured appendix misdiagnosed, or boy left psychotic and severely brain-damaged after wrong-side brain operation. At the root of these errors are miscommunication, lack of information, awkward workflow, and unwillingness of team members to speak up. As the students in the video experienced, these system flaws can be addressed through team-based learning.

Healthcare has become a highly regulated cost driven business dragging health education behind it to grapple with the challenges of training students to work in ever increasing complex environments. Educators are struggling to provide appropriate learning experiences in a clinical system that has limited tolerance for the cost of education. Well organized and coordinated simulation can be leveraged to provide training, assessment, and quality improvement opportunities that benefit the clinical environment without impinging on operations.

According to the Agency for Healthcare Research and Quality (AHRQ), which supports simulation research through its patient safety program, simulation in health care creates a safe learning environment that allows researchers and practitioners to test new clinical processes and enhances individual and team skills before encountering patients. In his 2004 article in the Journal on Quality and Safety in Health Care Dr. D.M. Gaba outlined a future vision of simulation and health care pointing out that only when simulation becomes fully integrated into the routine fabric of health care and is no longer an “add-on” will we reap the true benefit. To do this successfully, leadership needs to be fully engaged.

We have seen unprecedented growth of simulation centers in the past few years. Perhaps we are beginning to see leadership engagement. Whether it is a scenario, skills trainer, or computer-based interaction, simulation provides a rich set of tools to train health care practitioners in a culture of system-based practice and accountability that can eradicate the behaviors and system flaws currently contributing to medical errors and patient harm. We can no longer morally or financially afford acceptable loses in health care when simulation sits within the halls of academic medicine ready and proven to curtail these common causes of errors.

—Morgan Passiment oversees Information Resources Policy and Programs at the Association of American Medical Colleges (AAMC) and is currently leading an initiative to define the current and potential uses of simulation to improve learning and patient care. She can be reached at