Written by: Dr. Kathy Gennuso

The following words are taken from recently published research done in Belfast on simulation based learning in the healthcare environment: “Clinical workplaces are often dynamic and challenging environments in which to work. Often, healthcare professionals will encounter uncertainty, unpredictability and risk whilst carrying out their duties. Exposure to clinical uncertainty in medical curricula may better prepare students to manage complexity and explore the boundaries of professional competence and so improve their preparation for practice. By revealing those factors that lead to personal, ethical or moral compromise, learners may be more able to gain control of them on subsequent occasions (Lewis, et. al 2016).” If I didn’t know better, I’d think they were talking about US healthcare . . . .

These researchers wondered if one of the remedies to being unprepared to act properly in challenging, compromising, uncertain, and risky situations was to virtually immerse budding healthcare workers in simulation based learning vignettes of such situations. They made use of technology to do just that. One simulation pulled the student into a scene where relatives argued about advance directives beside the bed of their unconscious parent. This and other scenarios evoked emotions like fear, frustration, or moral outrage, in ways no textbook could. Participants were then able to reflect on the emotions they had experienced, talk it out, make a plan for how to best react in future situations, and become more comfortable with knowing, speaking out for, and doing what is right. Results were encouraging, and most likely larger scale studies will follow.

Now we all basically understand the underlying truth here that being properly prepared and trained for anything increases the odds for optimal performance, and that being emotionally invested changes things. But what I want to emphasize is that it’s easily doable — great technology exists and continues to evolve to help our future physicians, nurses, and technicians develop the necessary skills to keep themselves and their patients safe and to become providers of the best, most compassionate and intelligent patient-centered care. Simulation based learning doesn’t need to be futuristically elaborate or astronomically expensive to be effective. But it does need to be flexible and customizable to answer any healthcare facility’s or learning institution’s most relevant and immediate needs of their medical students, staff, and the patient populations they are attempting to serve. In today’s ethical complex healthcare environment, there’s a glaring need to provide a tool that addresses and helps to safeguard against moral distress (which does cause healthcare workers to leave the field!) for everyone’s sake – I think simulation based learning can have a substantial impact on that.

My organization built its strategy to deliver the most efficient, affordable, and relevant training technology around the creation of reusable learning objects (RLOs).  A RLO is a self-contained building block of education on a single subject matter, which can be used alone or in various combinations with others to suit the occasion.  This strategy provides a process and framework used to create and deliver learning experiences that support the needs of the targeted group. Scenarios can be constructed from existing nuggets or RLOs to invite a learner into a problematic situation that depicts uncertainty or risk and emphasizes that emotions can impair judgment and diminish personal capacity to respond objectively. Good simulation based learning can be proactive, preparatory, and protective, and that builds confidence and encourages compliance.

Too few daily interactions in healthcare are completely clear-cut and predictable. They require workers to think quickly on their feet, know what is right, and have the conviction to act on it. Healthcare workers need finely tuned soft skills, like courtesy, cooperation, empathy, honesty, and sensitivity. Patients expect and deserve them. Effective healthcare delivery requires collaboration between patients and physicians and other healthcare professionals. Open and honest communication, respect for personal and professional values, and sensitivity to differences are integral to optimal patient care.

As far back as 1992, the American Hospital Association stated in their Patients’ Bill of Rights:

“As the setting for the provision of health services, hospitals must provide a foundation for understanding and respecting the rights and responsibilities of patients, their families, physicians, and other caregivers. Hospitals must ensure a health care ethic that respects the role of patients in decision making about treatment choices and other aspects of their care. Hospitals must be sensitive to cultural, racial, linguistic, religious, age, gender, and other differences as well as the needs of persons with disabilities.”

But how does a medical institution establish adequate training and/or continually replenish the competencies necessary to fulfill these expectations? That is a tall order! Many training options have come on the scene at a high cost, but all are not necessarily efficiently repeatable, easy to access, nor nimble enough to respond to changing laws and situations.

Individuals like myself who love technology and are passionate about healthcare ethics know that twenty-first century technology truly holds the key. When structured correctly, learning management systems can easily create effective, active, and engaging learning environments that facilitate personal and professional knowledge acquisition, retention, and application. Affordable simulation based learning is one of the important features to incorporate into a viable learning management system geared toward making future healthcare workers the most competent, disciplined, and compassionate ever seen and toward the continuous expectation of all health care – that of improving patient outcomes!