Simulation and its role in medical education

Medical education is increasingly laying emphasis on a curriculum based on cognitive, psychomotor, and affective domains of learning which were originally proposed nearly 50 years ago. These reforms are framed around best standards of care, error management and patient safety, patient autonomy, and resource allocation. There is a worldwide shift in the method of medical education towards experiential (‘hands-on’) medical learning; however, applying this concept to real patients is less acceptable to society and is subject to legal and ethical issues.     

Three years of "CASMS": the world's busiest medical simulation centre

Medical simulation is a relatively new teaching modality suitable for medical education at all levels, although its long-term benefits have not yet been validated. Simulation allows the participant to practise diagnosis, medical management and behavioural approaches in the care of acutely ill patients in a controlled environment. Simulators have achieved widespread acceptance in the fields of anaesthesia, intensive care and emergency medicine. More recently, team training for pre-hospital and within-hospital multidisciplinary medical response teams has become popular. The increasing number and diversity of courses at "CASMS" parallels the evolution of simulation centres into regional clinical skills centres elsewhere. Such centres are likely to become a cost-effective means of achieving greater consistency in medical skill acquisition and may improve patient outcomes after medical crises.     

生理驱动高仿真模拟培训技术在危重医学教学中的应用初探

为了探索生理驱动高仿真模拟培训技术在危重医学教学中的应用,北京大学第三医院危重医学科将该技术应用于轮转医师的教学和考核工作中,并在考核结束后通过问卷调查的方式以了解其应用效果。调查结果表明,轮转医师对该技术的应用效果都比较满意,生理驱动高仿真模拟培训技术应用于危重医学教学和考核具有一定优势。     

医学模拟教学——快速提高医学生泌尿外科临床技能的新途径

随着泌尿外科医疗技术的飞速发展,临床中对医生临床技能的要求也在不断提高;而教学规模的日益扩大和医患关系的相对紧张导致教学资源日趋不足,这就严重地制约了泌尿外科医学生临床技能的培养。医学模拟教学通过模拟多种临床情境,可以安全、高效地培养医学生临床思维、技术操作和沟通技巧,正在成为快速提高泌尿外科临床技能的新途径。     

现代医学模拟中心的分类及规划

医学模拟实验室是指借助模拟技术和仿真手段营造出一个真实的临床操作环境,为医学生实习、全科医生及专科医生的培训提供一个有效的实践场所.医学模拟实验室分为临床技能实验室、专科技能培训中心、医疗模拟中心和模拟医院,其建立需遵循教学实践,工程施工空间分配,人员配置,资源选用等原则.科学地建立临床模拟试验室需要医学、教育、管理、工程等学科的理论,它为医学教育提供了有效的辅助.     

基于高仿真重症医学模拟训练的非技术技能培训研究

近年来,高仿真模拟病人技术已成为临床医学教学非常重要的手段。其中非技术技能（non—technicMskills,NTS）对于医疗质量的提高有着十分重要的作用。在此,将基于科室自身教学经验,探讨NTS融人重症医学模拟训练的理论和实践,并评价实施效果。     

Republished paper: The WHO patient safety curriculum guide for medical schools

BACKGROUND: The urgent need for patient safety education for healthcare students has been recognised by many accreditation bodies, but to date there has been sporadic attention to undergraduate/graduate medical programmes. Medical students themselves have identified quality and safety of care as an important area of instruction; as future doctors and healthcare leaders, they must be prepared to practise safe healthcare. Medical education has yet to fully embrace patient safety concepts and principles into existing medical curricula. Universities are continuing to produce graduate doctors lacking in the patient safety knowledge, skills and behaviours thought necessary to deliver safe care. A significant challenge is that patient safety is still a relatively new concept and area of study; thus, many medical educators are unfamiliar with the literature and unsure how to integrate patient safety learning into existing curriculum. DESIGN: To address this gap and provide a foothold for medical schools all around the world, the WHO's World Alliance for Patient Safety sponsored the development of a patient safety curriculum guide for medical students. The WHO Patient Safety Curriculum Guide for Medical Schools adopts a 'one-stop-shop' approach in that it includes a teacher's manual providing a step-by-step guide for teachers new to patient safety learning as well as a comprehensive curriculum on the main patient safety areas. This paper establishes the need for patient safety education of medical students, describes the development of the WHO Patient Safety Curriculum Guide for Medical Schools and outlines the content of the Guide.     

试论以问题为基础教学过程的实施与保障

以问题为基础的学习(problem-based learning,简称PBL)在医学教育改革中正逐渐被使用。我校借鉴国际医学教育经验,根据自己学校的实际条件,在23门课程中开展了PBL教学。通过科学设计、资源保障和有效管理等措施,使PBL教学得以顺利实施,并已经取得了初步成果。     

试论以问题为基础教学过程的实施与保障

以问题为基础的学习（problem—based learning，简称PBL）在医学教育改革中正逐渐被使用。我校借鉴国际医学教育经验，根据自己学校的实际条件，在23门课程中开展了PBL教学。通过科学设计、资源保障和有效管理等措施，使PBL教学得以顺利实施，并已经取得了初步成果。     

体验教育在医学生生命观教育中的应用

当前,生命教育在家庭教育、学校教育、社会教育中普遍缺失。体验教育作为一种新型的教育理念和教育模式,契合生命观教育的内在诉求,符合医学生自身特点和需求,是培养医学生素质的一次新探索。体验教育应用于医学生生命观教育,并从“敬畏一切生命、珍惜自我生命、善待他人生命、提高生命价值”4个维度出发,实施“生活体验、活动体验、专业体验、社会体验、家庭体验”5个模块教育,提高新时期医学生生命观教育的针对性和实效性,更好地促进医学教育目标的实现,进而为促进我国医疗卫生事业的健康和谐发展,具有十分重要的意义。     

关于提高临床医学专业实习医师临床技能的改革与思考

为了进一步高质量贯彻临床医学专业教学计划,我中心充分利用及拓展我校＂全军医学模拟训练中心＂教学平台,探索在临床医学本科医学课程体系中有效整合医学模拟教育的新途径,经过三年多的实践与探索,总结了相关经验,并提出思考与改进意见。     

关于重症医学教育的思考

重症医学是既与其它学科关系密切又有自己独特理论体系的一门朝阳学科,在某种程度上代表现代医学的发展方向。加强重症医学教育,培养合格的重症医学专科人才是现代医学教育的不可忽视的重要组成部分。这不仅是现代医院管理模式本身发展的要求,也是社会发展和对高质量医疗服务的需求增加的需要,是学科建设自身发展的需要。医学院校在临床医学教育阶段应该注重对医学生进行重症医学兴趣的培养,加强重症医学科临床基地建设,注重临床技能的训练以及知识的更新,培养学生整体看待疾病和患者的观念,培养正确的临床思维。要注重传授循证思维,使学生在运用循证医学方法进行学习过程q-掌握学会循证专业评价的知识,达到寻找最佳性的循证原则,同时注重培养医学生从实习阶段具备科研意识、创新精神的科学素质。     

手术体验教学在早期接触临床实践教学中的应用

为探索更为有趣、有效的医学教育早期接触临床的教学方法,温州医科大学附属眼视光医院在低年级医学生中开设眼科手术体验教学。设置多样的模拟眼科手术体验内容,如结膜缝合手术、角膜缝合手术、白内障手术、模拟眼底手术等,不仅有助于激发医学生浓厚的学习兴趣,更促进了学生对专业的思考和探索。     

临床技能教学平台的规划与建设

复旦大学上海医学院临床技能学习中心的建设，为临床医学各学科提供了教学平台，为医学生提供了临床技能实践操作机会。中心建立了临床技能教学平台，引入先进的临床教学模型和电子模拟人系统，对医学生进行各种临床技能培训，形成并完善了客观的评价体系，为改善临床教学和技能实践提供了可能的场所与硬件支持。目前，临床技能教学平台已经完成了初步建设并制定了进一步的发展规划。     

基于智慧医联体平台的脑卒中区域性管理新模式的建立

 目的  依托于华山医院-上海市第五人民医院-闵行社区医疗联合体信息服务平台(华山-五院-闵行社区医联体, H5M),计划初步建立针对脑卒中患者的全流程新型管理模式,为脑卒中单病种质量管理提供经验与方法。方法  由H5M平台提供原始的医疗数据、患者健康档案、互联网医疗服务项目等,利用云计算、大数据、物联网、人工智能等技术,构建以安全可靠的混合云为基础的单病种脑卒中新型智慧医联体平台。结果  绘制出脑卒中患者全流程管理模式图;建立了智慧化社区卒中早期筛查、多学科远程会诊、智慧化随访评估、临床教学同步的华山-五院-社区分级诊疗体系;实现了资源三级共享、为科研提供可靠完善的数据库。结论  通过云计算、大数据等技术的支持,初步构建出了满足多学科医教研一体化需求、满足以患者和医护为中心的、安全可靠的、基于互联网脑卒中智慧医联体平台的新型区域性脑卒中患者全流程管理模式。     

以体验为主导的护理学专业本科生培养模式的构建

目的构建以体验为主导的护理学专业本科生培养模式,为护理教育改革提供参考依据。方法综合运用头脑风暴法、专家深度访谈法、问卷调查法、数理统计法及实证研究等,对护理学专业本科生培养模式的四大要素（培养目标、课程设置、教学方法、考核评价）进行探索。结果形成护理学专业培养目标、确定适合以体验式学习方式的课程体系、探索了适用于护理学专业特色的体验式教学方法、尝试了多种考核评价方式,最终构建了以体验为主导的护理学专业本科生培养模式。结论从人才培养模式四要素（培养目标、课程设置、教学方法、考核评价）出发,构建了以体验式学习理念为主导,以培养高素质应用型护理人才为目标,以提高护理学专业学生综合素质为核心的三阶段螺旋式上升型（认知、发展、成熟）护理学专业本科生培养模式。     

整合医学理念联合PBL在麻醉住院医师规培教学中的应用

为培养系统掌握基础理论和临床专业知识、具有处理危急状况能力的“同质化”“高质量”麻醉医生，陆军军医大学第一附属医院麻醉科将整合医学教学联合以问题为基础的学习（problem-based learning，PBL）应用于住院医师规范化培训的教学中。该校始终以“病理生理改变”为核心整合相关知识，实行以病例为主线的规范化培训教学思路，并建立以整合医学教育理念为基础、以PBL教学为中心、以麻醉手术过程中病理生理改变为主线的规范化培训病例库，使规培学员有效地达到了理论知识与临床融会贯通的目的。其不仅培养了高素质的麻醉住院医师，而且提高了住院医师发现、分析、解决问题的能力，使受训学员养成自我学习、终身学习的习惯。     

进修医生带教中的医德教育

医德教育是临床进修医生教育的重要一环,直接关系到医院医疗质量及医疗水平的提高.作者强调培养进修医生与患者沟通的能力,换位思考,注重对患者的人文关怀,教育进修医生尊重患者的权力,保护患者的隐私权,在与病患交流时采用规范用语,并通过在临床实践中教育进修医生遵循循证医学原则,调动进修医生的积极性,在提高临床诊断治疗水平的同时,使进修医生在医德医术上有所提高.     

北京农村远程医学教育试点工作的体会与思考

为探索远程教育的可行性，以便在全市范围推广提供经验，北京市卫生局依托卫星网络技术平台——“智农天地网”为传播载体，在海淀区、大兴区、房山区、顺义区等4个郊区17个站点，面向农村基层开展了《急诊急救知识与技术》远程试播工作。结果显示，远程教育覆盖面广、可及性强、灵活便捷，受到基层卫生技术人员的认可和欢迎，尽管在管理、技术、师资和教学内容等方而还有待进一步改进和完善，但远程教育无疑是提高农村卫生队伍职业素质的必由之路。     

Satisfaction of medical students with simulation based learning

Objectives:

To evaluate medical students’ satisfaction with simulation based learning strategy (SBL).

Methods:

A cross-sectional survey was conducted between October and November 2013 at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. All third and fourth year medical students (n=185) both males and females were included. A self-developed questionnaire on the effect of SBL was used. Items included were related to knowledge, skill, environment, resources, and faculty. The questionnaire was validated by an expert reviewer, and the reliability was calculated for all the questionnaire items. Responses were measured on a 5 point Likert-type scale, and statistical analysis was carried out.

Results:

The response rate for this study was 62% (n=115). The alpha coefficient for all items was 0.73. Overall, respondents from both years’ students were satisfied with teaching strategy, use of mannequins, and learning environment. The challenges reported were lack of skill-laboratories facilities, students’ cooperation, allocated time for skill-laboratories, and knowledge of instructor. There was a small, but significant difference between the satisfaction scores among genders (p=0.001). Whereas no difference was identified between the participants’ scores on satisfaction with SBL and year of education (p=0.62).

Conclusion:

Although there were few challenges, most of the students were satisfied that SBL improved their knowledge retention, skills, and communication.Medical education programs are increasingly adopting simulation in both undergraduate and postgraduate curricula. Many reasons were cited on the use of simulation in clinical teaching including the changes in healthcare delivery, lack of objectivity of clinical examinations,1 limited clinical placement positions, and potential of simulation to improve clinical learning.2 Numerous reports support the introduction of simulation based medical education as an important step in curriculum development.3 Especially in training of high risk disciplines such as resuscitation, airway management, procedural training, trauma, and disaster management.4 Positive results in relation to enhancing knowledge, skills, and attitude toward technology-enhanced simulation have been reported in many studies.5-7 Two studies conducted in Saudi Arabia regarding usage of simulators for teaching laparoscopic surgery skills among junior surgical residents8 and local anesthesia teaching9 showed significant enhancement and improvement at a cognitive as well as psychomotor level. The technique has been widely used for the acquisition of specific clinical skill in specialties such as pediatrics, emergency medicine, intensive care medicine, obstetrics, anesthesia, radiology, and allied medical sciences.10,11 The potential advantages of simulation to student’s learning have stimulated the use of simulation in medical teaching in Kingdom of Saudi Arabia. In graduate medical education, the evidence is equivocal regarding whether simulation compared with traditional teaching methods improves learning or clinical performance.6 On literature review, we were unable to find research in relation to undergraduate medical students on their perceptions related to the effectiveness of simulation based learning (SBL) strategies. It is important to understand students’ satisfaction with the new teaching method to integrate simulation as a teaching learning strategy in medical education curricula. In the present study, we aimed to determine students’ satisfaction with this educational strategy in undergraduate medical students enrolled in King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. Also, to identify any challenges associated. The findings of their research could be utilized for future training and implementation of simulated activities in the curricula.