New Review of Simulation Education

A new article in JAMA looks at the effectiveness of simulations in health education.  The meta-analysis, which looked at over 600 published research papers, found large effects for the use of technology-enhanced simulations for knowledge, skills, and behaviors. 

Many of the papers included in the analysis dealt with surgical procedures, but there were other studies too, including dentistry, communication skills, nursing skills, examination skills, and obstetrics. 

The big limitation with this analysis is that it only looked at studies comparing simulation to no-instruction controls.  It's not surprising that some kind of instructional intervention is better than nothing at all, but this paper can serve as a good resource for those interested in learning more about simulations in medical education. 

Interactive CME Improves Physician Communication Skills

A very nice study, published last year in Patient Education and Counseling, shows that interactive instruction, that's heavily based on practicing skills, can have a positive influence on physician practice.  The study uses several elements that have been shown to influence provider behavior: skills practice, interactivity, and a design that spreads over several different sections (spaced learning). 

The Practice Setting
Physicians in a university health service clinic where there is a strong need to counsel patients on risky behaviors. 

The Instructional Design
The instruction consisted of five 2-hour workshops at 4-6 week intervals, over a span of six months.  the workshops all emphasized communication skills, and each focused on a specific area of need including managing difficult patient encounters, screening and assessment for depression, screening and assessment for alcohol use, taking a sexual history, and behavior change counseling.

Each of the workshops began with a short video or demonstration, to trigger discussion, then there was a brief, highly interactive lecture.  After that, the majority of the time was spent practicing skills with standardized patients and receiving feedback.  After each session, participants were given pocket cards to uses as references, and readings for further information. 

The Measures
This very thorough study, measured four different outcomes - participant satisfaction, learning (measured prior to the intervention and one month afterward), performance (assessed by chart review both before and after the intervention), and the impact on patient satisfaction.

The Results
The results showed positive increases in many important outcomes including knowledge, and more importantly, physicians changed their practice.  The patient satisfaction scores were already very high, and did not increase significantly as a result of the training. 


What it Means
Providers can change their practice.  Often, change requires something more than just education and training, but the elements that can help physicians change practice behavior are not a mystery, we see the same elements over and over again when we find CME that that changes practice:

1. Skills practice with feedback - people need to practice new skills before they can use them
2. Interactive information delivery
3. Practice over time - time is an often overlooked factor, but one of the most powerful