A New Way to Learn: Residency programs use medical simulation to fill training gaps

"It provides some opportunities for education that are very difficult to create in other circumstances," she said. "With simulation, you can create a medical circumstance or medical condition or complete scenario without waiting for it to happen amongst the patients that you’re seeing. So if there’s a particular concept that you want the residents to learn about…there are many of these that you could replicate in simulation and so instead of hoping that a person with a certain condition comes through the service, you can arrange very intentionally to represent that condition during a scheduled educational session."

A ‘Paradigm Shift’

Serving as a guidepost for the implementation of the new ACGME rules are restrictions put in place in 2009 in England. There, working hours for residents were reduced from 58 in 2004 to 48 two years ago. To help offset the lack of exposure for trainees, the Royal College of Surgeons has devoted part of its building to a simulation center.

Stateside, Dr. Deutsch is chairperson of a task force of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) that is studying the use of simulation in otolaryngology residency programs to see how American otolaryngologists should address the situation. Given the nascent nature of the methodology in otolaryngology, the Academy is looking to quantify roughly how many programs use simulators, what the applications can be and what some of the best practices are.

"It’s something we’re looking at" too, added Jennifer Manos, RN, BSN, associate executive director for the Society for Simulation in Healthcare and manager of accreditation for the Council for Accreditation of Healthcare Simulation Programs. "… One of the big goals for the future is how does simulation impact the clinical environment?"

Sonya Malekzadeh, MD, FACS, associate professor of otolaryngology-head and neck surgery at Georgetown University Hospital in Washington, D.C., and AAO-HNS’ coordinator-elect for education, said the new ACGME rules are just one facet of the changing face of surgical education. "We’re seeing this paradigm shift in surgical education where that traditional apprenticeship model of see one, do one, teach one…we’re not going to see that," she said.

Dr. Malekzadeh said health care reform, particularly its focus on patient safety, may drastically alter how residents are taught. "There are a lot of issues around this," she said. "Is it appropriate to let a resident do something for the first time on the patient if they’ve never seen it before, they’ve never done it before, they’re not familiar with the instruments?"