Much attention is being paid to the skill of “decision-making” in healthcare. This trend is driven by a number of factors including cost, patient safety, and an increasingly complex healthcare environment. Not only are there more diagnostic and therapeutic options, there are more regulations and insurance restrictions than ever before.
Simulation-based learning replicates the complex challenges healthcare providers face daily, provides a cost-effective way for organizations to improve both the consistency and accuracy of clinical decisions and share best practices. It is a proven educational technique that leverages adult learning concepts, particularly experiential learning. By “caring” for a patient online, learners acquire and hone the necessary knowledge and skills to make better clinical decisions. In addition, they receive personalized feedback to help them learn from their choices. Educators benefit by gaining objective insights into a learner’s decision-making process and a better understanding of potential education gaps within their organization.
Simulation allows for improving all aspects of health care, from testing and training on medical devices, to assessing diagnostic strategies, to developing and prescribing drug therapies. As a gastroenterologist, I have seen a number of exciting improvements and innovations in the GI field in recent years. My colleagues and I are often eager to use promising new diagnostic tools or therapies to benefit patients. However, good intentions without necessary skill and awareness may have harmful effects. Simulation-based learning platforms use realistic scenarios to contextualize the unique benefits and risks of new technology.
Consider as one example the introduction of the new antibiotic rifaximin, used to treat certain types of irritable bowel syndrome and GI infections. Its cost is considerable, running over $1,000 for a two-week course of treatment, making it necessary for clinicians to carefully select which patients will benefit most. Hospitals are developing guidelines to prevent over-utilization and development of resistance to this unique antibiotic. At the same time, insurance companies are developing rules to restrict use for cost reasons; the FDA is actively updating their approved uses, and clinical research is demonstrating wider applications for this new drug. All this makes patient selection difficult for the average, busy clinician.
A series of short clinical simulations could quickly get a provider up to date with the latest recommendations, restrictions, and guidelines. Providers could be exposed to a wide range of realistic scenarios presenting challenges of using this new medication. At the same time, they could get immediate feedback when he or she makes the wrong choice, enabling them to navigate their own learning experience. As recommendations evolve and change, these simulations could be easily updated. Additionally, key constituents in the health system could review the decisions made by the providers in the simulation to assess performance and identify gaps. This data can be analyzed longitudinally to measure performance improvement.
Currently, I’m working with a national gastroenterology society to develop tools to assess the competency of individuals seeking to demonstrate proficiency in using new diagnostic technologies. Given the cost of development—and, more importantly, the critical imperative to optimize patient safety—it’s well worth the limited time it takes to a complete a simulation before using a procedure to diagnose a potentially serious condition in patients.
Simulation can also be used in developing new treatments. This is critical in today’s healthcare market, where physicians and insurers must weigh the effectiveness of new drugs against existing therapies to make important treatment decisions. Consider acid reflux disease, a common GI condition with many effective treatment options. A company investigating a new anti-reflux drug can simulate a prescribing scenario among a group of physicians to determine the drug’s perceived and actual risks and benefits—a critical step in research and development.
Simulation is a flexible, proven, competency-based learning approach that benefits educators, learners, and organizations. It provides clinicians with new knowledge and decision-making skills, coupled with rich feedback and data that help transfer these skills in a constantly evolving clinical landscape. Moreover, it helps healthcare professionals build expertise in new and emerging medical technology, laying the groundwork for enhanced decision-making that ultimately results in improved patient outcomes.