Reply to Letter: Use of simulation-based medical education to improve patient care quality

Abstract

We appreciate the response of Drs. Siassakos and Draycott to our recent editorial1Wayne D.B. McGaghie W.C. Use of simulation-based medical education to improve patient care quality.Resuscitation. 2010; 81: 1455-1456Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar about the importance of rigorous evaluation during simulation-based education to improve patient care outcomes. The authors question our recommendation for rigorous assessment of healthcare individuals and teams using a minimum standard and whether such assessment might discourage clinical providers from participating in training due to evaluation apprehension. While we are aware of the impressive research in neonatal outcomes performed by the authors,2Siassakos D. Crofts J.F. Winter C. Weiner C.P. Draycott T.J. The active components of effective training in obstetric emergencies.BJOG. 2009; 116: 1028-1032Crossref PubMed Scopus (142) Google Scholar, 3Draycott T.J. Crofts J.F. Ash J.P. et al.Improving neonatal outcome through practical shoulder dystocia training.Obstet Gynecol. 2008; 112: 14-20Crossref PubMed Scopus (379) Google Scholar we respectfully disagree about the assessment issue. In fact, we believe that assessment of healthcare individuals and teams is not only necessary but is also an ethical imperative to ensure patient safety. Work at Northwestern University has shown that establishing a minimum standard for critical patient care skills such as Advanced Cardiac Life Support4Wayne D.B. Didwania A. Fudala M. et al.Simulation-based education improves quality of care during advanced cardiac life support events: a case control study.Chest. 2008; 133: 56-61Crossref PubMed Scopus (470) Google Scholar and central venous catheter insertion5Barsuk J.H. McGaghie W.C. Cohen E.R. Balachandran J.S. Wayne D.B. Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit.J Hosp Med. 2009; 4: 397-403Crossref PubMed Scopus (242) Google Scholar, 6Barsuk J.H. McGaghie W.C. Cohen E.R. O’Leary K.J. Wayne D.B. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit.Crit Care Med. 2009; 37: 2697-2701Crossref PubMed Scopus (389) Google Scholar allows skill to transfer from the simulated environment to clinical settings. This produces improved patient care quality. Moreover, this approach has dramatically reduced catheter-related bloodstream infections in the intensive care unit7Barsuk J.H. Cohen E.R. Feinglass J. McGaghie W.C. Wayne D.B. Use of simulation-based education to reduce catheter-related bloodstream infections.Arch Intern Med. 2009; 169: 1420-1423Crossref PubMed Scopus (347) Google Scholar and lowered hospital costs.8Cohen E.R. Feinglass J. Barsuk J.H. et al.Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.Simul Healthc. 2010; PubMed Google Scholar We have consistently documented 100% participation and a positive response from learners.4Wayne D.B. Didwania A. Fudala M. et al.Simulation-based education improves quality of care during advanced cardiac life support events: a case control study.Chest. 2008; 133: 56-61Crossref PubMed Scopus (470) Google Scholar, 5Barsuk J.H. McGaghie W.C. Cohen E.R. Balachandran J.S. Wayne D.B. Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit.J Hosp Med. 2009; 4: 397-403Crossref PubMed Scopus (242) Google Scholar, 6Barsuk J.H. McGaghie W.C. Cohen E.R. O’Leary K.J. Wayne D.B. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit.Crit Care Med. 2009; 37: 2697-2701Crossref PubMed Scopus (389) Google Scholar Our data and experience show it is unlikely that healthcare providers avoid simulation-based education due to testing. Most important, we disagree with the authors’ recommendation to use “prospective monitoring of quality indicators to assess the success of training.” This approach is inadequate because it does not ensure that competent providers are performing the procedure under study. When a cohort of healthcare providers receives simulation-based education, the group's overall performance may improve, but no information is available on an individual level.9Wayne D.B. Butter J. Siddall V.J. et al.Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial.Teach Learn Med. 2005; 17: 202-208Crossref PubMed Scopus (205) Google Scholar Patients deserve to know that healthcare providers and teams giving treatment are competent. Simulation-based education linked to rigorous, individual and team assessment is a powerful tool for medical educators and administrators to fulfill their responsibility to patients and society. Diane B. Wayne has nothing to disclose. Dr. McGaghie's contribution was supported in part by the Jacob R. Sucker, MD, professorship in medical education. Measuring the impact of simulation-based training on patient safety and quality of care: Lessons from maternityResuscitationVol. 82Issue 6PreviewWe read with great interest the recent editorial by Wayne and McGaghie,1 and totally agree that the best way to improve patient care during acute events is to combine simulation-based training, ideally interprofessional, with deliberate practice and measurement of patient outcomes. We also agree that initiation of immediate life support and administration of correct medications are probably the best measures of care for patients who experience catastrophic emergencies.2 Full-Text PDF