Question

This week we reviewed three examples of QI in health care leading to improved patient outcomes:

limiting interruptions during medication administration (policy/practice change)

electronic patch for home monitoring of patients (telehealth)

use of medical simulation to practice risky surgeries

Which example resonated with you the most? Give a detailed answer please!

Answer 1

The example that resonated with me the most is the use of medical stimulation to practice risky surgeries.

Simulation is defined as “a technique to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive manner.

Simulators can provide a safe and standardized method for training in surgery without the risks that come with operating on real patients. Such experiences can be realistic, highly engaging, and immersive, such that users forget they are in a simulation. Here, the acquisition of competency in procedural skills occurs hand in hand with team building and communication skills within an educationally focused environment. Learners can refresh themselves and gain confidence regarding infrequent or rare circumstances, intimate examinations, and risky procedures like arterial cannulation; iteratively practice protocols and drills; enhance the automaticity of emergency procedures; and ultimately develop professional and clinical competencies.

Simulation also helps to enhance psychomotor skills, hand-eye coordination, and ambidextrous surgery, especially important for endoscopic surgery. A recent systematic review of simulation for laparoscopic surgery included 219 studies, and the authors concluded that: “Simulation-based laparoscopic training of health professionals have large benefits when compared with no intervention and is moderately more effective than non-simulation instruction.

Skills can also be built sequentially with a planned, gradual increase in complexity at a pace that respects individual trainees within a cohort. Such repetition and exercises would not be possible with a real patient. This allows for intensive learning on procedures like venipuncture, central line insertion, and bowel anastomosis. Learners can be immersed in a safe environment with “permission to fail” and the opportunity to develop rich, meaningful debriefings with facilitators and coparticipants.

Trainees can also learn not just immediately from mistakes, but can potentially see their natural conclusion, a totally unethical position if a real patient were involved. These educational facets are particularly useful in a craft specialty like surgery, where the limits of each technique can be explored and challenging scenarios re-created to test adaptive responses, rather than having to remain confined to the “zone of clinical safety.” Indeed, simulation recognizes that errors are an integral part of human behavior, performance, and development: “The real problem isn't how to stop bad doctors from harming, even killing their patients. It's how to prevent good doctors from doing so.

Simulation is not just for trainees, but also for experts learning new techniques. Cadaveric simulations were especially useful in the recent face transplantations. Virtual reality simulation is now providing three-dimensional space and time parameters, thus improving preoperative planning. Chen et al showed how virtual reality allowed the construction of accurate three-dimensional models of the liver, individual hepatic volume, and the detailed character of anatomic structures (including vasculature around tumors), and these helped articulate the possibility of intricate liver resection and the operative risks.