Most health care professionals learn as apprentices to more experienced clinicians who teach them procedures, techniques, reasoning and decision making while providing actual patient care. Clearly, this type of training prohibits the opportunity for repeated practice, which is essential for mastering skills such as correctly using surgical instruments and life-saving equipment. Who wants to have a training clinician stick a needle in their arm multiple times in a row, or require an extra hour of anesthesia on an operating table because surgical trainees haven’t yet mastered their suturing skills?

A dress rehearsal

Consider the analogy to a concert pianist, who trains under the tutelage of a maestro. The trained pianist would never perform before an audience without having practiced extensively beforehand and likely warmed-up immediately prior to any performance. In this situation, the risk of poor performance would be embarrassment for the pianist and the maestro, and disappointment for the audience. Yet, requiring trainees to perform without similar preparation is standard practice in health care, where the risks of poor performance are much higher. Fortunately, advances in clinical teaching methods and technologies offer an alternate approach.

"Building a culture where quality and safety are integral components of clinical practice is essential for high performing health care institutions."

Simulation-based teaching methods allow learners to acquire and maintain clinical skills in a safe environment where they can practice as much as they want on realistic, simulated patients, instead of real patients. Technological advances have led to simulated patients that function like their real patient correlates, allowing clinicians to practice techniques from catheter placement and identification of abnormal physical examination findings, to more complex interactions involving communication, disaster management, and multi-disciplinary teamwork. Most patient simulators provide information to clinicians about where they need to improve performance to meet expected standards, and after mastering clinical performance in a simulated context, clinicians are well prepared to transfer their abilities to real patient care. This reduces risk for both patients and clinicians.

Greater risk

Training solely through clinical apprenticeship places both patients and clinicians at greater risk for potential adverse events, if only because by definition trainees are ill prepared and likely to be somewhat impeded by associated stress. Likewise, clinical preceptors must manage error-prone divided attention, which results from concomitantly providing patient care while teaching and overseeing the performance of the trainee. The advantages of mastering clinical skills in a simulated context prior to working with actual patients are obvious. Not only will patients benefit from timely and accurate care from training clinicians, supervising clinicians will be able to maintain their focus on the critical aspects of patient care, further increasing the overall benefits for everyone.

Building a culture where quality and safety are integral components of clinical practice is essential for high performing health care institutions.