Simulation Based Learning (SBL)

Kafilat Adeleke

PGY1 Pharmacy Resident

Holy Cross Health Hospital

Imagine teaching a class of pharmacy students practical topics such as Advanced Cardiovascular Life Support (ACLS) skills or patient medication counselling. What is an effective learning theory model that would be applicable to encourage students and enhance learning and motivation?  Are didactic lectures sufficient for learning these practical courses?  Simulation based education is defined as a learning model that replaces and amplifies learners’ real experiences with guided experiences.1 Over the years, pharmacists’ roles have continued to be evolved and developed with the main focus shifting from medication oriented to more patient oriented roles. Application of SBL provides innovations to enhance independent and collaborative skills required to become a successful candidate in the evolving roles in pharmacy.

Sole use of pedagogy teaching theory have been shown to limit development skills required for clinical practice. In a brain activity assessment study of students while asleep, in class, labs or while doing homework, students were found to have the lowest brain activity in class compared to other daily functions mentioned above. This ascertains that there is a need for active teaching and engagement of students in order to maximize their learning experience.2 Addition of the SBL model augments learners experience and allows for self-reflection and identification of knowledge gaps. This model provides learning opportunities for students where they can make and correct their mistakes without necessarily posing risks to patients. As a result, it provides an educational platform which maintains equilibrium between mitigating ethical tensions whilst resolving practical dilemmas.1, 3 It is imperative for learning to be practical in order to be relevant and applicable to real world experience. SBL applies an andragogy teaching style that accepts that students are adult learners who are intrinsically motivated and require practical learning in order to furnish their understanding and comprehension. Application of SBL allows students to attain these learning outcomes and as a result become better pharmacists.

In addition, SBL aids in developing collaborative teamwork skills. The majority of SBL are often assigned in groups such as role playing among students in class, or in conjunction with other multidisciplinary teams. For example nursing, medical, pharmacy students collaborating together to perform their respective roles in a response to emergency situations. Substantial part of the evolving pharmacy role is integrating with other healthcare team which has collectively improved patient outcomes. SBL activities help to build teamwork and communication skills and as a result become clinical pharmacist. SBL can be divided into different subgroups contingent upon the learning objectives and commitment as illustrated below:

Independent skill procurement:  This allows learners to operate independently without necessarily posing a risk to true patients. An example is blood pressure monitoring. A partial task trainer (defined as practice on some set of components of the whole task as a prelude to the performance of the whole task)4 can be utilized such as an artificial arm for blood pressure.3

Independent and communication skills procurement: This allows the learners to practice independently and improve their communication skills as well. This can be applied to patient counselling, medicine information scenario, and dealing with error performance assessment. A part task trainer with a standardized patient may be utilized in this setting.3

Collaborative team resource management: This allows for students to effectively work as a team member. This can be applied in the management of clinical conditions, responding to emergency crises, and developing communication skills amongst team members. Advanced technology such as the Simman mannequin patient simulator in emergency response training may be utilized in this setting.3

One of the most common conceptions of the simulation based learning model is that it requires utilization of advanced technology. SBL is a technique and not technology. Although technology may be used to execute SBL, but it is not a required tool for SBL design. Well-planned role playing is as effective as use of technology in enriching learners' experiences for some learning objectives. Also, as instructors, designing simulation based learning can be time consuming, as it takes a certain level of commitment to assign and develop an effective simulation based learning. Although, the amount of pre-class preparation time needed to implement SBL strategies may be greater than that needed to recycle old lectures; but it will not necessarily take any more time than that needed to create thorough and thoughtful new lectures. When planned properly, SBL model allows students to experiment, explore, and motivated by the class5, 6. SBL is an innovative training modality that could support the development of the clinical skills and competencies required of learners to become successful clinical pharmacist, and thus, should be utilized when teaching for effective learning outcomes.

References

1. Lateef F. Simulation-based learning: Just like the real thing. J Emerg Trauma Shock. 2010; 3(4):348–352.
2. Poh MZ, Swenson NC, Picard RW. A wearable sensor for unobtrusive, long-term assessment of electrodermal activity. IEEE Trans Biomed Eng. 2010 May;57(5):1243-52
3. Lloyd M, Watmough S, Bennett N, et al. Simulation-based training: applications in clinical pharmacy.  The Pharmaceutical Journal; 2018
4. Wightman D, Lintern G. Part-Task Training for Tracking and Manual Control. Sage Journals. June 1, 1985; Vol 27, Issue 3.
5. Bonwell, C. Active Learning: Creating Excitement in the Classroom. Green Mountain Falls, CO 8081, 1991
6. Filene P. The Joy of Teaching. A Practical Guide for New College Instructors. Chapel Hill, NC: University of North Carolina Press, 2005