Seminar Series 2018/19 Panel 3.

Recovering the complexity of patients reality in A&E assessment

This seminar emerges from the TaACT project that regards medical simulation as an apprenticeship model of educational activity that increasingly utilises an eclectic mix of media, technologies and approaches from arts, gaming, theatre, film and the aviation industry to replicate clinical scenarios in this high-risk profession. One aspect of TaACT is to reflect on ways in which this understanding of simulation can enhance the acquisition of ‘soft skills’ during this apprenticeship.

The problem: 

In medical practice the diagnosis and care of the patient typically unfolds in stories, and we recognise that the central event of health care occurs when the patient gives a personal account to the clinician who skillfully understands these stories as both a material and psychological expression.  Yet while simulations using an animatronic manikin effectively imitate physiological responses such as a palpable pulse rate, breathing sounds, and monitor readouts acting as a proxy for human patient, they provide limited opportunities to acquire interpretative skills (telling cues, gestures, inferences, tone of voice etc). Consequently, within this interactive training environment, a carefully crafted narrative plays an important role in the presentation of symptoms to stimulate a personally contextualised response to the patient. Nonetheless, the construction of realistic scenarios in medical simulation is fraught with discontent as narratives are technologically typically dependent on high realism and high fidelity, and frequently tend to reveal the limits of simulation rather than provide opportunities to develop necessary soft skills.  TaACT is concerned to use media theory and a sensitivity to visual intelligence to address this problem.

Invited seminar participants will experience a type of simulation other than the typical emergency response scenario that specifically addresses soft skills training during a stage of a patient pathway through the hospital. We intend that this simulation offers a view of medical training that positions you simultaneously as both impartial observers and active participants. We will then participate in a debriefing session that provides a post simulation space for all to critically reflect upon the procedures, interactions and outcomes. We will also discuss two trends in the simulation community that appear to be developing uncritically and without adequate evaluation: First, an apparent fascination with seductive high-fidelity simulation realized through sophisticated technology and second the technological appropriation of learning in the psychological domain under the rationale of ‘integration (Bligh and Bleakley, 2006).

It would be helpful to read this before the seminar:

John Bligh & Alan Bleakley (2006) Distributing menus to hungry learners: can learning by simulation become simulation of learning?, Medical Teacher, 28:7, 606-613, DOI: 10.1080/01421590601042335