Simulation activities as a form of CME have become an increasingly common method for physicians to learn new skills, refresh forgotten ones and make the learning experience more lifelike. The old fashioned way of sitting quietly in a semidarkened room, listening to an expert lecturer, can be quite soothing and even soporific, although it may not be that effective in changing physician behavior. For physicians who have already been to a few of their own medical school reunions, learning experiences and CME using simulation techniques may be unfamiliar.
Of course simulation comes with its own set of disadvantages, particularly when it comes to the stress levels involved in the learning experience. Being watched and evaluated by several different onlookers is hardly a private, personal mental exercise. Frankly, it can feel a bit like being thrown to the lions.
Having decided to attend a simulation course for “experienced providers” I quickly developed a real sense of how embarrassing a situation I might have gotten myself into.
The course took place in Sydney, Australia, which added to my apprehension because my accent immediately identified me as not a person from Down Under. I felt singled out for closer scrutiny. After all, who knew what kind of training I’d had in Canada? Had I overestimated my “experienced” abilities? I looked around hopefully for people of my own era and background. Fortunately I fell into the middle of the pack when it came to wrinkle count. I certainly wasn’t the only one sizing up the other members of our CME group.
The clinical scenarios were a variety of different critical resuscitations, with talking (and at times moaning) mannequins as patients and “assistants” who ranged from outrageously incompetent to very skilled. Participants took turns at being the physician in charge, completing different procedures, and finally, observing and giving feedback on each other’s performance.
We all did things a little differently and it was a great experience to see how alternate approaches to problems also worked well. Every one of us had gaps in knowledge or struggled in making some clinical decisions in a critical situation. Not knowing it all was uncomfortable for sure, but what would be the point of CME otherwise?
The debriefings after each scenario were challenging, both the getting and the giving of evaluations. It was difficult to give useful but tactful feedback and it was clear that anyone who did not meet their own expectations for performance felt it keenly. We were our own most severe critics. However, few CME opportunities I’ve had were as useful as this personal learning experience. Learning from others’ mistakes that day came in a close second.
In the end, all participants had an opportunity to discuss the experience and make suggestions for improving the learning environment. The stressfulness of performing in front of a peer group was a common theme, but the remarkable educational value of the day was appreciated by everyone. What a fantastic learning experience!
We are fortunate in having a simulation centre at UBC. If you have an opportunity to get outside your comfort zone and participate in some CME there, consider yourself lucky.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org