CME: Making it real

Issue: BCMJ, vol. 54, No. 4, May 2012, Page 166 Editorials

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.

Anne I. Clarke, MD. CME: Making it real. BCMJ, Vol. 54, No. 4, May, 2012, Page(s) 166 - Editorials.

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