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Department of Anaesthesia; Cheriton House; James Cook University Hospital; Middlesbrough, UK; a.d.paterson{at}doctors.org.uk
To the Editor:
Despite the claims by Barsuk et al. (1) their study does not add usefully to the current data on simulation in medical training. Their methodology only allowed them to show the expected decline in knowledge over time after training and that teaching of deficient knowledge before testing will result in an improvement. Benefit for simulation could have been tested had they used four groups. The pre-intervention group would remain the same, highlighting the current gaps in knowledge. The intervention groups would consist of one group of fresh Advanced Trauma Life Support graduates, one group taught the deficiencies in an Advanced Trauma Life Support style with no simulator, and one group taught the same information with a simulator. The beneficial effects of advanced simulation techniques could then be shown only if the fourth group was significantly better than the other two intervention groups. Retesting at 1 yr would allow examination of any long-term benefits of advanced simulation training.
The article referred to as demonstrating construct validity for the use of simulators in trauma training (2) is a pilot study examining the use of a simulator as an alternative assessment tool. Similarly, the value of advanced simulation in promoting trauma management is not shown by Marshall et al. (3) Their article uses a simulator for pre- and post-Advanced Trauma Life Support testing of candidates and as such does not use the simulator as a training tool. Perhaps the only tentative conclusion would be that the use of a simulator increases, rightly or wrongly, subjects’ confidence in their own abilities in a simulated trauma scenario.
The pre-intervention group appears to have had one third of the simulator familiarization time allocated to the intervention group before testing. It is likely that doctors used to performing in a situation involving a simulator will perform better when tested, so for valid comparison it is necessary to ensure that all examined groups have similar previous experience with medical simulators.
With changes to the way doctors are trained and improvements in the fidelity with which simulators recreate the real clinical situation, it is likely that they will become an increasingly important learning tool. With the inherent high costs (3) we require more research so that their role in training may be defined, optimized, and the financial outlay justified.
References
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