The medical profession continues to learn about the ways in which simulations can help to improve education and training. In addition, simulation is constantly evaluated regarding the many ways it can help to improve the abilities of surgeons throughout their course of training and practice. The goal of this study is to review the importance of reflection on clinical practice in situating surgeons as lifelong learners and explore the role that simulation can play in that process. As surgical trainees work to acquire basic necessary skills, simulations are often used to help new learners with such things as knowledge of procedural steps and development of psychomotor techniques. However, the following is an important question: can simulated procedures still play a role for more advanced learners to continue their professional development beyond the basics?
Get full access to this article
View all access options for this article.
References
1.
MadaniA, VassiliouMC, WatanabeY, Al-HalabiB, Al-RowaisMS, DeckelbaumDL, FriedGM, FeldmanLS. What are the principles that guide behaviors in the operating room?: Creating a framework to define and measure performance. Ann Surg, 2017; 265:255–267.
DreyfusSE, DreyfusHL. A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition. Berkeley, CA: California University Berkeley Operations Research Center, 1980.
4.
GuestCB, RegehrG, TiberiusRG. The life long challenge of expertise. Med Educ, 2001; 35:78–81.
5.
ChitpinS. Can mentoring and reflection cause change in teaching practice? A professional development journey of a Canadian teacher educator. Prof Dev Educ, 2011; 37:225–240.
6.
CheslerNC, RuisAR, CollierW, SwieckiZ, ArastoopourG, ShafferDW. A novel paradigm for engineering education: Virtual internships with individualized mentoring and assessment of engineering thinking. J Biomech Eng, 2015; 137:024701.
7.
SchönDA. The Reflective Practitioner. How Professionals Think in Action. London: Temple Smith, 1983.
8.
PinskyLE, IrbyDM. “If at First You Don't Succeed”: Using failure to improve teaching. Acad Med, 1997; 72:973–976.
9.
HaysR, GayS. Reflection or ‘pre-reflection’: What are we actually measuring in reflective practice?. Med Educ, 2011; 45:116–118.
10.
MuirF, ScottM, McConvilleK, WatsonK, BehbehaniK, SukkarF. Taking the learning beyond the individual: How reflection informs change in practice. Int J Med, 2014; 5:24–30.
11.
ClaraM. What is reflection? Looking for clarity in an ambiguous notion. J Teach Educ, 2015; 66:261–271.
12.
MamedeS, SchmidtHG. The structure of reflective practice in medicine. J Med Educ, 2004; 38:1302–1308.
SobralDT. An appraisal of medical students' reflection-in-learning. J Med Educ, 2000; 34:182–187.
15.
KneeboneR. Simulation in surgical training: Educational issues and practical implications. Med Educ, 2003; 37:267–277.
16.
TomlinsonPS, PomlinsoE, Perden-McAlpineC, KirschbaumM. Clinical innovation for promoting family care in pediatric intensive care: Demonstration, role modeling and reflective practice. J Adv Nurs, 2002; 38:161–170.
17.
HillK, HamiltonJ. Using videoed simulated clinical interaction to promote communication skills and reflective practice for overseas-born medical students. Commun Med, 2013; 10:1–11.
18.
Miller JuveAK. Reflective practice and Readiness for Self-Directed Learning in Anesthesiology Residents Training in the United States. Portland State University. Department of Educational Leadership Policy,, 2012:235.
19.
MamedeS, SchmidtHG. Correlates of reflective practice in medicine. Adv Health Sci Educ Theory Pract, 2005; 10:327–337.
20.
VygotskyLS. Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA, Harvard University Press, 1980.
21.
IssenbergAB, McGaghieWC, HartIR, MayerJW, FelnerJM, PetrusaER, WaughRA, BrownDD, SaffordRR, GessnerIH, GordonDL, EwyGA. Simulation Technology for Health Care Professional Skills Training and Assessment. J Am Med Assoc, 1999; 282:861–866.
22.
JohannessonE. Learning manual and procedural clinical skills through simulation in health care education. Linköping Studies in Health Sciences, Thesis No. 120,, 2012:1–75.
23.
D'AngeloAL, RutherfordDN, RayRD, LauferS, MasonA, PughCM. Working volume: Validity evidence for a motion-based metric of surgical efficiency. Am J Surg, 2016; 211:445–450.
24.
D'AngeloAL, RutherfordDN, RayRD, LauferS, KwanC, CohenER, MasonA, PughCM. Idle time: An underdeveloped performance metric for assessing surgical skill. Am J Surg, 2015; 209:645–651.
25.
PughCM, DaRosaDA, SantacaterinaS, ClarkRE. Faculty evaluation of simulation-based modules for assessment of intraoperative decision making. Surgery, 2011; 149:534–542.
26.
RileyW, DavisS, MillerK, HansenH, SainfortF, SweetR. Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. Jt Comm J Qual Patient Saf, 2011; 37:357–364.
GoodML. Patient simulation for training basic and advanced clinical skills. Med Educ, 2003; 37(Suppl 1):14–21.
29.
HandleyR, DodgeN. Can simulated practice learning improve clinical competence?. Br J Nurs, 2013; 22:529–535.
30.
MeechanR, JonesH, Valler-JonesT. Students' perspectives on their skills acquisition and confidence. Br J Nurs, 2011; 20:445–450.
31.
AndersonJM, WarrenJB. Using simulation to enhance the acquisition and retention of clinical skills in neonatology. Semin Perinatol, 2011; 35:59–67.
32.
ShafferDW. How Computer Games Help Children Learn. New York, NY: Palgrave Macmillan, 2007.
33.
DedeC. Immersive interfaces for engagement and learning. Science, 2009; 323:66–69.
34.
SatishU, KrishnamurthyS, DewanM. Role of cognitive simulation in healthcare. In: RileyRH (ed). Manual of Simulation in Healthcare, 2nd ed. Oxford, United Kingdom: Oxford University Press, 2015, pp. 424–438.
35.
PhuaDH, TanNCK. Cognitive aspect of diagnostic errors. Ann Acad Med, 2013; 42:33–41.
36.
GraberML, KissamS, PayneVL, MeyerAND, SorensenA, LenfesteyN, TantE, HenriksenK, LaBreshK, SinghH. Cognitive interventions to reduce diagnostic error: A narrative review. BMJ Qual Saf, 2012; 27:1–23.
37.
SmithC, GillhamD, McCutcheonH, ZiaianT. Scenariation: Scenario generation for online teaching in nursing and health sciences. Br J Educ Technol, 2011; 42:962–972.
38.
NormanG, BrooksL. The non-analytical basis of clinical reasoning. Adv Health Sci Educ Theory Pract, 1997; 2:173–184.
39.
MockKS. Best Practices in High Fidelity Patient Simulation to Enhance Higher Order Thinking Skills. Doctoral Dissertation, 2014:2769.
40.
KerJS. Developing professional clinical skills for practice—the results of a feasibility study using a reflective approach to intimate examination. Med Educ, 2003; 37:34–41.
41.
ThorpeK. Reflective learning journals: From concept to practice. Reflective Practice, 2004; 5:327–343.
42.
KneeboneRL, ApSimonD. Surgical skills training: Simulation and multimedia combined. Med Educ, 2001; 35:909–915.
43.
LauferS, D'AngeloAL, KwanC, RayRD, YudkowskyR, BouletJR, McGaghieWC, PughCM. Rescuing the clinical breast examination: Advances in classifying technique and assessing physician competency. Ann Surg, 2017. [Epub ahead of print] DOI: 10.1097/SLA.0000000000002024.
44.
AronsonL. Twelve tips for teaching reflection at all levels of medical education. Med Teach, 2011; 33:200–205.
45.
WatsonK, WrightA, MorrisN, McMeekenJ, RivettD, BlackstockF, JonesA, HainesT, O'ConnorV, WatsonG, PetersonR, JullG. Can simulation replace part of clinical time? Two parallel randomized controlled trials. Med Educ, 2012; 46:656–667.
46.
SaddenH, KneeboneR. Practical skills teaching in contemporary surgical education: How can educational theory be applied to promote effective learning?. Am J Surg, 2012; 204:396–401.
47.
NendazM, PerrierA. Diagnostic errors and flaws in clinical reasoning: Mechanisms and prevention in practice. Swiss Med Wkly, 2012; 142:1–9.
48.
AronsonL, NiehausB, Hill-Sakurai, LaiC, O'SullivanPS. A comparison of two methods of teaching reflective ability in year 3 medical students. Med Educ, 2012; 46:807–814.
