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      Clinical Cadavers as a Simulation Resource for Procedural Learning

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      , MD, MHPE, FRCPC 1 , 3 , 4 , , , MD, FACEP 5 , 2
      , MD
      AEM Education and Training
      John Wiley and Sons Inc.

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          Abstract

          “See one, do one, teach one” remains an unofficial, unsanctioned framework for procedural skill learning in medicine. Appropriately, medical educators have sought alternative simulation venues for students to safely learn their craft. With the end goal of ensuring competence, educational programming will require the use of valid simulation with appropriate fidelity. While cadavers have been used for teaching anatomy for hundreds of years, more recently they are being repurposed as a “high‐fidelity” procedural skill learning simulation resource. Newly deceased, previously frozen, and soft‐preserved cadavers, such as those used in Baltimore and Halifax, produce clinical cadavers with high physical and functional fidelity that can serve as simulators for performing many high‐acuity procedures for which there is otherwise limited clinical or simulation opportunities to practice. While access and cost may limit the use of cadavers for simulation, there are opportunities for sharing resources to provide an innovative procedural learning experience using the oldest of medical simulation assets, the human body.

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          The assessment of clinical skills/competence/performance.

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            Low- to high-fidelity simulation - a continuum of medical education?

            Changes in medical training and culture have reduced the acceptability of the traditional apprenticeship style training in medicine and influenced the growth of clinical skills training. Simulation is an educational technique that allows interactive, and at times immersive, activity by recreating all or part of a clinical experience without exposing patients to the associated risks. The number and range of commercially available technologies used in simulation for education of health care professionals is growing exponentially. These range from simple part-task training models to highly sophisticated computer driven models. This paper will review the range of currently available simulators and the educational processes that underpin simulation training. The use of different levels of simulation in a continuum of training will be discussed. Although simulation is relatively new to medicine, simulators have been used extensively for training and assessment in many other domains, most notably the aviation industry. Some parallels and differences will be highlighted.
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              Reconsidering fidelity in simulation-based training.

              In simulation-based health professions education, the concept of simulator fidelity is usually understood as the degree to which a simulator looks, feels, and acts like a human patient. Although this can be a useful guide in designing simulators, this definition emphasizes technological advances and physical resemblance over principles of educational effectiveness. In fact, several empirical studies have shown that the degree of fidelity appears to be independent of educational effectiveness. The authors confronted these issues while conducting a recent systematic review of simulation-based health professions education, and in this Perspective they use their experience in conducting that review to examine key concepts and assumptions surrounding the topic of fidelity in simulation.Several concepts typically associated with fidelity are more useful in explaining educational effectiveness, such as transfer of learning, learner engagement, and suspension of disbelief. Given that these concepts more directly influence properties of the learning experience, the authors make the following recommendations: (1) abandon the term fidelity in simulation-based health professions education and replace it with terms reflecting the underlying primary concepts of physical resemblance and functional task alignment; (2) make a shift away from the current emphasis on physical resemblance to a focus on functional correspondence between the simulator and the applied context; and (3) focus on methods to enhance educational effectiveness using principles of transfer of learning, learner engagement, and suspension of disbelief. These recommendations clarify underlying concepts for researchers in simulation-based health professions education and will help advance this burgeoning field.
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                Author and article information

                Contributors
                gkovacs@dal.ca
                Journal
                AEM Educ Train
                AEM Educ Train
                10.1002/(ISSN)2472-5390
                AET2
                AEM Education and Training
                John Wiley and Sons Inc. (Hoboken )
                2472-5390
                06 June 2018
                July 2018
                : 2
                : 3 ( doiID: 10.1002/aet2.2018.2.issue-3 )
                : 239-247
                Affiliations
                [ 1 ] Departments of Emergency Medicine Anaesthesia, Medical Neurosciences & Division of Medical Education Halifax Nova Scotia Canada
                [ 2 ] Department of Medical Neurosciences Halifax Nova Scotia Canada
                [ 3 ] Clinical Cadaver Program Dalhousie University Halifax Nova Scotia Canada
                [ 4 ] QEII Health Sciences Centre Halifax NS Canada
                [ 5 ] Dartmouth Geisel School of Medicine Department of Medicine Dartmouth‐Hitchcock Medical Center Lebanon NH
                Author notes
                [*] [* ]Address for correspondence and reprints: George Kovacs, MD, MHPE, FRCPC; e‐mail: gkovacs@ 123456dal.ca .
                Article
                AET210103
                10.1002/aet2.10103
                6050063
                30051097
                8124aa8a-bca0-4a1e-9163-7c6995033040
                © 2018 by the Society for Academic Emergency Medicine

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 23 January 2018
                : 14 April 2018
                : 21 April 2018
                Page count
                Figures: 2, Tables: 0, Pages: 9, Words: 6169
                Categories
                Commentary and Perspective
                Commentary and Perspective
                Custom metadata
                2.0
                aet210103-007
                July 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.3 mode:remove_FC converted:17.07.2018

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