Realistic Simulation Methodology in Brazil’s New Medical Education Curriculum: Potentialities
Authors: Cleto J. Sauer Jr
Introduction: Brazil’s new national curriculum guidelines (NCG) for medical education were published in 2014, presenting active learning methodologies as a cornerstone. Simulation was initially applied for aviation pilots’ training and is currently applied in health sciences. The high-fidelity simulator replicates human body anatomy in detail, also reproducing physiological functions and its use is increasing in medical schools. Realistic Simulation (RS) has pedagogical aspects that are aligned with Brazil’s NCG teaching concepts. The main objective of this study is to carry on a narrative review on RS’s aspects that are aligned with Brazil’s new NCG teaching concepts. Methodology: A narrative review was conducted, with search in three databases (PubMed, Embase and BVS) of studies published between 2010 and 2020. Results: After systematized search, 49 studies were selected and divided into four thematic groups. RS is aligned with new Brazilian medical curriculum as it is an active learning methodology, providing greater patient safety, uniform teaching, and student's emotional skills enhancement. RS is based on reflective learning, a teaching concept developed for adult’s education. Conclusion: RS is a methodology aligned with NCG teaching concepts and has potential to assist in the implementation of new Brazilian medical school’s curriculum. It is an immersive and interactive methodology, which provides reflective learning in a safe environment for students and patients.Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 48
 E. P. Finnerty, S. Chauvin, G. Bonaminio, M. Andrews, R. G. Carroll, and L. N. Pangaro, “Flexner revisited: The role and value of the basic sciences in medical education,” Acad. Med., vol. 85, no. 2, pp. 349–355, 2010.
 D. M. Gaba, “Do as we say, not as you do: using simulation to investigate clinical behavior in action.,” Simul. Healthc., vol. 4, no. 2, pp. 67–69, 2009.
 N. Gauthier et al., “Does Cardiac Physical Exam Teaching Using a Cardiac Simulator Improve Medical Students’ Diagnostic Skills?,” Cureus, vol. 11, no. 5, 2019.
 A. J. Bland, A. Topping, and B. Wood, “A concept analysis of simulation as a learning strategy in the education of undergraduate nursing students,” Nurse Educ. Today, vol. 31, no. 7, pp. 664–670, 2011.
 F. C. Forrest, M. A. Taylor, K. Postlethwaite, and R. Aspinall, “Use of a high‐fidelity simulator to develop testing of the technical performance of novice anaesthetists,” Br. J. Anaesth., vol. 88, no. 3, pp. 338–344, 2002.
 L. E. D. A. Troncon, “Avaliação Do Estudante De Medicina,” Med. (Ribeirao Preto. Online), vol. 29, no. 4, p. 429, 2013.
 M. J. M. Ferreira et al., “New national curricular guidelines of medical courses: Opportunities to resignify education,” Interface Commun. Heal. Educ., vol. 23, pp. 1–15, 2019.
 C. A. G. dos S. Franco, M. R. Cubas, and R. S. Franco, “The Medicine Curriculum and Competences Proposed for Curriculum Guidelines,” Rev. Bras. Educ. Médica, vol. 38, no. 2, pp. 221–230, 2014.
 D. H. B. Kussakawa and C. A. Antonio, “Os eixos estruturantes das diretrizes curriculares nacionais dos cursos de Medicina no Brasil,” Rev. Docência do Ensino Super., vol. 7, no. 1, pp. 165–184, 2017.
 C. A. de Oliveira, M. H. Senger, O. da S. Ezequiel, and E. Amaral, “Alinhamento de Diferentes Projetos Pedagógicos de Cursos de Medicina com as Diretrizes Curriculares Nacionais,” Rev. Bras. Educ. Med., vol. 43, no. 2, pp. 143–151, 2019.
 A. Y. Gasparyan, L. Ayvazyan, H. Blackmore, and G. D. Kitas, “Writing a narrative biomedical review: Considerations for authors, peer reviewers, and editors,” Rheumatol. Int., vol. 31, no. 11, pp. 1409–1417, 2011.
 A. Higgs et al., “Guidelines for the management of tracheal intubation in critically ill adults,” Br. J. Anaesth., vol. 120, no. 2, pp. 323–352, 2018.
 M. J. Cory, N. Colman, C. E. McCracken, and K. B. Hebbar, “Rapid Cycle Deliberate Practice Versus Reflective Debriefing for Pediatric Septic Shock Training.,” Pediatr. Crit. care Med. a J. Soc. Crit. Care Med. World Fed. Pediatr. Intensive Crit. Care Soc., vol. 20, no. 5, pp. 481–489, May 2019.
 F. Jones, C. Passos-Neto, and O. Melro Braghiroli, “Simulation in Medical Education: Brief history and methodology,” Princ. Pract. Clin. Res. J., vol. 1, no. 2, pp. 56–63, Sep. 2015.
 I. Tanoubi et al., “Identification tags and learners’ situational awareness during high-fidelity simulation.,” Int. J. Med. Educ., vol. 7, pp. 93–94, Mar. 2016.
 Y. F. Choi and T. W. Wong, “High-fidelity simulation training programme for final-year medical students: implications from the perceived learning outcomes.,” Hong Kong Med. J. = Xianggang yi xue za zhi, vol. 25, no. 5, pp. 392–398, Oct. 2019.
 S. A. Braksick, K. Kashani, and S. Hocker, “Neurology Education for Critical Care Fellows Using High-Fidelity Simulation.,” Neurocrit. Care, vol. 26, no. 1, pp. 96–102, Feb. 2017.
 S. Nunes de Oliveira, J. Gue Martini, and J. A. Caravaca-Morera, “Producción científica sobre la simulación clínica: revisión integrativa de las tesis y disertaciones brasileñas,” Rev. Latinoam. Simulación Clínica, vol. 1, no. 1, pp. 45–54, 2019.
 A. J. Adams et al., “A Comparison of Teaching Modalities and Fidelity of Simulation Levels in Teaching Resuscitation Scenarios.,” J. Surg. Educ., vol. 72, no. 5, pp. 778–785, 2015.
 J. R. Schoenherr and S. J. Hamstra, “Beyond Fidelity: Deconstructing the Seductive Simplicity of Fidelity in Simulator-Based Education in the Health Care Professions.,” Simul. Healthc., vol. 12, no. 2, pp. 117–123, Apr. 2017.
 G. Alinier, “Developing high-fidelity health care simulation scenarios: A guide for educators and professionals,” Simul. Gaming, vol. 42, no. 1, pp. 9–26, 2011.
 C. Escher et al., “Method matters: impact of in-scenario instruction on simulation-based teamwork training.,” Adv. Simul. (London, England), vol. 2, p. 25, 2017.
 C. F. S. Brandão, C. F. Collares, and H. de F. Marin, “A simulação realística como ferramenta educacional para estudantes de medicina,” Sci. Med. (Porto. Alegre)., vol. 24, no. 2, 2014.
 D. M. Mills, C. L. Wu, D. C. Williams, L. King, and J. V Dobson, “High-fidelity simulation enhances pediatric residents’ retention, knowledge, procedural proficiency, group resuscitation performance, and experience in pediatric resuscitation.,” Hosp. Pediatr., vol. 3, no. 3, pp. 266–275, Jul. 2013.
 L. Ann Kirkham, “Exploring the use of high-fidelity simulation training to enhance clinical skills.,” Nurs. Stand., vol. 32, no. 24, pp. 44–53, Feb. 2018.
 I. Dror, P. Schmidt, and L. O’connor, “A cognitive perspective on technology enhanced learning in medical training: great opportunities, pitfalls and challenges,” Med. Teach., vol. 33, no. 4, pp. 291–296, 2011.
 C.-W. Yang, S.-C. Ku, M. H.-M. Ma, T.-S. Chu, and S.-C. Chang, “Application of high-fidelity simulation in critical care residency training as an effective learning, assessment, and prediction tool for clinical performance.,” J. Formos. Med. Assoc., vol. 118, no. 9, pp. 1347–1355, Sep. 2019.
 F. Lateef, “Simulation-based learning: Just like the real thing,” J. Emergencies, Trauma Shock, vol. 3, no. 4, pp. 348–352, 2010.
 J. I. McSparron et al., “Simulation for Skills-based Education in Pulmonary and Critical Care Medicine.,” Ann. Am. Thorac. Soc., vol. 12, no. 4, pp. 579–586, Apr. 2015.
 V. Arcoraci et al., “Medical simulation in pharmacology learning and retention: A comparison study with traditional teaching in undergraduate medical students.,” Pharmacol. Res. Perspect., vol. 7, no. 1, p. e00449, Feb. 2019.
 B. M. Lo et al., “Comparison of traditional versus high-fidelity simulation in the retention of ACLS knowledge.,” Resuscitation, vol. 82, no. 11, pp. 1440–1443, Nov. 2011.
 S. Boet et al., “Complex procedural skills are retained for a minimum of 1 yr after a single high-fidelity simulation training session.,” Br. J. Anaesth., vol. 107, no. 4, pp. 533–539, Oct. 2011.
 K. Letrud, “A rebuttal of NTL Institute’s learning pyramid,” Education, vol. 133, pp. 117–124, Jan. 2012.
 K. A. Lewis, T. N. Ricks, A. Rowin, C. Ndlovu, L. Goldstein, and C. McElvogue, “Does Simulation Training for Acute Care Nurses Improve Patient Safety Outcomes: A Systematic Review to Inform Evidence‐Based Practice,” Worldviews Evidence-Based Nurs., vol. 16, no. 5, pp. 389–396, Oct. 2019.
 S. L. Mawhirt, L. Fonacier, and M. Aquino, “Utilization of high-fidelity simulation for medical student and resident education of allergic-immunologic emergencies.,” Ann. allergy, asthma Immunol. Off. Publ. Am. Coll. Allergy, Asthma, Immunol., vol. 122, no. 5, pp. 513–521, May 2019.
 S. Ali, A. Alexander, M. Lambrix, R. Ramakrishna, and C. W. Yang, “High-Fidelity Simulation Training for the Diagnosis and Management of Adverse Contrast Media Reactions.,” AJR. Am. J. Roentgenol., vol. 212, no. 1, pp. 2–8, Jan. 2019.
 M. Yiasemidou, E. Gkaragkani, D. Glassman, and C. S. Biyani, “Cadaveric simulation: a review of reviews.,” Ir. J. Med. Sci., vol. 187, no. 3, pp. 827–833, Aug. 2018.
 J. J. Weis, C. L. Croft, R. Bhoja, J. H. Lee, and D. J. Scott, “Multidisciplinary Simulation Activity Effectively Prepares Residents for Participation in Patient Safety Activities.,” J. Surg. Educ., vol. 76, no. 6, pp. e232–e237, 2019.
 M. P. Nacul, L. T. Cavazzola, and M. A. C. de Melo, “Situação atual do treinamento de médicos residentes em videocirurgia no Brasil: uma análise crítica,” ABCD Arq. Bras. Cir. Dig. São Paulo. Vol. 28, n. 1 (2015), p. 81-85, 2015.
 J. L. Kennedy et al., “High-fidelity hybrid simulation of allergic emergencies demonstrates improved preparedness for office emergencies in pediatric allergy clinics.,” J. allergy Clin. Immunol. Pract., vol. 1, no. 6, pp. 608–614, 2013.
 R. Aggarwal et al., “Training and simulation for patient safety.,” Qual. Saf. Health Care, vol. 19 Suppl 2, p. 20693215, 2010.
 R. Ballangrud, M. L. Hall-Lord, M. Persenius, and B. Hedelin, “Intensive care nurses’ perceptions of simulation-based team training for building patient safety in intensive care: A descriptive qualitative study,” Intensive Crit. Care Nurs., vol. 30, no. 4, pp. 179–187, 2014.
 C. E. McCoy et al., “Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation.,” West. J. Emerg. Med., vol. 20, no. 1, pp. 15–22, Jan. 2019.
 V. Mejía, C. Gonzalez, A. E. Delfino, F. R. Altermatt, and M. A. Corvetto, “Adquirir habilidades no manejo de crises de hipertermia maligna: comparação de simulação de alta‐fidelidade versus estudo de caso em computador,” Brazilian J. Anesthesiol., vol. 68, no. 3, pp. 292–298, May 2018.
 P. J. Morgan, M. M. Kurrek, S. Bertram, V. LeBlanc, and T. Przybyszewski, “Nontechnical skills assessment after simulation-based continuing medical education,” Simul. Healthc., vol. 6, no. 5, pp. 255–259, 2011.
 J. B. Cooper, “Pumpkin Carving, Patient Safety, and Simulation,” Simul. Healthc. J. Soc. Simul. Healthc., vol. 15, no. 3, pp. 139–140, Jun. 2020.
 K. Fraser, I. Ma, E. Teteris, H. Baxter, B. Wright, and K. Mclaughlin, “Emotion, cognitive load and learning outcomes during simulation training,” Med. Educ., vol. 46, no. 11, pp. 1055–1062, 2012.
 C. Bauer et al., “Anxiety and stress among anaesthesiology and critical care residents during high-fidelity simulation sessions.,” Anaesthesia, Crit. care pain Med., vol. 35, no. 6, pp. 407–416, Dec. 2016.
 I. Tanoubi, “The learners’ stress during high fidelity simulation. An equation with multiple unknowns.,” Anaesthesia, critical care & pain medicine, vol. 36, no. 1. France, pp. 5–6, Feb-2017.
 D. M. Wallace, J. Burnley, B. Langston, M. Russell, K. White, and M. H. Stroud, “Education Coupled With In-Situ High Fidelity Simulation Improves Medical-Surgical RN Code Blue Comfort Levels.,” J. Ark. Med. Soc., vol. 113, no. 9, pp. 222–224, Mar. 2017.
 G. Wells, J. Montgomery, and A. Hiersche, “Simulation to improve medical student confidence and preparedness to care for the dying: a feasibility study.,” BMJ Support. Palliat. Care, Aug. 2019.
 A. T. Goldberg, B. J. Heller, J. Hochkeppel, A. I. Levine, and S. Demaria, “Simulated Mortality-We Can Do More.,” Cambridge Q. Healthc. ethics CQ Int. J. Healthc. ethics committees, vol. 26, no. 3, pp. 495–504, Jul. 2017.
 A. Keitel et al., “Endocrine and psychological stress responses in a simulated emergency situation,” Psychoneuroendocrinology, vol. 36, no. 1, pp. 98–108, 2011.
 H. Tuzer, L. Dinc, and M. Elcin, “The effects of using high-fidelity simulators and standardized patients on the thorax, lung, and cardiac examination skills of undergraduate nursing students,” Nurse Educ. Today, vol. 45, pp. 120–125, 2016.
 L. Evans and M. Taubert, “State of the science: the doll is dead: simulation in palliative care education.,” BMJ Support. Palliat. Care, vol. 9, no. 2, pp. 117–119, Jun. 2019.
 J.-N. Evain, L. Zoric, L. Mattatia, O. Picard, J. Ripart, and P. Cuvillon, “Residual anxiety after high fidelity simulation in anaesthesiology: An observational, prospective, pilot study.,” Anaesthesia, Crit. care pain Med., vol. 36, no. 4, pp. 205–212, Aug. 2017.
 W. E. Hautz et al., “Shame in Medical Education: A Randomized Study of the Acquisition of Intimate Examination Skills and Its Effect on Subsequent Performance.,” Teach. Learn. Med., vol. 29, no. 2, pp. 196–206, 2017.
 M. Lilot et al., “Relaxation before Debriefing during High-fidelity Simulation Improves Memory Retention of Residents at Three Months: A Prospective Randomized Controlled Study.,” Anesthesiology, vol. 128, no. 3, pp. 638–649, Mar. 2018.
 M. Akaike et al., “Simulation-based medical education in clinical skills laboratory,” J. Med. Investig., vol. 59, no. 1, 2, pp. 28–35, 2012.
 R. M. U. Kaneko and M. H. B. de M. Lopes, “Realistic health care simulation scenario: what is relevant for its design?,” Rev. Esc. Enferm. USP., vol. 53, p. e03453, 2019.
 C.-H. Rhee, C. W. Kang, and C. H. Lee, “Intubation simulation with a cross-sectional visual guidance.,” Stud. Health Technol. Inform., vol. 184, pp. 344–348, 2013.
 K. D. Jenkins et al., “High-fidelity anesthesia simulation in medical student education: Three fundamental and effective teaching scenarios,” Int. J. Acad. Med., vol. 3, no. 1, p. 66, 2017.
 K. Khan, T. Pattison, and M. Sherwood, “Simulation in medical education,” Med. Teach., vol. 33, no. 1, pp. 1–3, Jan. 2011.
 J. M. Petscavage, C. L. Wang, J. G. Schopp, A. M. Paladin, M. L. Richardson, and W. H. J. Bush, “Cost analysis and feasibility of high-fidelity simulation based radiology contrast reaction curriculum.,” Acad. Radiol., vol. 18, no. 1, pp. 107–112, Jan. 2011.
 V.-J. CA, “Remembering Tenerife: 40 Years Later,” SF J Aviat. Aeronaut Sci, vol. 1, no. 2, pp. 1–5, 2018.