Our research in simulation is characterised by two broad but overlapping research themes.
The first theme focusses on investigating educational questions about simulation, especially in relation to developing simulation interventions for training and professional learning.
The second theme uses simulation as a research tool – a window on our healthcare system – to identify problems, develop care interventions, and evaluate those interventions, in order to improve the quality of care.
Research on simulation as an educational
As simulation has emerged as a major and important method of training within pre-qualification and postgraduate health professions education, a need has emerged to ensure the nature, quality, and effectiveness of simulation is evident as an educational intervention.
However, within clinical educational research, a traditionally narrow perspective on what counts as evidence has dominated published work so far. Major journals have generally indicated a preference for highly quantitative work using an experimental design, despite calling for further development of qualitative research in this area.
We have developed a programme of research exploring questions about how simulation can be used, how effective it is in particular settings, what it adds to clinical training, and what specific components of simulation training help in specific circumstances.
We continue to build our existing work in this theme by focussing on:
- developing and explaining how the theoretical underpinnings of simulation can be used to inform simulation practice
- developing and extending the ways and means of evaluating simulation interventions and programmes in various specific settings, with an aim of developing, synthesising, and validating a framework for quality control and evaluation of simulation courses and programmes
- further exploration of the possibilities for developing, validating, and using theoretically-grounded instruments for measuring and testing the effectiveness of simulation-based educational interventions
- the development of theory and practice around faculty development and the development of expertise in simulation education.
- reseaching the approach to and use of video footage in simulation (as video recording and playback is a part of almost all simulation approaches).
Through experience with debriefing in the centre, SaIL has already developed an innovative model of simulation debriefing, the SaIL Debrief Diamond.
We aim to continue our work in area of simulation by exploring and developing further understandings of the role of debriefing in the learning process. We will look at how different types of debrief are appropriate for different simulation approaches and at different methods of teaching for a variety of learning styles.
Simulation as a research tool to improve
the quality of care
Research within this theme focusses on investigating factors affecting human performance and identifying opportunities to intervene to improve the quality of care.
We seek to explore how simulation can be a window onto the healthcare system in order to understand how clinical professionals behave and interact and how this affects outcomes.
From this understanding, we will identify opportunities for interventions that will improve the quality of care for future development and testing either in simulated scenarios and/or in clinical practice.
We have a number of priorities for this theme.
- Team processes such as leadership, communication, shared information and task distribution have been shown to be related to team outcomes in anaesthesia but there has been little investigation of these issues in interprofessional teams or in other settings such as mental health. We seek to explore questions about differences between professions, team composition, overall co-ordination of interprofessional teams and how this is achieved, hierarchies and the distribution of power, and whether these factors are related to team processes and performance.
- Markers of skilled performance in particular clinical skills or areas can be identified using simulation. For example, for tasks requiring high level communication and interpersonal skills such as de-escalation and dealing with relatives, it is difficult to know how to train these without knowing the particular behaviours that are required for a successful outcome.
- Simulation provides an opportunity to study interaction with different devices and technologies to identify problems and difficulties that may be related to device design, individual knowledge or skills or team interactions. Simulated equipment or device failures are sometimes used in simulation training and provide an opportunity to investigate team and system factors (such as policies, device design) and how they influence clinicians’ ability to diagnose and recover from failures.
- The layout of the physical workspace may have an effect on team performance and interaction, which is a further opportunity to study using simulation, with an aim of identifying elements of the physical environment that could be improved.
- Developing a framework of markers of resilient individual or team performance and whether these are related to performance and outcomes is another potential area of work in this theme, building on the theoretical work being done our allied research group, the Centre for Applied Resilience in Healthcare (CARe), to understand resilience in the clinical setting. Simulated scenarios often provide unexpected challenges that require problem solving and therefore provide a good opportunity to examine team adaptive capacity.
- Simulation provides an opportunity to pilot test new interventions designed to improve the quality of care and identify problems before they are introduced into the clinical workplace.