李 瑛 ^1,2               章利铭²

长期以来，临床医学教育主要采用传统的学徒式教学方法“See one, Do one, and Teach one” ^[1]。然而这种方法缺乏对交流能力和领导才能等的训练，以致受训者往往无法有效掌握临床技能和处理复杂的医疗事件。1999年，由纽约中华医学基金会成立的国际医学教育委员会(IIME) 提出“全球最低基本要求” (GMER)，是指世界各地医学院校培养的医生都必须具备的基本素质，包括医学知识、临床技能、职业态度、行为和职业道德等，GMER由此成为国际医学教育评价标准的核心内容。

2000年美国医学会发表了“To Err Is Human: Building a Safer Health System”, 强调美国医院每年98,000人死于可以避免的医疗差错，已明显超过机动车交通事故(43,458)、乳腺癌(42,297)和艾滋病(16,516)所导致的死亡。患者安全性和医疗差错成为美国公众关注的焦点^[2]。为提高患者安全，美国毕业生医学教育鉴定委员会(ACGME) 提出临床住院医生要成为一名合格的医生，必须具备六项基本能力，包括：患者关怀、医学知识、交流能力、职业道德、以实践为基础的学习和以系统为基础的实践^[3]。2009年，WHO提议将患者安全教育内容整合到医学院课程中。医学生作为未来的医务工作者，需要学会如何减少医疗不良事件和如何解决医疗差错对患者安全的伤害^[4]。

模拟医学教育(Simulation based Medical Education, SBME)架起了从“See one” 向 “Do one”过渡的桥梁，是一种解决看和做之间差距的有效教学方法。迄今为止，越来越多的资料显示SBME能改善医学教育，提高实践能力和提高患者安全[^5,6]。模拟教学训练是近15年来医学教育最为凸显的教学改革，有效将其整合到医学教育和评估中，顺应当前医疗行业进步和发展的需要。

一、什么是模拟医学教育(SBME)

SBME概念的提出要追溯到19世纪60年代末和70年代初^[7]，是一种通过程序控制栩栩如生的人体模型或者标准化病人，代替现实中真实的患者进行临床教学的方法^[8]。SBME具有可重复、训练相对真实、内容规范、手段丰富和成本低耗等特点。用于医学模拟教育的工具主要包括简单的局部功能训练模型、智能化高级综合模拟人，高仿真患者模拟人以及标准化病人。目前，医学模拟已在全世界范围开展，美国大部分医学院已建立医学模拟训练中心，而且每年都陆续有新的中心成立。2010年1月-3月美国一项对133家医学院和263家教学医院进行调查的研究资料显示：美国匹兹堡大学、哈佛大学、麻省医学院和斯坦福大学等许多著名医疗机构均采用医学模拟进行教学、研究和训练^[9]。

SBME能给学习者和患者提供一个安全的教育环境，可以进行 重复的训练并允许犯错。不同水平的受训者，无论是新手还是专家，即便在练习中犯了错也不需担心对患者造成伤害而受到惩罚。过SBME，受训者得到的不仅仅是技术技能而且包括非技术技能^[10]。技术技能作为一种个人的技能主要用于完成一些特定的任务，如诊断和治疗程序，然而临床工作经常涉及交流和团队合作等，需要对许多临床迹象做出快速决断，如果受训者只具备技术技能，他们仍可能无法正确和安全地采用这些技能应对许多复杂的临床事件。非技术技能包括领导、团队、交流、感悟、决断等能力，这些对保证医疗安全非常重要。通过团队合作解决许多复杂的临床事件是当前医学教育发展的趋势，利用SBME，受训者可在高级模拟系统上进行团队协作共同治疗病人，培养其团队协作精神。

二、为何采用模拟医学教育(SBME)

历史上，老一辈医生的培养主要采用学徒式的教学方法，在医 学上称为“see one, do one, teach one”。这种传统的方法主要是初学者先看年长的医生执行某项临床工作，然后在他们的指导和监督下，亲自去做。这些年轻的医学生或住院医生往往直接在没有能力反抗的患者身上反复试验。虽然受训者得到了锻炼，但却给患者带来了不适，或者许多并发症。而且这种传统的教学方法还会导致许多医生缺乏处理有创技能操作的经验，如气管插管、插胃管和静脉置管等^[11]。如今的患者逐渐意识到学生们在他们身上进行试验，常常不能忍受这些初学者无经验的操作。因此，受训者获得在患者身上学习和训练的机会越来越少。

2000年美国医学会出版的“To Err Is Human”，报道70%医疗差错是由于人的错误造成^[2]。同期，加拿大^[12]、英国^[13]、澳大利亚^[14]和丹麦^[15]也发表了与美国相类似的数据。美国医学会呼吁全球重新评估医疗行业的医学教育，将患者安全整合到所有医疗行业的学习内容中。提高患者安全和减少医疗差错成为全球重点关注的问题。为此，国际上对医学生毕业后成为一个优秀的医生提出了许多要求，从而驱动了当前医学教育的改革。SBME不仅仅适用于医学生的教育，而且其在医护人员培训中的作用也显得越来越重要。

美国医学会强烈建议医疗机构学习航空人员培训方法—飞行团队应变能力处理(CRM)，这可能对降低医疗差错和增加患者安全具有指导意义^[16]。根据联邦航空管理委员会的定义，CRM是指有效使用航空资源如人力资源、硬件和信息，CRM目的是通过交流、领导和决断能力，避免、限制或减轻航空飞行中可能出现的错误。决策者需要根据既往的经验和训练，选择一种最可能成功的方法。CRM训练能发展交流能力，促进形成一个凝聚团队成员的环境，以及创造一个低年资人员可以自由发表言论的氛围。麻醉学是医疗机构最早采纳CRM的医学专业，目前已通过模拟建立了麻醉危急状况应变能力处理(ACRM)训练, 针对临床各种麻醉危急情况，采用不同的团队合作处理方法^[17]。麻醉医生重视采用SBME提高患者安全，在医学模拟领域处于重要的领先地位。更值得一提的是，麻醉专业已成立了提高患者安全相应的组织如：美国麻醉学会患者安全和危机处理委员会，及麻醉患者安全基金会。

三、模拟医学教育(SBME)的作用

SBME可给予学习者在交流、领导才能、团队训练等方面接近 真实场景的训练、并允许他们反复地训练，直到掌握了这些技术。SBME不但增加了受训者接受训练的机会，而且降低了训练者指导学习者进行训练的时间。SBME作为医疗训练的一个重要方法具有以下三方面的作用：

1. 提高受训者的能力和信心

SBME为受训者提供了一个快速训练的机会，解决了他们需要等待合适的真实患者进行训练的困难。另外，SBME能为受训者提供大量临床少见并发症，通过场景训练和与资深专家讨论，使他们丰富自己处理问题的经验。学习者可以根据个人的工作节奏，重复操作的必要性以及时间安排，随时进行训练。学习者也可有机会在训练过程中不断练习，犯错误，从而提高他们的技能和知识。

Sedlack等观察模拟训练对医生结肠镜操作的影响，结果发现^[18]，除了插入时间较长，经过模拟训练的医生其他各项表现都比采用传统训练的医生要好。Wayne等观察了医学模拟在住院医生处理心脏骤停过程中的作用， 所有住院医生均接受传统的高级生命支持(ACLS)训练，但是38位2年级住院医师接受了10小时以模拟为基础的培训，对照组40位3年级住院医师未接受此培训。与传统训练的住院医生比较，经过模拟训练的住院医生对美国心脏病学会的标准执行得更好, 而且对ACLS反应速度和能力更快^[19] 。 另外一个典型例子是外科腹腔镜手术(FLS)的模拟课程^[20]。这个课程已采用10年，现已成为美国所有外科住院医生毕业的前提条件，他们在完成常规的外科住院医师培训前必须掌握FLS ^[21]。哈佛医学院的外科医生必须获得FLS执照才能行医^[22]。如果在临床中操作不当，这些医生将接受1天的课程学习和考试，而且需要支付每次500美元的额外费用。此项要求为做一位安全的外科医生提供了保证。

2、减少医疗差错和提高患者安全

资料显示10%入院患者将遭受各种不同的医疗差错造成的伤害^[23]。一项来自美国哈佛医学院的研究报道，1984年纽约州30000例随机入院的患者出现了医疗差错造成的伤害，其中3.7%由于不良反应事件，27.6%由于疏忽，而13.6%导致了死亡^[24]。

在SBME出现以前，医疗人员获得技术的主要方法是在他们自己身上，在动物或尸体上，或者在专家监督下在患者身上进行。后者即所说的“see one, do one, teach one”，虽然这样能够成功，但是增加了对患者的风险操作，患者的安全由于新手的操作不熟练或错误操作受到威胁。SBME可帮助解决这些问题，允许被训练者在接触真实患者以前学习治疗方案和掌握基本操作技能。

Barsuk JH等观察了SBME对中心静脉置管和随后出现管道感染的影响^[25]。未接受模拟训练的医生感染率为3.20/1000，而经过医学模拟训练的住院医生完成这项操作，导管相关的血流感染明显减少为0.50/1000 。美国匹兹堡大学医学模拟教学研究所(The Peter M. Winter Institute for Simulation Education and Research, WISER) 是享有盛名的世界级多学科模拟训练与研究基地，也是美国麻醉学会授权的20家模拟中心之一。为保证患者安全，减少医院不良事件的发生，美国匹兹堡大学医学中心(UPMC) 规定所有的住院医师在开始临床轮训前必须在WISER接受中心静脉置管的训练。而麻醉系主治医师到医院执业之前必须在WISER接受困难气道处理训练并获得证书。与未接受模拟培训的医生比较，住院医师出现中心静脉置管相关的并发症减少70%。而麻醉医生比以前能更好地执行美国麻醉学会困难气道指南，从而明显减少了麻醉过程中气道管理失败导致的不良事件。

3、降低医疗费用

医疗差错将消耗大量的医疗费用，美国一家700张床的教学医院资料统计，据估算每年花费在处理药物不良事件和可被阻止的药物不良事件的费用分别为560万美元和280万美元^[26]。被培训者采用医学模拟设备不但能较快掌握操作技能，而且可减少并发症，从而节省大量的医疗经费。建立一个包括1-2台医学模拟设备的模拟训练中心的投资费用，将远远低于花费在年轻医生身上的导师工作报酬和为学习者提供临床训练场所和资源的费用。

Frost等报道了医学腹腔镜模拟技术能通过减少导师的工作时间、降低医疗差错、快速完成技术和降低机器耗损费等方面节约大于160,000美元医疗费用^[27]。采用模拟技术进行内镜、血管和静脉置管培训也有同样的效果。 Cohen ER等报道每年用于中心静脉置管的模拟培训费大约112,000美元，可降低导管相关的血流感染，从而节约治疗感染所需700,000美元的费用^[28]。

四、美国WISER提高患者安全的的经验

笔者2011年1月至今在WISER访问学习，感触很深。WISER主要服务于UPMC下属21个医疗机构的2-4年级医学生、护理学院学生以及麻醉、急诊、重症医学、心血管、呼吸、儿科、妇产科、牙科等专业医护人员。WISER本着“提高患者安全”为中心的服务宗旨，从环境、设备、诊断、治疗全方位进行模拟，让学习者感受一种真实的医疗场景。教学内容特别重视临床各种危重症处理和团队训练，以及支纤镜、胃镜、中心静脉置管等有创操作训练。WISER被美国心脏病学会授权进行基础生命支持 (BLS)、高级生命支持（ACLS）和儿童高级生命支持（PALS）培训并颁发证书。据了解UPMC规定所有医务人员必须经BLS训练并拿到证书，部分科室医务人员还需要拿到ACLS和PALS证书，且每2年要重新培训更新证书。UPMC的Presbyterian医院是美国第一家要求麻醉系主治医师到医院执业之前必须在WISER接受困难气道处理训练并获得证书的医院。

模拟教学中心最重要的不是昂贵的模拟人等硬件设备，而是能够创建模拟课程和授课的专业导师。WISER经过多年的努力，拥有一支由大量优秀导师组成的教学队伍，包括内、外、妇产、儿科、急诊、麻醉、护理、药理等各个专业共300多名兼职导师，运行250多门在线的模拟课程。在模拟信息平台的管理下，保证了模拟中心被高效利用、学生受益的同时，又促进了模拟教学的发展，形成良性循环。任何医护人员开始都是学生，导师们通过医学模拟方法训练学生，可提高他们提高患者安全的意识和增加他们处理急重症患者的信心。这样，一个经过模拟训练的学生在今后的临床工作中会明显减少临床医疗差错和纠纷的发生。

五、 小结

美国 WISER模拟中心的前门上贴有我国古代教育家孔子的 名言 “吾听吾忘，吾看吾记，吾做吾懂”，即任何事情只有亲自去做才能真正理解和感悟。SBME作为一种新兴有效的教学方法，为学习者创造了反复实践操作的机会，从而提高学习者的学习能力和信心，提高患者安全和降低医疗费用。在医学教育和医疗机构采用SBME能促进医疗教育模式从传统的“see one, do one, teach one” 向“see one, practice many, do one” 的转变，尤其重视团队合作训练。 SBME可对医学生在交流与沟通技能、职业素养、医学伦理、关爱患者和团队合作等方面进行全面培训，符合WHO提出的提高患者安全的理念，值得在医学生和医护人员的医学教育中广泛推广。

 

参考文献: 见后
 

Simulation-based Medical Education: An Effective Medical Teaching Tool to Enhance Patient Safety 

Ying Li ^1,2,  Li-Ming Zhang ²

¹ Second Xiangya Hospital，Central South University；² The Peter M, Winter instiute for Simulation, Education and Research (WISER), Department of Anesthesiology, University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine

Traditionally, apprenticeship model of “See one, Do one, and Teach one” has been proposed as the principle of medical education in clinical practice in the world ^[1]. However, it seems impractical for trainees to cope with complex medical problems because of lack of effective communications and leadership that are often required during critical situations. In 1999, The Institute for International Medical Education (IIME), created by the China Medical Board (CMB) of New York, has developed the ‘‘global minimal essential requirements (GMER)” that defines the knowledge, skills, professional behavior and ethics that all physicians must have regardless of where they received their general medical education and training. These minimum educational requirements were intended to form a core of outcome standards for medical education internationally.

Since the Institute of Medicine (IOM) released “To Err Is Human: Building a Safer Health System” in 2000^[2], highlighting that of 98,000 deaths in hospital each year were as a result of medical errors and deaths due to preventable adverse events even exceed the deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516) in the USA, patient safety and medical errors have been the focus of many national initiatives. Concurrent with the growing focus on patient safety, the Accreditation Council for Graduate Medical Education (ACGME) identified 6 core competencies clinicians must achieve to practice safely and effectively in the constantly changing healthcare environment：(1) patient care; (2) medical knowledge; (3) interpersonal and communication skills; (4) professionalism; (5) practice-based learning; and (6) systems-based practice^[3]. 1n 2009, WHO proposed that medical schools should include patient safety education in the curriculum. Medical students, as future clinicians, will need to understand how systems could impact on the quality and safety of health care, how poor communications could lead to adverse events and much more. Therefore, how to incorporate these themes into the curriculum in medical schools is an urgent necessity ^[4].

Simulation based Medical Education (SBME) is an educational tool that is located between “See one” and “Do one” and proposed as a technique to bridge this educational gap. To date, there is a small but growing body of evidence showing that SBME improves healthcare education, practice, and patient safety^[5,6]. Simulation is the most prominent innovation in medical education over the past 15 years. The effective integration of SBME into medical education and assessment will meet the requirement of challenge in our modern healthcare.

1. What is simulation based medical education (SBME)

SBME can be often traced back to the late 1960s and early 1970s^[7]. Simulation is defined as an educational method used in health care education to replace or amplify real patient experiences with scenarios designed to replicate real health encounters by lifelike mannequins^[8]. Presently, educational resources for simulations include simple plastic models for partial task training, mannequin-type simulators including dummy type and high-fidelity type, screen-based virtual-reality simulators, and simulated or standardized patients. Nowadays, simulation projects are occurring all around the world. According to a USA survey conducted in 133 medical schools and 263 teaching hospitals from January to March of 2010, medical simulation research, development, and training have been pursuing at many universities and hospitals, including the University of Pittsburgh，Harvard Medical School, Massachusetts Institute of Technology, Stanford University and so on^[9].

SBME can provide both learners and patients a safe, supportive educational environment for practice and error. It encourages the acquisition of skills through experience and allows users at all levels, from novice to expert, to practice and develop skills with the knowledge that mistakes carry no penalties or fear of harm to patients or learners. It should also be noted that medical learners can obtain not only technical skills but also non-technical skills by SBME^[10]. Technical skill is defined by as an individual skill that is required for the accomplishment of a specific task such as a diagnostic or therapeutic procedure. However, since clinical work is usually team-based and requires decisions for indication of procedures, if learners have acquired only technical skills, they cannot properly and safely use these skills in a clinical setting. Non-technical skills have been reported to consist of leadership, team work, communication, situation awareness, decision-making, and awareness of personal limitations such as a management of stress and fatigue, which are also important for medical safety. Simulation training provides an excellent teaching method for teaming active learning opportunity that meets the modern medical challenge with complex medical problems.

2. Why use simulation based medical education (SBME)

Historically, previous generation of doctors were taught psychomotor skills by using apprenticeship model as its main teaching style, often referred to in medicine as “see one, do one, teach one.” Under these traditional training scenarios, expert physicians would conduct a procedure, offering a novice the opportunity to first view, then assist and finally perform the procedure under supervision. By trial and error, medical students and residents practiced directly on frightened patients who were often powerless to resist. Although this allowed for gradual training of residents and fellows, there was some impact on patient comfort and associated complications. Accumulated evidence showed that physicians trained under these traditional methods of instruction were even lacking in many invasive and fundamental skills such as basic airway techniques, insertion of nasogastric tubes, venous sampling, and others^[11]. Patients nowadays become increasingly concerned that students and residents are ‘‘practicing’’ on them, they are sometimes less tolerant of students’ inexperience and novice abilities. Therefore, students’ access to sufficient and appropriate patient situations has decreased and their opportunities for learning and practice can vary considerably.

IOM report “To Err Is Human: Building a Safer Health System” in 2000 illustrated that 70% of medical errors were due to preventable human errors^[2]. Reports from Canada^[12], Britain^[13], Australia^[14], and Denmark^[15] were published around the time of the IOM report, which revealed a problem of similar magnitude. Based on these and other studies, the World Health Organization estimates that as many as 1 in 10 patients admitted to the hospital experiences an adverse event^[4] . IOM called for reevaluation of health professions education and the incorporation of patient safety into the curriculums of all health professions. Patient safety and medical errors have come to the forefront of healthcare and reducing harm caused by healthcare has become a global healthcare priority. Medical education reform has been driven by worldwide recognition of the need for students to be prepared as effective junior doctors after their undergraduate education. It has seen a rise in the use of SBME not only in medical student education, but physician and nurse training.

IOM highly recommended one of effective ways to reduce medical errors and enhance patient safety is to apply crew resource management (CRM) to health care and to use simulations whenever possible to improve patient safety[^16]. According to Federation of Aviation Administration (FAA), CRM is defined as, The effective use of all available resources: human resources, hardware, and information. CRM is designed to avoid, trap, and mitigate error through communication, leadership, and decision making. Its success derives from a change in values, beliefs, and behaviors. The decision maker generates actions based on past experience or training, then selects one most likely to succeed. CRM training develops communication skills, fosters a more cohesive environment among team members, and creates an atmosphere in which junior personnel will feel free to speak up when they think the something is amiss. Anesthesiology is the first medical specialty to initially adopt aviation CRM in flight simulation to develop its Anesthesia Crisis Resources Management (ACRM) with simulation that encompasses a range of approaches to training groups to function as teams, rather than as collections of individuals^[17]. Accumulated evidence has demonstrated that anesthesiologists have played important leadership roles in addressing organizational patient safety in all of health care. Most importantly the profession has institutionalized safety in its scientific and governing bodies, creating the ASA’s Patient Safety and Risk Management Committee and the Anesthesia Patient Safety Foundation (APSF, www.apsf.org).

3. The role of simulation based medical education (SBME)

SBME allows for realistic training in communication, leadership and team interaction as well as observation and repetition until the student has mastered the information. SBME increases access to training while decreases the time that trainers actually need to dedicate to the hands-on training task. On a more detailed level, SBME offers comprehensive and fully exhaustive access to information and resources that increase trainee skills and positively impact the delivery of services. Overall, SBME has played three important roles in medical training.

1) Improving learners' competence and confidence

SBME offers the learners prompt training opportunities and real time problem solving capacities. In addition, it provides easy access to a wide variety of clinical scenarios, including rare complications that allow trainees to benefit from experiencing themselves and learning from mistakes by debriefing with an acknowledged expert. Learners can benefit from a flexible training curriculum set at their pace, necessity for repetition, and scheduling. In addition, learners have the opportunity to practice, to make mistakes in order to improve their performance and knowledge on the simulated patient without any harm consequence to the patient.

In a study conducted by Sedlack and Kolars^[18], simulator trained fellows outperformed traditionally trained fellows during their initial 15 colonoscopies in all performance aspects except ‘insertion time’ . Simulator trained fellows inserted the endoscope significantly further and reached the caecum independently nearly twice as often during this early training period. Wayne et al published a retrospective study of cardiac arrest team responses. All residents received traditional advanced cardiac life support (ACLS) training, but second-year residents received a 10-h simulation-based educational intervention. Third-year residents were the control group. Simulator-trained residents showed higher adherence to American Heart Association standards (ie, 68% vs 44%) and were seven times more likely to lead an adherent ACLS response that the traditionally trained residents^[19] .

Another excellent example of a systems-based approach to surgical simulation is the development of the Fundamentals of Laparoscopic Surgery (FLS) curriculum^[20]. Since its development 10 years ago, it is now a prerequisite that every graduating surgical resident in the United States must have demonstrated proficiency in FLS before the completion of a general surgery residency^[21]. Furthermore, surgeons within the Harvard-affiliated system now have an incentive to become FLS certified^[22]. Their malpractice carrier paid the fees for surgeons attending the 1-day course and examination, and in addition offered a one-time $500 malpractice premium incentive. This suggests that FLS certification makes one a safer surgeon, and it is necessary for this type of approach to be rolled out across the nation.

2. Reduce human error and Improve patient safety

A number of global studies suggest that approximately 10% of patients admitted to hospital suffer from some kind of harm^[23]. Another important finding came from the Harvard Medical Practice Study, in which the authors reviewed over 30,000 randomly selected hospital records at New York State in 1984 as part of an interdisciplinary study of medical injury and malpractice litigation. They found that injuries from adverse events occurred in 3.7% of hospital admissions, 27.6% of which were due to negligence and in which 13.6% led to death^[24] .

Prior to the advent of SBME, alternative ways through which a health care professional could achieve competency by practicing on themselves, animals, cadavers or completing the procedure under expert supervision. The latter, often referred to as the ‘see one, do one, teach one’ technique, although generally successful, increased the risk to patients, whose safety was compromised by novice technique, mistakes and complications. SBME has been used to help eliminate these problems, allowing trainees to learn treatment protocols and master basic and procedural skills before touching a real patient.

Barsuk JH et al had extended the SBME to central venous catheter insertion and has studied its effect on subsequent bloodstream infections^[25]. Ninety-two residents completed simulation-based practice with focused feedback. Incidents of catheter-related bloodstream infections were reduced after simulation training (0.50 infections per 1,000 catheter-days) compared with the same unit prior to the intervention (3.20 per 1,000 catheter-days),a greater than six-fold decrease in infection rates. The Peter M. Winter Institute for Simulation Education and Research (WISER) in University of Pittsburgh is a world-class multidisciplinary training and research facility. It is also one of only 20 simulation centers in the United States endorsed by the American Society for Anesthesiologists (ASA). In order to increase the patient safety and decrease the adverse event of hospital, UPMC has set a policy that all residents should have a central venous canulation Training (CVCT) course prior to starting clinical rotation and all attending anesthesiologists have to obtain a difficult airway management (DAM) training certificate to get the hospital privilege to practice in the hospital. In WISER, central line insertion related complications were reduced 70% with the first year residents who were trained in CVCT simulation training course prior to clinical rotation compared to the first year residents who did not received CVCT. Moreover, anesthesia residents and attending anesthesiologists tend to more adhere to ASA difficult airway guidelines after DAM course training than before.

3. Reducing health care costs

Medical errors contribute to the cost of medical care throughout the world. The annual cost attributable to all adverse drug events and preventable adverse drug events for a 700-bed American teaching hospital was estimated by one study as $5.6 million and $2.8 million repectively^[26]. However, the cost of setting up a simulation center that contains one or more medical simulators is often less than the cost entailed in the number of hours that instructors must spend training residents and fellows and the cost of supplies and resources required as part of the training. The additional cost savings achieved from a trainee’s ability to complete the procedure faster and with fewer complications adds to the return on investment achieved by medical simulators.

A study conducted by Frost et al^[27] on Immersion Medical’s Laparoscopy AccuTouch System demonstrates this type of cost savings. The study found that in excess of $160 000 in savings could be achieved through instructor time savings, error reduction, faster time to completion and reduction in equipment spoilage costs, allowing the system to pay back the initial investment in approximately 6 months. Similar studies conducted on endoscopy, endovascular and i.v. insertion medical simulators developed by the company also demonstrated the same type of return on investment. Cohen ER et al reported the annual cost of the simulation-based intervention in central venous catheter insertion has been calculated to be approximately $112,000, with a net savings of approximately $700,000 from the reduction in rates of catheter-related bloodstream infections^[28].

4. Conclusions

WISER Simulation Center posts a Chinese famous philosopher confucious saying on the front door as its motto: “I hear, and I forget; I see, and I remember; I do, and I understand” . SBME as a novel and effective educational tool, offers the repetitive practical opportunities for learner to improve their’ competence and confidence, to decrease medical errors and increase patient safety, and also to reduce health care costs in the long run. Wide-spread employing SBME in medical education and healthcare can help advance medical education from the old 7 “see one, do one, teach one” method to a “see one, practice many, do one” and “team active learning” model for success. Although the application of SBME in health care is in its infancy, we believe it will revolutionize current medical education system to better meet modern healthcare needs .

References:
 

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