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Simulation is an effective educational technique that not only improves learning for medical trainees and providers, but also leads to improved patient care delivery and outcomes. When simulation-based medical education (SBME) is implemented by experienced educators and integrated into educational curricula and systems, it allows for safe experimentation, learning from mistakes, deliberate practice, and standardized assessment of learners’ competency.

Simulation-based training has been used for several decades to improve safety in high-risk industries such as aviation, where human error can lead to significant loss of life. Simulation-based training has contributed to the safety and reliability of the aviation industry through both technical skill training, where pilots practice the mechanics of how to fly a plane in a cockpit simulator and, more recently, in behavioral skill training during which the entire flight crew practices effective teamwork skills called crew resource management (CRM). Healthcare, like aviation, has identified that deficiencies in effective teamwork and communication account for up to 70% of medical errors. Based on the CRM skills identified as critical for safety in aviation, David Gaba, a founder of modern healthcare simulation and an anesthesiologist, adapted these skills for anesthesiology and termed them anesthesia crisis resource management (ACRM). There are 15 skills in total that are now identified as critical for effective healthcare teams (see Table 112-1).


Research has shown that these skills not only apply to the anesthesia field but can be applied to all of healthcare and are a key learning component of SBME. Although CRM is not yet a required component of medical education, medical and nursing schools, hospitals, and academic centers are increasingly incorporating SBME programs to train and improve the use of these critical skills.


Simulation, often used as an educational methodology, can be utilized for very different purposes, such as for improving quality and patient safety, as a method to assess competency, for introducing innovation or process change into healthcare, and for research. The implementation of simulation must be adapted to the specific goal desired.

Implementation of simulation with an intent to improve quality and patient safety is becoming more common in hospitals and academic institutions. The major sources of medical errors include latent safety threats and potential errors in hospital environments and systems of care that go ...

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