gms | German Medical Science

The use of simulation for instruction and examination purposes has been practiced for many years in a number of disciplines. The simulated scenarios encompass such diverse areas as the training and testing of pilots, the training of soldiers, the operation of nuclear power plants, or the practice of different management strategies [1], [2].

Also throughout medical education, simulation as a training and examination tool is being increasingly employed [3], and researched [4], [5]. Issenberg and colleagues, for example, have already identified factors for the appropriate use of simulation in a systematic review [6]. At the national level, the Practical Skills Committee, in their 2011 Consensus Statement, required the use of simulation-based instruction to convey practical and communicative skills [7].

Skills Labs are sites where one can practice simple skills, as well as complex scenarios, with the use of models or simulators. Such centers are employed by 38 of the 43 medical faculties in the European German-speaking countries [8], [9]. Skills Labs lead to a wide employment of simulation in medical education, and establish simulation as a form of instruction between theory and bedside.

Meanwhile, a variety of different simulators are available, and a large number of manufacturers are trying to place their simulators in the expanding market. Extensive financial resources are necessary to obtain an adequate supply of simulators, as well as to replace diverse consumable or wearing parts, and many faculties cannot or will not easily part with such amounts. Additionally, there is the often legitimate question of how complex (and therefore expensive) a simulator must be, in order to possess a high educational value [10].

The Skill Lab managers, who are responsible for the acquisition of simulators, have until now depended on the distributors and manufacturers to obtain such information. At best, an additional faculty that owns a simulator of interest is known, and can be questioned about their experiences. There is currently no independent source for this information.

In light of the above, during the Skills Lab Symposium in Münster 2010, the Practical Skills Committee of the GMA [http://www.gesellschaft-medizinische-ausbildung.org/index.php?option=com_content&view=article&id=134&Itemid=120&lang=de] first developed the idea of a “product certifier” for simulators, which would provide an independent source of information on simulators to all medical faculties in the German-speaking world.

A task group was formed to supervise the project, and to brief the Committee on its progress during meetings. Initially, the project was supported by the Skills Labs from the medical faculties of the Universities of Bern, Cologne and Marburg, whereas the latter was responsible for coordination. In the later course of the project, the Learning Center of the Charité Berlin was engaged primarily on technical implementation.

The goal was to create a database, originally protected by login, that

• allows access to relevant information about delivered simulators,
• contains a rating system, and
• offers a link to the simulators on the National Competency-Based Learning Objective Catalog for Medicine (NKLM) [11] (Work Package 14 “Practical Skills”) [7].

A first version of the "Simulator Network", in terms of a "soft start", was presented during the Practical Skills Committee meeting at the Skills Lab Symposium 2012 in Marburg. There, the attending Skills Lab managers received login data, which also allowed them to add their inventory of models and simulators to the database.

The network is based on the e-learning platform ILIAS [http://www.ilias.de/docu/goto.php?target=cat_580&client_id=docu], and uses its wiki function. Each of the four columns Simulator, Skills Lab, Organ System and Discipline detailed below are represented by a wiki page, which in turn contains links to the individual pages (see Figure 1 [Fig. 1]) [http://simnet.charite.de/ilias/goto.php?target=wiki_41_Hauptseite]. ILIAS also offers a sophisticated access rights system, messaging capability, as well as resources that allow for the posting of multimedia content, such as photos and videos.

In order to develop a comprehensible, user-friendly database, the arrangement of data must be logical and easy to understand. Therefore, a suitable structure must allow for cross-linking between different organizational structures, as well as the sorting of each simulator by various criteria. Four columns were created:

1.

Simulator: Here, each simulator has its own wiki page, summarizing key data such as manufacturer, approximate price, category (e.g., high scale, part task), etc. In addition, the evaluation system on this page is a central element, and will be discussed below in detail.

2.

Skills Lab: The wiki page of the individual Skills Labs will under no circumstance replace the websites of the individual institutions. A short informational text, as well as some photos, would serve to provide a first impression of the Skills Lab. A table will contain contact information, as well as a direct link to the homepage.

3.

Subject Area: This column groups the simulators according to their respective medical area. The groups were based on the current medical licensing guidelines, and were expanded as needed [12].

4.

Organ System: Here is a link to the Work Package 14 of the National Competency-Based Learning Objective Catalog for Medicine (NKLM) [7]. At the beginning of each wiki page overview, in the column "Organ Systems", the applicable learning objectives of the Work Package 14 "Practical Skills" of the NKLM are clearly listed.

All four columns are linked to each other, and the cross-linking enables the user to easily switch between these views. For example, a user visiting the wiki page of a simulator (column: Simulator) classified under the field of surgery, must simply click on the link to the column "Subject Area" to be taken to the “Surgery” listings, where he will find a full list with all simulators classified under “Surgery”. The column "Skills Labs", conversely, provides an overview of simulator inventory of a particular Skills Lab.

The rating system of the Simulator Network is based on two basic principles: a free-text review, and a visual rating scale with predetermined criteria. Regarding the latter, ILIAS currently offers only the possibility to evaluate an entire wiki page. The aim was, however, to rate simulators according to predefined criteria (e.g., durability, exam suitability, price-performance, teaching quality) using a visual scale. In order to obtain such a scale, a feature request was submitted to the developers of ILIAS, which is funded by the “Mittelbauvereinigung” of the University of Bern. The development of the first version is (as of 12/2012) completed, and the first test runs are currently in progress. The implementation of the system will take place in January / February 2013. The visual scale will be based on a star system, which is automatically calculated by averaging the ratings of sub-points. A blue dot above the star ratings will enable each user to see how they rated a simulator (see movie [http://www.ilias.de/docu/goto_docu_wiki_1357_Extended_Rating_in_Wiki.html]).

Simulation is an evidence-based teaching method throughout medical education [4], [6], but major obstacles to its curricular implementation are the high purchase and operating costs.

The developed database is designed to improve communication and information flow between simulation centers. This should help prevent poor investments, and optimize the use of resources towards implementation of evidence-based educational strategies.

The success of the database will depend on the participation of the Skills Labs. On the GMA Conference 2012 in Aachen, the database was once again presented at the meeting of the Practical Skills Committee, and again it was met with an overwhelmingly positive response. Several Skills Labs have already added models to the database, or designated student tutors who will soon do so. An interesting question for the future will be the extent of the Simulator Network’s data that can be made available to the manufacturers, and what synergies might arise from this. Additional features could be later implemented, such as links to relevant literature, or posts with recordings of teaching concepts in the Simulator Network.

In the German-speaking world, the systematic use of simulation-based instruction in Skills Labs of medical faculties is still relatively young. The evidence of the procedures currently in place must still be improved. Only with a prudent employment of resources can simulation be widely established, thus enabling relevant scientific research and validation. Thus, the Simulator Network seeks to contribute to the efficient use of resources in medical education. The authors were unable to identify any similar projects, in Germany or elsewhere. The success of the project will depend on the participation of the simulation centers. Diverse training sessions that aim to improve participation have been planned, or are currently taking place.

We thank all those who already added a model into the Simulation Network and Rudi Mörgli for help with the translation to English.

The authores declare that they have no competing interests.