Position statements
Annotation
Simulation plays a key role in solving universal health care problems, reducing inequality in education and reducing mortality, morbidity and improving the quality of patient care. Simulation contributes to the improvement of processes in the health care system, making a significant contribution to the development of safety in organizations. Simulation has proven to be cost-effective, it increases team productivity, staff stress resistance and improves patient outcomes.
Thanks to international cooperation, consultations were held with 50 societies operating in 67 countries on six continents. Common health challenges and simulation practices worldwide were identified. The target audience for this statement is politicians, leaders of health care organizations, medical education institutions, and specialists in the field of simulation medicine. The goal of the project is to reach consensus on key priorities for the widespread adoption of best practice simulation that benefits patients and healthcare professionals worldwide.
Basic recommendations
It is important to highlight the benefits that simulation provides to patients, staff and organisations, and to promote its adoption and integration into everyday training and practice across the healthcare spectrum. Inexpensive, high-performance simulation methods should be used to expand global availability and integration into systems improvement processes, as well as residency and residency curricula. Support at organizational and governmental levels is essential, requiring a unified and coherent approach in terms of political, strategic and financial commitment.
It is imperative that simulation is used appropriately, using evidence-based approaches that meet recognized standards of best practice. These standards include teacher training, assessment, accreditation, accreditation and certification.
We must strive to make simulation-based learning equally accessible, contextually appropriate, and firmly committed to equity, diversity, and inclusion. Special emphasis must be placed on scientific research in this field.
Call to action
We call on policy makers and managers to formally recognize and embrace the benefits of simulation in healthcare and education practice. This includes a commitment to provide ongoing support and promotion of the use of simulation in education and clinical practice.
We advocate that the healthcare system and educational institutions strive to provide high-quality healthcare and improve patient outcomes. This commitment should include promoting and resourcing simulation-based training for individuals and interprofessional teams in accordance with best practice standards.
We encourage simulation medicine practitioners to support the use of simulation in health care and education, adhere to best practice standards, maintain a commitment to lifelong learning, and advocate patient safety.
This statement is the result of an international collaborative effort to reach consensus on key priorities for the implementation of exemplary simulation practices that benefit patients and healthcare professionals worldwide.
Introduction
Simulation in the field of health care is a “methodology of displaying a real situation or external environment, which provides an opportunity for practice, training, evaluation, testing or for understanding the functioning of a person and his systems” [1]. In addition to education and professional training, it plays a key role in optimizing health care systems, thereby improving the quality of medical care, minimizing patient risk, increasing staff well-being, and improving treatment outcomes [2, 3].
The dynamics of knowledge sharing and interaction within medical communities have changed significantly in recent years, thanks to the exponential growth of access to virtual platforms [4]. This transformation has increased awareness of the diversity of simulation practices in health care worldwide. This emphasizes the need for a single global position on needs, solutions and priorities. The consensus-based process allowed for a careful consideration of key differences in conditions and practices, ultimately contributing to global agreement on future directions [ 5 ].
The collaboration, supported by the European Society for Simulation in Medicine (SESAM) and the Society for Simulation in Healthcare (SSH), aims to formulate a global view of the current scope of practice in simulation and reach consensus on future recommendations. The consensus emphasizes the critical role of simulation in improving health care practice and medical education, as well as its significant impact on the future of medicine. The resulting recommendations are aimed at the widespread adoption of simulation techniques, which will benefit patients and healthcare professionals worldwide. Consensus appeals to policymakers, healthcare leaders, medical education institutions, and simulation specialists.
It was possible to reach a consensus after long repeated consultations, in which representatives of 50 national and international simulation societies in 67 countries of the world took an active part.
Selected topics for discussion covered key health issues, the current situation in the use of simulation, and ethical considerations in practice. Prior to the virtual meetings, relevant questions were sent via e-mail, and in November 2023, an online meeting provided input to the draft document. All individual contributions were inclusively aggregated using the implicit method, and emerging themes were summarized in descriptive statements and tables.
Consensus on the identified topics was reached during face-to-face meetings held in January 2024. Subsequently, key issues were prioritized using an online survey. An initial draft of this document was created in February 2024 and then sent to all participants for peer review. The 24 responses received were thoroughly scrutinized, each contributing significantly to the final version of this document.
Current state of simulation practice in health care
Simulation is used across the spectrum of health and care services, including clinical disciplines and allied professions, including dentistry, psychiatric and social care. In this context, simulation practice serves educational and non-pedagogical purposes. It includes such actions as testing of devices, processes, systems, system integration, quality improvement, research and innovative approaches [2, 3]. The information obtained during the consultations showed that simulation serves as an adjunct to therapeutic interventions. It is used in a variety of settings, including complex individual surgical planning, assisting with analgesia during childbirth, supporting cognitive-behavioral therapy in mental health settings, and facilitating social skills training in patients with autism.
In addition, there was an exponential integration of simulation approaches in the work of medical teams, departments and entire institutions to improve the quality and safety of patients.
It should be noted that the simulation goes beyond the healthcare system. It becomes an excellent tool for interaction with the public and plays a crucial role in ensuring the readiness of interdepartmental groups to eliminate the consequences of a natural disaster.
The value of simulation in healthcare is immense and spans a wide range of tools and practices. These include, but are not limited to, training simulators for practicing individual manipulations, patient simulators (i.e., mannequins), cadaver simulations, and standardized patients or simulated participants representing patients, relatives, bystanders, and medical colleagues. It also includes telesimulation, computer simulation, tabletop exercises, data modeling, and various types of reality, including augmented reality, virtual reality, mixed reality, and haptic feedback models. As a society of practitioners, we provide unique opportunities to learn and improve the wide range of skills required to care for all patients, from performing simple procedures to managing rare life-threatening situations. We develop patient-centered communication skills, situational awareness, decision-making, teamwork, leadership, and other important professional behaviors. We continue to innovate and adapt, developing new initiatives to meet emerging needs, such as delivering comprehensive simulation materials to students to enable remote learning during the COVID-19 pandemic. With the growing use of telesimulation, the ability to provide simulation materials to students in resource-constrained and rural settings is also very important.
Submissions from the consultation process highlighted the universal problem of inconsistencies in access to simulation training and resources in different geographic regions and socio-economic contexts, as well as between different educational institutions and specialties. Members of different professions continue to learn within isolated opportunities for interprofessional education, especially in clinical settings. This disparity leads to uneven development of competencies and occurs at both the undergraduate and postgraduate levels, revealing a clear need to integrate simulation techniques into healthcare curricula and everyday learning opportunities in healthcare organizations.
Additional challenges reported include insufficient standardization of simulation-based learning programs and insufficient quality assurance of practices, particularly regarding teacher evaluation and professional development. A new problem arises due to the impact of the COVID-19 pandemic on the education of students, who are faced not only with the absence of a clinical environment, but also with the absence of classes using simulation techniques, which leads to stressful situations when entering a real medical environment.
Simulation offers global opportunities to support the quality of services in the field of health care. For example, in the training of medical workers when they enter the labor market. In addition, simulation helps mitigate skill degradation, especially in the context of high-risk situations such as CPR by medical personnel or bystanders.
Answers to challenges in the field of health care
In the process of consultations, problems in the field of health care of a global scale were identified. These challenges include significant inequalities in access to health and safety, extending to education and training of health professionals at all levels; financial constraints, and the most pronounced in low-income countries. The consequences of inadequate funding and allocation of resources are reflected throughout the health care system and the culture of health care delivery, limiting adaptation, professional development and continuous education of medical and allied personnel. Ultimately, these problems negatively affect the entire working population, patients and society as a whole.
The role of simulation practice in overcoming these problems is paramount. For example, the use of simulation techniques has demonstrated a positive impact on reducing inequality in education, which has led to a decrease in mortality and morbidity in regions with low levels of resources [6, 7]. In addition, it supports improving the quality of patient care [ 8 ]. Simulation interventions help to optimize the processes of the health care system, as well as increase the organizational safety culture [9, 10, 11]. They have proven to be cost-effective and successful in increasing team performance [12] while promoting staff well-being and stability [13, 14]. Undoubtedly, simulation contributes to the improvement of practical skills, for example, the installation of a central venous catheter, which leads to a decrease in the number of concomitant infections and improves patient outcomes [15, 16].
Simulation can help adapt to changing demands in healthcare, for example by preparing clinicians to cope with complexity [ 17 ], and also supports the development of skills in health and social care professionals in the care of an aging population [ 18 ]. In addition, it increases the effectiveness of the team in providing assistance to victims of injuries and natural disasters with mass casualties [19, 20].
Other emerging challenges include the ongoing transformation of health care and education practices driven by technological developments. Although implementation is largely unregulated, staff digital skills often lag behind, impacting the adoption curve of technology change in healthcare settings. Nevertheless, the increase in the volume of medical data requires innovative methods of management and interpretation, including the use of modeling, analysis and simulation [20].
Ethical considerations
Ethical considerations focus on issues that can be interpreted as “morally right or wrong, fair or unfair” [ 21 ]. These considerations help ensure that all individuals participating in healthcare simulation treat others with honesty, respect, empathy, and compassion.
The consultation process revealed a wide range of ethical considerations important to the global health community. A key requirement is to promote equitable access to high-quality health care, including dental, mental health and social care. Simulation effectively complements the process of development and improvement of medical specialists’ skills, without which it is impossible to provide high-quality medical care, namely, such medical care that every patient deserves. In connection with the above, the availability of simulation technologies in the field of medical education in every part of the world is the most important ethical task. This means, among other things, the need to identify opportunities for the development of medical simulation technologies by teachers around the world, including regions with limited resources.
Prescribing drugs and performing interventions in medical simulation also requires compliance with ethical standards, as in real clinical practice. The principles and standards developed by the International Association of Nurses in Clinical Simulation and Learning (INACSL), the Association for Simulation Practice in Health (ASPiH) and the Association of Standardized Patients (ASPE) must be adhered to. , as well as adhere to the ethical code of simulation training specialists in medicine [22, 23, 24, 25].
Encouraging and fostering a unified approach to safety culture is critical. This ensures the psychological and physical safety of all participants, the protection of personal and patient data, and eliminates the reaction of “guilt and shame” from simulation and clinical practice [ 23 ]. In addition, students should receive support in the process of experimental learning, which involves honesty and transparency of processes, compliance with standards of best practice [25].
The principles of diversity, equity, inclusiveness and accessibility are important in simulation and clinical practice [26]. By specifically integrating these principles, we create a more culturally competent and responsive environment. The responsibility for developing complex cultural relationships rests with medical and simulation teams, facilities, and extends to broader levels of health care. In addition, it is extremely important to promote equal cooperation at all levels of medicine and education.
While there is value in incorporating advanced technology into healthcare simulation, it is equally important to proceed prudently. We must minimize the potential for unintended negative learning outcomes, carefully evaluating the prospects for implementing these innovations.
We “run” this planet together, so we have a collective responsibility. Encouraging a joint approach to ensuring reliability and safety is a mandatory requirement [27].
Recommendations
The global consultation process produced several key themes for recommendations. Further recommendations are intended to ensure coordinated activities of simulation specialists, health care systems, medical educational institutions, and world leaders.
First and foremost, there is a need to spread the word about the benefits that simulation technology brings to patients, staff, and organizations. Incorporating simulation into daily training and practice across the healthcare spectrum is essential. In addition to enhancing the professionalism of healthcare professionals and teams, simulation can also empower patients by providing new perspectives and fostering the necessary accountability and helpful behaviors that ultimately lead to improved patient outcomes.
Political, strategic and financial support at institutional and governmental levels is vital. Ensuring the durability and reliability of simulation objects, programs and human resources requires constant concerted efforts.
The development of high-performance simulation methods that do not require significant costs can facilitate the use of simulation throughout the learning process. Simulation technologies can be especially useful in the field of interprofessional education. At the same time, the integration of simulation into the processes of improving the system, as well as into the curricula of all levels, should be carried out on the basis of a collective and prudent approach, based on the best experience of world practice.
There is global agreement that simulation should be used appropriately. To increase its effectiveness, we offer several key strategies:
Development and use of evidence-based tools for quality assurance in medical practice. These tools must meet recognized standards of best practice and evolve as simulation technologies improve.
Investments in the development of teachers to improve their qualifications in the field of simulation training.
Thorough evaluation of all types of simulation activities to maintain quality standards.
Development of quality approaches for programs for accreditation, attestation and certification (and re-certification) of simulation specialists.
Ensuring equitable access to high-quality, context-relevant learning opportunities based on simulation experiences. To achieve this, it is imperative to develop the necessary support to ensure ongoing funding for health simulation.
Using telesimulation and virtual approaches to facilitate access to learning across the spectrum of professions and practices, including rural, remote and underserved areas.
Adherence to the principles of equity, diversity and inclusion both within the simulation and through the simulation.
Compliance with environmental protection requirements when performing simulation activities.
Encouraging attention to research to develop a community of practitioners. Focusing on simulation-related initiatives, exploring new ways to integrate simulation into broader healthcare research and innovation.
Call
Healthcare simulation serves an important purpose beyond its own existence. Its mission is to improve the effectiveness of medical care, the improvement of medical professionals, the establishment of interprofessional collaboration, which will ultimately lead to improved health outcomes for patients and communities. Achieving these transformations will require a concerted effort by government leaders and policymakers, health care systems, medical education institutions, and simulation specialists.
For this, we offer several basic actions. We suggest that policymakers and leaders formally recognize and embrace the benefits of simulation-based practices in healthcare and education, ultimately improving patient outcomes by:
- Allocation of permanent resources for simulation training.
- Mandatory use of simulation technologies in educational and clinical environments.
- Explaining how simulation experiences can supplement or replace clinical experiences for residency and residency training.
We recommend that health care systems and health education institutions commit to the goal of high-quality health care and improved patient outcomes by:
- Promotion of simulation in the field of health care as an important and necessary learning tool at all stages and levels of a medical worker’s career.
- Providing the necessary resources for healthcare simulation, including staff, equipment, facilities and learning context.
- Using Healthcare Simulation to Create Interprofessional Education and Training Opportunities.
- Adherence to the standards of best practice simulation in the field of health care.
Training of teachers and mentors in the field of simulation training.
We are calling for simulation specialists:
- Contribute to the spread of simulation in the field of health care as the most important learning tool.
- Adhere to the standards of best global practice.
- To maintain the highest level of personal integrity and ethical conduct.
- Strive for continuous learning
- Defend the principles of patient safety.
We hope that this global statement will promote awareness of simulation in health care and serve as a guide for coordinating health simulation strategies and policies around the world.
