1. The Great Debate: Simulation (It won’t revolutionize GME) Brian Burkey MD, MEd Cleveland Clinic Foundation Cleveland, OH

2. The Present--The Perfect Storm More physicians and surgeons will need to trained more intensely and more quickly with less faculty and monetary resources “We can't solve problems by using the same kind of thinking we used when we created them.” ---A. Einstein

3. The Future? The Solution – Elements of effective reform GME re-engineering – Greater efficiency » Simulation: Means of safely recreating elements of a complex clinical reality » May play a increasing role as it is most effective where trainees need to master skills in areas of limited experience due to patient safety concerns, and time constraints » However, there are still few simulators in otolaryngology compared to general surgery and procedural medical specialties, eg. Pulmonology

4. Simulation Limitations Opportunity cost vs. non-simulation education – Opportunity lost with NOT using alternative resources (time, money) – Rarely is true benefit realized due to lack of debriefing; curriculum is not developed in accordance with educational guidelines – Simulation centers frequently are often driven by financial and productivity agendas

5. Simulation Limitations Artificial situation – Skills are learned outside of clinical context – Component skills are emphasized rather than unified scenario; lacks teamwork/communication training – Learner interacts with machine, not patient, and focuses on procedure – Can lead to learners’ false sense of security, ie. routine expertise vs adaptive expertise

6. Simulation Limitations Real cost – High fidelity simulators are very expensive and tech support is mandatory – Overall usage is low – Cannot be borne by most departments alone – Little data on cost-effectiveness and educational value Favors simpler models and progressive strategies, ie. from low fidelity to higher fidelity simulators

7. Simulation Suggestions Use simulation as a one element of overall curriculum, sparingly; KISS Focus should be on recreation (scenarios) and not replication (simulators) Simulation should recreate sociocultural practice rather than focusing on acquisition of component skills only – Roger Kneebone

8. Current Simulation?