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Live tissue versus simulation training for emergency procedures: Is simulation ready to replace live tissue?
Stephen L Barnes1, Alex Bukoski2, Jeffrey D Kerby3
1Department of Surgery, University of Missouri, Columbia, MO.
Surgery
|August 11, 2016
Summary
Live tissue and simulation training both improve emergency procedure skills. No single method is superior, suggesting combined training is most effective for healthcare professionals.
Area of Science:
- Medical Education
- Surgical Simulation
- Emergency Medicine Training
Background:
- Training for critical emergency procedures presents significant challenges in consistent application across healthcare settings.
- A debate exists regarding the efficacy of simulation versus live tissue training, with legislative proposals to ban live tissue training in the Department of Defense.
- Limited objective evidence currently informs best practices for emergency procedure training methodologies.
Purpose of the Study:
- To evaluate and compare live tissue training and simulation-based training for 12 life-saving emergency procedures.
- To assess the impact of training modality on self-efficacy, cognitive knowledge, psychomotor performance, and affective response.
- To gather expert opinions on the value and limitations of both training approaches.
Main Methods:
- A randomized study involving 742 subjects comparing live tissue and simulation training.
- Pre- and post-training assessments included self-efficacy, cognitive knowledge, and psychomotor performance.
- Electrodermal activity measured affective response, complemented by subject matter expert gap analysis.
Main Results:
- Both training modalities yielded significant pre- to post-training improvements across all measured domains (P < .01).
- No statistically significant differences in overall performance between live tissue and simulation were found, except for fluid resuscitation.
- Simulation showed an advantage in 7 procedures for the lowest pretest performance subgroup, while live tissue training elicited a greater affective response (P < .01).
Conclusions:
- Neither simulation nor live tissue training alone is definitively superior; combined approaches offer added value.
- The wholesale abandonment of live tissue training is not supported by current evidence.
- Continued integration of both live tissue and simulation-based training is recommended for optimal emergency procedure preparedness.
