Dr. Kenneth Gilpin Shares Why Sometimes We Can Do More Harm Than Good Through Medical Simulation

negative feedback in medical simulation

*Update: The recorded plenary session is now available to watch on SimGHOSTS.org thanks to CAE Healthcare & Mediquip! Click here to watch it now!

Last week at SimGHOSTS Australia 2015, CAE Healthcare sponsored the plenary session by Dr. Kenneth Gilpin BSc MB ChB FRCA FANZCA, Senior Lecturer University of New England, Australia – who spoke on “Negative Learning in Healthcare Simulation”. During the talk he argued that negative learning is a problem in our community and proposed that physiological modeling some tools to reduce negative learning. Dr. Gilpin demonstrated how the aviation industry regularly examines simulation training for negative learning — which means that learners build unintended habits during the simulation exercise which they carry over to real life engagements. In aviation, examples come from pilots first learning how to deal with stalls on one type of aircraft unwittingly crashing when actually flying on a different type of aircraft.

AviationWeek.com highlights how the problem became identified and corrected in commercial aviation:

“The training standards before 2012 unwittingly led to stall recovery success in terms of lost altitude rather than the need to reduce angle of attack and aerodynamic load on the wing by immediately pushing the elevator control forward—the universally accepted solution to stalls that had been ignored in training.

To succeed, pilots would begin the maneuver at a medium altitude, slow down and hand-fly the aircraft, with the elevator trim set so it would not cause pitch-up problems when full power was brought in on the first warning of a stall. The net result was a programmed reaction to give power more priority than pitch, a fatal mistake in many accidents. Actual stalls were not required nor were they allowed in the simulators because the aerodynamic models driving the systems did not accurately reflect the non-linear behavior of an aircraft in the stall and post-stall regime.

It is unclear how long it will take pilots to undo years of ingrained training. “There are so many professionals on the line that have habit patterns they are not going to give up,” says Clarke McNeace, a former Southwest Airlines pilot who is now vice president of flight training and standards at Aviation Performance Solutions (APS) in Amsterdam. “We have an entire industry of simulator instructors and line pilots who have the traditional stall recovery method ingrained. It’s going to be a long way down the road.” McNeace, who teaches upset prevention and recovery training (UPRT) at APS, says he is nonetheless encouraged that professional pilots coming for training in the past two years have told him they have “stopped doing it the old way” in their training departments.

Creating scenarios that produce the physiological response of surprise or startle in a pilot, while not introducing negative training in the recovery of the aircraft, will be key to effective next-generation flight training.” Read the full article on AviationWeek.com.

Dr. Gilpin reminded us that the following areas in medical simulation can cause negative feedback:

  • Simulation scenarios being “accelerated in time” to demonstrate the effects of medications.
  • Simulator plastics requiring physical actions of learners that will not translate in real life (ie intubation techniques)
  • Simulations can generalize archetypal disease symptoms in medicine, manifesting “classical presentations” which are not always realistic.

He then recommended that we explore our scenario templates and consider all the possible negative training outcomes inherent in our simulations in-order to make these notes known to learners. Even mentioning the known limitations of our simulation scenarios can mean the difference between success and failure with patient outcomes.

The presentation was recorded and will be made available shortly thanks to CAE Healthcare on SimGHOSTS.org.

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