Letters to the Editor
To the Editor:
Alper and Wachter1 give a fascinating account of the barriers that exist between risk management and patient safety and why it is important that there be more widespread sharing of and learning from data about critical incidents. While that is undoubtedly true, the question remains: What would be the most effective way of delivering this learning that would encourage doctors to incorporate it into their everyday practices?
Part of the problem in answering this question is that learners often become afraid, embarrassed, and defensive when discussing critical incidents; such feelings do not create a good educational climate. How can we do better? It is possible that simulation may be one way of squaring this circle. In simulation, small groups of doctors learn to train and test their skills in environments that are close to their real-life practices. Because the learning is done in teams, there is less of a spotlight on individual doctors. Whilst rich and immersive simulation environments are increasingly available, the essential components of simulations are the scenarios on which they are based. In the United Kingdom, simulation scenarios are often modeled on real-life critical incidents that have recently occurred in the learners' hospitals.
The simulation environment does not have to be state-of-the-art in terms of technology—low-technology solutions are likely to be both effective and cost-effective.2 Also, expense need not always be a barrier, for although a hidden cost of simulation is creating the scenarios, if they are based on real-life events, then the scenario-writing job will be largely done.
Clearly, simulation is the way to bring risk management and patient safety together. What better way to help doctors learn how to avoid error than by enabling them to educate themselves in environments where they feel safe and engaged and where patients cannot be harmed?
Kieran Walsh, FRCPI
Editor, BMJ Learning, the medical education service of the BMJ Publishing Group, London, United Kingdom; firstname.lastname@example.org.
2 Ker J, Hogg G, Mann N. Cost effective simulation. In: Walsh K, ed. Cost Effectiveness in Medical Education. Abingdon, UK: Radcliffe; 2010.