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Feature Medical Education

Shifting the learning curve

BMJ 2010; 341 doi: (Published 02 December 2010) Cite this as: BMJ 2010;341:c6260
  1. Toby Reynolds, FY2 doctor,
  2. Ming-Li Kong, specialist registrar in anaesthesia and intensive care medicine
  1. 1Royal London Hospital, London, UK
  1. Correspondence to: T Reynolds toby.reynolds{at}

How far can medical simulation replace clinical experience? Toby Reynolds and Ming-Li Kong report

Medicine has traditionally approached the problem of the learning curve by supervising trainees’ first attempts at new tasks and otherwise relying on them to call for help when they feel overwhelmed. But a growing movement within medical education argues that a better approach is to practise new skills in a realistic simulated environment before they are needed in a critical situation.

“The huge benefit of simulation is that it shifts the steep and dangerous part of the learning curve away from patients,” says Ian Curran, consultant anaesthetist and clinical director of the Simulation Technology-enhanced Learning Initiative (STeLI), a workforce development project funded by the UK National Health Service’s London Deanery.

“There always has to be a first time with a real patient so we must do all we can to ensure that these early encounters with real patients are as safe as possible.”

Simulation ranges from task trainer models that teach a particular skill in isolation to full immersion in a replicated environment with manikins that mimic the physiological responses of real patients and are able to develop, for example, laryngeal oedema, pupillary dilation, or cyanosis.

Use of simulation is growing worldwide. A database maintained by the Bristol Medical Simulation Centre lists more than 1500 dedicated manikin simulation facilities.1 In Israel, for example, internship doctors are required to attend a five day workshop simulating a variety of challenging scenarios. It has a simulation based exam for anaesthetists, and certification exams for paramedics and all advanced nursing specialties also include simulation. In the United States, anaesthetists who gained board certification after 2000 are now required to do a day of simulation training for recertification. And last year the UK government’s chief medical officer recommended that simulation …

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