Simulation-based medical education: An ethical imperative
Simulation-based medical education: An ethical imperative
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DOI：
10.1097/00001888-200308000-00006
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发表时间：
2003-08-01
影响因子：
7.4
通讯作者：
Glick, S
中科院分区：
文献类型：
--
作者：
Ziv, A;Wolpe, PR;Glick, S
医疗培训在某种程度上必须使用活生生的病人来磨练卫生专业人员的技能。但也有义务提供最佳治疗，并确保患者的安全和福祉。平衡这两种需求代表了医学教育中的基本伦理紧张关系。基于模拟的学习可以通过发展卫生专业人员的知识，技能和态度来帮助缓解这种紧张，同时保护患者免受不必要的风险。在其他高危险职业中，如航空、核电和军事，基于模拟的培训已经制度化，以最大限度地提高培训安全性并最大限度地降低风险。由于许多原因，医疗保健在模拟应用方面落后，包括成本，缺乏严格的效果证明以及对变革的抵制。最近，国际患者安全运动和美国联邦政策议程为扩大模拟器在医疗培训中的使用创造了一个接受的氛围，强调在面对经验证的大型流行病学研究时“首先不造成伤害”的道德必要性，这些研究描述了医疗管理对患者造成的不可接受的可预防伤害。四个主题为基于模拟的医学教育的伦理分析提供了一个框架：最佳护理和培训标准，错误管理和患者安全，患者自主权，社会正义和资源分配。这些主题是从患者，学习者，教育工作者和社会的角度进行审查。在可行的情况下使用模拟向所有人传达了一个重要的教育和伦理信息：患者应尽可能得到保护，而不是用作培训便利的商品。
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.