FOAM and Simulation: Kindred spirits in Education

We in clinical education can often be guilty of adopting academic terminology and educational theory at a very superficial level. In reading Chris Nickson’s recent post on ‘curriculum’ , I registered some overt parallels with my experiences in simulation education.

Simulation in healthcare is not a new thing. Madame du Coudray, the King’s midwife, is commonly attributed the title of the mother (yes a female, lady person) of technical health simulation. In 1751 Madame du Coudray observed startlingly high birth complication rates in rural France and devised an educational program for village lay midwives that incorporated the writing of a textbook and, more importantly, the development of rather sophisticated birthing trainers and technical instruction. This program was assessed to have a huge impact, with a massive decline in birthing complications subsequent to education. (Harry Owen, 2012 PMID 22374231)

Machine Pic BlogThe philosophy and practice of FOAM (Free Open Access Medical education) is not a particularly new concept either (read any post on the topic on LITFL – featuring William Osler) and it seems that both have been lost and re-found over the past couple of centuries.

People have had bad experiences with simulation before… role play anyone? The debrief more like Roger Harris’ “shit sandwich without the bread”, than encouraged reflection. FOAM too, has no doubt alienated some.

Both simulation and FOAM are evolving as disciplines within the world of modern health delivery. The elegance, modalities and exposure are growing rapidly for largely the same reason – technology. Within this rapid evolution, the key is to not try and place all the eggs in one metaphoric basket. I have observed facilities that have received an injection of simulation resources (i.e.. freaking expensive mannequins), go simulation crazy, trying to simulate everything and surging on creating simulation “curriculum”. Why would we build a curriculum out of one teaching technique?

Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.

Professor David Gaba 2004

FOAM can learn a great deal from the mistakes made by eager early adopters of sim. We have started to realise that, done poorly simulation is detrimental and can damage the psyche and practice of clinicians. The parallel with FOAM at this point is somewhat blatant.

This was not meant to be a long winded post, just a reflection on some inklings I had at SMACC 2013, that crystallised with subsequent discussions on the topic of FOAM.

In extrapolating this relationship out, let’s think of FOAM as a tool, teaching technique and resource. In itself we don’t give a teaching technique a curriculum, but instead embed it into “the curriculum”. This progression is yielding results in simulation, as we see unanticipated benefits such as improvements in communication, processes, patient flow and clinician confidence in unfamiliar contexts (transfer learning – the ultimate). Hopefully FOAM, in it’s latest guise can realise some of the successes of it’s mannequin cousin.