Telesimulation: A Paradigm Shift for Simulation Education

Medical education has undergone several paradigm shifts over the past few decades. Specifically, there has been a shift toward educating physicians who can effectively work together as a team and practice patient-centered care. Simulationmediated education has been a predominant vehicle for this shift and has been openly embraced by the medical community as a training tool that promotes active learning given its ability to approximate real conditions in controlled environments. Medical simulation has been proven to be an effective instructional tool that addresses both contentand process-specific learning objectives, including the development of interpersonal, communication, and problem-solving skills. Interestingly, simulation itself is now undergoing its very own paradigm shift. In this issue of AEM Education and Training, the authors define telesimulation and describe its potential role as an innovative teaching tool for educators within emergency medicine. The term telesimulation, unfortunately, has not yet been defined in the Society for Simulation in Healthcare’s Healthcare Simulation Dictionary. Although in its infancy, there is growing literature to suggest that telesimulation broadly falls under distance education and leverages technology to link learners with their respective instructors. To date, only studies that focus on the psychomotor domain of learning (i.e., intraosseous line placement, ultrasoundguided regional anesthesia) have been described. From an academic lens, however, a clear definition is essential to ensure that this training modality is appropriately advanced and developed. The authors present a cogent definition for the term and define telesimulation as “a process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location. ” Beyond simple definition, the authors relate several educational theories to scaffold the application of telesimulation into successful educational programming. David Kolb’s widely quoted “experiential learning cycle” has been heavily applied to simulation instruction. In this framework, the learner is immersed in a concrete experience (i.e., simulated scenario); he/she then observes and reflects on himself/herself or others (i.e., the debriefing); the learner is then able to make inductive systematic conclusions or abstractions (i.e., refining frames for his/her clinical practice); which then allows the learner to empirically test the action plans that arise from the abstract concepts (i.e., applying this new practice to another simulation or future patient encounter). Kolb’s cycle is most often used to describe the practice of reflection-on-action, which involves thinking through a situation after it has happened, where learners return “to experiences [they] have had, re-evaluate these experiences, decide what [they] could do differently, and then try out whatever [they] decided to do differently. ” Telesimulation demands moving beyond this educational framework, particularly during synchronous learner–instructor interactions. For several reasons, reflection-in-action may represent a more prudent framework during telesimulation education. Donald Schon’s work suggests that reflection-in-action (or simply, “stop and think”) better allows learners to think and reshape what they are doing while they