1

1 Educational Principles of Simulation-Based Procedural Training

2 Informed Consent for Procedures

3 Maintenance of Thermal Homeostasis

4 Methods of Restraint

5 Aseptic Preparation

6 Analgesia and Sedation in the Newborn

Preparation

and Support

I

2

Educational Principles

of Simulation-Based

Procedural Training

1

Ganesh Srinivasan

The Need

The traditional see one, do one, teach one, and hope not to

harm one apprentice model of graduated responsibility in

the care of real patients and for acquisition of clinical, procedural, and leadership skills has been termed “education

by random opportunity.” The rationalization of work hours

during residency and fellowship training, the increasing

breadth of technical skills required in neonatology, and the

limited opportunity to acquire competence in the context of

safety and time provide us with both a challenge and an

opportunity to revisit traditional training and embrace innovative learning strategies. The educational strategies best

suited to address acquisition of procedural skills include

supervised clinical experiences, simulated experiences, and

audiovisual review. Simulation enables repeated procedural

exposure in a safe environment without compromising

patient safety, that is, see a lot, simulate and train a lot, teach

and assist a lot, and harm none (1–10). Although animal

and other models have been used to teach and practice procedures used in neonates for the past 4 decades

(Fig. 1.1A–E and Table 1.1) (11), the role of simulationbased training has made a paradigm shift in the past 15

years to an educational experience that helps address the

need for integrated acquisition of technical skills, behavioral skills (including ability to work as part of a team), and

cognitive skills—factors where deficits identified and not

corrected may lead to adverse outcomes. For example, the

Neonatal Resuscitation Program™ has embraced simulation-based resuscitation training methodology to teach and

evaluate competence in neonatal resuscitation (12). This

chapter serves as a general overview of the current underlying educational principles of simulation-based training in

neonatology (13–18).

Definition

Modern-day simulation is an immersive instructional strategy that is used to replace or amplify real experiences with

guided experiences that evoke or replicate substantial

aspects of the real world in a fully interactive manner.

The Theory of Simulation-Based

Learning

Bloom’s Taxonomy

According to Bloom’s taxonomy of learning (Fig. 1.2),

knowledge and comprehension are the simplest levels of

learning. Simulation, when used with the goal of improving

practice, can allow the learner to move from knowledge or

comprehension to application, analysis, and synthesis, which

are better indicators of competence.

Adult Learners

1. Are self-directed and self-regulated in their learning

2. Are predominantly intrinsically motivated to learn

3. Have previous knowledge and experience that are an

increasing resource for learning

4. Through this previous experience, they form mental

models that guide their behavior

5. Use analogical reasoning in learning and practice

The process of having an experience (concrete experience), reflecting on the experience (reflective observation),

developing mental models (abstract conceptualization),

and testing that mental model (active experimentation) is

based on Kolb’s experiential learning cycle (Fig. 1.3).

Kolb’s Experiential Learning Cycle

1. Concrete experience (feeling): Simulations provide

concrete experiences that stress the learner, causing a

significant change of body state to foster meaningful

reflection of learner identified knowledge gaps.

2. Reflective observation (watching): Debriefing provides the opportunity for learners to reflect on the simulation and their performance. The learner observes

before making a judgement and seeks optimal comprehension by viewing the experience from different