Introduction

Simulation is an increasingly important aspect of modern medical education. The first medical task trainer, Resusci Anne, was introduced in 1960.[1] Three years later, the first standardized patient was utilized at the University of Southern California to teach medical students during their neurology clerkship.[2] Modalities of simulation used in healthcare have continued to expand over the ensuing years to include a variety of task trainers, high and low fidelity mannequins, software-based simulation, and virtual reality.[2][3] The expansion of simulation training in healthcare has indicated a need to improve healthcare simulation education with standardization and implementation of best practices.  

Function

There have been multiple guides written to highlight the best practices for effective use of simulation in healthcare education as well as simulation center operations.[4][5] These standards focus on curriculum design, integration and standardization, fidelity management, scenario engineering, faculty preparation, feedback, and debriefing.  Many of these best practices incorporate modern educational theories.[6][7][8] By following best practices in simulation, learners can have maximal educational benefits from the simulated activities in which they participate.

Continuing Education

The Society for Simulation in healthcare additionally provides certification for professionals dedicated to the delivery of healthcare education through simulation. Opportunities for certification include Certified Healthcare Simulation Educator (CHSE), Certified Healthcare Simulation Operations Specialist (CHSOS), Certified Healthcare Simulation Educator- Advanced (CHSE-A), and Certified Healthcare Simulation Operations Specialist-Advanced (CHSOS-A). Professionals who desire to become certified as either CHSE, CHSOS, or CHSOS-A are required to apply through SSH as well as complete a standardized examination. A Bachelor's degree or equivalent combination of education and experience is necessary for eligibility. Applicants are eligible for CHSE if they serve a role in healthcare simulation education and can verify two years of involvement with healthcare simulation education, research, or administration.  Similarly, CHSOS applicants must demonstrate two years of continuous involvement in the role of healthcare simulation operations.  

Applications are accepted year-round. If the applicant is eligible upon review of their application, they will be allowed to sit for the standardized examination, which can be completed at an approved testing center or the annual International Meeting of Simulation in Healthcare. The examination for CSHE consists of 115 multiple choice questions regarding the topics of professional values and capabilities, healthcare and simulation knowledge and principles, educational principles applied to simulation and simulation resources and environments. The examination for CHSOS also has 115 multiple choice questions under the topics of Concepts in Healthcare as Applied to Simulation, Simulation Technology Operations, Healthcare Simulation Practices/Principles/Procedures, Professional Role: Behavior and Capabilities, and Concepts in Instructional Design as Applied to Simulation. More information on the content covered in the examinations and how to prepare are on the SSH website. Certification is granted for a three-year period. After that time, applicants may apply for renewal by completing professional development requirements or retaking the examination.  

CHSE-A is reserved for educators that have proven to be experts in healthcare simulation education as well as leaders and mentors to others in the simulation community. The application is portfolio-based and awarded to high-performing leaders in healthcare simulation. Requirements include current CHSE status, a minimum of five years of experience in healthcare simulation, and a Master's degree or equivalent experience. This certification is also granted for a three-year period and requires renewal after that time. Additional information regarding the application process appears on the SSH website.  

There are additional options for individuals involved in healthcare simulation to obtain certificates in simulation through a university or college. These certificates show an individual has had advanced education and training in healthcare simulation. They are an option for those involved in simulation, not meeting the requirements for certification through SSH. The courses for certificates in simulation are also a great option for those applying for SSH credentialing to prepare for the examination.   

Clinical Significance

Medical simulation has shown to be related to improved medical knowledge, performance, and comfort level with procedures.[9] As simulation is increasingly relied upon in medical education, the need for standardization and adherence to best practices becomes more important. A Best Evidence in Medical Education systematic review of high-fidelity medical simulations found that learning is facilitated under the right conditions, including a controlled environment, simulator validity, defined outcomes, and providing feedback.[10] 

Enhancing Healthcare Team Outcomes

The Society for Simulation in Healthcare (SSH) is a non-profit membership society serving a global community of professionals utilizing simulation for education, research, and testing in healthcare. The SSH provides accreditation for simulation programs with a focus on healthcare education. The purpose of accreditation is to recognize simulation programs that adhere to best practices in simulation as well as ensure standardization across simulation centers. Programs may apply for accreditation in one or more areas, including Assessment, Research, or Teaching/Education.

To demonstrate compliance with SSH Core Standards as well as the specific standards required for each area, programs must provide two years of supporting data. Programs may also apply for accreditation for System Integration and Patient Safety as well as Simulation Fellowship if they are applying for one of the main areas of accreditation (i.e., Assessment, Research, or Teaching/Education). Accreditation can not be sought solely in System Integration and Patient Safety or Simulation Fellowship, however.  

Information regarding the required documentation for each area of accreditation, as well as the Core Standards, is on the SSH website. Programs that do not yet have two years of data supporting compliance with the required standards may apply for provisional accreditation in Teaching and Education. After two years of data showing compliance, the program may then apply for Full Accreditation. Full accreditation is granted for five years. During this time, a program must submit annual reports to the SSH to maintain accreditation. After the five-year period, the program will need to submit a Renewal Application to SSH. The annual application deadlines and associated fees for Provisional and Full Accreditation can be found on the SSH website as well.  

The American College of Surgeons (ACS) Division of Education also designates accreditation to simulation programs dedicated to surgical education and training through simulation. These accredited programs are referred to as The American College of Surgeons Accredited Education Institutes (ACS-AEI).  The designation of ACS-AEI ensures standardization and best practice in simulation education for surgeons, surgical residents, medical students, and surgical team members.

Simulation programs must show compliance with ACS standards, similar to the accreditation process through SSH. Programs may apply as a Focused Education Institute or Comprehensive Education Institute. Both application processes require proof of compliance with four standards: Learners and Scope of Educational Programs; Curriculum Development, Delivery of Effective Education and Assessment; Administration, Management and Governance; Advancement of the Field. The requirements for a Comprehensive Education Institute, however, are more rigorous and with additional requirements. 

Information regarding the requirements for accreditation, as well as deadlines for the application, are in the Education section of the American College of Surgeons webpage. Applications are accepted on biannual cycles. Accreditation is granted for five years. During this time, programs must provide annual compliance reports and apply for reaccreditation at the end of the five-year term.