Résumé
En France, l’implantation de la simulation comme méthode de formation et d’évaluation dans le domaine de la santé est encore très hétérogène. Actuellement, aucun examen standardisé de simulation n’est organisé ou même recommandé à l’échelle nationale pour valider les compétences nécessaires à l’exercice du métier de réanimateur.
Sur la demande justifiée de la société et par devoir moral envers elle, les enseignants en médecine et les professionnels des différentes spécialités doivent s’assurer d’un niveau minimum de compétences chez les médecins en exercice. La simulation permet d’évaluer de manière pertinente des compétences médicales qui ne sont pas explorées par les autres méthodes d’évaluation. L’intégration de la simulation aux examens pourrait améliorer la validité des évaluations.
Les principales méthodes de simulation médicale disponibles sont les patients simulés, les mannequins et les patients virtuels. Les méthodes les plus simples de chaque catégorie de simulation sont les plus étudiées et leur faisabilité serait tout à fait adaptée à des examens interrégionaux. En raison de leur faible coût, de leur validité avérée et de leur grande reproductibilité, les patients simulés, les mannequins partiels mécaniques, les cas cliniques QCM et les tests de concordance de script seraient les méthodes de simulation à utiliser en première intention aux examens des étudiants en réanimation. La place et la méthode d’utilisation des outils plus complexes comme les mannequins haute fidélité et les patients virtuels complexes restent à préciser.
Après une phase d’évaluation formative permettant de valider la qualité des examens, la simulation pourrait intégrer l’évaluation des futurs réanimateurs.
Abstract
Simulation-based education and evaluation of French medical students is still heterogeneous. To date, the use of simulation is not recommended for the tests required to obtain the certification in critical care medicine (CCM) in France. In response to a growing public demand for a safer healthcare system, teachers and medical societies have to guarantee that physicians are competent and able to provide optimal care to patients.
Traditional assessment methods as multiple-choice exams or continuing medical education exercises may not be appropriate to evaluate all competencies required for excellence in medical practice. Simulation provides relevant tools for assessing specific skills, not tested by other methods. Incorporation of simulation in the tests required to obtain the certification in CCM may improve their validity and provide a better guarantee of healthcare quality to the society.
The main methods of medical simulation are standardized patients, mannequins and virtual reality. The simplest techniques are strongly validated to accurately and easily evaluate small groups of students. These methods would be appropriate for local or interregional examinations. Due to their low cost, high validity and great reproducibility, standardized patients, low-fidelity mannequins, multiple-choice questions and script concordance tests should be used as first-line options. The role of more complicated techniques as high-fidelity mannequins and complex virtual reality is still to be determined.
We suggest that after a first step of evaluation, simulation methods may be part of the future validation tests for the certification in CCM in France.
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Clec’h, C., Préau, S. Place de la simulation aux examens de réanimation. Réanimation 23, 698–705 (2014). https://doi.org/10.1007/s13546-014-0931-8
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DOI: https://doi.org/10.1007/s13546-014-0931-8