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In the early 1990s, University Health Network Executive VP Education, Dr. Brian Hodges, was a newly-minted professor at the University of Toronto Faculty of Medicine. One of his first assignments was to "fix" the exam system for the psychiatry rotation. The status quo was a gruelling two-hour oral exam, which stressed students beyond reason and which generally resulted in faculty either passing them out of sympathy, or holding them to the rigid standard and failing them.
That assignment launched a 10-year stream of inquiry into the use of simulation for advanced communication skills, and the development of the first psychiatry OSCE (objective structured clinical examination). This research changed the way educators in countries around the world – including Canada, the United States and the United Kingdom – train and assess health professionals.
And, that research just earned Dr. Hodges one of the world's most prestigious prizes in medicine.
'An easy choice'
The Swedish Karolinska Institutet earlier today announced that Dr. Hodges will receive the
Prize for Research in Medical Education, worth €50,000 (about C$73,000) for his research into how health professionals are trained and assessed around the world.
The Karolinska Institutet is also home to the Nobel Committee for Physiology and Medicine.
"This year's prize winner was an easy choice, as Professor Hodges' research is of such outstanding significance, quality and originality," says Professor Sari Ponzer, Chair of the Prize Committee. "It has led to changes in practice and has had an impact on medical education.
"Professor Hodges has embraced both quantitative and best-practice qualitative methodologies. The outcomes of the research are well recognised as a substantial contribution to the medical education literature."
Decided to try simulations in mental health
Dr. Hodges' research focuses on the nature of competence and how it is assessed. He says even before he was tasked with the exam challenge, he knew something was missing in how schools were preparing health professions students to work with patients in the clinical setting.
"I worked in the emergency department at a psychiatric hospital, where we had some very intense scenarios," says Dr. Hodges, who is also Executive VP Education for the Michener Institute of Education at UHN. "We had patients who were violent, psychotic, yelling … you can imagine the intensity of a psychiatric emergency department.
"I didn't feel our teaching program was preparing learners for that environment, and the idea of immersive simulation didn't exist in psychiatry when I went through training myself. In fact, typically you would have an experience clinically – often alone – and you would describe it later to a teacher, who would give you feedback. That all seemed so poor pedagogically to me. Meanwhile, surgery and other areas were just beginning to experiment with simulation, so I started thinking we should try simulations in mental health."
Dr. Brian Hodges debriefing with students after a simulated clinical scenario.
Dr. Hodges recalls initially receiving a lot of criticism for the idea, with many colleagues saying it would seem fake and "too Hollywood" to have actors trying to pretend they were depressed or had schizophrenia.
"What we saw as we started to experiment with this was it felt very real and authentic to people right away, and we realized it's wrong to say simulation is only useful for the sore knee or to listen to the heart. Simulating strong emotions and complex mental health scenarios can be very realistic and powerful for both learning skills and assessment of competence.
"Communication is key for health professionals, both between patient/physician and between colleagues in the health care community. Caring and compassion are the foundation of our profession."
Prize ceremony in October
The Karolinska Institutet prize is made possible through financial support from the
Gunnar Höglund and Anna-Stina Malmborg Foundation. Drs Höglund and Malmborg, both professors at the Karolinska Institutet, created the fund in 2001 because they saw a gap in how this field of inquiry was recognized compared to the other Nobel prizes in the field of medicine. It is currently awarded every second year.
Dr. Hodges will receive the official recognition in Stockholm, Sweden on October 13 to be followed by a week of lectures and workshops in Stockholm. He says he will use the prize money to encourage more scholarship in the field of health professions education.
"Today, immersive simulation is everywhere and Michener is a fantastic example … one of the shining stars of this way of thinking, and evidence that the use of high quality simulation goes beyond medical education," he says. "All the health professionals now in training have simulation as a major component of their learning, and there is so much more that we can do."
For news release on 2016 Karolinska Instituet Prize for Research in Medical Education