Simulation played a key role in the recent launch of the “Building a Healthy Tomorrow”^TM fundraising campaign for Memorial University’s Faculty of Medicine.

Learning through simulation has an impact on medical education by improving the skills and confidence of learners in a safe environment. The hands-on experience enabled and obtained by using simulation allows for unique opportunities outside the classroom setting and provides a safer transition into clinical rotations. Aside from medical students, many other health care professionals also benefit from simulation by acquiring new skills and reinforcing what they already know. The “Building a Healthy Tomorrow” campaign presents the opportunity to provide support in acquiring costly medical simulation technologies to ensure that Memorial University’s Faculty of Medicine continues to produce world-class physicians.

During the recent launch of the fundraising campaign, we provided a sample of what simulation, and related educational technologies can offer to learners and seasoned health care professionals.  In the spirit of simulation, our displays were interactive, hands-on experiences with live standardized patients (trained actors portraying patient encounters), tele-simulation and ultrasound guided approaches, and pediatric computerized mannequins that respond in a human-like fashion to a number of treatments.

Here is what the experience looked like for those running the simulation stations:

First, we asked Jacqueline Turner, a Standardized Patient Educator at the Clinical Learning and Simulation Centre (CLSC) to tell us what it means to her to be able to participate in simulation-based education – both in general as well as during the campaign.

Jacqueline:

Pictured John O’dea(left) Kerry lynn Willams(center) and Jackueline Turner(right).

“This ability to share feedback from the patient’s perspective is paramount in the development of student learning”

“As a former Standardized Patient (SP) I had the opportunity to experience many medical student/resident encounters.  I was trained to realistically portray the history, physical, and emotional findings of patients.  Through these encounters, I was able to witness the important role that simulation plays in the teaching of all medical students. 

From the early days of medical school, students are taught about patient centered care and the importance of listening to the patient and their story.  They are taught how to ask some of the most difficult questions, how to demonstrate active listening and how to express empathy and understanding.  While the students understand that the SP’s are portraying a role and that the story is not real, it is amazing to see how the students become so engaged and “wrapped” up in the scenario and there are moments when they truly feel the encounter is real. I have witnessed students crying during many of these encounters after hearing a patient’s story.

Furthermore, while SPs are trained to portray various roles to enhance student encounters in a safe environment, they are also trained to provide effective feedback to the learner. This ability to share feedback from the patient’s perspective is paramount in the development of student learning.  When a patient goes to see their own doctor, how often does the doctor ask the patient for feedback on their experience as their patient? When the SP shares their thoughts to the learner from the patient’s perspective, identifying to the student what they did well and what needs improvement, the students remember the feedback and it does have a valuable impact on their learning. 

As a Standardized Patient Educator, I have a more direct link to the medical students and one of the best parts of the job is hearing the feedback from the students about how much they enjoy their SP encounters and how comforting it is to have the opportunity to practice both their communication and clinical skills on SP’s in such a safe environment. 

Several years ago, I was approached by a former student who was going through her clerkship and she shared with me that she often relies on her memorable experiences of working with faculty facilitators and SP’s to help her in her dealings with real patients on the floor.  She commented that many of her peers felt that their experience of working hands-on with SPs was the highlight of their medical school training.  As an Educator working with the CLSC, I could not wish for better feedback”.

Evidently, there are numerous benefits involved with using SPs to train new students. The unique features of SP encounters and relevant feedback help to enhance and maintain the high quality of health care that is currently being delivered.  

To increase the perception of realism, we often re-create clinical environments, such as a doctor’s office or emergency room, in order to immerse both the learners and the SP in the experience.  In addition, we often combine SP’s with inanimate simulators (also known as a fake body part), enabling the learners to attempt invasive procedures, such as suturing (see photo) without harming the SP.  This is known as hybrid simulation and allows us to address many learning objectives, such as showing compassion, taking history and performing a psychomotor skill, all at once. 

Another interactive station offered to the participants during the recent campaign launch  was the chance to insert needles into simulated patient’s necks!  This station was led by Dr. Andrew Smith, one of the leading innovators within the Faculty of Medicine.

Dr. Smith:

Pictured is Dr. Smith demonstrating an ultrasound assisted intravenous procedure

“…..skills training using simulation and ultrasound is improving patient safety one line at a time”.

“The philosophy of “see one, do one, teach one” is still the most common means by which most medical students and residents learn to perform procedures such as placement of central venous catheters, even though serious concerns have been raised regarding this approach. Traditionally, these specialized catheters have been placed blindly. There is clear evidence that the use of ultrasound decreases number of attempts, increases success rates and decreases complication rates when used to guide central line placement. Incorporating simulation into training programs is another mechanism to improve patient safety by developing resident comfort and skill prior to placing lines in clinical practice. The benefits to health authorities are also quite substantial. A formal training program provides a mechanism to train residents in the evidence-based infection control practices along with other quality initiatives.

It is estimated that catheter-related blood stream infections (CR-BSI) result in system costs of $7,000 - $18,000 while increasing patient length of stay in hospital. Formal training along with other infection control practices has been shown to decrease the rate of CR-BSI. Skills training using simulation and ultrasound is improving patient safety one line at a time”.

As a potential patient, hearing Dr. Smith talk about having to insert sharp objects into my neck or arm blindly truly emphasizes the benefits of being able to use ultrasound guided approaches.  This is no longer really an option but more so a standard of practice and we should all exercise the right to request a health care provider who is well trained in these novel approaches.

If simulation is one of the pathways to training competent heath care professionals, we should spare no efforts in making sure we have all the necessary resources and infrastructure to achieve our training goals.

Finally, many students and volunteers also took part in our simulation stations (Kerry-Lynn Williams, Cody Dunne, Emily Moores, Ben Ryan, Kristopher Hoover, Megan Pollard, Tate Skinner. We have asked Kerry-Lynn Williams, a medical student, what simulation offers to her development:

Kerry-Lynn:

“For most of us medical students, when starting out in medical school, it is the first time we are on the other side of a clinical encounter. Along with all the new information comes a plethora of new skills to learn, and often the learning is done on each other or on patients. Thankfully, here at Memorial University, simulation helps bridge that gap. 

I am a medical student about to start clerkship, and I have been involved with the Tuckamore Simulation Research Collaborative since my first year. Simulation has been, and will continue to be integrated in all aspects of our curriculum - communicating with patients, practicing physical exams, mock codes and trauma codes. 

Simulation provides a valuable opportunity to practice and learn in a safe environment with no risk to patients. It helps us build confidence in our new skills and knowledge, and provides us with a means to practice these skills. This allows us, when transitioning back to the clinical encounter, to focus on patient-centered care, not worrying if our technical skills are up to par, because through simulation and practice, we know they are”.

Kerry-Lynn’s words echo the words of those involved in running simulations (Jacqueline Turner) and of those involved in designing simulations (Dr. Smith).

All in all, simulation, as an educational tool is here to stay.  It is no longer an option or luxury, it is a necessary part of the training, and lifelong maintenance of skills, knowledge and attitudes of all involved in the health care sector.  Increasingly, it is also becoming part of quality improvement and patient safety initiatives. 

In saying that, it’s important to note that simulation is an expensive educational tool. Therefore, we need to ensure that as academics, we exercise every effort to use this tool appropriately.  We need to be sure we “use the right tool for the right job”.  For example, when we teach students how to insert needles, we use low cost simulators that are built to withstand many pokes and pricks.  When we teach communication skills, we employ our Standardized Patients.  When we teach elements of health care team behavior, we use highly sophisticated mannequins. 

But, despite the best efforts, equipment still breaks. It has an “expiry date” and needs to be replaced sooner or later.  As an academic director of the Clinical Learning and Simulation Centre here at the Memorial University, I am extremely happy that the importance of simulation in the educational process, as well as some of the barriers to simulation, have been recognized and are currently an area of focus for the “Building A Healthy Tomorrow”^TM fundraising campaign for Memorial University’s Faculty of Medicine.