At the Touro College of Osteopathic Medicine we have a robust program for training and assessment that incorporates many different simulation modalities. Dr. Joyce Brown and I have presented at the International Medical Simulation in Healthcare Conference, IMSH for the past three years, The American Association of Colleges of Osteopathic Medicine for the past three years and received a commendation for the simulation lab from the American Osteopathic Association-Committee on Accreditation. I chair the EMS Affinity Group for the Society in Simulation in Healthcare and have won the Excellence in Simulation award from iSimulate.  Our on-campus Simulation Club does community service by teaching Stop The Bleed and Hands-Only CPR events. 

The definition of simulation is “a technique that creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions” (SSIH Dictionary, 2020). Simulation can include many different modalities such as task trainers (anatomically correct model to learn procedures), standardized patients (actors), high fidelity robotic manikins (lifelike robots), environmental enhancements (sound, light, smells) and digital software.  

When using simulation as part of education it is imperative to match the appropriate simulation modality with educational objectives. For instance, if your goal is to teach the specific skill of starting an IV, a task trainer would be appropriate. This allows the student to focus on the specific skill while not needing to assess the patient or work on other skills. If your goal is to have students assess a patient for a specific condition and treat that condition, a high-fidelity robotic manikin which can mimic that condition would be appropriate. 

It is important that simulation be conducted correctly and that a safe learning space be maintained for participants to get the best educational outcomes. Simulation educators are typically certified by the Society for Simulation in Healthcare as Certified Healthcare Simulation Educators. This ensures a level of competency in simulation education, modalities, educational androgogy, debriefing and often technical abilities. 

At TouroCOM Middletown, our first-year students learn how to take vital signs on task trainers, assess lung and heart sounds on manikins and perform eye, ear and pelvic exams.  Our first- and second-year students take high stakes exams called OSCE’s (Objective Structured Clinical Exams) on our standardized patients. At times we use a hybrid model where students examine our standardized patients and perform a specific exam on a task trainer. This allows students to demonstrate various skills they have learned. We also have a medical simulation course for our second-year students to develop clinical decision-making skills by assessing and treating a patient (high fidelity robotic manikin). We have the students in groups of six with one faculty member, and they work through the case and debrief, a formal, collaborative, reflective process within the simulation learning activity (SSIH Dictionary, 2020), afterwards. This helps them prepare for their third-year rotations with actual patients. 

During the pandemic we had to adjust and teach remotely which was quite challenging for teaching specific skills and doing cases. We lectured over Zoom with a larger group but had a one to six ratio for skills. To enable the best view, faculty used document cameras or a second camera to focus on the skill, so the students could see them performing the skill. We used plastic needles, thread and burlap to practice suturing skills. Students did a no-contact pick up of materials so they could practice with the faculty. We also used a PowerPoint slide where we could show the manikin wearing an oxygen mask, having an IV, with their eyes open or closed. In addition, we displayed the patient monitor during the case, so the students had the vital signs. We found students did well with the skills, and when we were able to be back on campus and do a boot camp, the students were able to learn more advanced suturing because they learned the skill so well online. Also, in ACLS, the communication and teamwork were improved from previous classes. We are attributing this to the Zoom cases online, because only one student could speak at a time. 

There are various software programs that allow students to practice specific skills and communication.  We used SimTics for IV skills. We had positive results when students practiced on task trainers during the boot camp. In summary, simulation is a powerful educational tool. It is important to use the appropriate modality for the objectives and build students’ skills before putting them in an advanced situation such as cases. 

Notes:

Simulation Dictionary 

Webinar by Dr. Joyce Brown and Kelly Kohler on Using Simulation/Digital Skills to Teach Clinical Skills (hosted by Wolters-Kluwer Publishing).