12 minute read
ALL POSSIBLE SCENARIOS
from 2024 RCSI Alumni Magazine
by RCSI
With diverse career backgrounds and a wide range of skill sets, the RCSI SIM team work to provide a truly dynamic learning environment.
Since opening in 2017, the RCSI SIM Centre for Simulation Education and Research, a mini-hospital occupying three floors of 26 York Street, has become a hugely important part of the educational experience offered by the university.
One of the largest and most sophisticated medical simulation centres in Europe, with state-of-the-art facilities, RCSI SIM aims to improve patient safety, education and research through immersive and realistic simulation-based learning tools and techniques. By pushing the boundaries of innovation, RCSI provides a next-generation learning environment not just for medical students of the university but also to postgraduate surgical trainees and allied healthcare professionals at every stage of their careers.
RCSI SIM incorporates the National Surgical and Clinical Skills Centre, where professionals and trainees can master their skills in a multi-purpose ‘wet-lab’, surgical simulator suite and fully-functioning operating theatre. Each area is equipped with the latest laparoscopic equipment and an audiovisual technology-enhanced learning system, which connects the simulation-based learning environments with performance assessment tools.
“RCSI has been an innovator in simulation-based education, opening Ireland’s first medical simulation centre in Beaumont Hospital in 2000,” explains Dr Claire Condron (Postgraduate Studies, Class of 2022), Director of Simulation Education at RCSI SIM. “Ever since, simulation has allowed RCSI to optimise educational experiences for our learners.”
A Diverse and Creative Team
With a background in biomedical science and over 20 years’ experience in designing, delivering and evaluating teaching and learning across the healthcare professions, Claire leads a team with a wide variety of career backgrounds and an impressive range of skill sets. Together with health professional educators, they design, develop and fabricate immersive simulation-based learning activities, provide simulation faculty development, and train simulated participants.
Dermot Daly, Head of Operations, is an engineer who has worked in electronics, quality and product engineering, material science and nanotechnology, while Rebecca Kirrane, Senior Skills and Simulation Technician, is a simulation-based learning designer skilled in special effects makeup and moulage, the art of creating fake injuries such as gunshot wounds.
A recent addition to the team, Clinical Skills and Simulation Technician Robyn Mullen is a sculptor, who originally trained as a mortuary technician. Before he joined RCSI SIM, Caoimhín Ó Conghaile, Senior Skills and Simulation Technician, studied theatre, medical device innovation and healthcare innovation and worked in film as a production designer, and as a surgical theatre assistant in St James University Hospital. Another member of the team, Adam Roche, juggles his responsibilities as Senior Simulation Technician with a part-time PhD, exploring simulation initiatives in neurosurgery.
Claire’s area of research interest is understanding the social architecture and scaffolding required to provide authentic experiential learning and practice opportunities to different cohorts of learners. She places the involvement of service users front and centre in the design and delivery of RCSI SIM’s programmes.
“Training is a critical part of our response to equip people with the knowledge, skills and tools required to stay competitive and engaged,” says Claire. “Simulation enhances the range of clinical experiences for our learners and motivates them to realise their full potential and enter healthcare practice competent and prepared.”
With creativity at its core, RCSI SIM draws on the varied skills of its staff to provide a truly dynamic place of learning, an educational facility that’s more akin to live theatre than the dull lecture halls and dusty labs, which were the hallmark of medical education in the past, a place where no two days are ever the same.
Creating Real-Life Scenarios
In essence, RCSI SIM puts on new productions every day, with Claire and her team involved in everything from writing scenarios, to applying stage make-up, making fake skin and tissue, providing costumes and directing simulated patients in their roles. A storage room, which Claire describes as “a Halloween shop” is packed with hundreds of different fake body parts.
On any given day there could be students practising arterial blood gas tests, inserting nasogastric tubes, taking blood pressures calculating early warning scores and administering ECGs. ere could be a major incident re-creation, with opportunities to test out the consequences of different decisions as one might in a video game, a forceps delivery using a state-of-the-art pregnancy manikin, and an upper GI course examining different ways of handling internal bleeds using pig stomachs.
Technology-enhanced simulation training is associated with improved outcomes in patient care, and by mirroring a real hospital environment, RCSI SIM provides ideal learning conditions for practice and rehearsal to enable the development of skills. Working with high-fidelity patient simulators in the fields of emergency medicine, surgery, paediatrics, obstetrics and gynaecology, neurology, anaesthesia, nursing and other clinical specialties, students and healthcare professionals can practise and re ne their skills in a safe, controlled, and immersive environment.
High-Stakes Training
But it’s not just about mastering clinical skills in a safe learning environment before working directly with patients. By focusing on the development of other key skills such as dynamic decision-making, teamwork, communication and professionalism, RCSI SIM enables healthcare professionals to develop character, build resilience and hone leadership skills to equip them to be able to handle any situation which might arise during the course of their career with confidence and competence.
Moreover, creating high-risk or rare procedures in a simulated setting allows for education and training where it may not be feasible to gain experience through direct patient care. Simulation can also be used for high-stakes training, such as emergency response or disaster preparedness.
“Our goal is to recreate realistic clinical scenarios that are difficult to replicate in real-world settings, and to systematically study and debrief the impact of different interventions on patient outcomes,” explains Claire.
Simulation scenarios include critical actions in both clinical management and communication skills. Students are each assigned roles and guided through scenarios designed to address complex issues, such as end-of-life concerns, informed consent and disclosure of medical errors. Each simulation space allows for multi-angle video capture to enable participants to reflect on their performance independently and in an interactive debriefing session with others following the simulation scenario.
Simulated Patients
If Claire and her team are the director, producer and backstage crew, then the simulated patients are the ones who bring each performance to life. RCSI has a panel of over 100 simulated patients on whom it can call, and their profile reflects the diversity of the patient population and contemporary Irish society. The use of simulated patients is a proven method for helping learners gain skills and confidence in communicating, interviewing, physical examination, counselling and patient management in a low-risk environment. A mix of professional actors and members of the public, many of them retired doctors, the simulated patients are commonly engaged to simulate a wide range of scenarios, from routine medical check-ups to complex medical emergencies and trained to accurately and consistently portray a specific set of symptoms or medical conditions. The patient lounge operates as a green room, where the simulated patients can rehearse their lines. They also provide feedback on student performance.
Scene Setting
The third oor of the building functions as a GP surgery or out-patient clinic. Rebecca describes it as “OSCE Central” during exam season with medical students interacting with simulated patients to take a history, break bad news or practise other communication or practical skills. Each of the ten rooms is equipped with audiovisual equipment so students can watch themselves afterwards and reflect back on how they did.
Up on the fourth floor, the stakes are higher. One recent scenario played out in the operating theatre involved a patient being given the wrong medication by the anaesthetist and remaining awake when the surgeons arrived; another saw a patient having given consent to surgery on the left knee, but it was the right knee that had been marked up. In some situations, for example when a simulated patient is known to be a Jehovah’s Witness but has not refused blood products prior to collapse, there are no black and white answers.
“Some of the scenarios are very complex,” explains Rebecca. “For MASCOT (Multidisciplinary Anaesthesia Surgery Crisis Operation Training) the cases tend to be unusual. These are for people who are already working in a hospital who are coming to us to learn about things that they wouldn’t see every day. The scenario might take 20 minutes here, but they’ll do a debrief, which could take an hour or longer. So they learn afterwards as well; it’s not just in the moment. Traumatic cases are supposed to be debriefed in the hospital, but we know it doesn’t happen all the time. And so that’s why sometimes when they open up the can of worms here it can be upsetting and the trainees get quite emotional. For these days we have Professor Eva Doherty or another psychologist on site to address human factors.”
Innovation to Optimise Patient Care
“Simulation is an effective decision-making tool that provides understanding of the complexities involved in healthcare service provision,” says Claire. “By integrating research with teaching, we aim to provide the model for practice development and health systems research to optimise patient care pathways.”
RCSI SIM’s Innovation Lab is a hub for the simulation-based community to develop and explore new ideas with faculty, researchers, educators, students and simulated patients.
“We spent quite a lot of time here building every kind of model you can think of, from teeth to eyes to jaws,” explains Rebecca. “It’s much more cost effective to make our own than buy these things in.”
Creating fake skin out of latex and leather is one job, with the team striving for ever better hepatic characteristics. And given that this year’s graduating class come from more than 90 different countries, it’s important to have a diverse range of skin tones.
“We’re doing quite a lot of projects around bruising and what bruising looks like on different coloured skin,” says Rebecca. “The way I bruise having blue-white skin is quite different to how a darker skin would bruise. So students learning all about me and my skin and then going back to their home countries where skin might show different symptoms would not be the best training.”
3D printing and wearable simulation technology to teach skills such as cannulation are becoming ever more important, and students learn skills such as suturing through repeated practice. Manikins come with heart and lung sounds that students can listen to with a stethoscope, and increasingly are compatible with an ultrasound probe. There’s a €60,000 electronic baby that Claire says is “sophisticated in that it can bend at the knee and arm, go into seizure and has a very lifelike fontanelle, but is very easy to break.”
The lab works to create bespoke physical simulation models, which can be modified and improved after simulation testing. They are then assessed for their impact on learning outcomes and integration into teaching programmes. Simulation science within the innovation lab facilitates networking, knowledge transfer, interdisciplinary collaborations and mentoring, and helps to bridge the gap between simulation research and clinical practice.
Students can undertake a six-week research project of their choice and recently, student Tom Redmond, working with Senior Technician Adam Roche, created a retrosigmoid craniotomy model that he has tested at Beaumont Hospital with consultant neurosurgeon Mr Gulam Zilani. This was the second design-based evaluation of this model, which also simulates microvascular decompression of the trigeminal nerve. The model is taking shape, with one further design phase to go before it’s ready to be used in training.
Outreach and Collaboration
RCSI SIM has been involved in numerous outreach events over the years. Every year, the Centre welcomes hundreds of secondary school students as part of the Transition Year MiniMed programme, Undergraduate Open Day and other events. ACCESS learners participate in the Creative Arts Summer School with National College of Art and Design, and members of the public are welcomed on European Researchers’ Night, Culture Night and various open events throughout the year.
The Centre collaborates with higher education institutions, industry partners and professional training bodies to adapt experiential simulation-based learning to their needs. The ongoing collaboration with Dublin Fire Brigade, an early adopter of RCSI’s facilities and technology, delivers paramedic training, particularly in the area of obstetrics.
RCSI SIM also collaborates nationally and internationally with clinical specialties and industry, including leading simulation technology companies and medical equipment manufacturers, in designing courses, practical execution and assessments.
With such a wide range of activities ongoing, RCSI SIM is one of the most dynamic and exciting parts of the university
“It is,” says Dermot, “an incredibly stimulating place to work. RCSI SIM brings people from lots of different backgrounds and disciplines together and the way we come up with ideas collaboratively is fascinating.” ■
