Challenges to simulation in Asia
Prof Dr Ismail Mohd Saiboon MBBS. MS (Orth&Trauma), Emerg. Med (NSR)
Professor & Senior Consultant in Emergency Physician Simulation Educator
UKMMC
Content � Introduction to simulation
� What does simulation mean to you?
� Diversity in Asia
� The challenges to simulation in Asia
Introduction � Simulation is the imitation or representation of one act or
system by another
� Similar definition but meant differently to different people.
� ALL ARE RIGHT!!!
� Need everybody to be on the same wave-length.
� Has grown tremendously all around the world and one of the tool adopt in healthcare education.
Types of simulation � 5 types of simulation
� Verbal- role playing � SPs- actors � Part-task Trainers- anatomic body part task focus � Computer patient- interactive and may be software-based
or part of an Internet-based virtual world. � Electronic patient- mannequin, VR-based with
reapplication of clinical environment
� Cooper JB, Taqueti VR. A brief history of the development of mannequin simulators for clinical education and training. Qual Saf Health Care 2004;13:11-8.
David Gaba
� Knowledge can be obtained to classroom or self-directed study and tested through traditional methods.
� Performance (acute clinical decision making, and psychomotor skill) might not be adequately assessed with written or oral test.
� Exposure to all kind of cases during the training years might not be adequate. � Limitation and selectivity of the cases. � Bridging the gap
What is the evidence for effective simulation
� Simulation is an effective training tool for skills such as task performance, error reduction, reduce training time and decrease response time. (McLaughlin S et al. Acad Emerg Med 2008; 15 (11): 1117-1129
Team performance and medical technical skill may be significantly improved after multiprofessional obstetric team
training in medical simulation
� 31 subjects 4th medical student � 1 week course on acute care � Randomization to SIM vs PBL � Investigator blinded � Management of dyspnoea � Initial results score : SIM vs PBL ( 0.47 vs 0.44;
p=0.64) � Final results score: SIM vs PBL (0.72 vs 0.53; p <
.0001)
Simulation-based training is superior to problem-based learning for acquisition of critical assessment and management skills
Randolph H Steadman et al: Crit care Med 2006 Vol. 34 No 1. 151-157.
Simulation-based training is superior to problem-based learning for acquisition of critical assessment and management skills
Asian race, culture and country � Asia is very big & made of 48 countries (half of Russia
and Turkey)
� Great Diversity of culture, language, nationalities, ethic, values, belief system.
� Multi-Religion
� Rate of development: rich– middle – poor.
� Challenging yet interesting
Issue raise � Communication
� Language different - Misunderstand of the command given � Talking styles � Being direct in asking questions
� Values- � Each culture or even individual within the same culture have different
values � E.g. someone do it in a jovial manner, other take it as the person not
serious � Joke that was misunderstood
� Religion/Belief system � Gesture- taboo of certain gesture . � Food. � Social system
Challenges to Healthcare Simulation in Asia
1. Human Resource- simulation expert & simulation technologist/
technician
2. Buy-in
3. Standardized curriculum & accreditation for simulation
4. Financial
5. Time
6. Infrastructure
7. Support- institutional/ peers group
8. Language
9. Research in SBME
10. Rules @ guidelines
Simulation expert � We still lack people that are expert in simulation
� Subject matter expert, knows about simulators uses, limitation
� Create good scenarios
� ‘On-the-fly vs pre-programmed
� Able to teach well using simulation
� Able to maximize the use of a simulation to the fullest
� Road Ahead: Simulation as a specialty & build bridges
Simulation technologist � We need more sim-tech
� They operate the simulators very well
� Able to manage the simulation center in term of the technical inputs.
� Able to create or programmed the scenarios
� Road Ahead: Career pathway for sim-tech
Colleague buy-in � Educators are used to existing practice of teaching- lectures, tutorial
� Switching to simulation�? Reservation
� New tool too complicated
� Senior- no confidence in simulation
� Stick to old thinking and ways
� Need to ask the question why?
� People ask for proof but no one ask for proof of the effectiveness in the old ways.
� Road ahead: Build friends and network, Roadshow
Standardized curriculum � No standardized curriculum yet for learning simulation.
� Most did it through self-learned (D-I-Y) or attending courses, seminar or workshops.
� No standardization from one workshop to one workshop or centers to the next even with-in one country.
� Is it simulator operator-based vs academic-based?
� Road Ahead: Need formulate standardized curriculum
Financial source � Very important but limited
� Equipments generally expensive
� Need to show its worth
� Grants?
� Sponsors
� Road Ahead: To have long term planned for the use of simulation
Time � Most are part timers, even the sim-tech.
� No protected teaching time.
� Juggle between clinical hours, research hours, university activities.
� In Malaysia, difficult to survives if only operates a simulation centre.
� Road ahead: Acknowledgement, Protection, Respect, Carrier.
Clinical simulation centers � What are the basic instruments to be in a simulation
room?
� Space?
� Basic facilities: � Camera, � Microphone, Speakers, � Projector, White screen � Simulation equipments- simulator, resus trolley,
screen, monitors, patients trolley, cardiac table, telephone, etc
Equipment's and facilities � “Simulation is a technique and not technology”
� Not vital to buy all the fancy stuff
� Good to have buy a do without
� Need to be innovative and creative
� Avoid ‘ceremonial simulation’
� Buy what you really need to use
� Road ahead: Better understanding of simulation
Equipment fidelity � Challenge to manufacturer and also simulation specialist
� Creating a situation or simulation that is really high in fidelity
� Most patient - don t just lie down and look stiff
� Reality of life is motion, and you need to simulate life but in a safe manner. – hybrid, new simulator, hologram
� Road Ahead: R&D and collaboration between user & manufacturer
Simulation language � Need to standardized the sim-lingo
� On-the-fly
� Forcing function
� Alpha testing
� Beta testing
� Debriefing and meta-debriefing
� Orientation, Scenario
� Road Ahead: Glossary of simulation
Support � Institutional support � Dean � Director
�Peer-group support � Society- SSH, PASSH, MaSSH � Specialty interest group
Research in healthcare simulation
� Still a lot of untapped areas
� Opportunity to explore
� Evidence based simulation practice
� Journal for simulation
� Main thing for progress in SBME
� Road Ahead: Increase research in simulation and collaborated
Rules and regulation in simulation
� Do we want to have it?
� What about in-situ simulations/drills that might disrupt the real thing?
� Having expired drug in our simulation lab. What if emergency happened in the simulation lab?
� Something to think about?
How to overcome these challenges
� ?Just used import everything from the west
� ?Create our own
� Selective and modify
� The answer is ……………………………..
Conclusion � Simulation in healthcare is one of the better tool in
teaching.
� The are many challenges to simulation but it is an opportunity for the simulation in healthcare to be better organized and mature.
� Challenges = Corporate, Collaborate, Common goal
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