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Simulation to revolutionalise medical education at MUNI

The MU Faculty of Medicine is about to finish the construction of a new building, which will open its doors to first-year students of General Medicine and Dentistry this autumn.

Advanced patient simulator SimMan 3G to help students practice decision-making in clinical situations.

The Simulation Center (SIMU), complete with a simulation hospital, will bring about a massive transformation in medical education and stands out in comparison to other European countries.

The new five-storey building, which is expanding rapidly on the eastern edge of the MU campus in Bohunice, will be unique in many respects. “The sheer scale of the undertaking, with almost 8,000 square metres of usable floor area dedicated to simulation training, makes this one of the largest simulation centres in Europe. The centre will boast cutting-edge medical trainers and patient manikins as well as ‘virtual patients’, which are low-fidelity simulators created by computer algorithms, and it will be a remarkable facility at a global level,” says Petr Štourač, the director of SIMU at the MU Faculty of Medicine.

The Faculty of Medicine has been considering a major overhaul of its approach to teaching for several years. “Our main focus was to enhance student training in hospitals. While hospital internships are compulsory, they have their limitations. The average period of hospitalisation is getting shorter and patients are increasingly unwilling to participate in medical student training. This means that students are much less likely to encounter someone with a specific diagnosis or observe the whole process of providing care to that patient,” says Štourač when explaining one of the reasons why education is becoming increasingly focused on simulation.

The new trend also addresses the stricter standards for patient safety and aims to give students a thorough hands-on-training, in addition to theory, before they start treating patients. Combined with the boom in IT and advanced materials, these new requirements have given rise to a new medical simulation industry. “While this is a young industry, there has always been a need for this type of training in medicine. The first attempts at practising specific situations in a simulated environment can be traced to the mid-20th century and the first delivery and CPR simulators.

Petr Štourač, the director of SIMU at the MU Faculty of Medicine.

Skills training and team communication

Simulations are designed to help students learn the fundamentals common to all healthcare professions as well as highly specialised procedures, such as unusual diagnoses and interventions. Far from being a new-fangled way of memorising information, they are designed to test and improve students’ practical skills. Furthermore, simulation education helps students build 21st-century competencies, such as analysing the information available and using it in communication and teamwork.

Simulation Centre (SIMU)

The new facilities will comprise the full range of simulation techniques from seemingly simple low-fidelity computer simulations, also called “virtual patients”, and trainers for practising manual skills to advanced patient simulators that can display reactions mimicking those of the human body.

Virtual patients are designed primarily to help students practice decision-making in clinical situations. As Štourač explains: “They are essentially algorithms for decision-making where students have to decide what to do and how to proceed. The MU Faculty of Medicine currently houses one of the largest collections of virtual patients in the world, including 125 for acute medicine and several dozen more complex algorithms for pharmacology, psychiatry, internal medicine and other disciplines. These are all available in Czech, Slovak and English.”

Trainers will be used to practice essential skills such as suturing, airway management and laparoscopic procedures.

The most advanced types of patient simulators can react to healthcare interventions, such as drug administration, in the same way as the human body reacts. They can display the body’s physiological functions, such as sweating or turning blue due to asphyxia and they can also talk to the students. Experts say it is important for future physicians and dentists to be able to practice and drill both routine and uncommon procedures on simulators before they proceed to treating patients.

CPR training

More objective student evaluation

SIMU will bring about a marked change not only for the students but also for the teachers at the Faculty of Medicine, who have completed numerous training courses in the past months: “Our teachers need to acquire the necessary skills to be able to tailor the form of instruction to each simulation and have been undergoing training led by experts from other countries and by our teachers who are already experienced in using simulations,” says SIMU Director Petr Štourač when explaining one of the most important aspects of the project.

In addition, the teachers are preparing for a new way of evaluating student performance. Students will complete sophisticated three-hour lessons that will be supervised by the modern technology of the Simulation Centre as well as by their teachers. “This will enable us to see how the students work and behave and their strengths and weaknesses, which will be discussed in the follow-up debriefing interview. In other words, the assessment will not rest solely on the teacher’s opinion but will be grounded in an objective structured clinical evaluation.

Andrea Pokorná, the vice-dean for healthcare study programmes and information technology at the Faculty of Medicine, adds that the new form of instruction will place more demands on both students and teachers, as it goes beyond giving and receiving information in a passive manner: “The teachers will have to devote more energy to drafting their lessons and assembling their teaching aids to be thoroughly prepared, while the students will be expected to have learned the theory required for the intervention they will be practising.”

Bulding in progress in December and visualisation of the finished complex.

Positive feedback

The project included a survey analysing the requirements of GPs and hospital executives to make sure that the skill development focuses on the types of skills that are expected from graduates of the Faculty of Medicine by their future employees. The project team also conducted a survey among fresh graduates from the General Medicine and Dentistry programmes to ask for their feedback.

Both students and teachers who have had experience with some form of simulation education confirm its usefulness and say it gives them confidence. “Most importantly, you can practice specific tasks over and over in an environment where you cannot do any harm,” says Šimon Slavík, a student of General Medicine and Paramedic Practice.

Graduates Tereza Prokopová and Deana Slovjaková had the opportunity to use medical simulators in their emergency medicine course and helped create virtual patients during their studies, and they remain involved in medical simulation. “The potential is huge – there is simply no better way to introduce young doctors to real-life situations in a safe environment where they can practice their reactions. I am currently using simulations when teaching first aid,” says Prokopová.

Laparoscopy training during the Open Day.

Both graduates confirm that simulation training makes physicians and dentists calmer and more confident in real-life situations. According to Slovjaková, “As teachers, we gained valuable experience in creating simulations, communicating with students and conducting debriefing sessions. Being involved in this new way of teaching also makes our job more interesting.”

Simulation is becoming an integral part of teaching the physicians and dentists of the future and is also finding its way into further education. Vice-Dean Andrea Pokorná sums up one of the main benefits of this new trend: “Obviously, a simulator, no matter how sophisticated, cannot replace the interaction with an actual patient. However, it does help students gain more skills and knowledge and overcome the fear of harming someone by making a mistake. They can practice the interventions and learn the risks associated with each of them before they progress on to treating patients.”