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

Disclosure/Disclaminer � Nothing to disclosure

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.

WHAT IS SIMULATION?

WHAT IS SIMULATION?

� 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

Why should we adopt simulation in our practice?

Simulation Simulation Simulation

� 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

Diversity of Asia

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

DIVERSITY

STRENGTH WEAKNESS

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

What do you see? Old lady Young Lady Something else

What are the challenges for healthcare simulation in Asia?

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

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

Buy-in

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

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.

Basic infrastructure � Skill labs

� Simulation centers

Airway & Breathing Skill Lab

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 ……………………………..

It depends. You need to decide it

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

What are the challenges for healthcare simulation in Asia?

See you all again soon.

Thank you, Terimakasih, Sei Sei, Syukran, Nanri vannakum, Salamat, Arigato gozaimas, gomabseubnida ( ) K̄hx k̄hxbkhuṇ(ขอขอบคุณ ขอขอบคุณ) cè-zù tin-ba-deh, Cam on