Training future clinicians with simulation
On January 29, 2020, the National University of Kharkiv in Ukraine opened a state-of-the-art simulation center. The opening of the Center of Simulation Medicine was part of a series of events celebrating the university’s 215th anniversary. The simulation center will be a part of the School of Medicine and is designed to provide a safe environment in which healthcare students and professionals can learn, practice, and hone clinical skills.
The simulation center encompasses multiple rooms that are supplied with the same equipment found in a modern hospital. Each room represents a different area within a hospital, including an emergency department, a delivery room with neonatal and pediatric units, a surgical operating unit, and an intensive care unit. Learners will learn and practice on highly advanced patient simulators.
According to the President of the university, Vil S. Bakirov, the Center of Simulation Medicine is the first large-scale sim center with state-of-the-art equipment in Ukraine. The sim center will train all the future clinicians who attend the School of Medicine and be open to medical interns, graduate students, scientists, and healthcare professionals.
Integrating simulation into the curriculum
According to the Dean of the School of Medicine, Ihor Belozerov, “The opening of the Simulation Center is a historic event, as it presents unique equipment [patient simulators]. It [simulation] will significantly improve the quality of education of our future physicians”.
Simulation is fully integrated into the School of Medicine’s curriculum. Instead of a few sessions working with the simulators, sessions are planned through the students’ entire academic career. Educators at the sim center will teach practical skills by using patient simulators and skills trainers, including Gaumard’s NOELLE, Pediatric HAL, and Code Blue Newborn.
Learners will be able to use real medical equipment and practice patient care. Time spent working hands-on with the simulators engages learners in experiential learning. This allows them to learn and hone clinical skills, advanced procedures, and teamwork skills before interacting with real patients.
The high-fidelity simulators used in the sim center have many lifelike features and can reproduce various clinical cases. Therefore, learners can apply the knowledge they gained in the classroom and think critically as they undertake a procedure or patient care protocols.
The learners’ interventions will affect the simulator’s vitals. Thus, learners gain an understanding of the consequences of their actions in a safe environment. When a mistake is made, educators provide immediate feedback. Therefore, learners learn how to improve, and then they practice repeatedly.
These simulated sessions help them build experience and hone their skills. The goal is to reduce mistakes that could be costly to real patients. Once the clinicians enter the workforce, they will have the skills needed to provide safe and effective care. Ultimately, the sim center’s work will help Ukrainian medicine meet the standards set by international organizations like the European Resuscitation Council, American College of Surgeons, and the National Association of Emergency Medical Technicians.
Developing obstetric skills with in-situ simulation
During the opening ceremony, attendees saw a labor and delivery scenario play out using the NOELLE patient simulator. Improving obstetric skills is an important mission of the sim center. The World Health Organization (WHO) estimates that every day about 810 women die from preventable complications of pregnancy and childbirth. Moreover, at 19 deaths per 100,000 live births, Ukraine has one of Europe’s highest maternal mortality rates.
When emergency obstetric events occur, clinicians must be well-trained, coordinated, and confident to respond effectively. This is why gaining clinical experience is essential since being prepared positively affects patient outcomes. Simulation allows learners to work on a range of realistic scenarios, from a normal delivery to a rare emergency event.
In the simulated scenario, learners engage in critical thinking, work as a team, and apply practical skills on simulators to acquire that valuable experience. In fact, in 2016, the International Journal of Gynecology and Obstetrics released a study that showed that a group of students who trained on simulators showed “significantly greater accuracy in vaginal examinations” than a group of students who did not train on simulators.
Labor scenarios at the sim center will cover the full cycle of care. Students can use the NOELLE simulator to practice routine obstetric examinations, assist in delivery, practice postpartum care procedures, and learn newborn care skills using the Code Blue Newborn simulator.
As the students practice on the simulator, they also become comfortable working in a clinical environment and learn its protocols before entering a real delivery room. This helps them build skills safely and reveal gaps in their knowledge. Hence, students can transition easier into a real clinical setting because they know what to expect and can respond effectively.
Moreover, a 2019 study published in the journal Military Medicine found that the use of lower fidelity skill trainers can improve medical residents’ competency in the management of obstetric emergencies like postpartum hemorrhage. Practicing on the skill trainer allows participants to gain knowledge and experience using medical equipment (such as a uterine balloon tamponade), which increases their competency and comfort with that procedure.
The opportunity to practice procedural skills before entering a real clinical setting helps ensure clinicians will be prepared for any emergency event. This is especially important in low-frequency, high-risk events like postpartum hemorrhaging since these events require immediate and accurate action to avoid permanent harm or death. An inexperienced clinician cannot provide the level of care needed to ensure a good outcome.
As a result, students at the sim center will use Obstetric Susie® S500 skill trainers to practice hemorrhage control skills. Simulation-based training allows clinicians to focus on procedural skills, practice them repeatedly, and hone those skills until they become second nature. Thus, when they encounter a real emergency event, they will have the experience needed to provide quick and accurate care.
Training for obstetric emergencies, however rare, will be critical to reducing maternal deaths in Ukraine. Simulation is a safe and effective way of helping clinicians gain the hands-on training and experience needed to improve their skills and processes, resulting in better patient care and outcomes. The Center of Simulation Medicine will provide clinicians with the training they need to make deliveries safer and save lives.
 “Maternal Mortality.” World Health Organization, 19 Sept. 2019, https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.
 “Country Comparison: Maternal Mortality Rate.” Central Intelligence Agency (CIA) World Factbook, 19 Sept. 2019, https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.
 Arias, Tatiana, et al. “A prospective study into the benefits of simulation training in teaching obstetric vaginal examination.” International Journal of Gynecology and Obstetrics, vol. 133, no. 3, 2016, pp. 380-384.
 Lutgendorf, Monica A. & Abigail M. Ramseyer. “Implementation of Low-Cost Obstetric Hemorrhage Simulation Training Models for Resident Education.” Military Medicine, vol. 184, no. 11, 2019, pp. 637-641.