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Thriving together

Simulation collaboration combines forces to improve rural health care

special feature: COASTS

Part of a special feature showcasing Memorial's leadership and expertise in cold ocean and Arctic science, technology and society (COASTS).

By Susan Flanagan

Imagine a crew member is working on the deck of a cruise ship in remote Antarctic waters.

Seas are rough and he is thrown overboard. Luckily, the man is rescued from the frigid water, but his life is still in danger.

He requires treatment on board by the ship’s doctor who, due to the remoteness of their location, is the only person available to assist. What steps must the captain and ship’s doctor take together to ensure the safety of the patient?

From left, medical students Sabrina Alani, Desmond Whalen (behind), and Chris Harty inside a simulated helicopter working on a simulated patient who is injured and needs to be evacuated from an oil platform.
From left, medical students Sabrina Alani, Desmond Whalen (behind), and Chris Harty inside a simulated helicopter working on a simulated patient who is injured and needs to be evacuated from an oil platform.
Photo: Submitted

This scenario, and about 40 others, was developed during the past two years by the Tuckamore Simulation and Scholarship Research Collaborative.

The Memorial University initiative supports research activities using simulation, or, replication of a task or an event for the purpose of education as well as assessment.

The Tuckamore Collaborative

“The Tuckamore Collaborative functions by the same principles that spruce and balsam trees use to thrive together as tuckamore does in harsh climates,” said Dr. Adam Dubrowski, a professor in the Faculty of Medicine, founder and co-chair of Tuckamore, and academic director of Memorial’s Clinical Learning and Simulation Centre (CLSC).

“At Tuckamore, we conduct research to build best practices in how use innovative simulation technology to assist doctors and other health professionals in rural areas to keep up with best skills.”

Immersive experience

For the cruise ship situation, several units from within the Faculty of Medicine teamed up with researchers at the Marine Institute to produce a man overboard scenario with rescue at sea.

The scenario was developed by the team and then filmed for educational purposes using one of the Marine Institute’s Offshore Safety and Survival Centre (OSSC) faculty members in its environmental theatre, which simulates ocean waves, rain, wind, lighting conditions and sounds.

“The rescued “patient” is resuscitated aboard the cruise ship in its infirmary.” — Dr. Adam Dubrowski

It provides an immersive environment for training of maritime personnel, but also for conducting research into human and equipment performance for different maritime and offshore emergency scenarios.

Adam Dubrowski (FoM) and Rob Brown (MI) - at the control station
Dr. Adam Dubrowski and Rob Brown at the simulation control station.
Photo: Submitted

“The rescued “patient” is resuscitated aboard the cruise ship in its infirmary,” explained Dr. Dubrowski. “The health-care professional (potential trainee) uses the OSSC simulation laboratory to demonstrate the different steps required to move the patient from the water to the infirmary.”

Then, at the Marine Institute’s Centre for Marine Simulation, the simulation is further developed using a full mission simulator of a ship’s bridge to converse with the captain in order to discuss the patient’s condition and logistics and challenges of patient evacuation in heavy weather.

‘Full appreciation’

“This collaboration has provided us with a great opportunity to develop new educational scenarios for training of health-care professionals who may not have a full appreciation for the nature of shipboard operations and the limitations this sometimes places on them,” said Dr. Rob Brown, a research scientist at the OSSC who has been studying human and equipment performance in maritime emergencies since 2003.

Not only are these scenarios available to doctors in rural areas of this province, but they are freely available to anyone on a world-wide web-based journal called Cureus, which shares peer-reviewed, Pubmed and Medline indexed papers.


Dr. Dubrowski has partnered with Cureus to create a channel called ASSET (Archives of Simulation Scholarship and Educational Technologies), which is a repository of simulation teaching and learning tools, along with research supporting their best use.

Visit the Cureus website and search ASSET channel to find Trauma and Hypothermia in Antarctica: An Emergency Medicine Marine Simulation Scenario.

“There are two parts to using simulation as a teaching tool: technology and scenarios. The scenarios are like scripts for a screenplay, where the learner is the main actor,” Dr. Dubrowski said.

The aim is to create simulating events when health-care providers have to perform high-stake, low-accordance skills.

“We hope to cut down duplication of efforts.” — Dr. Adam Dubrowski

The Tuckamore scenarios, many of which include videos, are hosted on Cureus, and although they are contextualized to rural and remote environments, such as Newfoundland and Labrador, the group does work with researchers and educators from other parts of Canada, as well as Singapore, Malawi and Haiti to publish their work.

“Therefore, our Cureus channel offers the scenarios to other institutions that may already have the simulation technology but not the scenarios,” Dr. Dubrowski said.

“In doing so, we hope to cut down duplication of efforts and because the papers describing the scenarios are peer-reviewed, we hope that the educational and clinical quality of the scenarios will improve.”


Cureus: ASSET

Clinical Learning and Simulation Centre

Human Experiential Learning, Performance and Safety Lab

Marine Institute’s Offshore Safety and Survival Centre

Marine Institute’s Centre for Marine Simulation

This story first appeared in the July 31, 2017, edition of The Telegram as part of a regular summer series on research at Memorial University.

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