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Practice makes perfect

Simulation bringing real-life experience in safe environment

Teaching and Learning

By Virginia Middleton

Dr. Ainsley Decker is a fourth-year anesthesia resident who knows what it’s like to face critical choices when minutes matter and a patient’s life may be on the line.

To her relief, in the Clinical Learning and Simulation Centre (CLSC) at Memorial University, that patient is sometimes a simulation mannequin who can talk and bleed, but won’t die.

The Faculty of Medicine’s CLSC opened in September 2014 with the official opening of the new Medical Education Centre, an expansion to the medical school. Within the CLSC there are three support units: standardized patient, surgical skills and high-fidelity simulation.

The mission of the CLSC is to provide a state-of-the-art, low-risk learning, teaching and research environment for learners and faculty that simulates real-life, health-care situations in the most resource efficient and effective manner.

Dr. Ainsley Decker, anesthesia resident, in the Clinical Learning and Simulation Centre
Dr. Ainsley Decker, anesthesia resident, in the Clinical Learning and Simulation Centre.
Photo: Terry Upshall, HSIMS

Postgraduate students who are completing a residency in a clinical field of focus are in the final stages of becoming fully licensed physicians. After four extensive years of medical education and training to complete their doctorate of medicine (MD) program, they are building upon that solid foundation with additional skills and a more complex understanding of their medical specialization. It’s during these important years that simulated learning can provide essential experience.

“Simulation puts you in a high- risk situation in a low- risk environment,” said Dr. Decker. “In the Clinical Learning and Simulation Centre, we use high-fidelity mannequins that we can program to simulate any physiological function and display any sort of scenario we would want to simulate.”

Layer of complexity

There is a wide range of mannequins in the CLSC, such as units that can simulate labour and delivery, with the newborn mannequin also having a life-like role. This adds a layer of complexity to a scenario: as the situation will then have two patients who may need urgent medical attention instead of one. One mannequin, Laerdal SimMan 3G, also known as “3G”, has the ability to be moved to different environments, or stay located within the simulation centre where video capture and one-way windows allow for multiple layers of observation and learning.

Dr. Decker explains that simulation is also an important way for residents to learn how to work as a team. This is particularly important during crisis situations, where residents learn how to use their crisis resource management skills.  This usually involves a team leader, who must utilize good listening skills and assign roles to everyone involved so that the crisis can be addressed as quickly as possible.

Preparedness and insight can only come from practising real-life scenarios in a controlled environment. In the CLSC, students have an opportunity to learn, practise and repeat procedures as often as necessary. With the high-fidelity simulation mannequins, a resident’s skills can be refined without compromising patient safety. In real-life situations when confidence and quick decisions are necessary, it’s important to be prepared.

Varying scenarios

During her residency, Dr. Decker has been on the sub-committee for high-fidelity simulation within the Discipline of Anesthesia and has written a number of scenarios. These scenarios are then programmed into the simulation mannequins to replicate real-life situations that are used to teach fellow residents.

Authenticity of the scenarios is important; she believes the more real a situation can look and feel, the better the learning experience will be for participants. A sense of urgency and pressure can help with the learning experience, which in turn, may help deliver life-saving patient care in a future real-life situation. Dr. Decker describes the experience in detail in the following video.

When asked what it feels like to exit a simulation after successfully saving a patient, Dr. Decker says there’s a “huge” sense of relief and says the learning experience continues after the scenario ends.

Simulation teaching and learning doesn’t stop at the postgraduate level. Licensed physicians can also receive continuing medical education, as well as additional training to expand their skills and knowledge. Through technology in the CLSC, it’s possible to create hundreds of different scenarios that will help achieve this learning outcome.



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