How Simulation-Based Learning Can Enhance Resilient Healthcare Training and Services in Low-Resource Settings

Updated on: August 27, 2024

How Simulation-Based Learning Can Enhance Resilient Healthcare Training and Services in Low-Resource Settings

How simulation based learning can aid resilient health care trainings & services in low resource settings

Imagine you receive a surprise offer for a free 5-day trip to Goa---exciting, right? But what if I told you that the flight you'll be taking is the pilot's first ever, and that the pilot was trained during the COVID era? Suddenly, our excitement fades because we all value our lives. But when it comes to hospital setting, students who are novice and not fully trained are practicing on patients which can leads to medical errors.


The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the World Health Organization (WHO) has estimated that medical errors happen in 1 out of 10 patients every year globally but according to Harvard Study conducted by Prof. Jha revealed that 5.2 million medical errors happen annually in India and among that, medication and hospital-acquired infection errors are the major ones. The chances of having these errors can be more in low resource settings.


A comprehensive review done by Saud H and Chen R Found that competency --based education has the potential to be a more effective framework than conventional educational strategies in terms of achieving outcome including decreasing medical error, updations on emerging technological innovation in healthcare environment , growing awareness of patients and efforts to enhance patient's satisfaction which will help student to gain confidence, competence and satisfaction leading to better clinical outcome.


  • The impact of low-resource settings both in terms of education facilities and hospitals in India is profound and multifaceted, contributing to higher morbidity and mortality rates, particularly among vulnerable populations such as women, children, and the elderly. Addressing these challenges requires concerted efforts to improve healthcare infrastructure, enhance access to care, increase health literacy, and ensure that basic health services are available to all, regardless of geographical or economic barriers. Simulation based education is one of the best competency --based education methodology which help us achieve all these outcome. In India, the state of the art facility which exclusively focuses on learning through simulation based education is National Reference Simulation Centre (NRSC).

The National Reference Simulation Centre, SGT University, is established in the year 2018 in the tetrapartite collaboration with Indian Nursing Council (INC), John Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) funded by USAID, Laerdal Medical India, a Norway based company and Shree Guru Gobind Singh Tricentenary University (SGT), Gurugram. It is the Asia's First referral center which is well equipped, actively utilized and designed to cover the inter-professional education in nursing, medical and paramedical through skill and Simulation Based Education especially, where there is lack of resources in term of hospitals and patients. High, medium and low fidelity manikins are used in artificial representation of a real-world process, which makes the learners competent and confident to encounter the actual patients in any situation without making errors which they made during simulation session. Simulation based training shows various features, which will help the learners in their learning process at low resource setting includes:


Simulation Based Education (SBE) allows healthcare providers to practice critical skills in a controlled environment without putting patients at risk. This is especially important in resource-limited settings where there may be limited opportunities to practice on real patients. Studies have shown that a simulated environment enables repeated learning and re-learning, which helps correct mistakes and allows trainees to perfect procedures and refine skills, ultimately improving clinical outcomes. Lateef F. (2010). Simulation-based learning: Just like the real thing. Journal of emergencies, trauma, and shock, 3(4), 348--352. https://doi.org/10.4103/0974-2700.70743. At NRSC, students are getting trained in safe environment which replicate the real life scenarios in terms of infrastructure and well trained internationally certified facilitators, helps the student to learn through experiential and reflective learning in a good-judgmental way.



At NRSC, we have trained various number of students till date and its increasing day to day as students are regularly posted there as part of their curriculum.


  • Repetitive Practice: Providers can repeatedly practice procedures, which helps to build confidence and competence, leading to better patient care when these skills are applied in real-life scenarios. Simulation is an outstanding learning method and environment where skills can be practiced repeatedly, with increasing difficulty, under the guidance of an instructor or facilitators who make students reflective about their actions and performances. It also offers time for reflection and minimizes the risks associated with medical errors and patient harm. Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005 Jan;27(1):10-28. [PubMed].

NRSC provided opportunities to students to practice skill repeatedly on low, medium and high fidelity task trainers or manikins without the fear of errors, which will improve their psychomotor skills which is crucial for providing care on real patient. During simulation session after the debriefing students learn how to manage patient efficiently by changing their frame of mind through reflections, then they will practice those learnings repeatedly until they feel confident and competent to manage real patients.


The impact of simulation-based education is best reflected in the experiences of our students. Here's what some of them have to say about their training at NRSC:


"The simulation sessions at NRSC have been a game-changer for my medical training. The opportunity to practice emergency procedures and patient management in a controlled setting has not only improved my technical skills but also enhanced my ability to make quick decisions under pressure. I feel much more confident in my clinical rotations now." -- Palak Singhal, 4th Year M.B.B.S


"The hands-on experience at NRSC has been incredibly valuable. The realistic scenarios allowed me to practice complex procedures in a safe environment, which has greatly boosted my confidence. I feel much more prepared to handle real-life situations in the hospital now." - Kanika Sharma, 2nd Year BSc Nursing


  • Resource Adaptation When setting up simulation programs in limited-resource settings (LRS), it's crucial to consider factors such as the integration of cultural and linguistic elements, scalability, sustainability, and collaboration with local in-country stakeholders. https://link.springer.com/chapter/10.1007/978-3-319-24187-6_25#citeas. It will only be through continued curriculum development, rigorous program evaluation and faculty training. At NRSC, 6 days TOT ( Training of trainers ) training is regularly conducted every month which is sponsored by Indian Nursing Council where faculties of nursing colleges across India are enrolling and getting trained. Through this training, faculty members trained student by using their available resources to make them confident, competent and future ready. Till now NRSC has trained 830 faculties across India.

Faculty members who are trained through these trainings at NRSC play a crucial role in delivering high-quality simulation-based education at their respective institutes. Here's what they think about the effectiveness of this approach:


"Participating in the simulation training was an eye-opening experience. The realistic scenarios provided me an invaluable opportunity to apply theoretical knowledge in a controlled, risk-free environment. The hands-on approach allowed me to practice complex processes in a safe and regulated environment. The trainers were extremely knowledgeable and provided personalized criticism which greatly improve my skills, after each session I felt more confident .I would recommend National Reference Simulation Centre SGT University to faculty members from Nursing , Medical and paramedical field , as well as nursing students, medical students and paramedical students wishing to fine- tune their practical abilities, decision-making skills, reaction times, and gain confidence in handling complex situations. The training was meticulously designed, and the feedback provided was insightful. Overall it was a wonderful experience."- Dr. Poonam Sharma, Principal Teerthanker Mahaveer University, Moradabad, UP


In another context of resource adaptation, Simulations can be designed to mimic the resource constraints of the local healthcare setting, training providers to optimize the use of available resources and to be innovative in their approach. Simulation Based Training fosters problem-solving skills and encourages teams to improvise while maintaining safety and efficacy. It helps the learners to work effectively in low resource settings by applying Crisis Resource Management (CRM) skill especially in emergency situation where every second counts. Providers trained in simulation-based settings may be better equipped to use limited resources more efficiently, reducing wastage and improving overall healthcare delivery. Simulation help healthcare teams prioritize tasks and allocate limited resources (e.g., medications, equipment, staff) effectively during a crisis. This ensures that the most critical needs are addressed first, potentially saving lives when supplies are scarce. NRSC provide opportunities to learners, to learn through different situation in different settings which will inculcate the CRM skill in their daily practices. There are important considerations when establishing simulation programs in limited resource settings (LRS), including integration of cultural and linguistic factors, scalability, and sustainability and partnership with local in-country stakeholders. It will only be through continued curriculum development, rigorous program evaluation and faculty training.


Inter-professional Education


  • Medical, nursing, and allied health professionals typically receive training within their own specialized fields to acquire the specific skills and knowledge required for their roles. However, in real-world practice, patient care is managed by a team rather than a single professional, highlighting a different dynamic from the uni-professional training setting. It generate the need to train health care professionals in inter-professional teams and that how SBE plays an important role in training of health care professionals in inter-professional teams. SBE often involves scenarios that require teamwork and communication, helping to break down professional silos.

When learners go through the inter-professionals simulation, they learn about the wider skills like leadership, communication, decision making in teams etc which improves teamwork leading to better-coordinated care, which is crucial in handling complex or high-stress situations, ultimately that is vital in resource-constrained environments where support may be limited. At NRSC, inter-professional simulations are regularly conducted among students, through which they learn about the importance of each member and their challenges, perception related to patient management which helps to boost teamwork on the ground reality(hospitals). Marshall, Stuart D; Flanagan, Brendan. Simulation-based education for building clinical teams. Journal of Emergencies, Trauma, and Shock 3(4):p 360-368, Oct--Dec 2010. | DOI: 10.4103/0974-2700.70750.


Conclusion

Teaching technical skills, non-technical skills including CRM through simulation-based education is an effective way to prepare healthcare professionals in teams to handle real life situations effectively. By designing realistic scenarios, conducting thorough debriefings, and providing opportunities for repeated practice, we can help healthcare professionals develop the critical non-technical skills needed to manage patients ultimately leading to better patient outcomes and improved team performance in low resource settings in terms of trainings and hospitals. For further readings and enrolment in the courses at NRSC you can visit our site


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