It is acknowledged worldwide that simulation training is an useful and value-added precursor to actual clinical work for healthcare workers.
Simulation is becoming a norm and an essential part of pre-clinical training in several countries and reputed institutes worldwide. Some examples:
2. EISE ( Ethicon Institute of Surgical Excellence) , India
3. Medical Simulation Centre, Rhode Island Hospital
The Apollo Group of Hospitals has set up a clinical simulation centre at Hyderabad. In addition, Defence R & R Hospital, Delhi and AFMC, Pune have facilities for clinical simulation.
Presenting a conceptual note on Clinical Simulation Centres:
1.CPR (Cardiopulmonary Resuscitation) Lab :
This would be utilized for BLS, ACLS, NALS and PALS classes. CPR mannequins are used, which provide training in CPR, AED use, and the Heimlich maneuver. Airway, breathing and circulation systems are simulated and the results of interventions can be demonstrated.
A CPR mannequin for practicing cardiopulmonary resuscitation of a human has a simulated human head and neck portion with an air passage extending from a mouth opening to a neck opening in an end of the neck remote from the head. An inflatable simulated human chest portion is secured to the neck and has an upper flexible wall member, a lower wall member and a flexible bag there between and a further air passage connects the air passage in the neck to the flexible bag. The upper flexible wall member simulates a chest which rises and falls with inflation and deflation of the flexible bag.
The types of mannequins required would be-
a) Adult mannequin for BLS
b) Adult mannequin for ACLS
c) Pediatric mannequin for PALS
d) Neonatal mannequin for NALS
Other than these, the following would be required-
e) 3 demonstration rooms with Seating Capacity for 20 people each.
f) Audiovisual equipment
2. Airway Management Lab
This would be utilized for teaching of airway management to physicians, nurses and paramedics. It would be provided with a
variety of simulators including pediatric and neonatal models.
A mannequin such as the Human Patient Simulator (HIPS) system is used, which contains a self-regulating pulmonary system which regulates the body’s O2 requirements and rate of CO2 production and automatically adjusts the respiratory rate and tidal volume. Breath sounds are auscultated by standard stethoscopes in several locations to detect abnormalities. A number of techniques can be taught using the anatomically correct airway. Bronchoscopy can be performed in the upper airway and trachea. Nasal or oral intubation can be performed. Ventilation can be compromised by tongue or upper airway swelling, bronchospasm, or laryngospasm. If an esophageal intubation is performed, the stomach swells up when ventilated.
During a tension pneumothorax, the adult manikin allows either needle decompression or chest tube placement. The treatments are performed through the computer interface for the pediatric manikin.
i. Access Management Lab
Access Lab would have realistic models for both peripheral and central venous devices, placement of Intercostal catheters, and Spinal Punctures, Regional Anesthesia etc. The mannequin would simulate vascular access and fluid management. Infusions of whole blood, packed cells, crystalloids and colloids independently (artificial solutions), can be carried out. The patient can lose either whole blood or plasma, to simulate the different effects of blood loss through active bleeding versus volume loss through leakage into extracellular spaces.
ii. Emergency and Trauma Management Skills Lab
Trauma management skills are taught using mannequins, audiovisual aids and life support stations.
iii. General Surgical Skills Lab
It provides simulated hands on surgical skills to a minimum of 15 learners at the same time. Each student is able to see the skills being taught by the teacher, on the monitor and then perform the same at his/her station. All the skills are supervised by a team of dedicated trainers.
iv. Laparoscopic Surgery Skills Lab
This would contain a Laparoscopic Trainer station that includes an introductory board, several anatomic models, and a camera for training in laparoscopic surgery skills. Trainees begin on the introductory board. Stations demonstrate basic skills which will be incorporated into many real surgical procedures. Once the trainees are comfortable in the laparoscopic environment, the introductory board is removed and various surgical anatomic models are placed in the trainer, each of which will be used to teach operating techniques or full length procedures.
v. Endoscopic Skills Lab ( Lower GI / Upper GI endoscopy)
This would contain a endoscopic model, consisting of a endoscope, a box containing the computer components, and a screen to view images. Cases are grouped, to allow trainees to focus on basic principles (introduction module) or to learn biopsy or polypectomy procedures. Within all modules, the simulator gives instructional information beforehand, real time patient feedback during the simulation, and constructive feedback after the simulation has been completed.
The endoscope is shaped like a real colonoscope, including all the directional controls and adjunct buttons. The functionality has been removed from the scope, although the simulator senses what the user is doing and causes the image to change appropriately. During the case, the simulated patient responds in real time to the trainee's actions, both verbally and with vital sign changes. The modules contain a series of videos and text instructions.
vi. Bronchoscopic Skills Lab
The fiberoptic bronchoscopy simulator consists of an anatomic model of the face, with an opening in one nare for nasal insertion of the fiberoptic bronchoscope. It has an attached motion sensor system and a video system with screen for the images. As the user inserts and manipulates the bronchoscope, the simulator senses the movements and adjusts the screen images in real time. The respiratory tree and the full length of the bronchoscope are visible as it is currently positioned.
Feedback is given during the procedure (such as an audible patient cough if topical anesthetic is insufficient) as well as after the procedure is complete. Other output is intended to help the trainee develop a personal technique (such as the order the bronchial segments were visited).
Modules within the bronchoscopy simulation include basic maneuvers, lesion visualization, bronchial lavage, and tumor biopsy. There is also one pediatric difficult airway module.
3. Cath Lab , Imaging Lab, Neuroelectrophysiology Lab and other Labs as identified would be required.
In addition, Demonstration Rooms, Lecture halls and Audiovisual Aids would be required for teaching.
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