Basic research. Modern problems of science and education What is simulation training in medicine
1The article discusses current issues of using simulators in practical training of junior medical students in preclinical training rooms at the Department of Nursing and Clinical Care. Simulation training is now widely recognized as an important component of medical training and as a fundamental approach to ensuring patient safety. During the educational process, special attention is paid to the ability and readiness to implement professional knowledge, skills and abilities necessary in the further professional activities of the future doctor, pharmacist, social worker. The article lists the available simulators, and also clearly reflects all levels of organization of simulation training for students. Significant issues are also the improvement of educational and methodological materials. An analysis was carried out of the effectiveness of using simulation technologies during the educational practice of students in the specialty - General Medicine.
simulator
simulation training
practical skills
educational process.
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At the present stage, simulation technologies in medicine are the optimal training format with a strong emphasis on mastering practical skills. Therefore, it is natural that one of the main directions in the field of higher medical education is the need to significantly strengthen the practical aspect of training future doctors while maintaining the proper level of theoretical knowledge. It is the state of the student’s clinical training that is characterized, in our opinion, as a very complex and “sore” issue in the work of any university, regardless of its status and size. On the one hand, the growing requirements of new state educational standards for the professional competencies of graduates, and on the other, the unresolved problems of clinical departments, which experience well-known difficulties in their work, largely complicate the training of specialists already at the initial stages of clinical training. In this regard, the emergence of opportunities in organizing phantom and simulation training for students seems to us as a reasonable and necessary direction in the educational process. We want to emphasize this specifically for students, starting from the first year, and not just for certain groups of residents and interns. For junior students, medical care is a medical activity to ensure optimal conditions for recovery and therefore requires the same serious development by students of medical specialties as all other elements of medical activity. Before studying clinical disciplines, students must familiarize themselves with and master the necessary manipulations and procedures of medical care, and be able to provide emergency first aid. Today, mastering most skills and manipulations, especially those associated with the risk of complications during their implementation, is possible only in a theoretical format. And at the same time, every university graduate is required to confidently carry out a number of technical techniques aimed, first of all, at saving lives. In this regard, there was a need to create and widely implement an innovative approach to training and professional retraining of personnel. The traditional system of practical training in the healthcare sector has a number of disadvantages, which are mitigated by simulation training. The existing laws and standards regulating the training of medical workers (Federal Law of the Russian Federation of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”, Federal state requirements for the training of specialists) state that practical Students' training is ensured through their participation in medical activities under the supervision of employees of educational organizations. The patient must be informed and have the right to refuse the participation of students in the provision of medical care. It is becoming increasingly difficult to obtain patient consent for students to participate in their medical care. With the introduction of market relations in clinics and changes in the legislative framework during the training of specialists, it is necessary to redistribute training time in such a way that mandatory simulation training modules appear between theoretical training and participation in medical activities. High modern requirements for the development of practical skills by medical students, for updating educational material and bringing the educational environment closer to the new environment of practical healthcare make virtual technologies in medical education a key direction in the development of higher medical schools.
Purpose of the study: to analyze the effectiveness of using simulation technologies in the development of practical skills and the formation of professional competencies during educational practice in nursing among junior students.
Material and research methods. 237 1st year students of the Faculty of Fundamental Medical Education (FFME) - General Medicine took part in the survey while undergoing training practice “General nursing for therapeutic patients.” The survey was anonymous, each student could express their opinion on organizing educational practice, working with simulators and mastering professional skills. The questionnaire contained 12 questions.
Research results and discussion. Clinical Department of Nursing and Clinical Care (SD and CU) Krasnoyarsk State Medical University named after. prof. V.F. Voino-Yasenetsky is multidisciplinary, since the educational process is conducted at several faculties simultaneously. The department has organized two simulation training classes, where students develop and practice practical skills in educational practice classes in the junior years of FFME - General Medicine, Pediatrics, Dentistry, as well as at the Faculty of Pharmacy and the direction of training - Social Work. The Department of Diabetes and Health Care actively integrates organizational and methodological work with the College of Pharmacy of our university.
The department has a sufficient number of simulators for working with students as part of educational practice: interactive mannequins of an adult patient in human size for practicing practical skills in personal hygiene and emergency first aid;
interactive newborn mannequins and six-month baby mannequins to practice childcare skills; models for adults to master pre-medical care for cardiopulmonary pathology; simulators for all types of injections; simulators for performing nursing manipulations: practicing bladder catheterization; administering enemas, compresses; nasogastric zoning, etc.; kits for the prevention and treatment of bedsores, etc.
Considering that educational practice involves the acquisition of practical skills within the framework of a competency-based approach under the supervision of teachers, from the experience of our work, some methodological approaches to the development of practical skills and the formation of professional competencies using simulation technologies have emerged.
The organization of work during educational and practical classes was based on a 6-level scheme:
Level 1. Theoretical introduction
Students receive the topic of the lesson, independently work through theoretical aspects, relying on methodological recommendations for classroom and extracurricular activities.
Level 2: Observation of implementation
In preparation for the lesson, watch the video material of the practical skill. In the methodological recommendations there is a paragraph - practical skills for each lesson.
Level 3. Working with algorithms
They independently compile their own algorithm for performing practical skills on the relevant topic, using the algorithms posted on the department’s website.
Level 4: Complete theoretical understanding
During educational and practical classes, within 10-15 minutes, questions on the topic of the lesson are discussed and clinical problems are solved. Testing is underway.
Level 5. Demonstration of skill by teacher
During the training session, after theoretical analysis, the teacher slowly demonstrates practical skills on simulators.
Level 6. Execution (on simulators)
Further, during the training session, students practice practical skills in pairs, using checklists of algorithms developed by teachers of the department, bringing them to automaticity, and evaluate themselves independently, checking the checklist.
The teacher monitors the process of mastering skills, correcting mistakes that students have not noticed. After mastering a block of professional skills, students participate in the treatment process in the therapeutic departments of hospitals, where they implement developed practical skills under the guidance of a teacher and nursing staff of the clinic at the patient’s bedside.
After analyzing the student survey, the following results were obtained:
To the question “Did you use the teaching materials posted on the department’s page to master practical skills?” students responded positively (78.4%), did not use (10.5%) and did not know about their existence (10.9%), which is reflected in Fig. 1.
Rice. 1. Students’ use of teaching materials posted on the department’s website
These answers indicate the usefulness of the posted methodological material; Students who missed classes at the beginning of practice did not know about the existence of manuals on the site.
To the question, “Did you use the video bank of practical skills to master practical skills? ", (85%) students responded positively, (8%) students could not access the university website, forgot their password, but knew about the existence of the data bank, (7%) did not use the university website, which is presented in Fig. 2.
Rice. 2. Students’ use of the video bank of practical skills on the university website
76.4% of students responded that practicing injection skills most used the resource with a video bank of practical skills.
To the question “How do you assess the level of equipment of the department on a 5-point scale?”, (54.6%) students gave 5 points, thereby noting a high resource; (34.3%) answered a sufficient level (4 points), and (11.1%) students answered 3 points: they expressed a desire to have more simulators, for some skills there are not enough simulators (for example, gastric lavage), and they have to be concentrated in groups for training are not two, but 4-5 people, as shown in Fig. 3.
Rice. 3. Students’ assessment of the department’s equipment
To the question “Do simulators help you in mastering practical skills”? in (100%) a positive answer was received, which is presented in Fig. 4
Fig.4. Evaluating the effectiveness of simulators
To the question “Are you ready for the upcoming summer practical training”? students expressed their readiness by 5 points, which amounted to (44.5%), by 4 points - (55.5%), which is presented in Fig. 5. Students were concerned about filling out documentation and adapting to an unfamiliar team.
Rice. 5. Students’ readiness for upcoming practice
(74.5%) students noted their independence during educational practice, (22.6%) noted activity only in the presence of a teacher, and (2.9%) percent stated a lack of interest in classes.
1.Training with the help of simulators is one of the effective teaching methods in the development of practical skills and the formation of professional competencies of junior students at a medical university.
2. A properly organized methodological approach of the staff of the department and the College of Pharmacy: the use of methodological developments of algorithms for practical skills, a video bank of practical skills, makes the acquisition of skills faster and clearer, automaticity and correct execution of the skill are laid down.
3. The correct organization of the educational process of practice using simulation technologies leads to the mastery of professional practical skills at a higher level than the theoretical description of the latter, or the presence of first-year students in the department, when “they are not allowed to do anything except wet cleaning of premises.”
4. The effectiveness of training using simulation methods is confirmed by the independent work of students within the framework of educational and practical classes in therapeutic departments at the clinical bases of the department and the readiness of students for summer practical training.
Bibliographic link
Turchina Zh.E., Sharova O.Ya., Nor O.V., Cheremisina A.V., Bitkovskaya V.G. SIMULATION TRAINING AS A MODERN EDUCATIONAL TECHNOLOGY IN THE PRACTICAL TRAINING OF JUNIOR COURSE STUDENTS OF A MEDICAL UNIVERSITY // Modern problems of science and education. – 2016. – No. 3.;URL: http://science-education.ru/ru/article/view?id=24677 (access date: 02/01/2020). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"
Three paths lead us to the heights of wisdom:
the path of reflection is the noblest,
the path of imitation is more accessible than all others
and the bitter path is based on your own mistakes.
Confucius, 5th century BC
In the modern world, in the era of rapid development of high-tech medicine, society places increased demands on the quality of medical services. It is this indicator and the quality of life of patients after treatment that should form the basis for assessing the professional activities of individual specialists and medical institutions, as well as the level of healthcare in general.
The classical system of clinical medical education is not able to fully solve the problem of high-quality practical training of a medical worker. The main obstacles to this are the lack of continuous feedback between the student and the teacher.
Therefore, the key task of modern secondary, higher and postgraduate medical education is to create conditions for students to develop a wide range of competencies and firmly established practical skills without the risk of harm to the patient.
This includes developing the health care professional's ability to make quick decisions and perform a series of procedures or interventions flawlessly, especially in emergency situations.
One of the methods for improving the quality of practical training of future paramedics, nurses, midwives, and medical laboratory technicians is the use of simulation technologies. Simulation in medical education is a modern technology for teaching and assessing practical skills, abilities and knowledge, based on realistic modeling, imitation of a clinical situation or a separate physiological system, for which biological, mechanical, electronic and virtual (computer) models can be used.
The Federal State Educational Standard for Secondary Professional Education in the specialty allocates laboratory practical classes (LPZ) for the development of practical skills through the introduction of simulation technologies, as a stage of preparation for academic (EP) and industrial practice (PP).
Currently, according to the level of realism, seven groups of simulation technologies for teaching medicine are distinguished. The advantages of simulation training at the present stage of medical development are beyond doubt.
- Visual: classical textbooks, electronic textbooks, educational computer games.
- Tactile: simulators for practicing practical skills, realistic phantoms of organs, cardiopulmonary resuscitation (CPR) mannequins, for example, a phantom for practicing tracheal intubation.
- Reactive: mannequins of the lowest class of realism (Low-Fidelity).
- Automated: mid-range realistic mannequins, video equipment.
- Hardware: a middle-class simulator in a ward equipped with medical furniture and equipment, a simulator equipped with real medical equipment
- Interactive: robotic patient simulators of the highest class of realism (High Fidelity) and virtual simulators with tactile feedback.
- Integrated: complex integrated simulation systems - interacting virtual simulators.
When exchanging experience with colleagues from Kazan and Tabolsk medical colleges, we saw that these educational institutions have a multidisciplinary simulation center, which was created as a mini-clinic model and includes: a patient reception room, a treatment room, a dressing room, an intensive care ward, and an antenatal clinic room. , delivery room, healthy child room, enema room, test collection room.
In our educational institution, teachers dream of creating a full-fledged simulation center equipped with virtual simulators. The medical college uses elements of simulation technologies in the form of electronic textbooks, educational computer games, practical skills simulators, realistic organ phantoms, cardiopulmonary resuscitation mannequins, and practicing auscultation techniques.
For more effective use of simulation technologies, an “integrated” office was organized at the State Autonomous Institution “Bryansk City Hospital No. 1”, where a kit for practicing practical skills in PM was assembled. 01 “Diagnostic activity”, PM. 02 “Medical activity”, which is used when training students in the specialty “General Medicine”.
One of the richest experiences in using simulation technologies has been accumulated by PM teachers. 07 “Performing work in the profession of a junior nurse caring for patients,” which at the hospital use the following levels of simulation equipment to practice manipulations:
1. Visual - introduces practical actions, their sequence and the technique of performing the manipulation. Students develop an understanding of the sequence of actions to perform a manipulation, but no actual practical practice of the manipulation occurs. But, this level allows you to move on to the next stage - to the actual practical development of the manipulation. An example would be electronic manuals and videos.
2. Tactile - occurs at this level
reproduction and development of practical skills, i.e. a sequence of coordinated movements during the performance of a particular manipulation and, as a result, the acquisition of a practical skill. An example is practicing manipulations on a phantom, a dummy and a standardized patient, whose role is played by a student.
3. Reactive - the simplest active reactions are reproduced
phantom on typical student actions. For example: when indirect cardiac massage is performed correctly, a light comes on, thereby assessing the accuracy of the student’s actions and reproducing the motor skills of a separate basic skill.
The final performance of manipulations using the above simulation equipment is possible using an objective scoring system.
Thus, the methodological task of our teaching staff for the near future, the “maximum program” is the development of an “end-to-end” educational technology for the formation of each skill using models (phantom, mannequin, dummy, etc.), standardized patients with continuity and repeatability on each at the subsequent stage of training, as well as upon admission of students to the UE, PP or during certification based on the results of the PP.
But we can confidently emphasize in conclusion that simulation training is not an alternative to “live” communication with the patient, but a means to make this communication more effective and comfortable for the patient and the student, because in order to master the main types of professional activities for a medical worker, it is necessary not mannequins, but real, real patients.
Simulation training is an effective method for acquiring practical skills.
N.M. Manelis, teacher of the highest category,
GBPOU "Samara Medical College named after. N. Lyapina", Samara.
The emergence of high technologies in medicine, the acceleration of the pace of life, the growing volume of knowledge, the introduction of new treatment and diagnostic techniques - all this poses challenges for the modern medical education system to develop qualitatively new approaches to training personnel for healthcare.
Everywhere in the industry there is an acute shortage of highly qualified specialists. Therefore, it is natural that one of the main directions in the field of secondary medical education is the need to significantly strengthen the practical aspect of training nurses while maintaining the proper level of theoretical knowledge.
When passing clinical disciplines, it is not always possible to fully practice practical manipulations, and even less so to monitor the quality of each student’s performance of practical manipulations. In recent years, the situation has been aggravated by the widespread introduction of market relations in clinics and changes in the legislative framework.
In this regard, the emergence of opportunities in organizing phantom and simulation training for students seems to us as a reasonable and necessary direction in the educational process.
In addition, the principle of practical training “Look and repeat” has ceased to meet modern requirements, since it presupposes the development of reproductive knowledge and skills, and the Federal State Educational Standard focuses on the productive level of assimilation. Therefore, simulation training is coming to the forefront - one of the most effective methods of acquiring practical skills that complement traditional training.
Simulation training methods in medicine have been known for a long time; in particular, in anesthesiology, mannequins have been used since the 80s of the 20th century.
Currently, simulators are used for training and objective assessment of students in many areas of human activity that involve high risks.
Simulation training has a number of advantages over the traditional training system: the patient does not suffer from the actions of the nurse; the training is carried out regardless of the availability of relevant patients in the clinic and the work schedule of the healthcare facility; Due to the objectification of the assessment, the final result of the workshop is improved. It is simulators that can repeatedly and accurately recreate important clinical scenarios and the ability to adapt the training situation to each student.
The main and most important advantage of simulation is the ability to objectively record the parameters of the professional activity performed in order to achieve a high level of training for each specialist.
The main disadvantage of simulation training is its high cost.
We began to equip the center for practicing practical skills, classrooms for clinical disciplines, and the basics of nursing with multifunctional phantoms of the new generation, which, with the existing basic phantoms, makes it possible to hone skills in a situation close to real life. Systematization of the processes of formation of knowledge, skills, and practical experience is carried out in several stages.
The first stage is theoretical preparation. In any civilized society, the value of knowledge is great - fundamental, deep, meaningful.
College teachers, along with traditional teaching methods, widely use innovative approaches in creating a conceptual framework, theoretical foundations of medicine, and laying the foundations of professional thinking.
Fundamental knowledge is laid down in lectures, which are conducted in the form of explanatory and illustrated ones, in the form of problem-based lectures, discussions, using an interactive whiteboard, integrated lectures that allow one to generalize knowledge of anatomy, microbiology, pharmacology, surgery, therapy, and pediatrics. The modern teaching method used to master knowledge is the positional teaching method.
However, the application of knowledge in practical activities is ensured with the help of skills, and skills are closely related to skills. Therefore, the next level of training for the student, when mastering practical skills, are centers for practicing practical skills, clinical rooms equipped with modern equipment, phantoms for practicing such manipulations as: restoration of patency of the upper respiratory tract, cardiopulmonary resuscitation, vascular access, tracheal intubation, tracheostomy, ECG, use of a pulse oximeter, nebulizer; software and methodological documentation. In these centers, during independent extracurricular training, the student has the opportunity to bring practical skills to automaticity. During practical classes in the classrooms of clinical disciplines, functional areas are used to practice manipulations, static or dynamic pairs are organized that use expert cards to check the correctness of actions. The formation of skills begins with the formation of personal meaning of the upcoming activity. To do this, during practical classes, various problem situations are analyzed and analyzed, allowing students to realize the importance and necessity of mastering this skill.
And then, having theoretical training, possessing practical skills and having worked out an algorithm for providing medical care in emergency conditions, the student ends up in a simulation center, where, under conditions close to the real ones, through repeated repetition and analysis of errors, he achieves perfection of skills in working with equipment and patients. And difficulties in completing the tasks set by the teacher indicate a deficit of knowledge and skills that needs to be filled. The situation itself motivates the student to increase knowledge, practice manipulations, and self-education. Reflection helps him assess his own level of training, which is especially important when providing emergency medical care in an emergency medical setting, when the patient’s life depends on the speed and quality of medical care.
Thanks to this specialist training system, the survival rate of patients in critical condition, who were promptly and correctly administered extended cardiopulmonary resuscitation, has increased (more than 50% according to the Department of Reanimatology of Samara State Medical University).
Literature:
Usova N.F. The use of modern technical teaching aids to improve the visibility of teaching. // Siberian Medical Journal 2010. No. 2.
Sidorova V.V. Psychological and pedagogical aspects of modern teaching technologies. // Innovations in education 2008 No. 7.
Emelina L.P. Vorontsova S.A. Multimedia presentations are one of the forms of innovative technologies. //Siberian Medical Journal 2010 No. 7.
The problem of simulation training in medical education at the present stage is analyzed. A scheme is presented for integrating the simulation training system into the educational process for I–VI year students in the specialties “General Medicine” and “Pediatrics”, which is used in the established Center for Practical Skills of St. State Medical Academy. The necessity of creating large multidisciplinary educational and methodological units in the format of educational and simulation centers for clinical training of students and young specialists in medical universities is substantiated, with the implementation in the educational process of clearly defined clusters of practical training at all stages of training, including pre-university. The importance of using simulation technologies in teaching large student populations is especially emphasized.
simulation training
practical skills center
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2.Clinical simulation: importance to the internal medicine educational mission / P.E. Ogden, L.S. Cobbs, M.R. Howell, S.J. Sibbitt, D.J. Di-Pette // Am J Med. - 2007. - No. 120 (9). - R. 820-824.
3.National Growth in Simulation Training within Emergency Medicine Residency Programs / Y. Okuda et. al. // Acad. Em. Med. - 2008. - No. 15. - R. 1-4.
4.Pratt D.D. Five Perspectives on Teaching in Audit and Higher Education // Melbourne, FL Krieger Publishing Co. - 1998. - No. 83. - R. 103.
5.The effect of hi-fisimulation on educational outcomes / D.L. Rodgers et. at. // Simulation in Healthcare. - 2009. - No. 4. - R. 200-206.
6.Med Teach London / S. Barry Issenberg et. al. - 2005. - Vol. 27, lss. 1. - R. 10.
The implementation of priority national projects in the healthcare sector, the processes of reform and modernization of the industry have revealed with particular urgency the problem of professional training of medical workers.
Everywhere in the industry there is an acute shortage of highly qualified specialists. Therefore, it is natural that one of the main directions in the field of higher medical education is the need to significantly strengthen the practical aspect of training future doctors while maintaining the proper level of theoretical knowledge.
It is the state of the student’s clinical training that is characterized, in our opinion, as a very complex and “sore” issue in the work of any university, regardless of its status and size. On the one hand, the growing requirements of new state educational standards for the professional competencies of graduates, and on the other, the unresolved problems of clinical departments, which are experiencing well-known difficulties in their work, largely complicate the training of specialists already at the initial stages of clinical training.
When passing clinical disciplines, it is not always possible to carry out a full analysis of each of the supervised patients, and even more so the teacher’s control over the quality of each student’s performance of an objective examination of the patient. In a real clinic, this situation is aggravated by the lack of individual provision of students with thematic patients and forced work in a group. In recent years, the situation has been aggravated by the widespread introduction of market relations in clinics and changes in the legislative framework.
In this regard, the emergence of opportunities in organizing phantom and simulation training for students seems to us as a reasonable and necessary direction in the educational process. We want to emphasize this specifically for students, starting from the first year, and not just for certain groups of residents and interns.
Currently, simulators are used for training and objective assessment of students in many areas of human activity that involve high risks.
Simulation training methods in medicine have been known for a long time; in particular, in anesthesiology, mannequins have been used since the 80s of the 20th century. The use of simulators, mannequins, and phantoms allows you to repeatedly practice certain exercises and actions while providing timely, detailed professional instructions during the work.
It is simulators that can repeatedly and accurately recreate important clinical scenarios and the ability to adapt the training situation to each student.
However, in the literature available to us, we found little convincing evidence for the use of simulations in linear undergraduate education programs. New state educational standards and “by-laws” do not at all define the role and place of simulation training in the educational process; the methodology and didactics of teaching are not defined.
Each university moving in this direction at its own “peril and risk” is now deciding the issues of staffing and organizing the work of simulation training, often experiencing resistance even in its own teams - the evidence base for the effectiveness of using simulators is not yet sufficiently developed, their cost is high, time costs and resistance are significant changes, but the process of creating simulation training centers is being carried out, including in medical universities.
The first modest steps in the work of the center for practical skills of the Stavropol State Medical Academy showed the feasibility of investing material resources in the implementation of the idea of creating a center and received a positive response from many representatives of the teaching staff of our academy.
It is now clear that the role of the center will not be reduced only to a room equipped with special phantoms. The center is an educational and methodological unit where not only individual practical skills and manipulations will be practiced, but also educational and methodological work, scientific research, experimentation in teaching technologies will be carried out with access to clinical bases and paraclinical departments. Thus, ideally, this is the path to creating a unified educational and simulation center for clinical training of students and young professionals, where clearly defined clusters of practical training will be implemented at all stages of training, including pre-university.
We see these main clusters as follows: “emergency medicine”, “patient care”, “pediatrics - emergency care, child care”, “anesthesiology and resuscitation”, “surgery and laparoscopy”, “obstetrics and gynecology”. Currently, the center has begun full-fledged work from the new academic year according to the established regulations.
The first stage that students will go through at the training center is theoretical training - this is a specially designed special course in one of the sections of medicine. For example, these are recommendations for basic or advanced life support - Guidelines ERC or AHA 2005.
After this, students move to training rooms to master practical skills, where simulators for practicing individual medical procedures are collected by topic: vascular access, restoration of the patency of the upper respiratory tract, cardiopulmonary resuscitation, puncture of pneumothorax, immobilization and transportation, catheterization of the bladder, gastric lavage, nursing for stomas and catheters, auscultation, gynecological and obstetric manipulations.
This is followed by a computer simulation stage, when in a classroom setting the student must complete certain modules of the interactive curriculum (cardiac arrest, respiratory disorders, arrhythmias, poisoning and overdose, metabolic disorders and thermoregulation).
And then, having theoretical training (first stage), mastering practical skills (second stage) and having worked out a virtual algorithm for treating emergency conditions, the student ends up in the simulation part of the center (imitation ward), where, in conditions close to the real ones (real situation, real equipment) , a mannequin that independently responds to his interventions), he, through repeated repetition and analysis of mistakes, achieves the perfection of his psychomotor skills, skills in working with equipment and patients, and teamwork skills.
Junior year students who are preparing for nursing practice, before working in a hospital, must master not only the skills of caring for a patient, but also the basic resuscitation complex and the basics of providing emergency care for major critical conditions (suffocation, hypertensive crisis, fainting, etc. ) This is necessary so that the student feels more confident when working with patients, i.e. The educational process at the center will be structured so that by the time the student transfers to the clinical departments, he will have fully mastered the theory and practiced manipulations and clinical techniques on mannequins and simulators in accordance with the requirements of state educational standards in the specialties of general medicine and pediatrics. For example: currently, the teaching of the discipline “Resuscitation and Intensive Care” at the Faculty of Pediatrics is carried out in the 3rd year (2 hours - CPR training), in the 5th course in the 10th semester (prehospital stage of emergency care for the most common pathology in the volume 24 hours) and 6th course in 11-12 semesters (hospital stage of emergency care in the amount of 36 hours). There is also a lecture course. According to the decision of the Academic Council of the Stavropol State Medical Academy, in order to improve the acquisition of practical skills at the patient’s bedside, practice in ambulance and emergency care was approved for 6th-year students of the Faculty of Pediatrics (one night shift).
According to the requirements of Federal State Educational Standard 3 for the training of pediatricians, even more attention should be paid to students’ mastery of practical skills.
Also, according to the training program, teaching to pediatricians should be carried out in the discipline “Anesthesiology and Resuscitation” in the 11th-12th semester of study in the amount of 2 credit units + 1 unit for independent work.
Considering the complexity of the discipline being studied, it is not possible to fit two large sections of teaching into the specified amount of hourly workload while maintaining the quality of teaching practical skills.
In addition, the exam in the section of resuscitation and intensive care is taken by 5th-year students of the Faculty of Pediatrics during a comprehensive exam in pediatric surgery in the 10th semester, that is, before completing a course of practical training according to the new educational standard.
Taking into account the above, since September 2011, a decision was made to allocate 1.5 credit units to train 5th-year students of the Faculty of Pediatrics in practical skills at the Center for Practical Skills in the section “Anesthesiology”. In the 6th year of the Faculty of Pediatrics, issues of providing resuscitation and emergency care at the hospital and prehospital stages are resolved at the patient’s bedside at the training bases of the course. The skills are taught by course teachers due to their extensive practical experience.
We offer a work plan and a list of practical skills studied at the Center.
3rd year of all faculties - lesson volume 2 hours
Carrying out primary cardiopulmonary resuscitation on mannequins at the prehospital stage with mandatory quality control of skill acquisition;
Passing a test before undergoing nursing practice in order to be admitted to its completion.
5th year of the Faculty of Pediatrics - the volume of classes is 24 hours per group (one week of classes in the 10th semester)
Rules for working with a defibrillator. Preparing the defibrillator for operation, calculating the required dose of defibrillation discharge;
Analysis of heart rhythm disturbances according to ECG monitoring or ECG readings (work on a mannequin simulating heart rhythm disturbances);
Carrying out the initial stage of intensive therapy for cardiac arrhythmias;
Assessment of CO 2 monitoring indicators in exhaled air. Making a tactical decision based on the results of the data received;
Rules for communicating with the parents of a child in critical condition. Ways and means of eliminating conflict situations.
Thus, we propose to consider simulation technologies in the training of ordinary students not only as an integral part of clinical training, but moreover, as one of the mechanisms that trigger and shape clinical thinking at a high and motivated level. Consequently, these forms of training require deterministic methodological support and control from leading educational and methodological associations, scientific evaluation and further research and improvement.
Reviewers:
Aydemirov A.N., Doctor of Medical Sciences, Professor, Head. surgical thoracic department, State Healthcare Institution "Stavropol Regional Clinical Center for Specialized Types of Medical Care", chief thoracic surgeon of the Stavropol Territory, Stavropol;
Karakov K.G., Doctor of Medical Sciences, Professor, Head. Department of Therapeutic Dentistry, Head of the Center for Practical Skills of the Faculty of Dentistry, Stavropol State Medical Academy of the Ministry of Health and Social Development of the Russian Federation, Stavropol
The work was received by the editor on September 23, 2011.
Bibliographic link
Muravyov K.A., Khojayan A.B., Roy S.V. SIMULATION TRAINING IN MEDICAL EDUCATION – A TURNING POINT // Fundamental Research. – 2011. – No. 10-3. – pp. 534-537;URL: http://fundamental-research.ru/ru/article/view?id=28909 (access date: 02/01/2020). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences" in classes at medical college
Focusing on the professionalism of the future medical worker, there is a need to significantly strengthen the practical training of students while maintaining the proper level of theoretical knowledge.
Taking into account certain problems in the training of paramedical personnel, in particular nurses. Among them: graduates’ fear of patients, patients’ dissatisfaction with interacting with inexperienced staff, restriction of students’ access to treatment rooms during internship, psychological fear of performing the procedure. It is impossible not to draw attention to the lack of time to practice each practical skill, which leads to a high risk to the patient’s health.
The way out of this situation is to create modern practice rooms with the necessary set of equipment for performing nursing procedures. It is important to improve pedagogical teaching technologies, using such as gaming technologies, contextual learning, and the method of solving situational problems.
The most modern method of teaching students practical skills is the use of simulation technologies in the system of training paramedical personnel.
Translated from the Latin term simulation (simulatio- appearance, pretense) - creating the appearance of a disease or its individual symptoms by a person who does not suffer from this disease, or simulating any physical process using an artificial (for example, mechanical or computer) system. That is, this concept was originally already used in medicine. But if there is a patient faking illness, then there may also be a medical worker faking treatment. Although simulation training began to be actively used in the second half of the last century in those industries where errors during training on real objects could lead to tragic consequences. These are aviation, nuclear energy, and railway transport. In medicine, this type of specialist training began to actively develop in the 70s and today is the generally accepted norm for almost all models of medical education.
The transition from knowledge to abilities, and then skills, involves training mid-level medical specialists with the introduction of a simulation system or modeling of certain situations into the learning process.
The use of medical phantoms in practical classes can play a big role in achieving this goal. One explanation of the concept forfeitO m(French fantome, from Greek phantasma - vision, ghost) gives the Great Soviet Encyclopedia: a life-size model of the human body or part of it, serving as a visual aid.
The main task of medical phantoms is to create clinical situations that are as close as possible to real life situations. At Moscow Regional Medical College No. 1, during practical classes in professional modules, students must master not only patient care skills, but also basic manipulations in accordance with the practical training program, before starting practical training in medical institutions. Teachers are aware of the urgent need for the correct structure of the educational process in college, taking into account the student’s full mastery of theory and practice of manipulations and clinical techniques on mannequins and phantom simulators.
College classes are structured according to a certain algorithm. At the first stage, students receive theoretical knowledge. In the second, they master practical skills. The third stage is devoted to practicing practical manipulations in conditions close to real ones (real situation, real equipment, a mannequin that independently responds to student interventions). Students under the guidance of a teacher, through repeated repetition and analysis of mistakes, achieve perfection of skills in working with equipment and patients, working in a team, and mastering general and professional competencies.
Let us give examples of educational situations put before students and aimed at practicing the manipulations used in our college.
Academic discipline:“Fundamentals of resuscitation” (final practical lesson).
Study situation: Patient A. choked on an olive. The person wheezes, cannot take a breath, and the skin begins to turn blue.
Task: Provide emergency assistance to the victim.
Conditions for the manipulation: One student performs the manipulation, the rest watch his action and, upon completion, comment on the mistakes made. This manipulation is performed by each student in turn.
Stage No. 1.
To assist a person using the appropriate phantom simulator, the student must choose a method of removing a foreign body and apply this method in practice.
In this situation, students consolidate the Heimlich maneuver.
A) Procedure for helping someone who has choked: if he is still on his feet and has not lost consciousness:
1. The student needs to stand behind the victim, wrapping his arms around him.
2. Clench one hand into a fist and, with the thumb side, place it on the victim’s stomach at the level between the navel and costal arches (in the epigastric region of the abdomen).
3. Place the palm of the other hand on top of the fist, and press the fist into the stomach with a quick upward push.
In this case, you need to sharply bend your arms at the elbows, but do not squeeze the victim’s chest.
4. If necessary, repeat the dose several times until the airways are clear.
B) The victim is unconscious or cannot be approached from behind:
1. Place the victim on his back.
2.Sit astride the victim’s thighs, facing the head.
Place one hand on top of the other, place the base of the palm of the lower hand between the navel and costal arches (in the epigastric region of the abdomen).
3. Apply vigorous pressure on the victim’s abdomen in an upward direction towards the diaphragm, using your body weight. The victim's head should not be turned to the side.
4. Repeat several times until the airways are clear.
Stage No. 2.
If removal of the foreign body fails, the victim
cardiac and respiratory arrest occurs. Students (method I - 1 person, method II - 2 people), using the appropriate phantom simulator, must perform cardiopulmonary resuscitation. The latest generation phantom simulator shows the correctness of this manipulation using the appropriate indication, which allows the student to correct incorrect actions in a timely manner.
1. The student must check the signs of clinical death in the victim:
Pulse;
Breath;
Pupil reaction to light;
Cat's eye reaction.
2. Pull out the victim’s lower jaw.
3. Clean the victim’s mouth.
5. Exhale 2 times into the victim’s mouth.
6. Find the correct position for the hands (2 fingers above the xiphoid process, place the base of the palm on the victim’s sternum). Make 30 sharp pressures.
7. After 5 cycles: check for pulse. If there is no pulse, continue applying pressure.
Stage No. 3.
When restoring cardiac activity and breathing of the victim, it is necessary to insert a venous catheter and use it to administer medications to maintain cardiac activity using an appropriate phantom simulator.
The student independently selects the necessary equipment (presented on the manipulation table).
1. The student must check the integrity of the packaging and shelf life of the catheter.
2. Apply a tourniquet to the victim 10-15 cm above the intended catheterization area.
3. Treat the victim at the catheterization site with a skin antiseptic for 30-60 seconds and allow it to dry on its own.
4. Fix the vein by pressing it with your finger below the intended catheter insertion site.
5. Take the catheter and remove the protective cover.
6. Insert the catheter on the needle at an angle of 15 degrees to the skin, observing the appearance of blood in the indicator chamber.
7. Reduce the angle of inclination of the stylet needle when blood appears in the indicator chamber and insert the needle into the vein a few millimeters.
8. Fix the stiletto needle, and slowly move the cannula completely from the needle into the vein (do not remove the stiletto needle completely from the catheter yet).
9. Remove the tourniquet.
10. Clamp the vein along its length to reduce bleeding and finally remove the needle from the catheter.
11. Remove the plug from the protective cover and close the catheter.
12. Fix the catheter on the limb.
13. Inject 1 ml of 0.1% adrenaline.
This situation is aimed at consolidating professional skills in students:
Developing the correct algorithm of actions to assist the victim.
Selection of the required manipulation depending on the result of the previous manipulation.
Selection of necessary medical equipment depending on the procedure.
Perform manipulations alone or with a partner.
Building confidence in your actions when providing assistance to the victim.
Analysis of the actions of other students and mutual assistance.
The integrated use of phantom simulators makes it possible to combine theoretical and practical knowledge and isolated manipulations into a single whole of medical interventions, helps to develop confidence in one’s actions, and increases students’ interest and motivation in the learning process.
List of used literature
1. Muravyov K.A., Khojayan A.B., Roy S.V. SIMULATION TRAINING IN MEDICAL EDUCATION – A TURNING POINT // Fundamental Research. – 2015.
2. Journal of Virtual Technologies in Medicine, No. 2, 2015
Materials used and Internet resources
1. http://www.medsim.ru/
2. http://www.ugrasu.ru/
3. http://www.medsim.ru4.
4. http://stands-posters.rf/Fantom.htm