Walking the Tightrope Between Reality and Simulation in Education

By Jackie Langford, Director of Healthcare Simulation, Collin College

Jackie Langford, Director of Healthcare Simulation, Collin College

There are certain experiences, like fighting fires, that a person simply cannot learn from reading a book. Learning to rappel Australian style, a face-first experience, from a 100-foot cliff is a high-angle rescue simulation which provides firefighters with the practice they need to succeed in their jobs. While simulation exercises may not always be that adventurous, healthcare students such as respiratory therapists, nurses, surgical technologists, emergency medical technicians, and dental hygienists need that same kind of invaluable hands-on experience.

Educators are charged with providing students the best training experience possible. Research has shown that the more realistic the training experience, the better the learning experience. In order for simulation to be effective students must believe the scenario is plausible. Creating a simulated world that allows students to practice life-saving techniques requires several essential elements including technology, partnerships, creativity, and the right equipment.

Incorporating the latest technology

Virtual Reality (VR) plays a vital role in today’s simulation. Holo Lens devices and 3D computers allow students to lay “a patient” on a “table” and watch this virtual patient sweat or labor to breathe. Students can visualize muscle contractions when in reality nothing is there.

When anatomy and physiology students, who were raised on computers, are stunned into silence from a 3D computer exercise, educators can readily observe the power of technology. These students select a body part, such as a heart, then rotate it, pull it towards themselves, feel the heart beat through a selection tool, watch it float in front of them and then dissect it.

This technology has brought a whole new level of realism to simulation, something educators were not able to do previously with high-fidelity manikins. However, manikins are far from obsolete, and recent technology has also enhanced this teaching tool.

Forging partnerships

Thanks to a partnership with the president of SynDaver Labs, Texas undergraduate students have access to a new prototype line of life-like, full-body manikins. A far cry from the hard-plastic manikins and task trainers that students have utilized for years, these manikins have soft tissue and hair, and they are flexible. The adult prototype is the only manikin on the market that has posable limbs. Discussions regarding the value of manikins that can communicate and have heart and lung sounds have led to the promise of adding that feature to these prototypes.

Supervised simulation affords educators the opportunity to ensure that students are practicing the correct techniques and creating proper muscle memory

While external partnerships are critical for simulation directors, internal partnerships with faculty are equally important. Marketing products and equipment and explaining the potential of simulation exercises within an educational institution is vital to a thriving simulation program.

Cross disciplinary exercises showcase simulation opportunities and benefit both professors and students. A simulated heart attack during a dental hygiene procedure offers dental hygiene students the opportunity to practice emergency skills, while EMS students called to the scene practice lifesaving techniques. This scenario allows students to broaden their perspective and visualize a continuum of healthcare beyond their respective fields. In addition, interchanges, handoffs, and debriefing discussions provide invaluable insight for students in both fields. Finally, students have the opportunity to think through processes and explain their actions to their peers, crystalizing their experience into knowledge easily accessed in the future.

Creative ways to engage the senses

Creativity can come in the form of a simulation instructor who is out of sight but is able to inject personality into a manikin through a particular tone of voice or personality characteristic, bringing it to life. Likewise, creativity can come in producing just the right scent to mentally shift individuals to a particular place, such as the overpowering urine smell one might remember from a nursing home. That odor can be created, and if the smell is strong enough, participants can actually taste it in the air.

Bringing the senses to life is a valuable tool in creating a realistic environment. Students may not know how they will react to the scents of bile or large amounts of blood until they experience them.

Sometimes products that could enhance a simulation scenario are not readily available or are cost prohibitive, and individuals are forced to find creative solutions. Designing reusable wounds using moulage provides an added layer of reality to trauma day exercises. Creating realistic gunshot wounds which reflect a smaller hole on entry and a larger hole when the bullet has left the body draws students into a credible gunfire scene. This creative approach also offered simulation staff an opportunity to develop moulage techniques and generate a recipe booklet based on those techniques. The booklet was so well received that it was requested by manikin vendors and was ultimately disseminated with manikins across the world.

Setting the scene with real equipment

It is essential to use real equipment with simulated experiences wherever possible. Just as moving theater seats pull audiences into an action scene, students are transported to busy highways in a simulated ambulance while instructors tilt and rock the ambulance, mimicking the twists and turns of the road. It is one thing to explain the level of difficulty of intubating a patient or starting an IV or performing CPR while a vehicle is moving and another to experience it firsthand through a simulation exercise. Likewise, explaining to students that they need to cut seatbelts and break glass in the field but not in the classroom cannot replace the knowledge gained from experiencing the time, effort, and angles required to properly extricate individuals from a vehicle.

Creating a safe, simulated environment in which students can practice skills is invaluable. However, practice does not make perfect. Perfect practice makes perfect. Because students can practice the wrong way very easily, supervised simulation affords educators the opportunity to ensure that students are practicing the correct techniques and creating proper muscle memory. If these future healthcare workers are performing the correct procedures repeatedly in a life-like environment, they will not need to think through every step when they start an IV or rappel down a cliff to assist their patients.