The COVID-19 pandemic has intensified the need for highly skilled clinicians to staff healthcare facilities across the United States. However, as universities implement distance learning during the pandemic, graduation for an entire class of new clinicians has been postponed just as they are needed most. To ensure healthcare facilities remain adequately staffed, and patients receive safe care, many medical schools are turning to online learning so students can complete clinical education requirements. The Medical College of Wisconsin (MCW) has integrated online learning with its simulation center to enable students to continue their education and fulfill their clinical hours.
How simulation-based training is used at MCW
Staffing healthcare facilities with highly trained and experienced clinicians is essential to a safe work environment for healthcare workers (HCW) and effective patient care. As such, MCW is dedicated to providing its students with real-life clinical experiences in a secure and controlled environment, so they enter the workforce with the skills and knowledge needed to deliver quality patient care.
One of the critical ways MCW students gain the clinical experiences that will make them effective healthcare providers is through simulation-based training. The Standardized Teaching Assessment Resource (STAR) Center opened in the fall of 2005. The STAR Center was planned to integrate directly with and support MCW’s educational goals, making it one of the first simulation centers in the country created for that purpose. The work done by students in the STAR Center aims to help improve healthcare through simulation-based medical education and training.
According to Kurt Stefan, program manager at the STAR Center, “In the center, you can simulate real-life patient scenarios for learners and test their clinical reasoning and skills while not impacting real patient and health outcomes.”
During a simulated scenario, participants can apply what they have learned in the classroom and experience hands-on the challenges of providing care. Through complex health scenarios, participants think critically and practice clinical and teamwork skills before they enter the workforce and treat real patients.
Simulation-based training increases confidence in the participants’ clinical skills and abilities while also identifying opportunities for improvement. Simulation allows them to make a misinterpretation in a safe environment where they can practice skills and procedures until they become second nature.
Moreover, students debrief after every simulated session. Each session is recorded, so the videos are used to provide a more robust debriefing experience as the learners can objectively view all of their actions and learn from them. Stefan points out that debriefing is beneficial for students as they get direct and immediate feedback from a faculty member regarding their performance.
Developing skills and gaining clinical experiences through simulation-based training
Gaining clinical experiences is vital for students because it would be impractical and unethical for an inexperienced healthcare provider to treat patients. That is why the staff at the STAR Center stresses the importance of constant practice and learning to students, to enable them to obtain the knowledge they gain while completing their sessions.
Also, learning at these sites is often opportunistic, in that, students only get to practice treating ailments as they present themselves. As a result, healthcare providers entering the workforce might have gaps in their knowledge, and their inexperience can cause them to make mistakes.
As a major academic medical center and the only level 1 trauma center in southeastern Wisconsin, MCW students are fortunate to experience most medical conditions during their clinical rotations. Simulation is used to enhance their clinical rotations and provide additional opportunities to learn, specifically for low-frequency, high-risk events.
While rare, these events require immediate and accurate intervention. If clinicians have not honed these skills, patient outcomes may be affected negatively. The simulation-based training provided at the STAR Center can fill those gaps in knowledge and allow clinicians to gain the experience needed to provide high quality and effective care.
Training at the STAR Center is incorporated into the first-year curriculums of all MCW programs. Students from the School of Medicine, Anesthesiologist Assistant Program, School of Pharmacy, Graduate School of Biomedical Sciences, and MCW’s Residency and Fellowship Programs all use the STAR Center.
Medical students, for example, gain clinical experiences and patient exposure in the STAR Center starting from their first week in school. Students first use standardized patients and skill trainers to practice fundamental skills like performing physical exams, applying clinical reasoning, and communicating with patients.
As the students progress through the curriculum, the scenarios progress in complexity. By the start of the third year, participants use high-fidelity simulators to combine all the skills they learned and complete a full patient experience from assessment to treatment.
In addition to college students, the STAR Center also provides certification training and faculty training so current HCWs can maintain proficiency in specific clinical skills and procedures. Moreover, as part of the center’s initiative to help improve community health outcomes across Wisconsin, students from the School Nurse Program at Children’s Wisconsin and the Milwaukee Public Schools Nurses receive training at the STAR Center.
Thus, MCW and the STAR Center have a long track record of helping to keep healthcare facilities across Wisconsin staffed with highly trained HCWs who improve health outcomes in the state. However, the STAR Center’s most recent contribution to public health is the online training sessions being conducted during the pandemic.
Continuing training online using virtual simulation
The team at the STAR Center has utilized simulation to continue training sessions and provide students with opportunities to achieve their learning requirements while the campus remains closed. The STAR Center staff have created a virtual clinical exam room using Zoom, similar to the exam rooms at the STAR Center, where students would practice clinical skills on a simulated patient.
The virtual rooms recreate a telemedicine experience wherein the students will practice the same skills they would if they were meeting in person. Staff members monitor the students and engage them in questions as they perform a procedure or interact with the simulator. Thus, students hone their clinical skills while also practicing how to provide care through telemedicine.
Likewise, the STAR Center is using Gaumard’s UNI software in conjunction with the Gaumard Vitals monitor and Microsoft Teams to do remote simulation sessions with Certified Anesthesiologist Assistant (CAA) students. According to Michael Stout, MSA Program Director, it is believed that MCW was the only CAA program in the country running remote simulation sessions when they began in April.
Using a Gaumard simulator, a faculty member worked through four case scenarios with the students. As the scenario continued and clinical intervention was needed, a STAR Center staff member adjusted the vitals in real-time accordingly. Students had to think critically about their diagnosis and make clinical decisions to improve the patient’s vitals. The vitals were adjusted and displayed in real-time based on the students’ decisions.
Providing students with this training is especially important now considering the need for HCWs during this public health crisis. Thankfully, by using simulation, MCW allows students to get the hands-on clinical practice they need, ensuring that their students have no gaps in their education. Furthermore, the highly trained HCWs the STAR Center produces will ensure better health outcomes for the people of Wisconsin during and beyond this emergency.