Published: 30-Jul-2021

Citation: Musaeva PV, et al. Creation of New Types of Medical Simulation Systems with Feedback and Interactive Guides Using Augmented and Virtual Reality: The Innovative Project. Ann Med Health Sci Res. 2021;11:110-113

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Abstract

The article considers the features of the use of simulation technologies in distance learning, including in a complex epidemiological situation. The Purpose of the Work: To evaluate the role of simulation technologies in distance learning of senior students of medical universities. The study included 29 6th-year students of the medical institute of the Chechen state university (Grozny, Russia). The introduction of simulation technologies makes it possible to improve the connection of theoretical material with clinical practice, increase interest in learning and self-discipline.

Keywords

Simulation training; Distance education; Medical education; Students

Introduction

The discipline of hospital pediatrics, taught in the 6th year of the medical institute, is devoted to improving knowledge and acquired competencies in previously studied sections of pediatrics, familiarization with rare and complex in diagnostic terms, diseases and syndromes in the age aspect (neonatology, early age, older age). [1-3] Traditionally, the training took place on the basis of a multidisciplinary pediatric hospital “at the patient’s bedside”. However, despite the undeniable advantages of teaching students on real patients, this method has its limitations: Parents and children may refuse to be examined, in the case of rare diseases, a patient with an appropriate diagnosis is not always in the hospital at the time of passing the appropriate training cycle, when studying immune compromised patients, their contact with students is undesirable for epidemiological indications. [4-6] Special difficulties arise when analyzing urgent conditions, complications of the course of the disease and the development of iatrogenia. In addition, it is shown that the number of medical errors is reduced when simulation technologies are included in education before the stage of communication with real patients [7,8] in the absence of risk for both the patient and the student. Simulation training can take various formsboth the development of individual skills, for example, auscultation of the cardiovascular and respiratory systems, [9-11] and working with the patient as a whole (the “standardized patient” technique, [12-16] the use of robot simulators of the child with advanced functions of monitoring vital functions and feedback, virtual simulators of the patient). An important positive factor when using simulation technologies is the possibility of their repeated repetition by each participant, video recording with subsequent debriefing (in the case of a real patient, it is poorly implemented due to the need to protect personal data and respect the rights of the patient), the possibility of modeling rare diseases and syndromes, as well as modeling complications, including iatrogenic origin. [17,18] In meta-analysis, Cheng et al. it has been shown that simulation is a highly effective teaching method for pediatric education. [19]

Due to the sharp deterioration of the epidemiological situation caused by the COVID-19 coronavirus infection pandemic, it became necessary to minimize the risks of “live” communication around the world. [20-23] We believed that the use of exclusively distance learning at senior courses of medical universities does not allow us to fully develop such skills as communication with the patient, teamwork. Even in the work of Lopreiato et al. it is emphasized that simulation is not a substitute for clinical experience. [24] Therefore, a combination of distance learning and work on the basis of a multidisciplinary accreditation and simulation center in small groups was made, also based on C++ programming skills. [25] Unfortunately, due to the deterioration of the epidemiological situation, the training was completely transferred to the remote form in the future, but we plan to resume this work after the pandemic subsides.

Objective

To evaluate the role of simulation technologies in distance learning of senior students of medical universities.For the simulation lesson, a workstation was prepared on the basis of a multidisciplinary accreditation and simulation center of the Medical Institute of the Chechen state university (Grozny, Russia), equipped with a child simulator robot with advanced functions for monitoring vital functions and automated feedback (PediaSIM robot simulator), medical devices, consumables and medicines for the purpose of modeling the situation of metabolic and electrolyte disorders in acute kidney injury. During the lesson, a direct assessment of the actions of students of the 6th year of the pediatric faculty was carried out. Classes were held in small groups (4 people-6 people) in March 2021. After completing the cycle of training and certification of trainees, a questionnaire was conducted, in which 29 students of the 6th year of the pediatric faculty took part. The survey was personalized, since it was already conducted remotely due to the deterioration of the epidemiological situation on the basis of the distance education portal with mandatory authorization of participants.Since the study was a pilot study, no calculation of the sample size was carried out.

Results

When directly evaluating the actions of students, both a low willingness to work in a team and an orientation to work in the “question-answer” and “monologue on a given topic” with a sufficient level of theoretical training with insufficient synthesis of existing knowledge and the need to provide assistance in a specific clinical situation were obvious. These shortcomings were demonstrated to some extent by 100% of students. It was also noted that there was an established hierarchy of relations in the groups of students, which was rigid to changes in the conditions of emergency and emergency care. During the debriefing process, the students also indicated that it was emotionally difficult for them to perceive the robot dummy as a living patient requiring emergency medical care. Therefore, if there was a sufficient theoretical basis, the students provided insufficient assistance in an illogical sequence. In addition, the lack of perception of the simulator as a real patient led to the adoption of ill-considered therapeutic decisions that threaten the development of iatrogenia. Thus, when modeling arterial hypertension with bradycardia against the background of electrolyte disorders, beta-blockers were recommended. The advantage of simulation training in this case was the opportunity to clearly demonstrate the development of complications. During debriefing, the trainees reported that they knew about the effect of beta-blockers on heart rate, but in an emergency they missed this fact.

During the survey, 63% of students indicated that distance learning is comparable to full-time for them, 18% had the impression that it was easier to study, 18% was harder to study because of technical problems and 9% because of problems with self-discipline and other reasons (students could choose several answer options). All students were satisfied with the quality of the lecture material; the vast majority (90%) found the completion of tests and tasks comparable in complexity to the full-time part. A total of half of the students visited the MASC, the rest took advantage of the opportunity to attend freely. Of those who visited, 100% believe that simulation technologies are a good addition to distance learning, of those who did not attend and took part in the survey, all regret the missed opportunity.

Discussion

Simulation robots with advanced vital function monitoring and feedback functions create a focus for team interactions and treatment decisions, as it happens in real life. The simulator also provides an integrated model on which not only medical manipulations and procedures can be performed, but also coordination and interaction between team members can be practiced. [28,29] It should be noted that the scenario program should include the solution of no more than three educational tasks. [30,31] In this regard, it seems appropriate to conduct separate trainings on team building, starting with junior courses. However, these trainings will be ineffective without systematic support in the study of clinical disciplines. In addition, an important task is to create a favorable psychological climate during the training using special cocktails with control of general toxicity conditions, [32-35] especially given the emotional difficulties with the perception of the robot simulator as a living patient, noted in our study.

The inclusion of simulation technologies in distance learning, in our opinion, helped to smooth out the negative consequences of minimizing contact with patients in the context of a pandemic when studying hospital pediatrics. A well-structured logistics of visiting the MASC by small groups of students with the use of personal protective equipment is relatively epidemiologically harmless on the one hand; on the other hand, it allows preserving the advantages of “live communication”, which was noted by the students themselves during the survey.

However, the deterioration of the epidemiological situation due to the COVID-19 coronavirus pandemic required the transfer of training completely to a remote model. A similar situation has developed all over the world, but it should be considered not only as a period of missed opportunities, but also as an incentive to revise the goals of medical education themselves. [1] It is also shown that the distance education model contributes to the increase of self-discipline, which is necessary for further professional formation and growth. [6] In our study, 9% of students indicated problems with self-discipline, but we assume that they were also insufficiently self-critical and in reality a much larger percentage of students had such problems.

Conclusion

In our opinion, simulation technologies in distance learning of senior medical students harmoniously complement distance learning and can be used in a complex epidemiological zincsituation. At the moment, we are also developing models of online simulation trainings.The introduction of simulation technologies makes it possible to improve the connection of theoretical material with clinical practice, increase interest in learning and self-discipline.

Acknowledgement

The authors express their gratitude to Professor. Igor Spartakovich Baklanov.

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