The Simulation Hospital that Prepares Future Health Professionals

Beep! Beep!

The childbirth scenario is complex. The newborn has just suffered shoulder dystocia, an injury that occurs when one or both shoulders get stuck inside the mother’s pelvis. In the delivery room, a group of midwives reacts to the situation while the multiparameter monitor, used to measure the patient’s vital signs, emits loud beeps.

Beep! Beep!

The team works as per the procedure, they lower the stretcher and call for medical support. They prepare to perform a first-line maneuver known as McRoberts, which involves forced flexion and abduction of the mother’s thighs to allow an opening of the diameter and an increase in uterine pressure.

If McRoberts does not work, they must apply another first-line maneuver called suprapubic pressure, which would allow the fetus’s shoulders to be released.

Beep! Beep!

The monitor continues to emit sounds. In the middle of the maneuver, a team member suddenly stops the process. He asks his team: «Did everyone understand the procedure?».

«Yes,» the team members respond in unison, stopping their work immediately.

The abrupt end to the activity is not unusual, as the birth is not real, neither is the mother, nor the child inside her. This is a simulated scenario with manikins (models or artificial dolls) that surprise with their realism and allow a birth with complex situations such as shoulder dystocia to be recreated.

«They can talk, complain, bleed, or even convulse,» they will explain later.

However, the team members are real. The team member who asked if the exercise was understood is one of the two teachers present, and those who learned are Obstetrics students from Andrés Bello University in Santiago, one of the programs which receive professional training at the simulation hospital. It was not only the participants who learned during the procedure, the entire class also learned from the observation room as they watched the procedure through a one-way mirror set up in the pavilion.

Learning in a Nearly Real Hospital Environment

Since 2016, UNAB has had a modern Simulation Hospital, which allows students to learn in a hospital and primary care environment very similar to what they will find during their internships and in their future professional life. The UNAB Simulation Hospital has three campuses that total more than 4,000 square meters and are located in Santiago, Viña del Mar, and Concepción.

Obstetrics students are not the only ones trained there; Medicine, Nursing, Medical Technology, Chemistry and Pharmacy, Nutrition and Dietetics, and Veterinary Medicine students also train there. Each course wears a uniform of a color that distinguishes them, and they, besides simulating care with manikins, have other tools that include striking technological advances. A true metahuman test before facing flesh-and-blood patients.

At the República campus located in downtown Santiago, Dr. Rodolfo Paredes, Academic Director of Clinical Education and Simulation, explains that «unlike other universities, we consider clinical simulation as another campus and not just as a laboratory… here we have the possibility of recreating even a very complex picture, just as if you could have it in a real hospital. The only difference is that here it is a safe, controlled, and programmable condition. Here we can learn from mistakes, something that cannot be allowed in a real situation,» he indicates.

«To ensure that this recreation is effective, the Simulation Hospital has various technological tools aimed at providing the best possible care to patients that the students will treat in the future, thereby trying to reduce the margin of error in humans.

The tools available to students surprise those who are unfamiliar with this space. Medical Technology students, for example, can practice with an immersive virtual reality software that, through a headset and controllers (similar to a video game), can accurately recreate various radiology procedures.

«Virtual reality allows students to do it just as it is done in real life. While students work in virtual reality, their peers have checklists to see what they are doing. As the students progress, their peers review what they did well or correct what went wrong,» explains Dr. Rodolfo Paredes.

The UNAB Simulation Hospital also has a hospitalization area with 10 manikins that simulate patients who can be treated with all the tools that a room of this type has in a real context. Different scenarios or clinical cases can be assigned to the hospitalized manikins, which the students will work on based on a previously defined medical file.

Regarding patient engagement, there are other available tools. For example, there is a software developed in Brazil that allows a medical consultation with a virtual patient who, through a 65-inch screen, responds positively or negatively to the indications given by the student, who must provide treatment according to the patient’s symptoms. UNAB has multiple digital tools that provide more than 300 virtual clinical cases from all areas of medicine.

In the skills rooms, students can also use other software to access knowledge that previously could only be gathered through expensive books. The software includes interactive anatomy atlases or programs that allow for digital dissections.

Furthermore, the hospital also has a group of actors who simulate clinical cases that future health professionals must attend to. The consultations are carried out in a box practically identical to those of a clinic or hospital, allowing students to prepare a nearly real scenario. These consultations are recorded for subsequent evaluations.

«In these interviews, there is an actor who has a script behind him, who knows what to say. Students in the early years of their careers have a simpler case than an intern, but the resource behind is that of a standardized patient,» comments Dr. Paredes.

The above are just some examples of the advancements within the Simulation Hospital that can recreate virtually any real situation in a hospital center, such as practical work with incubators, radiant cribs, and defibrillators (simulated, without electric discharge), among others, that allow for practicing resuscitations or the installation of probes.

«Before simulation, this was learned theoretically or with a video, but in practice, it was the doctors in the hospital who had to teach them with real patients. But now, simulation allows them to learn this skill with a significant number of repetitions supporting the safety of students and patients,» notes Dr. Paredes.

He adds that practical work is not the only training that students receive. The Simulation Hospital also aims to prepare students concerning the development of an extremely important element in the health area: soft skills.

«What we aim for with this simulation is to ensure that students aren’t encountering clinical situations for the first time in a real-life medical setting. This spans from handling a simple procedure to navigating complex clinical cases. These situations can be challenging, with a significant psychological component. However, confronting them in a simulated environment means students already gain experience before facing the real thing. Here, we allow practice in everything – even difficult tasks like delivering bad news to a patient,» he explains.

«It Helps Us Feel Confident»

In one of the rooms of the Simulation Hospital, fourth-year nursing students from the Santiago campus sit around a table with small plastic arms. These arms simulate real ones, and the students use them to practice a complex procedure in a real patient: installing an intravenous line in infants.

With tourniquets, syringes, lines, needles, and other real implements, students must locate the vein and perform the procedure with safety, hygiene, and skill. Inside the room, a group of fellow students performs the procedure while a small camera records every detail.

«The technique is the same as the one used with a real patient, this helps to practice the degree to which to insert the needle and things that in practice need to be done more quickly,» one of them explains.

Although they are aware that nothing can resemble a real case, the students agree that the repetition of the process with manikins helps them build their confidence and assurance.

«Reality is obviously more difficult because the patient talks and moves, but practicing with a manikin is good. With this, I feel more secure when facing a real patient,» comments one of the nursing students.

«More than anything, it helps to feel more confident, it helps to loosen the hand. You learn more by doing than by reading,» adds her classmate before finishing the process under the watchful eye of their teacher, Nurse Valentina Sánchez.

Nurse Sánchez, who graduated from Andrés Bello University in 2012, before the opening of the Simulation Hospital, had a very different educational experience than her students do today.

«The first time I inserted an arterial line was when I was already a nurse (…) It was very much like going in blind, you went out with more fear,» recalls the professor.

Drawing from her own experience, Sánchez values that the new generations from her university enter the working world with experience in practical processes, even if they are simulated.