The landscape of teaching health and social care subjects has drastically changed over the past few decades. The rapid advances in technology have not only allowed educators to use better equipment, but given rise to entirely new and effective approaches to teaching.
Traditionally, healthcare students would observe demonstrations and develop their professional skills on their peers – before finally going into practice to assess and treat real patients. This long-standing approach however has its challenges, such as the lack of realism, which detracts from the learning experience.
The students acting as patients know what is expected of them and, as a consequence, those practicing their skills don’t feel the need to provide the same level of explanation, patient care or attention to detail. This means that when they are faced with a real patient for the first time, it is a scary prospect.
One of the best innovations we have introduced at RGU is the use of high fidelity simulation. This features an array of structured activities that represent realistic situations, allowing participants to enhance their knowledge, skills and attitudes in a safe and simulated environment.
This method has a long history, for example in aviation – watch the film ‘Sully’. In medical and nursing education, it enables students to practice practical and softer skills in a very realistic way, either with standardised patients or mannequins. The ability to train this way allows them to learn from their mistakes in a safe way, getting feedback to improve their performance, and meaning that the step up to working with real patients is a less daunting one.
In physiotherapy education, many areas use high-fidelity simulation to allow students to experience treating critically ill patients in intensive care. Simulated mannequins – such as Metiman, Simman and Hal – make fantastic intensive care patients, particularly when you can scare the living daylights out of the students by making them cough! Being able to manipulate physiological variables such as heart rate, oxygen saturations and blood pressure in response to the students actions, while also making them solve problems like what has happened, why it happened and what needs done to fix it, creates a great learning opportunity in a safe environment.
In fact, at RGU, the range of uses for high fidelity simulation in education is now huge. We use it across multiple professions – from physiotherapy to dietetics, occupational therapy to diagnostic radiography – and for developing practical skill performance, as well as clinical reasoning.
As an example, students can be provided with a set of notes, or simply a referral for a patient – a volunteer member of the public, asked to behave in a particular way – and they have to assess the patient, before clinically reasoning what is wrong and performing the appropriate treatments.
I think the most entertaining activity however is the community simulation, for the staff observing and the simulated patients at least! A bit of makeup for a bruise and some fantastic acting from our ‘patients’ and the students learn so much about how to adapt their skills to a patients home environment, how their communication skills can impact on how a patient responds, and subsequently how they need to adapt their behaviour, attitude and/or language.
We have also undertaken an interdisciplinary ward simulation, with physiotherapy, diagnostic radiography, occupational therapy, dietetics, nursing and pharmacy students. Not only did they develop their teamwork and prioritisation skills, but it gave everyone involved a greater understanding of each healthcare worker’s roles.
It also brings home some great safety messages. One student left a patient’s crutches spread across the ward floor where I accidentally (on purpose) tripped over them. He was horrified that his actions could have such consequences and learnt what could have been a terrible lesson in a safe and supportive environment where nobody was actually hurt.
Our students perceive huge benefits from these learning opportunities and we find that high fidelity simulation in all areas of practice makes an ideal stepping stone between working with peers and real patients on placement.
In some instances, we have also been able to offer our students the opportunity to work with real patients in a university setting. For example, the creation of a student-led neurological rehab group. This group, supervised by a chartered physiotherapist, is run by physiotherapy students to provide rehabilitation to people in the community with neurological conditions.
Not only does this kind of simulated teaching give students a more effective learning experience, but we have also find that they love it. The realism helps them gain confidence in their own abilities and they benefit from working together across disciplines.
But, most importantly, they have greater freedom to reflect. As one student told us:
“You’re able to learn about yourself and what kind of anxieties you have going in, but can overcome them by just doing what you need to do. Or if you didn’t do things the best way, or things could have gone better, you can focus on what did go well and use the rest as a learning experience.”