Results of a Consensus Process on Research Directions in Distance Simulation
The advent of COVID-19 and “social distancing” forced a rapid shift within the simulation community toward “distanced” modalities of simulation-based education. While the current nomenclature surrounding this mode of simulation is still being debated, for the purpose of this article, “distance simulations” are defined as those simulations in which some combination of participants, facilitators, operators, or equipment is in different physical locations while interacting synchronously (i.e., no separation in time). Given the pressing need to maintain educational activities, there was little time to generate the rigorous research base needed to assure the effectiveness of distance simulation techniques. This constitutes a significant gap, as a proper theoretical and evidential foundation is needed for the optimal development, growth, and evaluation of distance simulation.
Simulathon 2020 - Integrating Simulation Period Prevalence Methodology Into the COVID-19 Disaster Management Cycle in India
The disaster management cycle is an accepted model that encompasses preparation for and recovery from large-scale disasters. Over the past decade, India’s Pediatric Simulation Training and Research Society has developed a national-scale simulation delivery platform, termed the Simulathon, with a period prevalence methodology that integrates with core aspects of this model. As an exemplar of the effectiveness of this approach, we describe the development, implementation, and outcomes of the 2020 Simulathon, conducted from April 20 to May 20 in response to the nascent COVID-19 pandemic disaster. We conclude by discussing how aspects of the COVID-19 Simulathon enabled us to address key aspects of the disaster management cycle, as well as challenges that we encountered.
Low-Cost “Telesimulation” Training Improves Real Patient Pediatric Shock Outcomes in India ORIGINAL RESEARCH
Pediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcomes. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COVID-19 pandemic restrictions on in-person simulation led us to the development of telesimulation for shock. We hypothesized that telesimulation training would improve pediatric shock recognition, the process of care, and patient outcomes in both simulated and real patient settings.
Are High School Students Ready to Stop the Bleed from Injuries? Needs Assessment in a Low Resource Country
Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained. However, the willingness of high school students to train in bleeding control is unknown. We report Stop the Bleed training needs assessment from high schools in India and estimate the potential multiplier effect. Methods: A cross-sectional survey was conducted from 12 randomly selected schools in Hyderabad.
Active bleeding control pilot program in India: Simulation training of the community to stop the bleed and save lives from Road Traffic Injuries
Road Traffic Injuries (RTI) and deaths are one of the toughest public health challenges confronting India. During 2018, India lost 151,417 lives due to RTI. Uncontrolled bleeding is the number one cause of preventable death from trauma. Exsanguination on the scene and massive blood loss are estimated to account for nearly 40% of RTI trauma-related deaths. For every RTI death, 10–50 more people may be estimated to be.
Closing the gap: a call for a common blueprint for remote distance telesimulation
The COVID-19 pandemic has brought distance learning in various forms to all levels of education. The simulation community has embraced this challenge, creating a variety of simulation experiences in the era of physical distancing, calling it distance simulation, telesimulation, remote simulation, or even virtual simulation. These techniques—which we will refer to collectively as ‘distance simulation’—have been in the toolbox of simulation programs worldwide for several decades. As distance communication technology has evolved, software such as Zoom, WebEx, Skype, Google Hangouts, and Blue Jeans has become easily available.
A Road Map for Simulation Based Medical Students Training in Pediatrics: Preparing the Next Generation of Doctors
Current Medical training in India is generally didactic and pedagogical, and often does not systematically prepare newly graduated doctors to be competent, confident, and compassionate. After much deliberation, the Medical Council of India (MCI) has recently introduced a new outcome-driven curriculum for undergraduate medical student training with specific milestones and an emphasis on simulation-based learning and guided reflection. Simulation-based education and debriefing (guided reflection) have transformed medical training in many countries by accelerating learning curves, improving team skills and behavior, and enhancing provider confidence and competence. In this article, we provide a broad framework and roadmap suggesting how simulation-based education might be incorporated and contextualized by undergraduate medical institutions, especially for pediatric training, using local resources to achieve the goals of the new MCI competency-based and simulation-enhanced undergraduate curriculum.
Pre Hospital Pediatric Trauma: EMS experience, Improving the Prehospital Care and Road Map for the Future
Pediatric trauma in the context of pre-hospital care attention of researchers and policymakers in India. Trimodal distribution of trauma deaths reveals that most of the deaths occur during the first peak, within seconds to minutes. Mode of the trauma differs in children from adults. Understanding the pattern of trauma to identify risk factors and urgent implementation of injury prevention measures are the only answers to stop these preventable deaths. Second peak occurs within minutes to several hours. Timely prehospital care, rapid assessment, resuscitation, and transfer during this time-critical period are crucial for survival and prevention of secondary injury.
Pediatric Trauma, It is Time to Act
India is witnessing exciting achievements in the care of children, major breakthroughs in improving communicable diseases, and evolution of high-quality pediatric intensive care setups. However, we are facing a unique challenge, the challenge of containing an old disease with a rapidly growing burden, which is the “burden of trauma.” Injury kills more people every year than HIV, TB, and malaria combined. India is leading the world in trauma deaths! Every minute we lose one precious life to injury in India. Children are prone to more severe injuries than adults because of their small stature, delicate body, and curiosity to experiment with a new environment which makes routine objects into potential causes of injury.India is witnessing exciting achievements in the care of children, major breakthroughs in improving communicable diseases, and evolution of high-quality pediatric intensive care setups. However, we are facing a unique challenge, the challenge of containing an old disease with a rapidly growing burden, which is the “burden of trauma.” Injury kills more people every year than HIV, TB, and malaria combined. India is leading the world in trauma deaths! Every minute we lose one precious life to injury in India. Children are prone to more severe injuries than adults because of their small stature, delicate body, and curiosity to experiment with a new environment which makes routine objects into potential causes of injury.
Golden Hour Management of Pediatric Polytrauma in India- Emergency Department Resuscitation
India has one of the highest numbers of trauma deaths in the world. According to the WHO, injury kills more people every year than human immunodeficiency virus (HIV), tuberculosis, and malaria combined in low-income countries. National Crime Records Bureau 2014 report shows that there has been a 63% rise in injury deaths in India in the past decade (451,757 deaths compared 277, 263 in 2004). Interestingly, the population growth during the period 2004-2014 was 14.6%. Data from the Medical Certification of Causes of Death, Government of India 2014 reveals unintentional injury as the 3 leading cause of death in children 5-14 years and 4 leading cause of death in 1- 4-year age. For each death, there will be 4 children who will be permanently disabled. Environmental hazards, small stature, inexperience, curiosity to explore a new environment, bravado, and inadequate supervision put the child at risk for trauma. The World Health Organization estimates that nearly 2 million lives could be saved every year if there is a timely emergency.
Simulation in Acute Care Pediatrics: New paradigms in care
Simulation offers tremendous promise to improve healthcare delivery, especially in acute care areas. It can be an efficient mode to learn, probe, and improve crisis resource management, unit risk assessment, establish an environment for discussing errors without punishment, investigating human performance, assessing situation readiness, implementing new protocols, testing new instruments, improving interdepartmental coordination, learning new concepts or procedural skills, and also in establishing systems and usability of a new unit. Simulation-based learning relies heavily on reflective practice, a key foundational concept of adult learning. PediSTARS India is actively working towards addressing the challenges of implementing simulation-based interventions to better the care of sick children in India.Simulation offers tremendous promise to improve healthcare delivery, especially in acute care areas. It can be an efficient mode to learn, probe, and improve crisis resource management, unit risk assessment, establish an environment for discussing errors without punishment, investigating human performance, assessing situation readiness, implementing new protocols, testing new instruments, improving interdepartmental coordination, learning new concepts or procedural skills, and also in establishing systems and usability of a new unit. Simulation-based learning relies heavily on reflective practice, a key foundational concept of adult learning. PediSTARS India is actively working towards addressing the challenges of implementing simulation-based interventions to better the care of sick children in India.
Pediatric Advanced Life Support (PALS) and Simulation
The Pediatric Advanced Life Support (PALS) course is a very popular course directed towards Pediatricians aimed at improving the outcomes of sick children. However, despite the popularity of the course, the translation of this knowledge to the bedside has been far from satisfactory due to a variety of reasons. Few strategies have been employed to make the course more effective. Modular training by delivering PALS components in a staggered fashion over a defined time period, self-directed interactive web-based learning, use of high fidelity simulators to deliver realistic scenarios, conducting the course in the provider’s workplace using his resources and team, and using reflective practice-based debriefing techniques to enhance learning from real-life events have shown some promise.
Contextualising Simulation in Emergency Medicine Department and Pediatric Intensive Care Unit in India
Emergency Department and Pediatric intensive care units are acute Pediatric care areas with high risk and require quality and safe care to deliver good outcomes to children. Simulation appears to be adapted well in many Emergency Departments as well as PICUs across the world to understand and optimize the delivery of acute care. We have little data on the adaptability and application of simulation methods into acute Pediatric care provision in India. Simulation is currently limited to a few task-training workshops and is yet to become an integral part of healthcare in day-to-day practice. There is a lot of room to expand the scope of simulation in Emergency Departments and PICUs across the country. There is a need to expand the expertise and numbers of simulation trainers to facilitate the wider application. Further studies are needed to understand the impact on patient outcomes and understand the challenges in the wider application to patient care.
Simulation Training in Neonatology - Setting the context
Appropriate management of neonatal emergencies not only requires knowledge and skills but also effective teamwork. Adults are experiential learners who learn by reflecting on the clinical situations they were involved with. Simulation is an effective tool to train as a team and also learn by reflection in a safe environment. Simulation brings out the human factors, which significantly contribute to medical errors and helps train in crisis resource management. Simulation-based training is now recommended by resuscitation councils worldwide. In neonatal training, simulation can be used as a tool in many contexts – learning psychomotor skills, identifying knowledge gaps, communication skills, and teamwork. In situ simulation will also help test the systems. We describe some key contexts wherein simulation-based training can be used effectively as a tool to improve clinical care and enhance quality in neonatal medicine.
Debriefing – What, why and how?
Medical education has increasingly focused on patient safety in the last few decades. Awareness of and emphasis on adult learning principles have made simulation training a novel method. Creating a realistic case scenario experience is very important for the active engagement of the participant to facilitate reflection during debriefing. Designing a simulation session to recreate a realistic clinical experience requires rigorous research and meticulous planning. Poor preparation may cause the whole experience of simulation to be counter-productive. These insights are simplified into a step-by-step approach in this article where the importance of a thorough Needs-Assessment, clear aims, SMART learning Objectives, and a well-designed scenario is elucidated thus demystifying the intricate process of planning a simulation session.
A Road Map to Planning a Pediatric Simulation Session
Medical education has increasingly focused on patient safety in the last few decades. Awareness of and emphasis on adult learning principles have made simulation training a novel method. Creating a realistic case scenario experience is very important for the active engagement of the participant to facilitate reflection during debriefing. Designing a simulation session to recreate a realistic clinical experience requires rigorous research and meticulous planning. Poor preparation may cause the whole experience of simulation to be counter-productive. These insights are simplified into a step-by-step approach in this article where the importance of a thorough Needs-Assessment, clear aims, SMART learning Objectives, and a well-designed scenario is elucidated thus demystifying the intricate process of planning a simulation session.
