February 2022 - SEM Trainers

Importance of Medical Simulation in Obstetrics & Gynecology

SEM TRAINERS / February 23, 2022March 2, 2022 / Equipment

The individual healthcare professionals and teams are called for the development and maintenance of skills that are necessary for effective and safe clinical care, and this is termed as ‘Medical Simulation’. In this, the trainee surgeons become more efficient and gain confidence by practising and treating their patients remotely. David Kolb (1982) developed the Experiential Learning Theory (ELT) that explains how simulation is another name for deep learning.

The simulation-based training should be fully funded and integrated within training programmes at all stages for the clinician so that the operative gynecology fully takes the advantage of the benefits that the explosion of endoscopic surgery has offered in recent years. It is important for all healthcare organisations to value and adequately resource the simulation-based training, high-quality simulation training to be delivered by developing a skilled faculty of expert clinical facilitators and the necessity of human factors training to safe care to be widely communicated.

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Introduction to Simulation in Obstetrics and Gynecology

About 46% of all maternal deaths and 40% of neonatal deaths happen during labour or the first 24 hours after birth.

Permaturity (35%), neonatal infections (33%), birth asphyxia (20%), and congenital malformations (9%) are one of the main causes of newborn deaths.

To increase skills and knowledge acquisition in obstetric and gynecologic clinical scenarios, simulation is used as a valuable teaching tool. The obstetric and gynecologic simulation also plays a very important role in both competency-based as well as outcome-based medical education. The ability of simulators to reproduce clinical situations has been brought into use in obstetric and gynecologic education, whereas they were created in the 1920s for flight training for pilots, initially.

The simulations that are used in medical training were used first in the 1960s with standardized mannequins and patients. With the development of simulation software for medical education, simulation has also continued to evolve in the 1980s.

It is an effective way for students and residents to develop their abilities in a safe learning environment. A realistic approach is offered by simulation for practising such skills that do not cause harm to a living patient. Although, due to the decreased volume, the residents may not encounter specific cases but the reduction in duty hours has shown to enhance the quality of standardized examination scores for them and simulation allows them and students to experience skills and cases scenarios that might come into use in a reproducible environment.

Simulated learning interactions with patients is provided by standardized patients and is very advantageous in obstetrics and gynecology to practice and model procedures in simulated scenarios. Clinical simulation encounters offer learning skills for instrument deliveries, standard delivery, shoulder dystocia, postpartum haemorrhage, massive blood transfusion protocol, fetal malpresentation, amniotic fluid emboli or disseminated intravascular coagulation. Robotic operative and Laparoscopic simulations facilitate operative skills for salpingectomy, oophorectomy, hysterectomy, and access to the abdomen.

Role of Medical Simulation in Obstetrics & Gynecology

Curriculum Development

The transition away from the classic master-apprentice model is allowed by simulation. They are executed with various gynecologic and obstetric procedures such as management of postpartum haemorrhage, pediatric-adolescent gynecology exams, interdisciplinary obstetric emergencies, cesarean sections and laparoscopic hysterectomy.

Other examples of procedure-specific simulation in gynecology include – operative hysteroscopy, laparoscopic tubal ligation, loop electrosurgical excision procedure, vaginoscopy, cystoscopy, and vaginal repairs, salpingectomy, total abdominal hysterectomy, vaginal hysterectomy, Burch colposuspension, laparoscopic sacrocolpopexy, laparoscopic hysterectomy.

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Procedural Skills Assessment

Though simulation in the field of obstetrics and gynecology is widely available across the world, there still exists a disparity in the benefit learned and retention during simulations. That is why there is a need to develop a standardized way of assessing knowledge of students and residents after each simulation experience.

Increasing the Outcomes of the Healthcare Team

The simulation training in obstetrics and gynecology has helped in enhancing knowledge acquisition and it has also introduced residents and students to increased levels of care coordination and interpersonal communication that somehow resulted in the increase in the overall performance of the team. There have been increased patient-centred care and safety and improved outcomes through the use of simulation.

Conclusion

Simulation is essential for improving the skill level of obstetricians and gynecologists. The training in simulation offers the opportunity for participants to acquire team-based skills and procedural knowledge in a safe environment.

ACLS (Advanced Cardiac Life Support) – Types & Providers

SEM TRAINERS / February 8, 2022March 2, 2022 / Uncategorized

ACLS is the acronym of Advanced Cardiac Life Support. It is a set of techniques and procedures for treating sudden life-threatening conditions such as cardiac arrest, shock, stroke, and trauma. The goal is to achieve the best possible outcome for all those individuals.

This process is a series of evidence-based responses compatible enough to memorize and be recalled under some traumatic conditions and stabilize them in the moment of stress. This includes restoring normal essential signs and alertness. These techniques and procedures are categorized into algorithms that are a set of standard guidelines that help in the speed, effectiveness and outcomes of ACLS.

The protocols of ACLS are formed after a lot of research, patient case studies, clinical studies, and the opinions of experts in this respective field. ACLS is a kind of intensive medical care that saves lives but it is not successful in all cases. It does not reverse or cure an underlying end-stage or life-threatening condition.

Types of ACLS Treatments

Airway stabilization and treatment including inserting a breathing tube in the windpipe (intubation). Mechanical ventilation that uses a ventilator assists or executes breathing.
Pacing to rectify certain abnormal heartbeats
Breathing treatments to open constricted airways due to allergic reactions, asthma, or COPD (chronic obstructive pulmonary disease)
Intravenous (IV) or central venous catheter placement to deliver fluids, blood transfusions and medications
Cardioversion to cure certain cardiac arrhythmias (abnormal heartbeats). A known example is atrial fibrillation. Cardioversion uses medications or low-energy electrical shocks to restore an ordinary heartbeat.
IV medications to cure many conditions. IV medications can reverse life-threatening allergic reactions, suppress abnormal heartbeats and correct acidosis. They can help in the reduction of the workload on the heart, decrease fluid buildup, and dissolve a clot that is resulting in a heart attack. They can also help with blood pressure and vital signs.
Defibrillation to restore a natural heartbeat using a high-energy electrical shock
Cardiopulmonary resuscitation (CPR) to keep oxygenated blood pumping through the body until the heart and lungs can execute the same function on their own. This demands pushing down fast and firmly on the chest.
Oxygen therapy to enhance the amount of oxygen in the blood
Arterial line insertion to constantly take blood pressure readings. It also comes with a catheter in an artery to draw blood for necessary lab tests.
Needle decompression or Chest tubes to re-inflate a collapsed lung

When Advanced Cardiac Life Support is Performed?

ACLS is performed at the time of severe life-threatening conditions such as:

Heart conditions consisting of cardiac arrest, heart attack, cardiac arrhythmias (abnormal heartbeats), certain congenital heart defects (birth defects), and congestive heart failure.
Severe allergic reactions come under anaphylaxis, a dangerous allergic reaction
Coma due to stroke, head injury, meningitis, seizures, or diabetes
Electrolyte imbalance that comes with abnormal amounts of potassium, calcium or magnesium in the bloodstream
Arrhythmias include ventricular tachycardia, ventricular fibrillation, supraventricular tachycardia, and rapid atrial fibrillation
Shock due to extreme bleeding, spinal cord injury, heart conditions, and sepsis (a body-wide reaction to infection)
Trauma and injuries undertaking severe burns, major cuts, head and spinal cord injuries, multiple trauma, and smoke inhalation
Drug toxicity and chemical exposure that consists of overdose, poisoning, or major adverse effects of medications and street drugs
Respiratory failure including problems because of asthma, pulmonary oedema (fluid in the lungs), and pulmonary embolism (blood clot in the lung)
Terminal illnesses having end-stage liver failure and advanced cancer

Who are ACLS Providers?

ACLS can only be provided by qualified health care providers because only they have the ability to manage the person’s airway, operate emergency pharmacology, read and interpret electrocardiograms, and initiate vascular access. These providers consist of physicians, pharmacists, paramedics, advanced practice providers (physician assistants and nurse practitioners), respiratory therapists, and nurses. The other responders may also be trained to be of help at the time of emergencies.

It is important for the advanced cardiac life support providers to be very particular about their timeliness and to provide the intervention that suitably fits the needs of every individual. A quick and exact assessment of their condition is required for the proper utilization of ACLS. This should not only be followed at the initial stage of assessment but also at the time of reassessment throughout the course of treatment with ACLS.

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