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Simulation in Echocardiography: Can it Fill the Demand?

Shyam Gajrani / June 14, 2022June 27, 2022 / Medical Simulation, Nursing Education, Simulation-based Learning

Echocardiography, which is the use of ultrasound waves to observe the action of the heart, is known to be notoriously difficult to learn and requires extensive training to master. Can simulation in echocardiography be the answer to the growing demand?

Echocardiography needs a lot of skill to master

Today, cardiovascular diseases are one of the most common causes of death around the globe. And as they become more prevalent, the demand for diagnosis also increases. Since echocardiography is an affordable, non-invasive imaging technique that delivers immediate results, it is of importance to see how we can improve the learning process for aspiring learners. But it is difficult to learn.

Apart from being technically competent and practically skilled in what they do, echocardiographers need to understand:

The physics behind the modalities
Sufficient knowledge of the anatomy
The physiology and pathology of the heart

It is hard enough to handle the transducer and connect it to the heart’s anatomy, but they need to understand the basics of ultrasound physics and extract and assess information of the 3D heart from a 2D image.

Challenges to Learning Echocardiography

A 2019 study by Dieden, Carlson, and Gudmundsson discovered the main challenges to learning echocardiography, and the things that could aid the learning. Students found the main challenges to be:

The projections: It can be a sizeable task to steer the transducer and obtain a projection, and then make sense of it. And it can be hard for the students to link the projections to where in the heart the ultrasound beam cut.
Handling the probe: It can be hard for learners to figure out where to place, angle, and turn the transducer for some projections. They can be clueless about how to position and turn the transducer if they never have any practice.
Connecting ultrasound physics and measurements to practical application: Students can find it difficult to link the theory of ultrasound physics to practical performance with the machine.

Things That Help Students Learn Better

The study mentioned above also stated 5 things that would improve learning:

Immediate feedback: Real-time feedback and correction from instructors and the screens on the task trainers can improve the learning process; like if the screen can tell them whether they have placed the transducer correctly
Playing with the ultrasound machine: it allows learners to use the machine firsthand where no button is off-limits and nothing can go wrong
Video lectures
The possibility to swiftly alternate between practice and theory: while getting hands-on experience with the ultrasound machine helps learners practice what they just learned, it also helps them understand when and how to apply some concepts and measurements in the clinical setting
Learning by their mistakes in a risk-free environment without serious consequences: Students learn to accept that making mistakes is a positive part of the learning process and can make them better at the task

It is interesting to see that 4 out of the 5 things mentioned above can be achieved with the help of manikins and simulators. Using a manikin helps students learn echocardiography in a way that lets them truly understand the fundamentals behind what they are learning, and can even help learners link the anatomy of the heart, placing the probe, and the location of the beam. Echocardiographic simulation can aid traditional training strategies and improve their efficiency.

It can be hard to get real heart patients for learners to operate on. Additionally, if they do learn by operating on real patients, it can make the patients uncomfortable, put them at risk, and breach their privacy. And it can be hard for teachers to explain concepts to learners while managing the needs of a live patient.

It is well-known how simulators allow repeated practice of diverse scenarios ranging from high-risk to rare, and have been adopted into medical and surgical training. Numerous studies have proved that using simulations and mannequins for learning echocardiography is largely beneficial.

By incorporating simulation in echocardiography, learners profit by shorter learning times(by accelerating the learning process), better outcomes, and lower complication rates. They learn to manipulate the transducer better and angulate it to the skin safely, and comprehend the projections easily. Finally, incorporating simulation in echocardiography helps produce competency.

Top 10 Tactical Combat Casualty Care (TCCC) Medical Simulators You’ll Need | SEM Trainers

Shyam Gajrani / May 23, 2022May 28, 2022 / Medical Simulation, Medicine, Nursing Education, Simulation-based Learning

Tactical Combat Casualty Care (TCCC) are guidelines for providing immediate medical care for life-threatening injuries on the battlefield. Training for TCCC skills can be provided in 3 phases (care under fire, tactical field care, and tactical evaluation care). Students learn the management of trauma care and blast related injuries, and handle hemorrhage control and airway management. Learners cannot be assigned to real patients for handling traumatic combat injuries, but with the help of hyper-realistic simulators, they get all the practice they might need!

Here are some of our powerful TCCC simulators:

Casualty Care Rescue Randy – powered by Strategic Operations Hyper-Realistic® technology

The three most preventable causes of death are massive bleeding, airway obstruction, and tension pneumothorax. This one is a hyper-realistic full-body manikin that is perfect for training on the procedures that treat these 3 conditions. This manikin holds 3-4 liters of blood and simulates a 2-3 psi blood pressure.

Tactical Combat Casualty Care Simulator with Major Vascular Injuries – TCCS 2

This full-body simulator is great for realistically training combat trauma care for major vascular injuries for hemorrhage management and airway control using common wound patterns of combat. Durable in the toughest training scenarios, this simulator is water resistant and great for indoor and outdoor training for the military, government forces, medical rescue, and private security. It is remote-controlled and simple to operate, and comes with an instructor interface tablet with simulation logs and self-diagnosis. Use it for high threat extraction training and realistic TCCC field training scenarios.

Tactical Combat Casualty Care Simulator with Traumatic Amputations – TCCS 3

A full-body TCCC simulator for training combat trauma care for traumatic amputation injuries that are above the left elbow and above the left knee along with an amputation at the upper right thigh above the tourniquet line. Highly durable in the toughest training scenarios and water resistant, this simulator is great for indoor and outdoor training. With its lifelike tissue, it is great for training of hemorrhage management and airway control, high threat extraction training, and realistic TCCC field training scenarios.

Tactical Combat Casualty Care Simulator with Traumatic Amputations and Gunshot Wounds – TCCS 4

This full-body simulator is great for training for multiple traumatic gunshot wounds (like sucking chest wounds) and amputation injuries above the left elbow and the left knee. Like the others, this is highly durable and water resistant, and great for training of hemorrhage management, airway control, high threat extraction training, and realistic TCCC field training scenarios.

Tactical Combat Casualty Care Simulator with Abdominal Evisceration – TCCS 5

A full-body simulator good for training combat trauma care for abdominal wounds with evisceration and a traumatic amputation above the right wrist. Highly durable and water resistant, and great for external hemorrhage and airway control, high threat extraction training, and realistic TCCC field training scenarios.

Tactical Combat Casualty Care Simulator with Gunshot Wounds – TCCS 1

Another full-body TCCC simulator for combat trauma care training of gunshot wound management, hemorrhage management, airway management, and trauma management related to the casualty’s breathing and circulation. Highly durable and water resistant, and great for hemorrhage management, airway control, high threat extraction training, and realistic TCCC field training scenarios.

Tactical Hemorrhage Control Trainer – THCT

This one is a full-sized, remotely-activated simulator for point-of-injury, tactical medicine training for law enforcement and first responders. With realistic and anatomically-accurate soft tissue, durability, and water resistance, this simulator has remotely-activated pulsatile bleeding, multiple injuries like gunshot wounds, stab wounds, and crushing injuries, and an amputation on the left leg above the knee for tourniquet application.

CPR Module for REALITi360 Patient Monitor Simulators

This one is a CPR module with detailed real-time visual feedback on CPR quality. A sensor keeps track of the rate, depth, and release of each compression, and the system evaluates CPR time, correct chest compressions, pressure depth status bar, pressure posture, and pressure CPR rhythm. The system can be worn on the wrist, deployed on a manikin, or even placed inside a manikin.

Hemorrhage Control Arm Trainer P102

A trainer for hemorrhage control on the upper extremity with realistic wound and bleeding simulation. Affordable and great for training of bleeding control and management of traumatic arm injuries. It has a deep laceration/stab wound, a large caliber gunshot wound, and a junctional wound in the shoulder.

Simulated Patient Monitor – REALITi Plus

A patient monitor that is a smart, integrated, and modular simulation ecosystem and lets medical educators run multiple scenarios – from basic to sophisticated. It is mobile, so you can conduct training anywhere- whether it’s an ambulance, a helicopter, a hospital, or a skills lab.

For meticulous tactical combat casualty care training with the help of simulators, call us at 02632 257259 or drop us a mail at sem@semtrainers.com today!

How Simulation-based Learning is Revolutionizing Nursing Education

Shyam Gajrani / May 15, 2022May 27, 2022 / Clinical Skills, Equipment, Medical Simulation, Medicine, Nursing Education, Simulation-based Learning

Nurses are the heart of healthcare. With that in mind, it is intriguing to discuss the benefits of a simulation-led approach to nursing education.

Through the inclusion of role-playing, devices, trained persons, trainers, environments, and lifelike manikins, promoting learning and eliminating risk for the trained and the novice alike, simulation-led learning creates the perfect opportunity for learners to acquire necessary nursing skills in a safe environment. This also offers the added advantage of building critical decision-making skills by simulating various real-life scenarios. Affected slightly by the level of fidelity, simulation-based learning for nursing education can have a range of benefits.

Hands-on Learning

While it is detailed and complete, theoretical learning can quickly become boring for a group of learners eager to become skilled professionals. Simulation-based learning solves this problem. Not only does it provide learners a way to learn specific skills by actually practicing them, it lets them do so in a safe environment.

Immediate Feedback

A multitude of simulators is designed to provide real-time feedback for the learner’s performance (often through a screen or through lifelike response to stimuli). This feedback can then be used to further improve a learner’s prowess in specific skills. And it all happens in a safe environment, successfully avoiding the risk of causing harm or inconvenience to real patients. Additionally, people learn better when they aren’t afraid of making mistakes.

Learning through Repetitive Practice

Practice makes perfect. Besides, with something as important as nursing, repeated practice builds skill, instills confidence, clarifies the fundamentals, and prepares the learner for stepping into a real clinical setting.

Building of Important Skills

Simulation allows learners the opportunity to practice caring for patients in ways that they cannot in the real-life hospital setting. Through several studies, it has been found that simulation-based learning for nursing education has a positive impact on knowledge acquisition, psychomotor skills, self-efficacy, satisfaction, confidence, critical thinking skills, and communication skills. It does all that within a safety net.

From mass casualty and wound care to mental health and end-of-life care, nursing skills education benefits from the adoption of a simulation-based approach to learning.

Benefits of a Simulation-Based Approach to Nursing Education

Teaching nursing skills through simulation involves a lot of role-playing and playing out realistic scenarios using actors and manikins. A student can pretend to be a patient, a nurse, a healthcare assistant, a manager, a student, a doctor, or even an angry relative. Imagine that as a student, you are pretending to be a nurse tending to three patients and receiving a call from the relatives of one of them. Think about what skills you would take home from that experience. No matter what scenario plays out, the result is improved patient care skills for everyone involved in the scenario. Simulation-based training is effective at bringing on the following changes in learners:

The ability to think on their feet
Refined communication and management skills
Acute decision-making skills
Confidence in their nursing abilities
The ability to work under pressure
Improved knowledge of nursing skills
Visibly improved technical skills
Stronger leadership skills
Developed self-confidence and attitude/aptitude for nursing
Students are exposed to rare clinical situations
Students are able to practice clinical reasoning skills

Other Miscellaneous Benefits

Other than the obvious benefits to the learning process and the learner, there are some other benefits to the nursing education system as a whole:

Enhanced patient safety and quality
Learners can manage patients without posing risk to actual humans
Controlled and safe learning environment
Structured feedback
Faster time to competence
Fills the gap in faculty/clinical site resources

Additionally, simulation-based nursing-skills training avoids inefficiency due to the following during training:

Feeling awkward for getting in the way of nurses’ work
Getting flustered by an unexpected situation or care instruction
Experiencing difficulty in adapting to training because many parts were not covered in school

It can safely be said that a simulation-based approach to nursing skills training lays the foundation for a student-centred learning paradigm. So owing to the array of benefits that it brings with itself, simulation-led training has secured its place in nursing skills training as an indispensable asset. And with further advancements in the technology, it may open up newer horizons of learning in nursing and other aspects of healthcare.

Simulators from SEM Trainers

If you’re looking to purchase medical simulators for the purpose of nursing skills training, your search ends here, because SEM Trainers is the #1 provider of premium-quality simulation products sourced from Germany, USA, Japan, and Europe.

Clinical Skills Training – Development, Facilities & Training Centres

SEM TRAINERS / November 26, 2021December 3, 2021 / Uncategorized

Clinical Skills Training is specially designed for students to obtain and integrate general and special medical skills at the patient’s bedside. General history taking and examination procedures are being taught and practised through Clinical Skills Training. This occurs among the students first and then to the patients as well from the involved departments and hospitals. The goals of Clinical Skills Training are mentioned as scripts and guidelines.

Medical Simulation is a Disruptive Change in Medicine

It has changed the ancient and age old practice “One Doctor to One Apprentice”, a practice in “Residency Training” which was introduced by Dr Halsted at the turn of the 20th Century. This “Master-Apprentice Model” served well for the exigencies of that age and time. “The time now is to redesign for the requirements of the current era. However It should be noted that “disruptions” are the originators of paradigm shifts in human evolution, social developments and in scientific discoveries. Disruptions lead to paradigm transformational changes. Simulation has for the first time in the history of medicine, made it possible for the Apprentice to acquire, practice, and become proficient on demand, besides meeting the critical requirements of various Clinical Competencies says Dr. Stephen C. Schimpff in his book “The Future of Medicine-Megatrends in Healthcare”.

Why Simulation is becoming “Indispensable”

Simulation is now rapidly becoming an important and integral adjunct to Medical Education and training.

Let us look at the reasons why Simulation is becoming so indispensable for Healthcare Training.

Learning any new skill means making mistakes
Making mistakes is a normal part of the learning process. Learning medical procedures has traditionally meant making mistakes on real patients.
Making mistakes on real patients can put the patients at serious risks sometimes life threatening, but
Hands on “Experiential” learning is indispensable for Healthcare Professionals, be it at a basic nursing level, or undergraduate level or post graduate level or even at the practicing level

Development in Clinical Skills Training

The training of appropriate clinical skills is an essential element of healthcare education. It is seen that students are able to gain all the theoretical knowledge but somewhere lack the skills in practical and physical examination and thus, are unable to take simple and practical procedures. Hence, Clinical Skills Training makes a strong part of the core curriculum and this training programme ensures that all the students have the necessary learning opportunities and the appropriate assessment.

With frequent changes in the healthcare delivery process and pressure on clinical resources, the desired educational targets are not easily achieved with so many number of students. The hospital wards are not always the appropriate settings for the students to be introduced to clinical skills, practise them and master the essential technique. Thus, clinical laboratories were established to provide students the necessary environment in which they can get the training in clinical skills in a systematic manner using effective educational strategies and experiences.

Clinical Skills Competencies

Clinical skills competencies include:

Communication and history-taking skills
Professional attitudes and awareness of the ethical basis of healthcare
Physical examination, procedural and clinical laboratory skills
Diagnostic and therapeutic skills
Resuscitation skills
Critical thinking, reasoning and problem-solving skills
Team-working, organisation and management skills
Information and technology skills

Clinical Skills Facilities

To develop clinical skills competencies using manikins, fellow class members, simulated and real patients, clinical skills facilities have a space set aside for this purpose. The feedback is also provided through television monitoring or directly through simulated trained patients, their instructors or tutors. Because of these reasons, many medical institutions have now set up clinical skills training facilities or are in the process of doing so.

Targets According to Educational Needs

The clinical skills training is planned having one group in mind. It is usually set up in the context of a new undergraduate medical curriculum with the targeted users being medical students. The target users, however, can be broadened to involve other students from a wide variety of healthcare backgrounds and at various stages of their healthcare development.

Clinical Skills Training Centres

There are many financial, management and educational arrangements for clinical skills training where the multipurpose education remains ascertained. But to make students learn together in carefully selected, practically relevant, task-based scenarios, that prepares students from different professional backgrounds for later work practice as the members of the healthcare team, clinical skills training centres are made. They provide an ideal setting for the early development of such relationships.

Use of these clinical skills training centres by students at different phases of their educational spectrum (undergraduate or basic training, post graduate or vocational training, continuing professional development) emphasizes the importance of the continuous sequence of education. Thus, the making clinical skills training centre accessible by different groups of students allows the facilities to be consumed in a much proper way.

Different Approaches Through Studies

There are many approaches that focus on how to engage students in self-directed learning and peer learning activities to improve clinical skills training in undergraduate medical students. In the first study, the clinical skills training provided by student teachers and associate professors is compared. The results have shown the student teachers performing as good as or even better than associate professors when they are giving simple clinical skills training.

The second study examines how complex clinical skills, such as patient management skills, develop with increasing levels of competence. To reflect this change, the Reporter-Interpreter-Manager-Educator framework was used and explored. In the third study the effects of training in pairs (also known as dyad practice) were examined. This study showed that the students practicing in pairs significantly out-performed those training alone using RIME-based assessments and that dyad training significantly improved students’ confidence in managing future patient encounters. The final study examined students’ use of self-directed clinical encounter cards (CECs) based on the RIME framework.

Results from this study showed that self-directed CECs can have positive effects on participatory practice and clinical reasoning when implemented in a supporting environment but the chance of success depends on the context of use.

For Ideal Skills Lab Development Programme, contact us.

Why Do We Need to Train Nurses in PICC Insertion?

Shyam Gajrani / May 24, 2021May 24, 2021 / Clinical Skills

You can’t think of oncology care without thinking of Peripherally-Inserted Central venous Catheters (PICC). Patients who require long-term venous access, like those suffering from cancer, benefit from PICC lines. It is used to administer or deliver medication, liquid nutrition, and other treatment directly to the large central veins near the heart. If you frequently need to be jabbed for medicine or bloodwork, you may be advised a PICC line to avoid repeated irritation to your veins, and the pain from repeated jabbing.

A PICC line is a long, thin tube inserted through a vein in the arm (or, rarely, in the leg) and passed through so your doctor can access the large central veins near your heart. This is a temporary procedure, and is a great option if your treatment is going to last for at least a few days or weeks.

PICC Line Insertion: Techniques

Let’s talk about how we carry out PICC. The conventional technique is the landmark method where we feel the most prominent vein [usually] in the antecubital fossa, and cannulate it with a wide bore needle/sheath, and then insert the catheter through the sheath. Alternatively, we can use ultrasound and a micro-introducer needle where we identify [usually] the basilic vein above the elbow via ultrasound, and then insert a 21 gauge needle into the vein under direct ultrasound image. Then, we pass a guide wire through to the catheter through the needle and the sheath. This is a newer technique with a nearly 100% success rate and minimal injury rate.

Why Do We Need to Train Nurses for This?

In the past, only certified radiologists and specially-trained assistants would be allowed to perform PICC insertion. So why shift this responsibility to nurses? Well, here’s why. If we train our nurses in performing PICC insertions, it will create efficiency and take a load off an already overwhelmed hospital setting. Further, we will discuss the benefits of training nurses in PICC insertion.

Benefits of Training Nurses in PICC Insertion

As discussed previously, training nurses in PICC insertion has a number of benefits to it:

It helps nurses upskill.
With proper training, nurses can learn to competently insert a catheter, effectively avoiding running the risk of patient complications.
If nurses will be able to perform PICC insertions, it will take a considerable load off an already overwhelmed clinical setting.
It could reduce the overall costs of running the setting. When performed by a radiology specialist, a PICC insertion is more expensive.
If nurses would perform PICC insertions, patients won’t have to wait a long time for their turn. This would prevent procedure delays for the patients.
We could avoid post-insertion complications and infections alike. (PICC lines need to be monitored for complications like infections, bleeding, blood clots, nerve injury, irregular heartbeat, damage to veins, and a blocked/broken PICC line). Radiology specialists could do it, but then they likely won’t stick around after the procedure. Nurses will always be available to check up on the patient, and can keep monitoring the situation periodically. The nurses can preasses, follow-up, and troubleshoot.
It also helps avoid complications caused by delay in treatment.
Allowing nurses to handle PICC insertion ensures a better use of valuable healthcare resources.
It helps increase patient satisfaction.
It helps decrease the length of stay for the patient as delays are minimized.
It can reduce the number of failed cannulations.

Limitations

So are nurses qualified to do PICC insertions all the time? There are a few circumstances when a nurse must not insert a PICC line, and refer the patient to a medical practitioner instead:

When the patient does not give consent to the nurse.
When the patient is a minor.
When the patient has a pacemaker.
When the patient has an anatomical distortion from surgery, injury, trauma, or disease.
When the patient has bilateral arm lymphoedema.
When the patient has an implantable defibrillator.
When the patient has an arterio-venous fistula.
When the patient is on haemodialysis or peritoneal dialysis.
When the patient is scheduled for an arterio-venous fistula.
When the patient won’t allow care for the PICC line.
When the patient has an allergy to Lidocaine Hydrochloride 1%.
When the patient has a platelet count of 50 or less.
When the patient has a coagulation disorder.
When the patient has had thrombolytic therapy within 2 days.
When the patient has an inappropriate vein size under ultrasound.
When a PICC line insertion by the nurse has failed.

Nurses can be trained with a one-week course. If they have the necessary training and experience, their competence has been successfully assessed by a qualified professional, and they are confident in their ability to perform the insertions, training our nurses to perform PICC insertions would be a favourable decision.

Simulators for PICC Insertion Training

Like we said, manikins and simulators specially made for PICC insertion can help immensely with training. We provide some high-quality simulators for this purpose.

Peter PICC Line Simulator

This is a PICC line simulator and a great teaching model that is portable and lightweight. It is an upper torso with neck, chin, right arm, ribs, muscle tissue, arm skin, body skin, arm vein set, body vein set, fluid bag, a carrying case, and an additional pouch. It is anatomically correct and features the superior vena cava, subclavian, jugular, median basilic, basilic, and cephalic veins. It has a movable chin that might occlude insertion in real life just as well, and has palpable ribs that allow measuring proper catheter length from the insertion site to the second/third intercostal space. It also allows standard IV catheter placement.

Standard Arm for Chester Chest, Light Skin – VATA

This simulator helps train with infusion, withdrawal, care, securement, and dressing of multiple vascular access lines. The right chest area has a tunneled central catheter with a Dacron cuff, the external jugular vein is raised and opens to connect to a triple lumen catheter, and the upper chest area opens to connect to a subclavian catheter. It also has a real port for accessing IVAD placements. It allows infusing fluid and withdrawing blood.

We’ve been doing this for 25 years, so we know what we’re doing, and only deliver the best quality simulators. To make a purchase, you can call us at 02632 257259, +91-88495 63724, or +91-98791 03905, or write to us at sem@semtrainers.com.