First E-Simulation Conducted at RSU Medical Education Technology Centre for International Doctors

The Rīga Stradiņš University (RSU) Medical Education Technology Centre (METC) held their first international virtual clinical simulation in mid-October. During the virtual simulation students, residents and doctors from RSU, the University of Leicester (UK) and Yale Medical School (USA) played out a scenario to treat a six-year-old patient with pneumonia andsepsis, or blood poisoning, resulting in severe complications. The success of the event has ranked RSU alongside other Western European universities that include virtual simulation in both their undergraduate and postgraduate medical training. The next such training is already scheduled for November.

‘The COVID-19 restrictions have made it necessary to increasingly organise meetings, studies, examinations and clinical simulations online. Although this type of activities have obvious shortcomings, particularly regarding practical skills, many universities are developing this format, because it is necessary to think about alternatives that allow studies to continue as fully as possible in pandemic conditions,’ says the Director of the RSU METC, Ieva Šlēziņa.

The virtual simulation took place on a video conferencing platform. Participants were introduced to the patient, played by an actress, via video, who in this scenario had severe complications in addition to pneumonia – shortness of breath, low blood pressure, low spirits and seizures. The aim of the exercise was to recognise and prevent the complications of an infection (sepsis) by working as an international team. During the simulation, participants were able to monitor the patient's vital signs (heart rate, respiration rate, blood pressure, blood oxygen level), as well as share instructions via the chat function (e.g., lung sounds, X-rays, tests). The course of the scenario changed depending on the actions and instructions that participants performed remotely. Before each simulation, participants were given randomly allocated roles, so a medical student could also become the doctor in charge of the case, but a doctor might be given one of the assisting roles. This was done deliberately to both allow everyone to learn leadership skills as well as for the less experienced participants to understand teamwork under direction of an expert.

Speaking about the emergence international e-simulations, RSU METC Senior Simulation Instructor Asst. Prof. Reinis Balmaks says: ‘A similar approach has developed rapidly in other fields, for example in sports. There is e-training in cycling, as well as in fitness, running and rowing. The results have shown that participants work together well, despite their location and training levels. Influenced by this successful example, the RSU METC’s vision is to provide international simulation training sessions that would bring together students from different levels and professors from around the world. The aim is to equalise the level of medical education and practice in the world in an inspiring and interesting way.’

The participants of the event appreciated the possibilities of this type of simulation – to be able to work in an international team and to participate in the simulation from a convenient location. ‘It was great to practice virtually with doctors from different countries and with such different experiences. I learned a lot in a new and exciting way,’ says Sofia Athanasopoulou, a resident from Yale Medical School. At the same time, participants pointed to opportunities for improvement. Dr. Sarah Edwards from the University of Leicester, for example, stressed that the simulation highlighted differences in terminology, units and even medication dosages across countries, which can lead to serious misunderstandings when working together. According to participants, the technology changed the sense of time when administering drugs, for example, and there were some shortcomings in using Zoom on a tablet. Resident Baiba Cikovska, who followed the simulation of the virtual scenario, concluded that both teamwork and communication with the patient's relatives would be improved by verbal rather than written communication.

According to Šlēziņa, the Director of the RSU METC, for a first attempt at such an international event the outcomes were overall positive, and the international participants praised RSU achievements in working on this innovation. ‘The work will continue in two main directions: first, the technical side will be improved to make the simulation more interesting from a practical point of view, a virtual defibrillator will be created, for example, as well as virtual medicine and inventory cabinets that would require participants to find they need; secondly, work will be done to simplify and disseminate the existing model so that it is available to a larger number of instructors,’ adds Asst. Prof. Balmaks. The future vision of the RSU METC is to create an academic virtual simulation platform that anyone can connect to at any time to practice medicine together with international experts.