In search of most effective pediatric treatment algorithms through simulation-based tele-learning

09:35, 21 August, 2017
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At some point, every one of us must have taken admiration for the inspirational characters on medical drama TV shows – compassionate, sharp-minded, highly intuitive and always successful in solving the most complex and hopeless cases. Medical skills are not inborn but acquired in the result of hard studies and thorough training. Riga Stradiņš University (RSU) in collaboration with the U.S. top medical schools – Yale University and Washington University – have launched work upon development of an algorithm to enable more effective and efficient training and assessment of prospective paediatricians – medical residents in intensive care and emergency medicine through clinical case simulations and techniques, therewith opening new and previously undiscovered training possibilities.

Simulation – a dialogue and self-analysis

As explained by the author of the project idea and the lead partner, Assistant Professor at RSU and paediatrician at the Pediatric Intensive Care Unit at the Children’s Clinical University Hospital R.Balmaks, “The main phase of simulation-based learning is debriefing. In our context, it is an educational tool implying self-analysis. Medical residents with certain experience in clinical work know the theoretical part; however require assistance with shaping their algorithms of conduct in professional environment. It may be attained by asking structured questions allowing themselves arrive at the necessary answers through self-analysis and reflection”.

“The art of asking the right questions is acquired in collaboration with U.S. lecturers. Instead of describing the clinical case, they ask guiding questions. A question – answer panel is a more effective tool than a “didactic” outline of “the right” conduct. Lecturers ask inquiring questions in a noncritical manner as to what the medical practitioner felt and what he thought of when facing the particular situation. What were the hindrances with taking a decision or understanding some specific aspects,” he continued emphasizing that knowledge gained from books will not suffice for a rheumatologist, “analytical skills, situational awareness, ability to bring together diverse aspects and build an effective team are of paramount significance; in fact - it is like putting together a jigsaw puzzle – arriving to a clear picture and gaining complete understanding on the measures to be taken in the particular circumstances.”  

Goal – to discover the most effective debriefing pattern

We are looking forward to elaborate a joint research with pediatric critical care specialists from the Yale School of Medicine on improving simulation-based debriefing, by defining the most effective debriefing patterns. “This is something utterly new and never experienced at transcontinental level before,” R.Balmaks outlines the universal nature of the debriefing mechanism, “every simulation-based debriefing involves assessment of team work, situation analysis and risk assessment skills.” We would like to introduce simulation-based learning for each medical residency study course, engaging specialists of the respective area.

As noted by Isabel Gross, clinical fellow from the Yale School of Medicine involved in the project, “Medical simulation is an effective tool for training future medical practitioners, however it requires certain skills, knowledge and experience for the tool to be applied more effectively. Training courses for simulation instructors are rather expensive and due to geographical considerations, it would be rather complicated to organize such training in Latvia.” I. Gross is looking forward to visit RSU this September, as the cooperation with the Yale School of Medicine will be set forth in the new study year, “We have received positive feedback from students, the training progress is enormous and we have managed to achieve this without physically crossing state borders and without paying huge simulation course participation fees!”

Dr. Goldsmith, a professor at Washington University School of Medicine, director and practicing paediatrician at St. Louis Children’s Hospital, Pediatric Critical Care Unit is another project participant. During implementation of the project he has visited Latvia for several times, “In the last couple of years Reinis and I have participated in clinical webinar training sessions for pediatric residents. It was my first and truly unique experience. As to my observations, RSU medical residents are competent, enthusiastic and motivated. It is beyond question that the quality of medical education at RSU is high. Web-based seminars are an excellent opportunity for the lecturers to overcome large distances, creating opportunities which I as a student did not have. I am looking forward to continue this cooperation to streamline the programme in the future.”

Gains for students

The gains from the introduction of simulation-based learning have been highlighted also by RSU 2nd year pediatric resident Luīze Bidiņa, “The new simulation and analysis model makes residents think critically and analyse clinical cases at another level than before. Self-experienced and self-analysed cases, as a rule, are better remembered. Situations requiring immediate action, when there is no time to consult a senior, more experienced colleague are rarely faced, however one cannot exclude such a necessity and we have to be well-prepared for that. I see no better chance to prepare for such critical cases than simulation-based modelling in safe environment were mistakes are allowed. Proper analysis of own and colleagues’ mistakes or actions ensure a more productive learning process. Currently while working at the Admissions Unit I feel that the training has left a positive impact upon my way of thinking, speed of acting and approach towards patients.”

Future belongs to telemedicine

Intercontinental simulation-based medical training is effectuated via modern means of communication, e.g. Skype, and this is a general trend of modern medicine. R.Balmaks is convinced that, “The future belongs to telemedicine,” noting that there are numerous examples when doctors from US clinics have used live streaming through mobile phones for distance teleconsultations, e.g. on encephalography. “The number of encephalography specialists is limited and such professionals cannot be consulted at every hospital, therewith modern means of communication offer good replacement. There are cases when Mexican hospitals organize web-based consultations with doctors from US clinics, therewith avoiding time consuming flights from one location to another. Similar practice is implemented also e.g. in the United Kingdom for the treatment of severe burns in children. It is recommended to treat severe burn injuries at specialized burn care centres, which in most cases are adjusted to adult patients. To treat the small patients most effectively, paediatricians commonly use virtual consultations with specialists working at adult centres”, he illustrated the modern healthcare trends.

Novelty in RSU medical training

The contribution of R. Balmaks and his commitment to the introduction of new and contemporary study methods goes hand in hand with the RSU development plan. The implementation of a project of such-scale requires teamwork, however initially it is based upon the initiative of individual lecturers, where the contribution by R.Balmaks should be marked out particularly. The Dean of the Faculty of Continuing Education, Professor Ilze Grope revealed, “The Faculty of Continuing Education, together with the Department of Paediatrics and the Medical Education Technology Centre have offered pediatric residents to be the first to try the new learning tool. Why residents? It is necessary to understand that the given training model is an utterly new experience in Latvia and requires thorough previous arrangements and teamwork. Members of the team require courage and confidence in their skills and a good command of English. One must be able to apply the acquired knowledge and skills in imitated stressful situations what is not an easy task to do, knowing that each movement and each word you say is recorded and afterwards analysed together with internationally recognized medical experts. Residents represent part of the medical society that is full of initiative, they are willing and have the ability to accomplish things and are eagerly capturing global trends.”

Facts & figures

According to the World Health Organization, Latvia has one of the highest (3rd place) child mortality rates in the EU. Reduction of child mortality was among UN millennium development goals, which Latvia had committed to achieve. The global goal was not achieved by 2015 and now has been transformed into a UN sustainable development goal.