Sim­u­la­tion in Saudi Ara­bia

UAMS group sets up women’s school train­ing cen­ter.

Arkansas Democrat-Gazette - - FRONT PAGE - AZ­IZA MUSA

It’s hard to tell the dif­fer­ence be­tween what’s real and what’s fake at the Univer­sity of Arkansas for Med­i­cal Sci­ences’ sim­u­la­tion cen­ter.

The cen­ter is home to man­nequins — rang­ing from pre­emies to a preg­nant and birthing doll named Noelle — along with stand-alone arms and chests. They’re plas­tic and rub­ber, but some re­spond to anes­the­sia. Oth­ers breathe and blink. Most have heart­beats and pulses.

The com­put­er­ized man­nequins serve as prac­tice tools for UAMS doc­tors and stu­dents. Sce­nar­ios can range from the be­nign to the life-threat­en­ing. The tech­nol­ogy is ideal for train­ing stu­dents and doc­tors be­fore they en­counter real pa­tients in one of those sit­u­a­tions, UAMS’ sim­u­la­tion cen­ter team mem­bers say.

UAMS started its cen­ter in 1997. It has since moved to the main cam­pus in Lit­tle Rock and has about 10,000 square feet of clin­i­cal rooms, seven sim­u­la­tion the­aters and five de­brief­ing rooms. The cen­ter’s team has trav­eled across the state in re­cent years to set up the equip­ment in ru­ral ar­eas and train med­i­cal pro­fes­sion­als there.

And this year, the team took its first trip abroad.

For a week in Septem­ber, the team was in Riyadh, Saudi Ara­bia, to set up in an all-women’s school called Princess Nora Univer­sity. The univer­sity is named af­ter the sis­ter of the coun­try’s first king, Ab­dul Aziz bin Ab­dul­rah­man.

“A col­league of mine from Aus­tralia was go­ing over there to do a needs as­sess­ment,” said Mary Cantrell, the ex­ec­u­tive di­rec­tor of UAMS’ sim­u­la­tion cen­ter. “And they asked me to go over there and do that.”

Cantrell made her first week-long trip in June.

“So just to give you an equiv­a­lence, we have 10,000 square feet, and they have 300,000 square feet,” she said. “Yeah, four sto­ries. It’s big. We have about 10 full­sized man­nequins that have pulses and heart­beats, and they have over 90. We have the largest sim cen­ter in the state. They have the largest one in the world.”

At the end of her trip, the women asked whether there was a sim­u­la­tion team that could help them get started. Cantrell of­fered up her team.

Five peo­ple — in­clud­ing Cantrell; Mike An­ders, the di­rec­tor of ed­u­ca­tion and re­search at the sim­u­la­tion cen­ter; and Travis Hill, the di­rec­tor of sim­u­la­tion tech­nol­ogy and out­reach — pre­pared to go in Septem­ber. The men had to get spe­cial per­mis­sion to ac­cess the all-women’s univer­sity, Cantrell said.

The group’s mem­bers re­ceived their travel visas the day be­fore they were to leave, An­ders said. And off they went.

Start­ing on a Satur­day, the team mem­bers toured the fa­cil­i­ties and pre­pared for the next few days. They spent the next two days teach­ing the sim­u­la­tion cen­ter staff, and the two days af­ter that teach­ing univer­sity fac­ulty and hos­pi­tal staff mem­bers, An­ders said.

Their days started at 8 a.m. and ran through about 5:30 p.m., Cantrell said. In to­tal, the UAMS team gave lessons to about 65 fac­ulty and staff mem­bers on how to pro­gram the man­nequins and use them for sim­u­la­tions.

Sim­u­la­tion tech­nol­ogy is fairly new in the med­i­cal world, dat­ing back about two decades. At Princess Nora Univer­sity, it was a dif­fer­ent type of method­ol­ogy, and the women there needed some guidance on it, Cantrell said.

“If you think about it, we had our in­dus­trial revo­lu­tion in the 1800s,” said Sara Tariq, a gen­eral in­ternist and med­i­cal di­rec­tor for the Cen­ter for Clin­i­cal Skills Ed­u­ca­tion. “They really had theirs in the 1930s. So, they had to catch up very, very quickly, and they’ve done a fan­tas­tic job of that.”

Sim­u­la­tion tech­nol­ogy got its start in the avi­a­tion in­dus­try. Us­ing it has re­sulted in one of the safest avi­a­tion records in the world, An­ders said. The tech­nol­ogy has also been used for train­ing at nu­clear fa­cil­i­ties, in­clud­ing at Arkansas Nu­clear One in Rus­sel­lville.

It’s only re­cently caught on in the med­i­cal in­dus­try.

Be­fore sim­u­la­tion, med­i­cal stu­dents learned from work­ing with real pa­tients.

“It [used to be] see one, do one and then teach one,” An­ders said. “I found my­self teach­ing pretty early on ac­tu­ally, and I can’t tell you that was a great [method.]”

Sim­u­la­tion isn’t just about learn­ing ob­jec­tives. It’s also a way for the stu­dents to prac­tice work­ing as a team and learn­ing to ef­fec­tively com­mu­ni­cate.

At UAMS, the tech­nol­ogy al­lows med­i­cal stu­dents to carry out team sim­u­la­tions with team lead­ers blind­folded. It’s all about com­mu­ni­ca­tion and lis­ten­ing, they say.

“I think the best ex­am­ple I can give is if you can imag­ine if a doc­tor says, ‘I need so much mor­phine given,’” Cantrell said. “Was it given? Or was it given twice? So, you know, what hap­pens is, ‘I’ll give the mor­phine. How much do you want? I’ll get a dose.’ And then you give it, and you say, ‘I’ve given the mor­phine.’”

The sim­u­la­tion train­ing was es­pe­cially rel­e­vant in Saudi Ara­bia, Tariq said.

“Right now in Saudi Ara­bia you might have heard that there’s an epi­demic of coron­avirus or MERS — Mid­dle East res­pi­ra­tory syn­drome — and so their stu­dents aren’t al­lowed to go to hos­pi­tals right now. For months,” she said. “So they’re not get­ting their clin­i­cal ed­u­ca­tion that they need in their ro­ta­tions. So they really rely on sim­u­la­tion ed­u­ca­tion to really sup­ple­ment their cur-

ricu­lum right now.”

They also can use the man­nequins to prac­tice what could eas­ily be other re­al­i­ties in that re­gion, like trauma cases.

They were ea­ger to learn and really soaked up the ma­te­rial, the UAMS team mem­bers said.

“They were pro­gram­ming the man­nequins,” said Sherry John­son, a health care sim­u­la­tion ed­u­ca­tor. “They had the chest skin off and the en­gi­neers knew the in­ner work­ings, and that was just within two days.”

In many ways, the trip was sim­i­lar to those the team takes across Arkansas. The Mid­dle Eastern­ers had more re­sources, but the sit­u­a­tion was the same: teach­ing peo­ple how to use the man­nequins.

“So [the Saudi Ara­bi­ans] have the ad­van­tage that we have here that you have a team and you have peo­ple that are tech­ni­cal-ori­ented, you have peo­ple that are med­i­cal-ori­ented, you have ad­min­is­tra­tion,” Hill said. “Whereas a lot of ru­ral ar­eas here may not have that. They may have one nurse, who has to learn the equip­ment, who has to get the course de­vel­oped.”

Hav­ing a staff that doesn’t know how to op­er­ate the man­nequins is like hav­ing $60,000 text­books, Cantrell said.

UAMS team mem­bers said they forged a strong re­la­tion­ship with the women at Princess Nora Univer­sity and are look­ing at long-term col­lab­o­ra­tions. They are hop­ing to go back to teach more cour­ses there.

“I think we’re go­ing to see a group that’s really rockin’ and rollin’,” Cantrell said. “You know, that’s your hope is that they kind of grow up.”

Spe­cial to the Demo­crat-Gazette

Travis Hill, Univer­sity of Arkansas for Med­i­cal Sci­ences’ di­rec­tor of sim­u­la­tion tech­nol­ogy and out­reach, gives tech­ni­cal in­struc­tion to sim­u­la­tion tech­ni­cians at Princess Nora Univer­sity in Saudi Ara­bia in this photo pro­vided by UAMS.

Arkansas Demo­crat-Gazette/STEPHEN B. THORN­TON

UAMS sim­u­la­tion cen­ter team mem­bers (from left) Dr. Sara Tariq, Mary Cantrell, Sherry John­son, Michael An­ders and Travis Hill trav­eled to Saudi Ara­bia in Septem­ber.

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