Simulation in Saudi Arabia
UAMS group sets up women’s school training center.
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.”
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.
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.