Saving lives through crisis simulation

Medical emergencies occur daily across the world, without warning. Human lives depend critically upon the well-honed skills of our doctors and nurses.

Associate Professor Dr Rafidah Atan’s passion is teaching medical students how to handle crises and minimise harm to patients, through carefully designed simulation exercises.

Dr Rafidah shares about the dynamic learning that takes place in the Patient Safety unit she teaches in Monash Malaysia’s Jeffrey Cheah School of Medicine and Health Sciences.

What is the Monash Patient Safety Unit about?

It’s an extensive unit with 4 fullday workshops. It covers topics such as what patient safety is about, human factors and human errors, teamwork, communication, and medication safety. The afternoons are for clinical skills where students learn basic procedures and operate basic equipment.

Each day ends with a 3-hour immersive simulation session in which students are “interns” managing an ill patient. At the debriefing session, we talk about the crisis that happened and effective strategies to manage the patient

This unit was developed in 2006 at Monash Australia. We have added features that are unique to the Malaysian context – for example, a component on transporting a critically ill patient which is taught through simulation.

Students also learn skills like how to make phone referrals, how to take consent, or how to voice out safety concerns when they feel afraid to speak up.

What skills do students gain?

Skills like effective communication, teamwork, and leadership are best learned during immersive simulation.

We talk about them during tutorials, but it is only during simulation that they actually develop these skills. Also, it is the only environment where students can practice crisis management during life-threatening emergencies without risking harm to real patients. They practice thinking on their feet.

Tell us what a simulation actually looks like.

Each simulation involves a team of 4 to 5 students. We ensure that they work with different team members every time because this reflects actual clinical practice.

They elect a team leader and allocate tasks to each member. They will then manage a crisis situation as if they were “first on scene” (first responders) before senior help arrives.

Students have been taught all the skills needed to perform effectively in the session. Some of these were addressed in the early clinical years, while others – like setting up infusion lines, using the defibrillator, and airway management – are taught in workshops prior to the simulation.

The instructor is in the room as an observer. She may call for a pause to help students or if there are safety issues. Students can also call for a pause if they are unsure of what to do.

This “pause and discuss” approach is necessary as they have never managed a crisis on their own. Expecting them to do so without help would create a stressful learning environment and result in “lulls” in action.

How do you provide feedback to students in a helpful manner?

During the “pauses”, a short debriefing is held to address issues students are currently facing. At the end, a final debriefing is held to emphasise important take-away lessons.

What facilities is the campus equipped with for simulations?

We have two simulation rooms with audio-visual equipment, oneway mirrors, and a control room. We also have two high-fidelity mannikins.

What are the strengths of Monash’s medical education?

We’re truly global. In their final year, students attend rotations in private hospitals, tertiary centres as well as rural hospitals in both Malaysia and Australia.

Monash provides students with a supportive learning environment. Student-tutor ratios are low, creating an excellent environment for an interactive learning experience.

The program incorporates the latest trends in medical education. Other areas include major emphasis on professionalism and assessment of professional behaviour.

For more information on the medicine program at the Jeffrey Cheah School of Medicine and Health Sciences, please visit www. med.monash.edu.my