Overcoming Barriers in Simulation-based Medical Education: Challenges and Strategic Solutions

INTRODUCTION In the recent competency-based medical education curriculum of 2019, the national medical education of India, as well as simulation-based medical education (SBME) as compulsory, all medical colleges in India began implementing SBME. However, they faced so many challenges in implementing SBME. In this article, we will discuss the challenges encountered and the strategies employed to overcome them. The subheading on simulation lab setup, financial support, faculty, students, and supportive staff discusses some of these challenges and their solutions. SIMULATION LAB SETUP Some medical colleges in India have already implemented SBME before 2019, which means they have a skills lab and are already familiar with the concept. Medical colleges typically lack skills labs, and those established after 2019 are the only ones grappling with this issue. How to set up a skills lab is the first question and challenge faced by medical colleges. The National Medical Commission has clearly outlined the infrastructure requirements, including space and a simulation room, for student admission, as well as the mannequin requirements for each department within the medical college.[1,2] If setting up the skills lab presents any challenges, the most effective approach is to form a committee comprising medical faculty, infrastructure staff, and biomedical staff. This committee should visit medical colleges that have already established skills labs to learn about their construction methods, challenges they faced, and the mistakes they made. They should enquire about the methods they used to build the skills lab, the obstacles they encountered, and the errors they committed. The committee finalized the purpose and created a blueprint for the skills lab, outlining where and how it should be set up in the medical college. Another method involves some simulation-based organizations and societies developing a standard operating procedure for the skills lab, which simplifies the setup process. FINANCIAL SUPPORT Financial support is crucial for building a skills lab and purchasing and installing mannequins, AV aids, and video recording systems for communication skills labs, among other important challenges. Once the skills lab is constructed, it requires financial support for the regular use of consumables such as suture materials for practice purposes. The total cost of the money varies depending on the mannikin company and the type of mannikin ordered, such as medium fidelity or high fidelity. If you do not have enough funds to face these challenges, proper planning is critical. Allocation of funds is based on priority. A new medical college aims to purchase only the mannequins required for 1st-year students, gradually increasing the number of mannequins in subsequent years as they progress to the next year. If limited funds require you to purchase the mannequin first and distribute it department wise, consider using the mannequin in your department for maintenance purposes. This approach will help you avoid investing a significant amount in the skills lab at one time. Invest in task trainers, models, low-fidelity mannequins, and medium-fidelity mannequins before purchasing high-fidelity mannequins. Once the faculty receives training in this area, they will opt for higher-fidelity mannequins. If a postgraduate teaching institute opts for high fidelity, it will prove to be more beneficial. Collecting the skills lab fees from students is an unavoidable task. Every year, a portion of the fees should be collected to alleviate the financial burden on the skills lab. Encourage faculty members and nonmedical staff to prepare simulation items such as a suturing task trainer and other simulation equipment. They should also use expired items from the hospital pharmacy, such as suture materials and medicine, for simulation activities. Don’t use more costly materials for simulation activities. FACULTY Some of the faculty new to SBME do not know how to run the simulation activity, and some are not interested either. Therefore, to conduct a faculty development program focused on SBME, It is most effective to conduct a faculty development program based on specialization, as each department has its own unique simulation scenarios. To initiate a certificate or diploma course in SBME, interested faculty members will enroll in this program. The medical college’s goal is to identify and train faculty members who have a keen interest in and active involvement in medical education. Every medical college should have a separate committee for skills labs, such as the medical education unit and curriculum committee. TIMETABLE Making a timetable for the skills lab and deciding how to allot the time and how many hours for each competency is one of the difficult processes. In a single session, two or more departments requested a simulation activity in the skills lab. The curriculum committee, the medical education unit, and the skills lab committee convene to devise a schedule for the skills lab. Another solution, if possible, is to send task trainers or mannequins from the skills lab to a specific department for teaching. Construct infrastructure simultaneously to support two or more simulation activities without interfering with each other. STUDENT Another challenge is that some students are not interested in practicing on a mannequin, preferring to practice on a real patient instead. We can overcome this problem by enhancing the realism of the scenario and emphasizing the importance of patient safety. The insufficient time to instruct all students, approximately 250 in a single batch, poses a challenge. While some students receive training in as little as 5 min, others require more time. In this situation, ask the students to come in during their free time to practice; ask the student to send a request to practice the skills; and allot enough time for that student to practice. SUPPORTIVE STAFF One of the challenges in implementing the skills lab is the lack of sufficient supportive staff. Indeed, operating the skills lab or center would be challenging without the presence of supportive staff. Appoint an adequate staff pattern for the skills lab to run the skills lab effectively and appoint an adequate staff pattern. Apart from the coordinator or director of the skills lab or center, we need to appoint full-time staff, including tutors, computer operators, technicians, and housekeeping. We must instruct them on how to operate the mannequin, resolve technical issues, and utilize this assistance for simulated patients. Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.