SimgLab, opens the center dedicated to simulation in medicine

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SimgLab of the Italian Society of General Medicine and Primary Care it is the latest born among the centers dedicated to simulation in medicine. A space that wants to guarantee an approach that is as realistic and innovative as possible, leading to training that is preparation and professional practice. The center is equipped with robots, high fidelity mannequins, procedural software, augmented reality that recreate situations, environments, pathologies, interventions, simulating them in realistic scenarios in order to teach diagnostic and therapeutic procedures, repeat medical processes and concepts, make decisions by of a healthcare professional or a team of professionals.

Learning medical practice takes time and experience – points out Claudio Cricelli, President Simg. This path can be significantly shortened with tools that simulate patients with certain symptoms, characteristics, diagnoses. The simulation accelerates training and illustrates less frequent clinical pictures, allowing trainees to learn both basic and complex tasks“.

He is wrong, but on the mannequin

The motto of simulation medicine is do to make mistakes and make mistakes to learn – he adds Cricelli. – This process is possible with interventions carried out not on physical persons, but with virtual patients who have all the characteristics of the real patient. The doctor with the simulation can improve their skills, both at a basic level and in some second level interventions, which allow the General Practitioner to make them take on a more relevant role in the NHS. The Florentine center is an example of the spread of this type of structures that allow the development of simulation medicine the subject of a technical working group set up at the Ministry of Health. The table is dedicated to the promotion of simulation in the health sector through research and training, aimed at improving operational and technical activities as well as the communication skills of health professionals.

Another example comes from Trieste where a few months ago a structure was inaugurated that includes four simulation rooms connected by three control rooms with four life-size mannequins (two adult models and two for the pediatric age) that perfectly mimic the functioning and human body reactions to medical, surgical and pharmacological interventions, a digital anatomical table for virtual autopsies, an advanced simulation device for ultrasound scans and two others for cardio pulmonary auscultation.

It is the endowment of the Center for Medical Simulation and Advanced Training (CSMAA) of the University of Trieste, which is a candidate to become a reference in the sector for Central-Southern Europe. The Center is set up in a 400sqm building, designed and built in the Cattinara Hospital area and is equipped with a latest generation Learning Space CAE system that allows you to record simulation sessions and review them in streaming or in debriefing, as well as the ability to save students’ performances and monitor their progress over time. You can also create the Voice of Godthe diffusion in the various laboratories of the voice of the instructors who, from the control rooms, will be able to guide the students.

Trieste is perhaps the most advanced, but not the only Italian simulation center. Others are scattered around the Peninsula to testify the importance that simulation has, together with the need for renewal and innovation of the National Health System. A consolidated reality in the training of first aid, such as the Italian Resuscitation Council has more than 350 training centers present throughout the territory with 150,000 operators of various disciplines that issue diplomas recognized in Europe.

High risk at low frequency

These centers can make use of increasingly advanced equipment such as Victoria, a robot that can give birth. In the sense that it is advertised as “The most realistic birth simulator in the world”. Victoria includes several programs to simulate situations that can occur during pregnancy, including an amniotic fluid embolism or placental abruption. The goal is to put operators in a “low-frequency high-risk environment“. Victoria is a product of Gaumard Scientific, a company that develops patient simulators on which doctors can perform intramuscular injections, glucose measurements, urinary catheterization, and a variety of interventions and procedures. “You may only have a complicated birth once every two years or sobut when that happens, it is vital to be prepared”, Says Jim Archetto, Vice President of the company. The simulators are also offered with different skin modes from light to darker. Gaumard’s robot isn’t the only one around.

In fact, in this sector technology plays a fundamental role and the growing demand for advanced mannequins and simulators has stimulated the offer, now able to simulate the most varied physiological and pathological characteristics of human beings. In the more technological versions, the mannequin, complete with an iPad, has a number of features such as spontaneous breathing, blood pressure, carotid and femoral pulsations, heart and lung sounds and allows the simulation of procedures such as ECG interpretation, defibrillation, cardioversion, catheterization and infusion, treatment of tension pneumothorax, chest tube insertion with simulated drainage and advanced and difficult airway management.

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There head it can allow the management of the airways, has an edematous tongue, laryngospasm, cricothyroidotomy, fracturable teeth and is compatible with laryngeal tube, endotracheal tube. It is also possible to have an arm for measuring blood pressure.

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Other types include intubable head, shockable chest, arm with venous access. Compatible device for airway management includes endotracheal tube insertion, esophageal obturator, pharyngo-tracheal lumen, laryngeal mask, esophageal gastric tube. There are also pediatric models with a nine-month suckling manikin which includes a leg with intraosseous access, peripheral sites for venous access on the hand and foot, sites for intramuscular and subcutaneous injections, insertion of the endotracheal tube and laryngeal mask, positioning of the nasogastric tube with reservoir for fluids and other functions.

The Decalogue

The students can practice on special techniques and skills. This is the case of the manikin for anesthetic nerve block and analgesic therapy, which represents a valid support for teaching and training the ultrasound-guided insertion of the needle in the anesthetic blocks of the nerves, the didactic simulator for ultrasound-guided vascular access and of the Chester Chest torso to practice performing central venous catheter. Other versions concern the nursing simulation, with the adult arm for intravenous, the training stethoscope usable on manikins and standardized patients, the management of trauma with the manikins that include a bleeding system.

The frontier is represented by virtual reality or augmented reality simulators which, as the book explains “Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice”allow the creation of environments for transporting students to educational settings other than the world the student is currently occupying.

This is ideal for educational programs that may have limited access to simulation or patient care areas. Both methodologies lower the cost of ancillary treatment equipment resources, while providing a potentially dynamic interaction with the patient that can adapt based on student performance.

The validity of the simulation is confirmed in the programmatic document of the Italian Society of Simulation in Medicine which also proposes a handbook which at the first point asks that the simulation be integrated into all programs for the insertion of health professionals in all stages of their educational and training path. “An ethical goal should be a priority: never the first time on a patient“.

The article is in Italian

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