UNM BATCAVE Joining Forces with Argentina
The training called for a surgical team to stabilize a patient. Lights flashed and the steady beep of a vital signs monitor filled the room as a group of scrub-wearing Argentine health professionals surrounded a patient in an OR setting and began one procedure after another.
It was easy to forget, as the minutes ticked by, that the patient – and the situation – wasn’t real.
The training was part a weeklong effort by faculty and staff from the National University of Rosario to not only learn from The University of New Mexico (UNM) simulation lab but ultimately export the educational training to their country, according to center director John Rask, MD, a professor in the UNM Department of Anesthesiology & Critical Care Medicine.
UNM’s Basic Advance Trauma Computer Assisted Virtual Experience (BATCAVE) is a state-of-the-art simulation program offering the ability to run customized medical training scenarios. Students practice procedures that range from labor and delivery to trauma, surgery and disease progression on mannequins that simulate babies, pediatric patients and adults.
The BATCAVE has long hosted online education for UNM and medical professionals across the state, but the scope of the Argentine collaboration goes further, the ultimate goal being to advance the technology throughout that country’s medical infrastructure and flow to its medical teaching institutions.
The National University of Rosario is a relatively new institution, is the second largest medical school in Argentina’s and one of only a few beginning to offer simulation training for students. Adding the simulation-orientation in health education approach is "an innovative proposal,” said Ricardo Nidd, Rosario’s dean of the Faculty of Medical Sciences.
“Although simulation is being used in the world, particularly a simulation hospital within the architecture of a real hospital is an unprecedented proposal in our country," Nidd added.
The collaboration began informally during last year’s Friends of Fulbright Argentina program at UNM, when Veronica Plaza, MD, MPH and Jorge Wernly MD, who attended the Argentine UNR before moving to the US, began to consider how to foster the collaboration. They spoke about the UNM program to long-time friends in Argentina and the idea began to grow within an existing general agreement between UNM and UNR. The idea began to grow from there. Plans are for UNM faculty to travel to Argentina in 2019.
Dramatic though the high-tech setting with mannequins may be, much of the time spent training the UNR faculty focused on the educational and psychological aspects of simulation education. A great deal of the training time at UNM was devoted to anticipation of how students may react to feedback on their performance and how to create psychological safety in this intense, and sometimes emotionally-charged, unique mode of teaching.
“This is change management,” Rask said. “How do you make cultural change? You have to choose to work together as a group.”
One of the greatest stressors for participants comes from being observed – and ultimately, publicly judged – by their peers and teachers, he said.
“You can’t just show up in the simulation and expect people to know what to do,” Rask told the group.
During a teaching scenario, IV lines might be attached, shots given and oxygen levels monitored. As lights flash and monitors beep, a student can quickly become absorbed in the situation.
“It is easy to get off on the wrong track, and you don’t want for students to become anxious and overwhelmed,” he said. “I’ve had people in tears – or denial, just saying, ‘Well, that didn’t happen,’ when they made a mistake.”
The underlying culture of an institution may change as it changes the way it teaches students, Rask told the group. The mistakes made in a simulated clinical setting ultimately translate into safer care in the real world, he said.
“All of us have the experience of hitting a wall, where you do not know what to do next,” Rask said. “But if you have already practiced cases that resemble one now in front of you, memory and training kicks in. Step by step, it comes back and you move forward. In that sense, actually producing that much anxiety in the classroom beforehand can be considered a success.”