The role of simulation in medical education

In this podcast we are discussing what the role of simulation is in medical education and in the delivery of the MBChB Curriculum at the University of Aberdeen. We are joined by Dr Jerry Morse, lead for Clinical Simulation and the lead for Year 3.

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05. Simulation in Medical Education.mp3

Speaker 1 Good afternoon everyone. My name is Florian. I'm joined today by Jeremy Morse, lead for clinical simulation and also the lead for year three. Today we'll be discussing the role of simulation in medical education. So before we get started, Jerry, I think when most people think of simulation, the first thing that comes to their mind is either a large computer processing something in the background, but I'm pretty sure there's a lot more simulation than that.

Speaker 2 Oh yeah. Where do we start when it comes to simulation? You're quite right, Florian. Most people think of simulation as the gaming, online, etc. but when it comes to medical education, simulation has a huge remit. And also the, the scope of what we can do for simulation is so much, I always say that you can simulate with a block of wood all the way through to a quarter of £1 million, piece of equipment. The most important thing is getting the right piece of equipment for the simulation, which is required by the by the student or for that activity. And that's where part of my role is leading the simulation. Along with Craig, who's the others, clinical educator lecturer is to is to identify the requirements and make sure that Aberdeen University has the right pieces of equipment to deliver the simulation for the undergraduate curriculum at Aberdeen.

Speaker 1 What are the primary ways in which simulation is used in medical education to enhance the learning experience?

Speaker 2 So, traditionally, simulation has been well, those simulation has always been spread throughout the curriculum. I think people's perception of simulation, certainly the sort of higher fidelity simulation where we use the mannequins for deteriorating patients, etc., has always been much more of a, senior use simulation. One of the things that we're developing in the simulation strategy, which we're finalising at the moment, is that we are introducing simulation much earlier on in the curriculum. And, you know, one of the things we're trying to embed is that there's this sort of journey of simulation from year one all the way through to year five, which is then in preparation for the foundation years, where there's even more simulation. And as I explained to the first year when we do the introductory session, you know, simulation, you're going to be using simulation from now until you're a consultant. All the way through, you're training all the royal colleges now use simulation in some form or another. So it's really important for us within the strategy to ensure that we prepare our students for a lifetime learning of simulation.

Speaker 1 So I take it then that there are a number of activities that students are exposed to quite early on that they might not realise are simulations and could benefit from your assistance.

Speaker 2 Yeah. So, one of the, one of the things that I will do in the introductory system for year one is that we explain the role of simulation within within medical education. We also show them a whole raft of pictures which people may. Oh, I didn't realise that simulation, you know, so, I mean, you can go from, as I say, a piece of wood where we could demonstrate something all the way through to, you know, patient partners, communication skills, clinical skills, resuscitation skills, you know, deteriorating patient, all these skills, you know, we can show you all these different things, but it's using the right modes of simulation at the right time to get the right output.

Speaker 1 And generally, what are the attitudes of students towards simulation?

Speaker 2 The majority of students these days know a bit about simulation. You know, as you said, right at the beginning floor and you know, the okay, was it the was it the, you know, the gaming simulation or whatever? But there are more and more people, seeing simulation. So a lot of people may have done resuscitation training in school, and they would have used one of the mannequins which we use in simulation for, for practising, cardiopulmonary resuscitation. So I think more people are aware, and certainly when we start talking about some of the newer pieces of equipment, such as, you know, the immersive simulation room, which, you know, we are very fortunate in Aberdeen to have, all the, you know, virtual reality headsets, you know, which we can be using for some, some simulation sessions. A lot of people will have used these headsets in sort of gaming modes, but we can then turn that into simulation based education for clinical, clinical awareness or clinical decision making.

Speaker 1 And this simulation still seen as something exotic, or is it already part of the traditional way of delivering medical education?

Speaker 2 I think over the past few years, yeah. Always used to be. Known as the fantasy stuff. But medical simulation based education in medical education is still one of the fastest growing disciplines. And since since Covid remains, you know, the climb in the right amount of simulation which is required has improved, increased, and will continue to do so for somewhat and especially with potentially the challenges, you know, of increasing numbers. And, you know, although we've had two increases, you know, what's happened in the government's plans the other day is are there even more?

Speaker 1 What are some of the unique advantages of using simulation as opposed to more traditional ways of delivering teaching?

Speaker 2 I think the first point you've got to, to realise is that simulation should never be a complete replacement for traditional methods. I you know, you cannot learn the whole of medicine through simulation. Likewise, when we tried to, accommodate through Covid, you know, you can't learn medicine online. There is, you have to have that face to face contact. You have to have that sort of hands on patients. One of the the biggest issues coming through from Covid with obviously was reduced numbers of students allowed on wards, number of patients, people on clinical environments. And so it was really imperative that only, senior students, you know, when we were prioritising the numbers going into clinical placements, they were the senior senior students who needed that exposure to be safe to graduate, which meant, of course, that the knock on effect was that some of the other year's threes and twos were not getting the same clinical exposure that we would like them to have in that level of training. So what we were able to do, of course, through simulation in the simulation ward, was we were able to at least provide some experience of patients, etc., in a, in a simulated environment rather than the actual ward environment. And again, we are very lucky in Aberdeen that we have, a simulated ward which is based within Aberdeen Royal Infirmary, the simulation training centre, which is a ward environment.

Speaker 1 How exactly does simulation effectively prepare students for real world clinical scenarios?

Speaker 2 Well, one of the one of the benefits of, of simulation is that we can replicate time and time again. And, you know, that's why royal Colleges we use simulation of, for example, the Royal College of Anaesthetists use simulation as does a cognition emergency medicine, because you can replicate it whether we're here in Aberdeen, in Dundee, Inverness. The scenarios of this can be the same and the outcomes are the same for those scenarios. So when they're being examined, it's the same outcomes for each student. The other benefit, of course, is that so we're sat here today beginning of July. And it's unusual for someone to see a child with croup, for example, in July because it's quite seasonal. So it also means that the students who are doing paediatrics in June, July when this is non croup season, we can replicate croup so that they still get that experience of having seen croup or a similar illness, but in a simulated environment, so that when they do see that situation for real, they have been prepared.

Speaker 1 Are these strengths of simulation recognised by students?

Speaker 2 Certainly. What I've found over the past few years that students have become more and more receptive to simulation, and have seen the benefit and certainly, you know, a classic example is the we in year five, we run a ward simulation exercise, in which, in pairs, what is observing one is the leader. And so the five one who has to look after manage three patients. And those three patients have different levels of acuity or requirements. And this simulation is designed to sort of get them to think about prioritising care and how they communicate within the multi-disciplinary team. And when we do the learning conversation after those, a lot of the time the students will come out and say, oh, you know, I didn't realise this, that or the other, but I see the benefit of doing that simulation because I've gone through that experience. I now know what it's going to feel like when I step up to the to my first F1 job. And that's the beauty of simulations that we can prepare people for clinical practice. We can give them, a simulated experience so that they are aware so that have next time it's. Not as scary. It's not as frightening.

Speaker 1 So we'll be discussing a lot about how students use simulation. But what about the educator? Do you think that more educators could open up to using simulation?

Speaker 2 I hope so. And again, you know, one of the challenges that we have at the moment is with increasing numbers of hours of required for simulation throughout the curriculum and the drive for more simulation, which I think is absolutely right. The downside is we need more people to be able to help deliver that simulation. And simulation has always been fairly resource intensive from a faculty point of view. And whilst we have trained many people within the NHS and in the university to assist in delivering the simulation, we are also acutely aware of the acute pressures on our clinician colleagues in NHS to to help deliver these sessions. So one of the, one of the things that we are investigating at the moment, and I think will be will be of huge benefit to but not just us, but also the students is we're, we're looking at we've already got what we call the Powell system, which is peer assisted learning. One one of the things that Craig and I and Angus have discussed is how we extend that to actually become a student, simulated faculty. So we'll go through the same sort of training that we would pull. Ha. But some of our educators through. But then that can help our senior students help deliver to the junior students, the simulation sessions as well.

Speaker 1 And would that be just in terms of the actual delivery of the simulation, or also, deliver some of the conversations that take place after.

Speaker 2 So, absolutely. No, absolutely. It will include the the learning conversation. So, the training that they would get would be, the same training that we would give for, any other member of the faculty. The, the one thing which we would probably amend is that they would need to be able to need to know how to write the scenarios, because those are the the sessions are written. It's how we deliver them and how they structure the learning conversations so that we have a consistent way of using the learning conversation to bridge the gaps of potential students.

Speaker 1 What are the components of a simulated activity? What are the stages that a student goes through? And equally, the stages that a staff preparing that activity must go through.

Speaker 2 Well, let's let's start with, the activity itself. So when, when, when a student, depending on where the student comes in from. But if the student is going for the first ever session in the simulation area. Then we would we start always off with, a welcome and then a familiarisation of the area or where we're going to be doing the simulation so that they expect they know what to expect. The other thing is, the next thing is that we, we then talk about any of the equipment and the pitfalls, i.e. the things that the equipment can't do. So for example, if we're using one of the mannequins, you know, you can't make them suddenly feel hot. And likewise, you can't suddenly make them start sort of looking blue, you know? So there are the things which we can do and the things that you can't do. And we we make aware of that. But the most important thing is that we say we're going to try and make as a faculty, we will try and make this as real as possible for you, as long as you believe and buy into that situation with us. And I'm going to say that probably 98% of the time, students too, we always will find and you will always find that there are the the odd student who, for whatever reason, just cannot, you know, just cannot buy into that simulation. And we accept that. But if we can get the majority, that's good. So that after they've gone through the familiarisation, they would come back in and depending on how the session is being run, if it was a, if it was a one person going in, the one person as a leader and one as a follower, we would brief them as to what the scenario was in the situation, and then they would go off and do the scenario. A lot of the time, I think this is a really good point to bring up here, especially if we've got, more junior students listening. It is very usual these days in simulation for us to use cameras to record, or more often than not, just to allow a wider audience to see the simulations taking place. Again, that's because of numbers. If you've got 300 students and you've got a pair going through at a time, that's 150 sessions. Yeah, that's a lot of the sessions. But if we can increase that by having more people observing and taking part, we can create a much more manageable number. People go through the simulation and after they've gone through the simulation, then we would come back and that's when we would hold the learning conversation. And there are different ways of holding that learning conversation. And that's something which we sort of highlight when we do our faculty development days. Of the different styles that you can use. For example, learning, advocacy with inquiry is, is one of the classic ones which educators are using at the moment. It could be the diamond debrief, or it could be one of the other models. It's the beauty of it. Or one of the things about being a simulation based educator is that you have different tools that you can use at different times to elicit the best response. You know what's working and you say, yeah, I'm going to use this one, or oh, that's not working. That's just change, right? But that's the experience of of being an experienced educator.

Speaker 1 So what are the most recent advancements in simulation technology, that have had an impact at our institution?

Speaker 2 One of the things actually, that, you know, we talk about all these human patient simulators and then, and the things like the big sim men, the metal man, the, the house and all these other things which cost so the 90 odd thousand pounds, and yeah, they are that we can use them for a purpose, but more and more, you know, we look at different things and, you know, one of the things that, because we're, again, trying to get people to buy in is we we've started looking at these. What could the life cost? Mannequins. These are really lifelike mannequins. They're made by the film studios, Pinewood Film Studios or Elm Street, film studios. They shipped over from the States, but basically that's bespoke to us. We tell them what they've built them to look like, if we want them to have scars, if we want them to have this, if we want to have that, and they look real, so that increases the fidelity. The other thing which we use now is something called I simulate. So this is, where we can create any monitor, but we can also use it on real patients or patient partners. So for example, we can use the monitoring and the paths which we can create the different states of. But we can have a patient partner. And so we can have them using real communication skills with a live person. But the screen is telling them that they're very sick. So you know, you have. And so we're using this little hybrid type. And I think these are really important. And the other I think the other really important one to mention of course, is the is the immersive simulation room, which we have now got in, one of the clinical skills rooms where we can make it look like not only any area in the hospital, but any area in the world, so we can make the scenario happen there with the prehospital in hospital, in, in a theatre, in CT scan, you name it, we can recreate it again. It's about creating that suspension of disbelief to assist the student in believing they are where they are so that they can relate to that experience.

Speaker 1 So you mentioned a number of, new techniques, new new tools at your disposal. Has the curriculum kept up with all these, changes?

Speaker 2 Again, the answer to that is yes. We I have no doubt that we have been extremely fortunate as a university and as a, a department, that we have been very fortunate to, to always have support in any of the requests that we have made, to ensure that Aberdeen keeps at the forefront. And, you know, with the latest equipment that we have kept up with where we should be, I think we were one of the first universities, when, there was the Black Lives Matter and all the rest of it. We were one of the first, I think, to react to, to making sure that we had the right mannequins in place, which represented the equality and diversity across the, you know, for the curriculum. And again, great support from the university for that. Similarly with, all the other bits and pieces as, you know, technology has changed and we've said, you know, if we want to be ahead of the game and keep up, then this is where we need to be. We've had that support, so never know ever. Any problems?

Speaker 1 Two challenges on the horizon, the increase in student numbers. And in a way, what that might also imply in terms of its relation to rural, how exactly would simulation help up with those things?

Speaker 2 Okay. Well, let's let's let's start with the the elephant in the room. The student numbers simulation is there. And you know, one of the things that, Craig and myself and Angus are doing within the strategy is identifying how. Simulation can be used to assist in the increasing numbers, you know, and one of the things of course, we have to be acutely aware of is that the the numbers are going to be increasing, which means that there's going to be a number of people in clinical placements who the numbers are increasing, which, you know, if anything else happens in the numbers are on the wards full. You know, it's it's how we create a balance and simulation will play a huge role. The the downside, of course, is that the more simulation that we would like to do to meet the students requirements means that we have to have more faculty, it means that we have to have more simulation space. And that I know that is a huge priority. And without that space, without, the, the increased, faculty, you know, not just student faculty, but, you know, staff, faculty as well to deliver it. You know, that's going to be our biggest challenge. But yes, it has a huge place to play from a remote, rural point of view. One of the beauties is that, you know, we are very again, Aberdeen has been very supportive of our remote rural colleagues. So we have a, a hub, I suppose, if you like, in Inverness with the centre for Health Sciences there. We also have, a space in Elgin and we have a faculty there. So we've got faculty in Elgin, Inverness, and we've also got faculty in Stornoway, and not just Stornoway, Shetland and Orkney. And again, we through clinical skills we have supported and have got sessions there, which also means again, we've got the simulation scenarios which can be run in these places, which mean that students in remote rural placements are getting the same scenario, may not be just the same experience because obviously geographically we are slightly different, but the same scenario, whether it's croup or cardiac arrests. So shortness of breath, asthma, etc., or the ones which we would tend to do to generating patient.

Speaker 1 How would a new or an existing educator that wants to make even more use of simulation? Or could you for the first time benefit from your support?

Speaker 2 Well, the most important thing is come and talk. Come on, find this. Come and have a chat. If you're interested in any way, shape or form, we would love to hear from you. I'd love to see you and obviously I'd love to work with you if that's where you want to go. So one of the first things is come and see some sessions. And then we, I think, 2 or 3 times a year, we run the simulation based educators faculty development course. This is, a Scottish wide thing. We, aligned to the CSE meant year one, two and three, which is the Scottish simulation based educators program. That has, again, that has changed over the past few years. Used to be a two day course, predominantly. Now, what we do is a is a one day course because there's one day's worth of online learning which can be done over a period of time. And then you come and do the, the sort of the practical elements of that where we go through the, how to design, run and have a conversation about a scenario and then, you know, we look forward to working with them. So, yeah, I think the most important thing is if you have any interest, come and give us a show.

Speaker 1 Well, Judy, thank you very much for discussing with me the role of simulation in medical education.

Speaker 2 You're welcome. For.

05. Simulation in Medical Education.mp3

Speaker 1 Good afternoon everyone. My name is Florian. I'm joined today by Jeremy Morse, lead for clinical simulation and also the lead for year three. Today we'll be discussing the role of simulation in medical education. So before we get started, Jerry, I think when most people think of simulation, the first thing that comes to their mind is either a large computer processing something in the background, but I'm pretty sure there's a lot more simulation than that.

Speaker 2 Oh yeah. Where do we start when it comes to simulation? You're quite right, Florian. Most people think of simulation as the gaming, online, etc. but when it comes to medical education, simulation has a huge remit. And also the, the scope of what we can do for simulation is so much, I always say that you can simulate with a block of wood all the way through to a quarter of £1 million, piece of equipment. The most important thing is getting the right piece of equipment for the simulation, which is required by the by the student or for that activity. And that's where part of my role is leading the simulation. Along with Craig, who's the others, clinical educator lecturer is to is to identify the requirements and make sure that Aberdeen University has the right pieces of equipment to deliver the simulation for the undergraduate curriculum at Aberdeen.

Speaker 1 What are the primary ways in which simulation is used in medical education to enhance the learning experience?

Speaker 2 So, traditionally, simulation has been well, those simulation has always been spread throughout the curriculum. I think people's perception of simulation, certainly the sort of higher fidelity simulation where we use the mannequins for deteriorating patients, etc., has always been much more of a, senior use simulation. One of the things that we're developing in the simulation strategy, which we're finalising at the moment, is that we are introducing simulation much earlier on in the curriculum. And, you know, one of the things we're trying to embed is that there's this sort of journey of simulation from year one all the way through to year five, which is then in preparation for the foundation years, where there's even more simulation. And as I explained to the first year when we do the introductory session, you know, simulation, you're going to be using simulation from now until you're a consultant. All the way through, you're training all the royal colleges now use simulation in some form or another. So it's really important for us within the strategy to ensure that we prepare our students for a lifetime learning of simulation.

Speaker 1 So I take it then that there are a number of activities that students are exposed to quite early on that they might not realise are simulations and could benefit from your assistance.

Speaker 2 Yeah. So, one of the, one of the things that I will do in the introductory system for year one is that we explain the role of simulation within within medical education. We also show them a whole raft of pictures which people may. Oh, I didn't realise that simulation, you know, so, I mean, you can go from, as I say, a piece of wood where we could demonstrate something all the way through to, you know, patient partners, communication skills, clinical skills, resuscitation skills, you know, deteriorating patient, all these skills, you know, we can show you all these different things, but it's using the right modes of simulation at the right time to get the right output.

Speaker 1 And generally, what are the attitudes of students towards simulation?

Speaker 2 The majority of students these days know a bit about simulation. You know, as you said, right at the beginning floor and you know, the okay, was it the was it the, you know, the gaming simulation or whatever? But there are more and more people, seeing simulation. So a lot of people may have done resuscitation training in school, and they would have used one of the mannequins which we use in simulation for, for practising, cardiopulmonary resuscitation. So I think more people are aware, and certainly when we start talking about some of the newer pieces of equipment, such as, you know, the immersive simulation room, which, you know, we are very fortunate in Aberdeen to have, all the, you know, virtual reality headsets, you know, which we can be using for some, some simulation sessions. A lot of people will have used these headsets in sort of gaming modes, but we can then turn that into simulation based education for clinical, clinical awareness or clinical decision making.

Speaker 1 And this simulation still seen as something exotic, or is it already part of the traditional way of delivering medical education?

Speaker 2 I think over the past few years, yeah. Always used to be. Known as the fantasy stuff. But medical simulation based education in medical education is still one of the fastest growing disciplines. And since since Covid remains, you know, the climb in the right amount of simulation which is required has improved, increased, and will continue to do so for somewhat and especially with potentially the challenges, you know, of increasing numbers. And, you know, although we've had two increases, you know, what's happened in the government's plans the other day is are there even more?

Speaker 1 What are some of the unique advantages of using simulation as opposed to more traditional ways of delivering teaching?

Speaker 2 I think the first point you've got to, to realise is that simulation should never be a complete replacement for traditional methods. I you know, you cannot learn the whole of medicine through simulation. Likewise, when we tried to, accommodate through Covid, you know, you can't learn medicine online. There is, you have to have that face to face contact. You have to have that sort of hands on patients. One of the the biggest issues coming through from Covid with obviously was reduced numbers of students allowed on wards, number of patients, people on clinical environments. And so it was really imperative that only, senior students, you know, when we were prioritising the numbers going into clinical placements, they were the senior senior students who needed that exposure to be safe to graduate, which meant, of course, that the knock on effect was that some of the other year's threes and twos were not getting the same clinical exposure that we would like them to have in that level of training. So what we were able to do, of course, through simulation in the simulation ward, was we were able to at least provide some experience of patients, etc., in a, in a simulated environment rather than the actual ward environment. And again, we are very lucky in Aberdeen that we have, a simulated ward which is based within Aberdeen Royal Infirmary, the simulation training centre, which is a ward environment.

Speaker 1 How exactly does simulation effectively prepare students for real world clinical scenarios?

Speaker 2 Well, one of the one of the benefits of, of simulation is that we can replicate time and time again. And, you know, that's why royal Colleges we use simulation of, for example, the Royal College of Anaesthetists use simulation as does a cognition emergency medicine, because you can replicate it whether we're here in Aberdeen, in Dundee, Inverness. The scenarios of this can be the same and the outcomes are the same for those scenarios. So when they're being examined, it's the same outcomes for each student. The other benefit, of course, is that so we're sat here today beginning of July. And it's unusual for someone to see a child with croup, for example, in July because it's quite seasonal. So it also means that the students who are doing paediatrics in June, July when this is non croup season, we can replicate croup so that they still get that experience of having seen croup or a similar illness, but in a simulated environment, so that when they do see that situation for real, they have been prepared.

Speaker 1 Are these strengths of simulation recognised by students?

Speaker 2 Certainly. What I've found over the past few years that students have become more and more receptive to simulation, and have seen the benefit and certainly, you know, a classic example is the we in year five, we run a ward simulation exercise, in which, in pairs, what is observing one is the leader. And so the five one who has to look after manage three patients. And those three patients have different levels of acuity or requirements. And this simulation is designed to sort of get them to think about prioritising care and how they communicate within the multi-disciplinary team. And when we do the learning conversation after those, a lot of the time the students will come out and say, oh, you know, I didn't realise this, that or the other, but I see the benefit of doing that simulation because I've gone through that experience. I now know what it's going to feel like when I step up to the to my first F1 job. And that's the beauty of simulations that we can prepare people for clinical practice. We can give them, a simulated experience so that they are aware so that have next time it's. Not as scary. It's not as frightening.

Speaker 1 So we'll be discussing a lot about how students use simulation. But what about the educator? Do you think that more educators could open up to using simulation?

Speaker 2 I hope so. And again, you know, one of the challenges that we have at the moment is with increasing numbers of hours of required for simulation throughout the curriculum and the drive for more simulation, which I think is absolutely right. The downside is we need more people to be able to help deliver that simulation. And simulation has always been fairly resource intensive from a faculty point of view. And whilst we have trained many people within the NHS and in the university to assist in delivering the simulation, we are also acutely aware of the acute pressures on our clinician colleagues in NHS to to help deliver these sessions. So one of the, one of the things that we are investigating at the moment, and I think will be will be of huge benefit to but not just us, but also the students is we're, we're looking at we've already got what we call the Powell system, which is peer assisted learning. One one of the things that Craig and I and Angus have discussed is how we extend that to actually become a student, simulated faculty. So we'll go through the same sort of training that we would pull. Ha. But some of our educators through. But then that can help our senior students help deliver to the junior students, the simulation sessions as well.

Speaker 1 And would that be just in terms of the actual delivery of the simulation, or also, deliver some of the conversations that take place after.

Speaker 2 So, absolutely. No, absolutely. It will include the the learning conversation. So, the training that they would get would be, the same training that we would give for, any other member of the faculty. The, the one thing which we would probably amend is that they would need to be able to need to know how to write the scenarios, because those are the the sessions are written. It's how we deliver them and how they structure the learning conversations so that we have a consistent way of using the learning conversation to bridge the gaps of potential students.

Speaker 1 What are the components of a simulated activity? What are the stages that a student goes through? And equally, the stages that a staff preparing that activity must go through.

Speaker 2 Well, let's let's start with, the activity itself. So when, when, when a student, depending on where the student comes in from. But if the student is going for the first ever session in the simulation area. Then we would we start always off with, a welcome and then a familiarisation of the area or where we're going to be doing the simulation so that they expect they know what to expect. The other thing is, the next thing is that we, we then talk about any of the equipment and the pitfalls, i.e. the things that the equipment can't do. So for example, if we're using one of the mannequins, you know, you can't make them suddenly feel hot. And likewise, you can't suddenly make them start sort of looking blue, you know? So there are the things which we can do and the things that you can't do. And we we make aware of that. But the most important thing is that we say we're going to try and make as a faculty, we will try and make this as real as possible for you, as long as you believe and buy into that situation with us. And I'm going to say that probably 98% of the time, students too, we always will find and you will always find that there are the the odd student who, for whatever reason, just cannot, you know, just cannot buy into that simulation. And we accept that. But if we can get the majority, that's good. So that after they've gone through the familiarisation, they would come back in and depending on how the session is being run, if it was a, if it was a one person going in, the one person as a leader and one as a follower, we would brief them as to what the scenario was in the situation, and then they would go off and do the scenario. A lot of the time, I think this is a really good point to bring up here, especially if we've got, more junior students listening. It is very usual these days in simulation for us to use cameras to record, or more often than not, just to allow a wider audience to see the simulations taking place. Again, that's because of numbers. If you've got 300 students and you've got a pair going through at a time, that's 150 sessions. Yeah, that's a lot of the sessions. But if we can increase that by having more people observing and taking part, we can create a much more manageable number. People go through the simulation and after they've gone through the simulation, then we would come back and that's when we would hold the learning conversation. And there are different ways of holding that learning conversation. And that's something which we sort of highlight when we do our faculty development days. Of the different styles that you can use. For example, learning, advocacy with inquiry is, is one of the classic ones which educators are using at the moment. It could be the diamond debrief, or it could be one of the other models. It's the beauty of it. Or one of the things about being a simulation based educator is that you have different tools that you can use at different times to elicit the best response. You know what's working and you say, yeah, I'm going to use this one, or oh, that's not working. That's just change, right? But that's the experience of of being an experienced educator.

Speaker 1 So what are the most recent advancements in simulation technology, that have had an impact at our institution?

Speaker 2 One of the things actually, that, you know, we talk about all these human patient simulators and then, and the things like the big sim men, the metal man, the, the house and all these other things which cost so the 90 odd thousand pounds, and yeah, they are that we can use them for a purpose, but more and more, you know, we look at different things and, you know, one of the things that, because we're, again, trying to get people to buy in is we we've started looking at these. What could the life cost? Mannequins. These are really lifelike mannequins. They're made by the film studios, Pinewood Film Studios or Elm Street, film studios. They shipped over from the States, but basically that's bespoke to us. We tell them what they've built them to look like, if we want them to have scars, if we want them to have this, if we want to have that, and they look real, so that increases the fidelity. The other thing which we use now is something called I simulate. So this is, where we can create any monitor, but we can also use it on real patients or patient partners. So for example, we can use the monitoring and the paths which we can create the different states of. But we can have a patient partner. And so we can have them using real communication skills with a live person. But the screen is telling them that they're very sick. So you know, you have. And so we're using this little hybrid type. And I think these are really important. And the other I think the other really important one to mention of course, is the is the immersive simulation room, which we have now got in, one of the clinical skills rooms where we can make it look like not only any area in the hospital, but any area in the world, so we can make the scenario happen there with the prehospital in hospital, in, in a theatre, in CT scan, you name it, we can recreate it again. It's about creating that suspension of disbelief to assist the student in believing they are where they are so that they can relate to that experience.

Speaker 1 So you mentioned a number of, new techniques, new new tools at your disposal. Has the curriculum kept up with all these, changes?

Speaker 2 Again, the answer to that is yes. We I have no doubt that we have been extremely fortunate as a university and as a, a department, that we have been very fortunate to, to always have support in any of the requests that we have made, to ensure that Aberdeen keeps at the forefront. And, you know, with the latest equipment that we have kept up with where we should be, I think we were one of the first universities, when, there was the Black Lives Matter and all the rest of it. We were one of the first, I think, to react to, to making sure that we had the right mannequins in place, which represented the equality and diversity across the, you know, for the curriculum. And again, great support from the university for that. Similarly with, all the other bits and pieces as, you know, technology has changed and we've said, you know, if we want to be ahead of the game and keep up, then this is where we need to be. We've had that support, so never know ever. Any problems?

Speaker 1 Two challenges on the horizon, the increase in student numbers. And in a way, what that might also imply in terms of its relation to rural, how exactly would simulation help up with those things?

Speaker 2 Okay. Well, let's let's let's start with the the elephant in the room. The student numbers simulation is there. And you know, one of the things that, Craig and myself and Angus are doing within the strategy is identifying how. Simulation can be used to assist in the increasing numbers, you know, and one of the things of course, we have to be acutely aware of is that the the numbers are going to be increasing, which means that there's going to be a number of people in clinical placements who the numbers are increasing, which, you know, if anything else happens in the numbers are on the wards full. You know, it's it's how we create a balance and simulation will play a huge role. The the downside, of course, is that the more simulation that we would like to do to meet the students requirements means that we have to have more faculty, it means that we have to have more simulation space. And that I know that is a huge priority. And without that space, without, the, the increased, faculty, you know, not just student faculty, but, you know, staff, faculty as well to deliver it. You know, that's going to be our biggest challenge. But yes, it has a huge place to play from a remote, rural point of view. One of the beauties is that, you know, we are very again, Aberdeen has been very supportive of our remote rural colleagues. So we have a, a hub, I suppose, if you like, in Inverness with the centre for Health Sciences there. We also have, a space in Elgin and we have a faculty there. So we've got faculty in Elgin, Inverness, and we've also got faculty in Stornoway, and not just Stornoway, Shetland and Orkney. And again, we through clinical skills we have supported and have got sessions there, which also means again, we've got the simulation scenarios which can be run in these places, which mean that students in remote rural placements are getting the same scenario, may not be just the same experience because obviously geographically we are slightly different, but the same scenario, whether it's croup or cardiac arrests. So shortness of breath, asthma, etc., or the ones which we would tend to do to generating patient.

Speaker 1 How would a new or an existing educator that wants to make even more use of simulation? Or could you for the first time benefit from your support?

Speaker 2 Well, the most important thing is come and talk. Come on, find this. Come and have a chat. If you're interested in any way, shape or form, we would love to hear from you. I'd love to see you and obviously I'd love to work with you if that's where you want to go. So one of the first things is come and see some sessions. And then we, I think, 2 or 3 times a year, we run the simulation based educators faculty development course. This is, a Scottish wide thing. We, aligned to the CSE meant year one, two and three, which is the Scottish simulation based educators program. That has, again, that has changed over the past few years. Used to be a two day course, predominantly. Now, what we do is a is a one day course because there's one day's worth of online learning which can be done over a period of time. And then you come and do the, the sort of the practical elements of that where we go through the, how to design, run and have a conversation about a scenario and then, you know, we look forward to working with them. So, yeah, I think the most important thing is if you have any interest, come and give us a show.

Speaker 1 Well, Judy, thank you very much for discussing with me the role of simulation in medical education.

Speaker 2 You're welcome. For.