skilling in healthcare
TRANSCRIPT
Skilling in HealthcareDr. Abhijat Sheth
NBE
Education:Rigorous efforts to transform and scale up health professionals’ education
Demand and supply gap :Major Supplier of Doctors and Nurses to the developed Countries.
Human Resource: High investment on human resources and retaining skilled workers
Service Quality: Lack of dominant service lines unable to attract more patients and healthcare professionals
Skill Capacity & Regular Updates: The increased awareness of different diseases and medical advancement among the masses makes it vital to be aware of the latest knowledge and trends
Healthcare Requirements/Growth/Deficiency: Complex health‐care delivery system has evolved into a competitive, performance‐driven industry demanding the best management and operational skills
Migration & Influx: Absence of competitive advantage in recruiting additional physicians forcing patients to flock in hospitals in other parts of the country
Integration of Educational Services: Present educational system doesn’t support integration of all the levels of health education
Current Challenges in Healthcare Sector
Nurses and midwives population ratio
(per 1000 population)
Average annual Output(per medical College)
930100
125
149220
110
China
India
Eastern Europe
Central Europe
Western Europe
North America
61
417
6.5
Staff per 100000 people
Nurses
Pharmacist
Dentists
Physicians surgeons
It costs between 40-50lakh INR to complete an MBBS degree under management quota
Ref: World health statistics report 2013. World Health Organizationhttp://pib.nic.in/newsite/erelease.aspx?relid=30771http://www.thehindu.com/sci‐tech/health/policy‐and‐issues/acute‐shortage‐of‐mental‐health‐care‐staff‐in‐india/article4305058.ece
Doctor population ratio(per 1000 population)
Indian Healthcare Situation
NEED FOR UPSCALLING IN SKILLING IN HEALTHCARE
One million jobs created annually with added seats*
~5 Direct Jobs
~10 Direct +Indirect Jobs
For Every Doctor
*Assuming only postgraduates join workforce and ignoring intermediate job creation by MBBS
Current Scenario• Quantity Gap 70% of population live in villages while 40% healthcare workers access to them 2000 PHCs need Doctors 50% of the 150000 Health and Wellness Centres need male healthcare workers Approx. 6000 centres need midwives
• Quality Gap 11% of Sub centres , 13% PHCs, 16 % CHCs meet short of standards 58 % of urban doctors and 19% rural doctors are qualified with medical degrees 66% of Nurses/midwives not studying beyond secondary education while 89% of them are not having appropriate certification or qualifications
Source: Elets News Network Dr Vikram A Munshi, Whitespace consulting and capacity building
Skill Gap• Core Clinical Work• Professional Skills Communication Medical Ethics and regulatory aspectQualityPatient Safety Leadership and Managerial• Technical and learning aptitude• Research Methodology• Work Culture
Case studies
Traditional media
Health talk
Lecture
Brainstorming
Group discussion
Buzz group discussion
Demonstration
Role playWorkshop
Panel discussion
Conference
Seminar
Symposium
Drama
Formal FormInformal Form
Knowledge – Practice Gap Lack of Uniformity Need based learning Available resources and accessibility Knowledge base informed by research rans ahead of clinical applications
Human Resources Learning Tools
Key Challenges in Skill Education
Learning Goals NBE Stakeholders• Clinical care• MDT Approach• Ethics & accountability at all levels (clinical, professional, personal & social) • Professional Curriculum• Leadership and mentorship • Social accountability and responsibility • Scientific attitude • Lifelong learning
No issues of
patient safety or confidentiality
Advantages of mannequin‐based computer simulators.
Students can refine and apply their skills in
realistic healthcare situations
Learning
tailoredto the educational needs of students
Allows unlimited
creation ofsituations that might be too dangerous or expensive to perform live
Allows students
repeated practice of procedures to reach proficiency
Allows adherence to standard guidelines by
reinforcement
Allows
evaluationof individual or group performance
Scenarios can be
halted at any time to allow for discussion of management strategies
Concept of Structured Skill Leaning Model
Clinical situations are simulated for teaching and learning purposes, creating opportunities for deliberate practice of new skills without
involving real patients.Simulation‐based education (SBE) is a rapidly developing method of supplementing and enhancing the clinical education of medical
students
Simulation takes many forms, from simple skills training models to computerized full‐body mannequins, so that the needs of
learners at each stage of their education can be targeted.
Emerging evidence supports the value of simulation as an educational technique; to be effective it needs to be integrated into the
curriculum in a way that promotes transfer of the skills learnt to clinical practice
Simulation learning evokes structured reflection on practice to bridge the gap between educational theory and clinical practice .
Scaffolding Learning Through Simulation
Simulators are bridging the gap between requirement and opportunities for trainingSimulation as a component of training is well‐accepted and adopted in developed health care systems.Training centres are advertising high end simulators as an added attraction to their program
Way Of HopePresent situationChallenges in Simulator’s Use
Simulation Scenario in India
Resistance in Accepting use of simulators as a technique of teaching‐learning
Plenty of patients material available for residents to learn whereas simulators are applicable only in limited clinical material.
Late acceptance of simulation as compared to western countries
Low success rate in adopting the lessons learnt on the simulator.
Lack of trained Faculty for conducting a simulated session
Limited resources in terms of cost, manpower and time.
Lack of evidence showing positive impact on patient safety and quality of care due to simulation training
1 2
3
Research are happening to
harness potential in
developing low cost technology in simulation.
Relevant data are gradually generating to
ensure widespread acceptance of simulators.
By Product
Simulated Clinical EnvironmentLive EnvironmentsVirtual Environment—Second lifeSerious Games
Interventional SimulationEndovascular SimulatorsSurgical SimulatorsCardiovascular SimulatorsIV SimulatorsOthers
Ancillary ProductsPatient MonitorsVentilatorsThermometersMasksOthers
Imaging SimulationMagnetic Resonance Imaging(MRI)Ultrasound imagingPositron Emission TomographyComputed Tomography(CT)
Human Patient SimulatorsAdult PediatricSurgicalObstetricsOthers
Simulated Training ServicesCustom ConsultingVendor Based TrainingLaerdal SunCAE Healthcare HPSNEducational SocietiesOthers
SoftwareBehavior Analysis SoftwareManagement Software
Task Trainers
High Fidelity Full Body manikinsMid Fidelity Low FidelityHybrid SimulationExperimental Learning Theory(ELT)
Military Health Organizations
By Application By Geography
Simulation in World Map
U.SCanadaMexico
GermanyFranceUKItalySpain
BrazilSaudi ArabiaSouth Africa
JapanChinaIndiaAustraliaNew‐Zealand
Academic Institutions
Research Centres
Hospitals & Clinics
Single Platform for all level of Healthcaresimulations and Training
Support Integration of Training
Develop Skilling opportunities
First Mover’s Advantage
Create Avenues for Research & innovation
Create Job Opportunities(Health Care, IT, Finance etc.)
Create Global Branding
Enhancement of State’s Health Care Effectiveness
Quality Healthcare Training and Services.
Strong, motivated & skillfully updated workforce
Better clinical outcome
Excellent Healthcare services
Better patient/relatives satisfaction
Lesser migration, Improved inflow
Reduced healthcare expenditure
Improvement in Health Care Practices and Infrastructure.
Increase in focus on outcome-oriented results
Benefit of State in Developing Simulation Centers
Dir
ect
Indirect
Dimensions of Simulation
11 Feedback
• Automatic critique by simulator, Real timedelayed
• Instructor critique of records of priorsimulation sessions
• Real time critique, pause/restart ,Realtime mentoring
• Video based post‐hoc debriefing,Individual/group
2 Participants
Individual Crew Team Work Unit Organisation
3 Experience
School Primary Secondary College, University Initial professional Education Residency, on the job training Continuing Education and training
4 Application Domain
Imaging Primary Care, In‐Hospital Ward based Procedural Dynamic, High Hazard
5 Participation Domain
Aids, Clerks Allied Health, Technicians Nurses Physicians Managers, Executives, Trustees Regulators, Legislators
6 Contribution Methods
Conceptual understanding Technical Skills Decision making skills, Meta Cognition,
Static, Dynamic Attitudes and Behaviours, Teamwork,
Professionalism
7 Patient’s Age
Neonates Infants Children, Teens Pregnant Adults Elderly
8 Technology
Verbal, Role Playing Standardised Patients Part‐task Trainer, Physical, Virtual
Reality Computer Patient, Computer Screen,
Screen Based, Virtual World Electronic Patient , Replica of Clinical
Site, Mannequin Based, Full VirtualReality
10 Direct Participation
Remote viewing only, No Interaction Remote viewing with verbal
interaction, Simulation based M&Mconference
Remote viewing with hands‐oninteraction , Remote haptic surgicaltrainer
Direct on‐site hands on participation Immersive participation
9 Site Home or Office Multimedia, screen‐only School or Library Multimedia screen only Dedicated laboratory, Physical part‐task trainers,
Virtual reality part‐task trainers Replica Clinical Environment, Replica Clinical
Sites, Patient Simulation Systems, Full VideoCapture
Actual work unit “Insitu” simulation ,MobileSimulation
1 Purpose
Education Training Performance Assessment Clinical Rehearsal Research
Dimensions of Simulation
Simulation Centers in India
GSL Smart Lab, RajahmundrySimulation Modules for Advanced Research Training LaboratoryAnatomage Table5 SimulatorsAn animal experimental Lab https://www.youtube.com/watch?v=qE4QuZG65lk
SGT University: ‐National Reference Simulation Centre, Gurgaon, Delhi NCR
Area:‐13000 Sq ft Cover the entire curriculum of BSc Nursing Collaborators: USAID, Laerdel, JHPiego
https://www.youtube.com/watch?v=Ulj2WiIATFs
It has India’s First “Human Patient Simulator” established in2013.
It is Asia's 1st comprehensive medical training facility. It connects to a real patient monitor and supports
mechanical ventilation to deliver more realism forimmersive learning.
Collaborator: ‐ Abbott Indiahttps://www.youtube.com/watch?v=wigLApTuXU8
D Y Patil University’s Medical Simulation Laboratory, Navi Mumbai
Bangalore Baptist Hospital (BBH)‐ “Simulation,Education and Research Centre for NursingExcellence” (SERC), Bangalore
A four storied state‐of‐the‐art simulation laboratory to train nurses anddoctors.
Established in 2017. Area:‐ 16,000 square feet Use high‐fidelity mannequins Baylor University Collaborators: ‐ Baylor University, USAID & American Schools and
Hospitals Abroad (ASHA) Program.https://www.youtube.com/watch?v=tuRsFK8b8FI
National training Center: NBE Learning Solutions
Primary Objectives Holistic learning solution
Hub and Spoke Model
Concept:‐Simulation & Web platform
TechnologyTask Trainer, VR/AR/MR, Dry lab, Facility Simulation, Web Platform, Studio/Broadcast.
Beneficiaries:NBE, Faculty, Students, Others
Course DetailsSkill Development & Enhancement,Acute Care, Procedures,InterventionsSurgical Skills, Basic Science, Resuscitation,Organ System , Journal Clubs Research/Publication, Thesis Preparation.
Certification ‐NBE , Society ( Nat/Int)Universities, Ministry, Authority Simulation Society
Participation:NBE Students:‐Mandatory /Optional , Others,Industry Engagement
Partners /CollaboratorsSocieties ,University ,Industry experts.
Faculty/Trainers/SM‐TechNBE faculty , Domain Expert, Int / Nat invited guests ,Industry experts , Full/Half time trainers.
Program Advancement Phase
Services/Facilities
Learning Solutions
ACLACL
RCL Ahamdabad
RCL Ahamdabad
RCL MumbaiRCL Mumbai
RCL KolkataRCL Kolkata
RCL PuneRCL PuneRCL Bengaluru
RCL Bengaluru
RCL ChennaiRCL Chennai
RCL Hyderabad
RCL Hyderabad
Apex Centre of Learning
Reference Centre of Learning
Full range of simulation,
VR & Task trainer.
Dry Lab
Facility Simulation
Studio & Broadcast
Central Archive
Full Tech Support
Limited Range of Simulation
Limited Range of VR
Task Trainer
Studio
Broadcast
Tech Support
Hub And Spoke model
Learning Centre Distribution Mode
Digital Archive
Onsite Courses
Phygital Courses
Digital Learning
ACL
RCL
Learning Centre Concept
Basic Sciences:-Anatomage
Basic Skill-----Development & Enhancement
Advance Clinical Skill Development & Enhancement in Respective speciality
Customised Courses for respective specialities
Procedure / Task Trainer Hands on practice of Basic procedure
Imaging & Diagnostic Basic to Advance Learning
Dry Lab Surgical / Intervention VR/HOLO
Lens band learning & practice
Simulated Scenarios Team work & Practice
Structured courses ( Nat + Int. Society approved)Acute care Life Support Courses
Onsite Learning
Hands on
Experience Practise
Didactic Learning
Intuition
Queries
Pre & Post‐Test analysis
Credit Points
Digital LearningArchive
Certification
Simulated scenario
Basic Understanding
Information
Courses
Phygital Courses
Online classroom Recording Studio Live Chat at faculty’s Location Webcasting / WEBCON / WEB PD / ZOOMMeeting
Archives
Interaction & Opinion Speciality band group –CEP model limited time video/mailbox
Conference & Events: Highlights Important notice & announcement
Digital Learning
Additional Learning Resources NBE• Communicon Workshops across the country• Professional Curriculum for all DNB/FNB students• Faculty Training Centres/Workshops• Library Consortium• Creating Thesis Repository • E Logbook System for Training• “Good Practices and Professional Obligation Guidelines”• Mandatory Online Research Methodology Training • Partnering with Academy/Institutions/Associations/Industry for existing effective learning solutions/resources
Public Private Partnership• Strength of Private SectorInnovation Technical Knowledge Job Specific SkillManagement Entrepreneur Spirit
• Strength of Public Sector Social responsibility Social Justice Public AccountabilityLocal Knowledge
• Infrastructure Development • Management and Operations • Capacity Building and Training • Financing Mechanism • IT infrastructure development for Networking and Data Transfer • Materials Management
Public Private Partnership
PPP – Partnering Organisations• National Skill Development Corporation (NSDC) – A development financial institution, set up in PPP mode
• Government/Private Medical Colleges/Organisations• Private Sector Healthcare Organisations• Industry • Private Academic Organisations• NGO• International Education Organisations
Key Challenges PPP• Right Aptitude for The Job• Demographic Variations• Research‐Innovations Keeps changing the dynamics of The health care• Adapting Employment standardisation• Accountability/ Regulations• Lack of Faculties/Trainer• Financial Ambiguities• Changing Market Forces
Way Forward• Better Integration of Public‐ Private sector • Creating Universal Accreditation Standards For Skill Training• Train the trainers• Employers engagement• Technology Adaptation• Central Regulatory Framework• Standardisation of Assessment Tool• National Data Repository • Continue to Evolve research and innovation
Louis Pasteur
Chance favors the prepared mind.