Closing the distance on learning
Adam Dubrowski is a pioneer, one of the few people in the world who can teach others how to assess technical skills in simulation-based education and training of health professionals.
Known for his collaborative work, he was invited to speak to an international symposium at the engineering school of Universidad Pontificia Bolivariana (UPB) in Bucaramanga, Colombia last year. While there, he also went to see Fundacion Cardiovascular de Colombia, a large teaching hospital, which was looking for advice in the planning of its new simulation centre.
The trip resulted in an ongoing relationship that benefits SickKids, Sunnybrook Health Sciences Centre, University of Toronto, University of Western Ontario and University of Ontario Institute of Technology, as well as the Colombian organizations.
Dubrowski holds a PhD in kinesiology and is an Associate Professor in the Department of Paediatrics at U of T. He was recruited by SickKids Learning Institute last year as an educational researcher. Previously he served as director of the Centre for Research in Nursing Education at U of T’s Lawrence S. Bloomberg Faculty of Nursing where he helped to train the trainers who will teach in a new simulation centre at Black Lion Hospital in Addis Ababa, Ethiopia.
At SickKids his role is to contribute to the Learning Institute’s simulation program and advise how current thinking and new approaches can help to improve its performance.
Simulation is an old art in medicine. Surgeons used to practise their craft on fruit and dead or synthetic tissue, and learned apprenticeship-style. With the advent of technologically-augmented simulation – including online simulation training – the learning model is changing. Trainees can now safely practice new and often difficult techniques and manoeuvres and learn how well they are doing. This approach makes more effective use of trainees in the hospital as they are more knowledgeable, skilled and efficient, and it provides better service to patients.
“Unlike the traditional model, simulation allows you to commit errors and shows you what happens without anyone being hurt,” Dubrowski says.
The partnerships in Colombia offers several opportunities. The engineering school at UPB, which established the first master’s course in simulation-based medical education in Colombia, will develop in-house expertise. SickKids will benefit from new and refreshing ways of thinking about the use of cutting-edge technology in education and training. Dubrowski has taught both faculty and students at UPB, and he has arranged for students to come to Canada as interns, not only at SickKids and U of T but also at other Ontario universities.
“The engineering students help us work out the technical aspects of simulation training, and we give them some experience which will help them move ahead in this particular field of engineering,” Dubrowski says.
One student served as an intern with SickKids Research Institute, developing a simulator that detects how people are doing as they practise tying surgical knots. The device monitors pressure and consistency of people’s movements which reveals the proficiency of the knot-tier. Research documenting the effectiveness of the device is currently under review by an international medical journal.
Another project resulting from the collaboration with Colombia is a robotic beating-heart simulator – a torso with a beating heart – for which the team is seeking a patent. The simulator is used to teach surgeons how to repair diseased coronary arteries without cardiopulmonary bypass operations.
The torso can also be used to teach other cardiac surgery skills such as suturing and grafting, and it can be part of a larger scenario where a team of doctors, nurses and anesthesiologists practise their roles in rare and potentially dangerous situations, for example, when a vessel is severed by mistake during surgery. As unlikely as this would be in real life, the team learns how to communicate and multi-task during a stressful event.
“The novelty of this simulator isn’t so much in the tool as in the program,” says Dubrowski. “We can start learners in a low-complexity situation – how to tie a knot, for example – and when the simulator shows the learners are ready, we can escalate them to a high-complexity situation.”
The partnerships in Colombia have produced a number of papers. Sayra Cristancho, a post-doctorate fellow at the Learning Institute, is co-author of two papers that will be presented at the Medicine Meets Virtual Reality Conference in Newport Beach, California next February, focusing on these north-south partnerships.