PREPARE FOR PRACTICE IN A SIMULATED ENVIRONMENT

After introducing a new topic or skill, provide opportunities to apply new knowledge or practice new skills in a simulated or safe environment when possible. Simulated environments are places where students can work together in small groups, observe or participate in

with anatomic models, or work on computers if available. Some teaching institutions may have the space and resources for setting up a formal, simulated practice environment. These are sometimes referred to as Skills Development Labs, Student Practice Centers, Clinical Skills Centers, or Student Learning Centers or demonstration rooms. Remember learning how to take a history or blood pressure? What was more helpful when you learned these skills—lecture or “hands-on” practice? “Hands-on” learning is essential for gaining new skills. Below are some examples of practice activities that work well in a simulated environment:

zPractice counseling during role plays

zLearn to perform a pelvic examination using an anatomic model

zPractice counting breathing rate using videos of children with acute respiratory infections

zPractice assessing maternal nutrition using simulated patients

There are many benefits to providing opportunities for practice in a simulated environment before the clinical practice session with patients. Practicing with anatomic models and simulated patients (such as volunteers or other students) allows students to learn and practice skills without harming or inconveniencing patients. The following are some ways to provide practice opportunities in a simulated environment:

zIn the classroom. Set aside a class session for practice after

introducing the theory. Gather the necessary supplies and create space for students to work—either by rearranging tables and chairs or by setting up in another room. Use the class time to allow students to practice and receive feedback. If you cannot set up supplies and space to work in the classroom, use another room that has enough space.

zIn a skills development lab or clinical skills center. Collaborate

with administration and other teaching staff to set up and maintain a clinical skills learning facility. This can be done by adapting existing space or constructing new space. For example, a former ward or stock room may be converted into a skills development lab. The benefits of a space dedicated to clinical skills development are that it can be:

z readily accessible to major users;

z attractive to students, staff, and patients; and

z permanently equipped with audiovisual, telecommunications,

and computer facilities.

zAt the clinical practice site. Coordinate with clinic administration

to use a room that has space for working in groups and setting up the necessary equipment and supplies. Take along the needed supplies and equipment and set them up before the students arrive. Provide opportunities for practice with feedback in a simulated environment before a clinical practice session begins, during times of low patient caseload, or immediately after a clinical practice session.

No matter where you choose to provide opportunities for practice, obtain the necessary supplies and equipment for the desired practice session. Be sure that the related learning materials (such as textbooks, learning packages, and checklists) are available. Set them up before the students arrive so that they have enough space to work with models, watch a video, or work in small groups. Provide sufficient light and be sure the room can be locked if you will not be able to stay with the equipment until the students arrive. Obtain what you can of the following equipment and supplies:

zAnatomic models such as breast, pelvic, condom, and injection

arm models. If possible, other models such as the childbirth, Norplant implants insertion arm, or no-scalpel vasectomy models can be added later. Teachers in many schools have made their own models using locally available materials.

zLearning materials such as related manuals or textbooks,

checklists, supplemental exercises, videos, and computer software if available. Supply additional topic-specific materials (e.g., IMCI, breastfeeding, child health, adolescent and general reproductive health, maternal/newborn health) as well.

zPhysical supplies such as chairs and tables, place for handwashing

or simulated handwashing, an additional light source, videotapes, video player and monitor if possible, flipchart stand, paper, and markers.

zMedical supplies such as examination gloves, required

instruments and equipment, cloth sheet or drapes, cotton/gauze swabs, syringes, oral rehydration supplies, infection prevention supplies, and contraceptive samples. Obtain any medical supplies you need for demonstration and practice of the essential skills in the simulated practice environment.

Even if a certain room is not set aside for practice opportunities, take the time and energy to provide opportunities for practice, no matter which setting you choose. Provide the necessary supplies and equipment for the related skills practice or group activities.

Introduce and Manage a Simulated Practice Environment

In this manual, we use the term Skills Development Lab (SDL) for a simulated practice environment. Planning and initiating a SDL require significant time, resources, and commitment from your institution’s administration. The following are recommended steps for planning for a SDL, whether for your school or for an associated clinical practice site:

zEnsure that the administration involved is willing to support the

SDL by dedicating the chosen space to that purpose, providing the necessary supplies and equipment, and the necessary time for orienting faculty and staff.

zChoose a room that can be locked but is in an accessible location.

zChoose a room with adequate light and space for students to work in small groups.

zChoose a room that is secure. The room should contain a lockable

storage cabinet space for storing valuables such as video players and recorders, monitors, etc.

Introducing a Skills Development Lab

Several issues need to be discussed with administrators and faculty involved in the initiation and management of a SDL. There must be consensus among administrative staff regarding the location, supply, use, and management of the SDL. The suggested steps involved in initiating a SDL are listed below:

zGather the administrative staff capable of making institutional decisions and related faculty across departments for an initial discussion of why the SDL will benefit the institution and how it can be incorporated into present teaching practices. Develop consensus with this group about how the SDL will be managed and used within the existing program.

zChoose several individuals involved in the skills training to be

“champions” or serve on a small working group for the development and management of the SDL.

zGather the initial group to achieve consensus regarding physical location and setup, supply management, faculty orientation to the SDL, SDL hours, and staffing.

zPhysically set up the SDL. Gather models, tables, supplies, and equipment to set up the center. Refer to the previous section for the recommended supplies. Set up tables with sufficient room for students to work in groups with anatomic models. Set up areas for study or small group work with chairs or tables. Place supplies and learning materials (including exercises, role plays, checklists) in a central area. Post related wall charts and posters. Make sure there is adequate light. Administrators will need to provide some financial support to purchase supplies, laminate learning materials, and make copies. A sketch of a sample layout in shown in Figure

4-1.

zOrient faculty to the SDL. Inform them about the purpose of the SDL, use and care of anatomic models, use of checklists to develop skills and assess competency, use of the SDL for demonstration of skills, and times of operation. Plan how the SDL will be incorporated into the existing teaching methodology. Determine when the SDL will be staffed with faculty or senior students and who will staff it.

zOrient students to the SDL. Schedule a day for orientation and rotate students through in groups. Discuss when the center will be open, when skills can be practiced and observed, whom to contact for keys, and whom to go to with questions. Discuss handling anatomic models and using checklists for practice with anatomic models. Demonstrate how to use a checklist to practice a skill with anatomic models.

Managing Simulated Practice

zPost in key locations the hours that the SDL will be open and any related schedules. Provide instructions on how to gain access to the SDL after hours.

zRemind appropriate faculty of the availability of the SDL for

demonstration of skills and assessment of competency prior to clinical experiences.

zDelegate someone to be available and responsible for keeping the keys.

zStaff the SDL with faculty or senior students during designated

zMaintain supplies, resources, and equipment and ensure that they are not borrowed for other uses.

zChoose several senior-level students to be available during practice times. Orient these students to the SDL and, before approving them as assistants, use checklists to evaluate their skills with models. Figure 4-1. Overhead View of a Skills Development Lab

Establishing and maintaining a SDL may be beyond the organizational capacity and resources of many schools with limited budgets and staff. Consider whether there are sufficient resources not only for introducing a SDL, but also for maintaining the supplies, equipment, and staffing. If your school cannot implement a SDL, provide practice in other simulated environments. More important than where practice occurs is how practice occurs—by students’ introduction to theory, observation of a correct demonstration, opportunities for practice with feedback, and demonstration of skill competency before working with patients in clinical practice sessions.