Better training? Like real!

14 March 2017 | EducationFacilities and Buildings 

On 11 January 2017, SingHealth signed a Memorandum of Understanding with the Singapore Civil Defence Force (SCDF) to advance pre-hospital emergency care and training for paramedics in Singapore. Taking centre stage is the SingHealth Duke-NUS Institute of Medical Simulation (SIMS), where paramedics and clinicians train in simulated environments.

His lips are turning blue, his pupils dilate, he starts choking.

They check the patient’s blood pressure, which falls suddenly. Before they can intubate him, a stranger – likely the patient’s relative – bursts into the room sobbing, causing the nurse to flinch and accidentally draw too much dopamine to start an infusion.

Instantly, the healthcare team disassembles as their supervisor calls for time out.

If this sounds like a scene from a movie, it is not. The ‘patient’ is a high-fidelity mannequin with sophisticated life-like responses, including a heaving chest and bleeding skin. The operating team, including the startled nurse, is real.

They are healthcare professionals undergoing inter-professional training. The ‘stranger’ is an actor engaged to add authenticity to the scenario.

Such is the degree of realism observed in simulation-based medical training today, and with SingHealth Duke-NUS Institute of Medical Simulation (SIMS), more healthcare professionals will benefit from advances in this field.

Led by Associate Professor Fatimah Lateef, Senior Consultant at the Singapore General Hospital’s (SGH) Department of Emergency Medicine, and three co-directors, SIMS was formed in 2016 to group four simulation facilities in SingHealth under one administrative roof.

Assoc Prof Fatimah Lateef (seated) in a simulation facility with her SIMS co-directors (L-R) Ms Sabrina Koh (Sengkang Health), Assoc Prof Andrew Tan (SGH Campus) and Dr Mok Yee Hui (KKH Campus)

It comprises the SGH Institute of Medical Simulation and Education (IMSE), SingHealth Duke-NUS Surgical Skills Centre, KKH Simulation Centre, and Duke-NUS Medical School’s simulation facility. With the integration of Eastern Health Alliance, the Changi Simulation Institute (CSI) in Changi General Hospital will also be part of SIMS.

“Simulation-based training has been shown in many studies to enable doctors or trainees to master skills faster, as they practise repeatedly in a safe and nurturing environment,” says Assoc Prof Fatimah, who has been an instructor in simulation-based learning for nearly 20 years.

“We want to make this form of training a default for healthcare professionals at SingHealth. If someone wants to master a skill or explore hands-on ways of learning a technique, even for complicated procedures such as endoscopies, they can approach SIMS for a simulated model to practise on.”

SIMS’ impact reached national levels when the MOU with SCDF was signed in January. Over 250 SCDF paramedics are expected to benefit from the training annually.

SingHealth and SCDF will also facilitate the development of Singapore’s first paramedic educator training programme.

Under the MOU, the number of SGH nurses seconded to the SCDF 995 Operations Centre will be increased – from four to 14 – to further improve to pre-hospital emergency care.

By pooling its resources, SIMS brings together a team of 18 staff and $5.6 million worth of equipment from the SGH Campus, Sengkang Health and KKH to bring greater accessibility to simulation-based training.

"Simulation-based training has been shown in many studies globally to enable doctors
or trainees to master skills faster."
– Assoc Prof Fatimah Lateef, Director, SIMS

As more interdisciplinary training opportunities arise, and more partnerships with external bodies are formed, healthcare staff can look forward to improved facilities, richer simulation scenarios, as well as access to regional and international conferences, new courses and programmes.

SIMS also hopes to develop more trainers in medical simulation by equipping more staff with the right skills to craft medical scenarios relevant to each discipline.

Simulation-based training has come a long way from the days where simple anatomical models and static plastic moulds were used. Technology used today include mannequins that respond to trauma and pain as complex procedures are ‘performed’. Live models may also don “cut-suits” with ‘organs’ such as the liver or stomach that can be ‘operated’ on.

“Simulation training is a very dynamic area which is advancing rapidly, and incorporating areas of training using virtual reality and even serious gaming mechanisms,” says Assoc Prof Fatimah.

“SIMS plays a vital role in fostering the continuing professional development of healthcare professionals in our Academic Medical Centre, and for our nation.”

SingHealth Academy’s Colleges


SingHealth officially launched SIMS and five colleges under the umbrella of SingHealth Academy to boost training of healthcare professionals.

Together, the colleges will offer a wide range of training – from undergraduate, graduate, postgraduate, continuing professional education to faculty development.

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