Practical clinical scenario in surgery for remote simulation using custom-made surgical suturing task trainers

Introduction: Remote learning caused by COVID-19 pandemic and subsequent lockdown has prevented medical students from training their practical clinical skills in clinical simulation centers. As a temporary alternative, many schools have begun experimenting by sending task trainers to students at home, while conducting classes remotely. The purpose of this work is to create a full-fledged surgical simulation scenario that would combine several types of doctor’s activities in the emergency department of the hospital at once (examination, history taking, administration of local anesthesia, sewing wounds, immunization, and paperwork) that would be able to organize not only on-site but also remotely.

Methods: Surgeons who work in the emergency departments of the hospital were interviewed, information that included the specifics of working with patients with trauma was collected. To create a custom task trainer, skills of working with sculptural plasticine, creating molds, casting two-component pigmented silicone in two layers with the integration of elastic fabric inside were applied. Special simulated documents were created. As a result, a simulation script was written for a remote workshop.
Before the workshop students have received Educational kits, which include: custom made surgical suturing task trainer, intramuscular injection task trainer for simulation of vaccination, surgical suturing set, wound dressing set, surgical and non-sterile gloves, simulated documentations. Students while staying at home are connected to the video platform. A simulated patient and mentor are also connected to the same video session. The scenario goes as follows:
A patient comes to emergency room of the hospital after getting into a fight with a use of knife. The patient is excited, stable, and in order to obtain doctor's document about the injuries received for its further transfer to the police, he talks to the surgeon. He tells about his injury, complains of pain, and also shows a bloody wound sealed with a band-aid. Students are expected to take an initial examination - they will see images of bruises and wounds on the screen. When students see an image of a bloody wound, they are expected to open previously received Educational kit and proceed with the following clinical skills: flush the wound of blood, administer local anesthesia, suture up the wound, vaccinate the patient against tetanus and diphtheria (according to Latvian guidelines), and fill out the necessary documentation - trauma protocol and a patient examination sheet.

Results: A trial workshop was held in person, for 40 senior medical students, participants of the Student Surgery Academic Society of Riga Stradins University, and received a very high rating and positive feedback.

Conclusions: The methods of hybrid distance learning that we have applied can significantly increase students’ interest in classes and give them the opportunity to practically train their clinical skills. Also, by including all the stages of the work of a doctor with a patient in the simulation – anamnesis collection, examination, processing and suturing a wound and filling out documents, we increase the fidelity of the simulation and the involvement of students, despite the remote format of the event.
This method will be implemented to create similar scenarios with other types of injuries and patient complaints, to conduct workshops of this format among students participating in the Student Surgery Academic Society.