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.