Simulation Training Prepares Students for Rural Primary Care

Since its inception in 2021, South Carolina AHEC’s Simulation Education Training (SET) has remained a favorite experience amongst health professions students statewide.

Pee Dee AHEC Scholars and other health professions students pose for the camera during a simulation

Since its inception in 2021, South Carolina AHEC’s Simulation Education Training (SET) has remained a favorite experience amongst health professions students statewide. SET uses simulation-based technology to expose students to clinical environments and scenarios that mirror what providers experience in rural, medically-underserved communities.

“A lot of simulations are emergent or hospital-based and students are usually being graded as a formal assessment when they participate,” said SC AHEC Curriculum Coordinator Dawn Leberknight, who was heavily involved in the development of the initiative. “We tried to make [SET] more informal to expose students to simulations before it’s high stakes, and then to really focus on rural primary care. That’s what sets it apart, there just aren’t that many cases out there like that.”

SET was the result of a one-time federal grant SC AHEC received from the Health Resources & Services Administration (HRSA) in September of 2021. With this initial funding, SC AHEC developed a curriculum containing online, virtual, and in-person trainings, and worked collaboratively with four regional simulation labs to implement high-fidelity cases focused on team-based rural primary care. Partners include the MUSC Healthcare Simulation Center (Charleston) as well as community-based nursing simulation labs at Francis Marion University (Florence), University of South Carolina (USC) – Lancaster (Lancaster), USC – Salkehatchie (Walterboro) and USC – Upstate (Spartanburg). 

The training, SC AHEC developed uses scaffolding so “the activities build off each other,” said Leberknight. “We want the students to know what topics to expect and the structure as they move forward through the curriculum.”

Students begin with a self-paced Intro to Core Topics online module, before moving on to virtual discussions over paper cases in an interprofessional team case conference. Next they have the opportunity to participate in a virtual interprofessional team case simulation with standardized patients, before finally arriving at the much-anticipated high-fidelity simulation at a regional simulation lab.

What do SC AHEC’s high-fidelity simulations look like?

The high-fidelity simulation, in which students interact as the interprofessional care team of a lifelike manikin, quickly became very popular with participants. Students complete three cases with the manikin per session, with each case scenario taking approximately one hour.

At the beginning of each case, an AHEC Regional Coordinator/Staff facilitates a brief with the team of health professions students. Following the briefing, one student provider conducts a visit with the simulated patient manikin while the rest of the team watches through a live-video feed. The students then come together to discuss the patient’s case and develop a longitudinal care plan, followed by a debrief with the facilitator on the case and how the simulation went.

A student interacts with a sim manikin (left) while a team of health professions students observes through a live-video feed.

Hannah Robinson, MD, a current OB/GYN resident and alumna of the SC AHEC Scholars program, named the high-fidelity simulation as a high point in her training. 

“One of my favorite experiences was the simulation,” said Robinson. “It was an interprofessional simulation where I served as the provider, but there were also nursing students and other specialties like social work, physical therapy and occupational therapy [in attendance]. I remember going in and doing an encounter and talking to the patient, what I’ve been trained to do, and then I came back and we debriefed.”

The manikin in Robinson’s case presented as having asthma and a nursing student suggested using the asthma protocol. 

“She asked me if I knew the asthma protocol and I was like, ‘… I actually don’t,’” said Robinson. “It was eye-opening that each of these professions have these different specific things they learn that is just really informative for us all to learn. And so I definitely went home and learned that protocol because as a provider, even if I’m an obstetrician/gynecology resident, I’m going to have a patient with asthma and I should learn how to help manage that.”

A recent graduate of MUSC’s physician assistant (PA) program, AHEC Scholar Vyoma Barodia also appreciated the interdisciplinary nature of the simulations. 

“I didn’t think of certain things that OT and PT were thinking about [during the simulation],” Barodia told AHEC. “Holistically, I thought we were able to provide the best care that we could. That was very enriching.”

(To view Dr. Robinson’s and Ms. Barodia’s full stories
visit our AHEC Scholars video page)

Evolving and Expanding

When additional SET grant funding from HRSA became available in 2022, SC AHEC used it to provide professional development for facilitators and purchase representative manikins and additional simulation equipment for each regional center.  

“Initially, [SET] funding was supposed to be for one year,” said Leberknight. “Then HRSA came back with another funding opportunity so it turned into a two-year grant. In the end, we actually [subsequently] wrote it into our five-year AHEC grant after seeing how much the [AHEC] Scholars liked it.”

The simulations have evolved over the years, taking feedback from both participants and facilitators into consideration. Among the requests from students included the opportunity to interact with the manikins more and to consult with other disciplines during the case scenario. 

“In the first year, we didn’t have them interact with the manikin as much as we could have,” said Leberknight. “It was more patient-centered communication focused, without including aspects of a physical exam. After that, we had them taking vitals and just made the patient more complex, clinically.”

By the end of this year, there will be nine cases available. Three of those cases are part of a longitudinal case, in which students experience three separate visits from the same patient over time that take place during one simulation session. The most recent set of cases involves visits from different members of the same family.

“So in one set they’re following a patient, and then in another set of cases, they’re seeing the grandfather, the mother and the son,” said Leberknight. “It’s a way to really promote and get them interested in family medicine and practicing rural.”

Staff members from across the SC AHEC statewide system have taken advantage of the opportunity to become trained as facilitators as more cases have become available.

“Not only do they have to play the patient (they’re speaking through the manikin and taking on the character), but they also have to run the equipment,” said Leberknight. “It’s a learning curve on both of those tasks and they put in a lot of effort to prepare for their role as facilitators.”

Staff members from Lowcountry AHEC and Pee Dee AHEC run through new cases at a facilitator training.

Facilitators need to learn the patient thoroughly, as the health professions students don’t necessarily always stay on script. They also tailor the simulations to a community near that regional center to make the scenario feel more real.

“Facilitators will meet with the students before the simulation scenario begins and explain the setting, like “we’re at this federally qualified health center and these are the services we have and think of these providers,’” said Leberknight. “The facilitators really try to get them to think of community-based resources available when they’re going through [the simulation].”

SET has come a long way since its initial funding, with more plans on the horizon to continue expanding the program in the future. Up next: getting high school students into the simulation centers.

“We are implementing an orientation to the simulation manikin that is not focused on the clinical aspects,” said Leberknight. “High schoolers will go in and respond to prompts from the manikin like, ‘My blood pressure feels high – Can you please take it?’ It will walk them through step-by-step interacting with the manikin and provide an initial experience in that simulation environment.”

About the Program

South Carolina AHEC Health Professions Student (HPS) programs provide community-based training experiences, exposing students to the opportunities of working in rural and underserved areas of South Carolina. For more information on HPS programming, visit www.scahec.net/healthstudents.html.