Vall d’Hebron has inaugurated the new Advanced Clinical Simulation Centre to coincide with Simulation Week, from 25 to 29 April. The space is equipped with cutting-edge technology to recreate clinical processes and procedures of any degree of complexity in environments comparable to the real ones. Any errors do not have any impact on the patient, making these useful learning opportunities. It allows for education and training in technical skills (specific to each speciality) and non-technical skills such as communication skills, leadership, teamwork and decision-making, which are not usually emphasised in the academic world and which are essential for the proper development of healthcare activities.

“Simulation allows for experience-based and immersive training in a controlled and error-free space”, summarises Dr Mònica Rodríguez, director of Teaching at Vall d’Hebron and at the new Advanced Clinical Simulation Centre: “it also serves to develop non-technical skills and to rehearse difficult situations and procedures to improve quality of care and patient safety”. Vall d’Hebron not only uses simulation for resident training, but health professionals of all professional categories and specialities — medical staff, nurses, assistant nurses, psychologists, pharmacists, biologists, etc. — have incorporated it into their professional development. It is also planned to be incorporated into the training of security guards and other professionals in the near future.

The new Advanced Clinical Simulation Centre at Vall d’Hebron, located on the fifth floor of the Traumatology, Rehabilitation and Burns Hospital, is one of the largest simulation centres integrated in a hospital in Europe and has a direct impact on healthcare, teaching, research and innovation. A total of 200 simulation instructors have already been trained among Vall d’Hebron professionals, with teaching skills to lead a simulation, explain its theoretical foundations, lead training programmes for technical and non-technical skills and design and evaluate simulation environments. Vall d’Hebron is promoting the new centre to mark Simulation Week, and also wishes to create a space for debate on the use of simulation as a tool for training and educating professionals while raising awareness of the latest developments in this field.

 “With the simulation we not only recreate a physical environment but also a human one, where the participants are the protagonists: the interaction they establish with each other as a team and their emotions play a fundamental role,” stated Dr Jordi Bañeras, coordinator of the Advanced Clinical Simulation Centre at Vall d’Hebron and assistant physician in the Cardiology Department. “The introduction of simulation in aviation has helped to significantly reduce accidents, as it allows for rehearsal and training in real-life situations. Any medical procedure is indiscernible from the human factor. And simulation in healthcare lends the human factor the prominence it has in real life in the process of embedding knowledge,” he stated. For example, simulation has been used to improve stroke code times, drastically reduce shoulder dystocia in neonates and make cardiopulmonary resuscitation (CPR) equipment more effective.

The new Advanced Clinical Simulation Centre has a High Complexity Area that reproduces a critical care unit, an emergency room, an operating theatre and two outpatient clinics, allowing healthcare workers to be trained and educated under real-life situations. It covers a total surface area of 1,400 m2. Its renovation has been made possible thanks to a 5.2 million euro grant received through the ERDF (European Regional Development Fund). It also has virtual reality simulators that allow rehearsal of everything from obstetric procedures to laparoscopic surgery and robotic operations. To improve the degree of fidelity of the simulation scenarios, bodily fluids such as blood and vomit, produced in a laboratory, and even the clinical signs of certain pathologies, can be recreated to make the simulation as realistic as possible.

Each simulation space in the High Complexity Area —critical care unit, A&E department, operating theatre and outpatients clinic— has an adjacent control room and debriefing room where instructors, technicians and colleagues can observe the simulation without being seen, so as not to interfere with the process. They are separated from the action by one-way glass, which the participants perceive as a mirror from the inside. As important as the simulation itself is the subsequent reflection on and analysis of the process. The simulations can be recorded by cameras inside the rooms and then subsequently analysed in the debriefing room. Audiovisual recordings of each simulation can be saved through a specific piece of software, and these may end up proving useful for analysing the procedure for research purposes. “Simulation makes it possible to recreate the vast majority of situations that arise in a hospital, both common and uncommon,” explained biomedical engineer Ignasi Maspons: “for example, it is possible to reproduce a complex surgical procedure on a simulator based on the patient’s pathology. This is why it is useful for all professionals, regardless of their years of medical practice”.

Simulation Week

Vall d’Hebron will celebrate Simulation Week for the first time between 25 and 29 April, which is due to take place in the new Advanced Clinical Simulation Centre. Through a series of round-table discussions, symposiums, showrooms and exhibitions, the latest developments in the use of simulation as a tool for educating and training professionals will be analysed through face-to-face and streamed sessions. Gamification and virtual reality, the integration of simulation with healthcare services and its role in the training of medical residents will be some of the issues addressed.

In the showrooms you can attend practical demonstrations of how the new simulators work. These include the Winco USG simulator, which teaches safe puncture under ultrasound control, and the FlowCAT simulator, which can be used to practice breaking up thrombi. There is also the Hybrids VITA simulator in ECMO (extracorporeal membrane oxygenation), a technique used for patients in a critical condition and with very severe respiratory and/or cardiological diseases where conventional life support is not sufficient. All of these simulators have been designed by Vall d’Hebron professionals and the Vall d’Hebron Research Institute (VHIR) has participated in their development. There is also an exhibition that allows participants to connect to Simoons (SerIous gaMe per a la formaciÓ OnliNe amb Simulació), a virtual simulation platform developed at the Advanced Clinical Simulation Centre involving the participation of almost a hundred clinical experts from Vall d’Hebron and in collaboration with an external virtual design company (PsicoVR). It is an example of the innovative potential and co-creation opportunities offered by this new simulation centre. The Simoons platform has been used to help train professionals for over a year, providing virtual scenarios that recreate real environments such as an A&E unit that was used during the Covid-19 pandemic for professionals to rehearse the correct use of Personal Protective Equipment (PPE).

Some of the topics to be addressed in round-table discussions during Simulation Week are what residents think about learning through simulation, the importance of debriefing, the role of gamification and virtual reality and where simulation will lead to in the coming decades, with the intervention of world leaders in this field.