How this Medical Assisting program expanded into two more states (with help from SIMTICS)

By Terri-Beth Williams

As Director of the Clinical Medical Assistant (CMA) program at West Virginia Junior College (WVJC), Rayan Matthews is responsible for over 180 on-ground and online students across West Virginia, Ohio, and Pennsylvania. About two-thirds of the students are in the online program, which is growing rapidly, while the numbers in the residential program are dwindling. In late 2018 Rayan adopted the SIMTICS simulation-based product for her online CMA program, and she recently spoke with us about why she chose SIMTICS, her experience so far, and reactions from her students.

Why was there a need for online simulations?

In 2011, the College developed an online education delivery platform to support students who need to balance school with work and family. WVJC Online strives to maintain the same level of service that students experience at the residential campus.

Rayan Matthews joined WVJC five years ago, after working in multiple roles in the medical assisting field since 2004. This was to be her first teaching role.

“I originally applied for a position as a weekend instructor, teaching students on campus, but I was asked to consider the director position which was responsible for the online program. So not only was I new to teaching, but I was also wondering how on earth it was possible to teach medical assisting online!”

Rayan took responsibility for the Online CMA program, which at the time was operating in the state of West Virginia. For the online students, the approach involves assigning them to a campus for a regular clinical session. Staff members, who work as medical assistants during the week, go in to each campus to check off the students’ competencies.

Rayan was then asked to expand the program into two neighboring states. “Due to state guidelines we had to change the ratio of clinical component hours, so I started looking for simulations to enable us to achieve that without affecting the students’ learning opportunities. SIMTICS was one of the options we considered and it is the one we selected. Before SIMTICS I only ran the Online CMA program in the state of West Virginia – now I’m running the program in three states, including Ohio and Pennsylvania. We could not have achieved this without SIMTICS.”

Why choose SIMTICS?

When we asked Rayan what prompted her to choose SIMTICS over other medical training resources on the market today, her main criterion was clear: she wanted a product that would accurately represent the real-life situations students would face when working with patients in a clinic. She had seen other products which use animated characters in their simulations, but that wasn’t right for her program.

“None of the other products were as realistic. With SIMTICS it’s like you’re right there, doing the procedure on a patient, which is just what I wanted for my students.”

When it came to choosing the right educational resource for her program, Ms. Matthews wasn’t only looking for realism. She needed a technology platform that would work well for the many students who are located in remote areas with limited and unreliable internet access.

“I had to work closely with our IT Director to check out each product. It was important to know whether the students would be capable of running the product at home, particularly in the southern part of our state (West Virginia). When I was looking at other products the lag time was terrible for some internet providers. But when I found SIMTICS, I actually ran and got our IT Director since it not only looked so realistic but it worked so much better than other products I’d been evaluating.”

Stellar customer support is critical

There was one final factor in Ms. Matthews’ choice of product. Setting up and managing an online learning solution is not always easy, and when you’re putting education tools to work at a distance, you need responsive customer support to be there when you need them and to walk you through the questions and challenges that will inevitably arise.

For Ms. Matthews, the high level of customer care has been one of the most distinctive and valuable features of SIMTICS as a company: “With some other companies, you might have to wait for days for somebody to respond, but with SIMTICS, if I have a question, they answer me right back. It really makes a difference when you’ve got a student on the other line and you need an answer as soon as possible.”

Accelerating teaching and learning

When we asked Rayan how SIMTICS is integrated into her program curriculum and what effect that has had on teachers and students, she explained that the really important part for her students is the simulations. She requires them to go through the practice and test simulations, and they submit proof of their test simulation score which she uses to grade them. Rayan has also found that the ability for students to repeat each activity over and over is a big advantage, helping them to “lock in” all the steps for each procedure, right from gaining consent, to performing the procedure, including the post-procedure considerations.

Another significant benefit has been the effect on teaching. “Since we’ve been using SIMTICS, by the time the students come in to do the hands-on part on campus, my instructors can honestly move at a faster pace with them, rather than having to start at point A. The students have already done all the academic bookwork and completed all the simulations, so they have the knowledge they need to recognize the medical terminology, and the instruments and equipment they need for each procedure. Now, when the instructor gets to them, they are prepared and ready to jump right in.” Rayan says this gives her instructors extra time to help each student truly master the skills, which is better for the students and more rewarding for the faculty.

Rayan also notes that the interactive nature of the SIMTICS product appeals to the learning preferences of her allied health students, promoting interest, mastery, and memorization. “Interacting, doing; this is how my students learn best. SIMTICS is amazingly wonderful for this, it helps to lock in their knowledge. Anybody can look at a book, but when they actually do it in a simulation, they remember it… After studying with SIMTICS, it’s like the whole procedure is automatically embedded in their brains.”

Students “love it”!

Rayan laughed when we asked what kind of feedback she’d had from her students since integrating SIMTICS into the curriculum. “Oh my gosh, they love it.” She went on to explain that since using SIMTICS modules, she’s been able to significantly expand the number of student assignments each week and noted, “There has not been one complaint, because it’s fun and it’s interactive. They’re not just reading. It’s like real life for them. They love it and they don’t complain about the workload.”

And it’s not just the students’ interest that’s piqued by SIMTICS—so is their sense of pride and accomplishment in their learning. Rayan says: “One student told me, ‘I made my mom watch me do a procedure in SIMTICS because she couldn’t believe I could ever do something like that. She thought it was really cool to see exactly what I will do in real life.’ I was so pleased to hear that. For me, it’s all about the students, seeing them succeed.”

Advice for other instructors?

Rayan recalled her initial reluctance to use a web-based product. “I was very old school, so I was thinking, how can you teach medical assisting online? Will online simulations work? Of course, doing it on a computer is different than, say, performing a blood draw on an actual patient … But we have to face that times have changed. The generation of students we’re working with now are computer gurus compared to some of us. They like using computers and they expect technology to be part of their learning.”

We asked Rayan if she had any advice for those who are looking for web-based simulations or considering integrating SIMTICS into their program curriculum. “SIMTICS has changed my program for the better. As a long-time MA professional, I never believed that a simulation could be so realistic. So I would say, give SIMTICS a chance. You’d be surprised at how effective it is.”

The SIMTICS team would like to express their sincere thanks to Ms. Matthews for her time and insights, and for being a valued member of the SIMTICS customer family!

John Windsor: On a mission to democratize medical education.

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Imagine having a missionary as your father. Or moving to a foreign country as a small child and going to school in a remote rural area. Or learning about medicine from the age of 9, standing on a box by your father’s operating table. Any one of those life experiences would probably give you a very different perspective on the world, but for Professor John Windsor, the co-founder of SIMTICS, they were all fundamental parts of his life until he was fifteen years old!

“I grew up in northern India and did all of my primary and secondary schooling there,“ says Professor Windsor. “My father went out in 1963 to set up a heart unit in a post-graduate institute, and thus helped establish that specialty in India.  He went on to work as a general surgeon in mission hospitals for twenty years.”

It’s no wonder John has such an interesting worldview, and such a passion for making education accessible and available to all, regardless of geographic location or economic circumstances.

As well as the wonderful climate and the spectacular Himalayas, he also remembers the principles he learned. “Under my dad’s influence I grew up understanding the importance of healthcare and community development, and that educational opportunities were precious. It was a wonderful upbringing, to be honest.”

When he finished secondary school John returned to New Zealand, completed a double major in physiology and biochemistry and then enrolled in preclinical medical school at the University of Otago. He later transferred to the University of Auckland and qualified as a medical doctor before training as a general surgeon. He then completed a two-year fellowship in hepato-biliary and pancreatic surgery in Edinburgh, working under Sir David Carter.

Windsor seems tireless; on top of all his surgical, academic and research work, over the last 5 years he has published 112 of 235 manuscripts, raised $6m in grants and given over 100 invited talks, including Visiting Professorships to Harvard, Oxford, Karolinska, Singapore, Capetown, Johannesburg and Delhi.

Back in New Zealand, he was encouraged to pursue an academic career. In 1992 he founded the Pancreas Research Group, which has been at the centre of his research endeavor, and in 1994 he was appointed as Senior Lecturer of Surgery at the University of Auckland and as a Consultant Surgeon at the Auckland Hospital.

Around this time, the advent of the laparoscopic revolution was putting significant pressure on traditional approaches to surgical training.  John set up the first Surgical Skills Centre in New Zealand to address this need.  Later, in 2007, he raised $2 million and, in partnership with the Mercy Ascot Integrated Hospitals Ltd, he designed a purpose-built facility: the Advanced Clinical Skills Centre. This has become a world-class environment for skills research and training.

So how did a surgeon come to develop an online simulation technology like SIMTICS?

The lessons learnt during his early life in rural India, the years of skills training, and experience with using physical simulators have all played a significant role in John’s thinking. From this the approach to ‘integrated cognitive simulation’ was developed, in partnership with two other doctors.

John’s interest in virtual learning began back in 2003 when he met George Oosthuizen, an experienced surgeon who had recently moved from South Africa to New Zealand. Oosthuizen had to become a student again and retake his fellowship exam, before he could practice in his newly adopted country.

“George found studying inefficient and exasperating. He had to pull books and journals from libraries, videos off the internet, advice from colleagues, diagrams from elsewhere… while trying to build 3D pictures in his mind and pull all this information together to become proficient at different procedures. He shared his frustrations and this led us to ask: could we use technology to bring together all of the necessary materials in one place to promote more efficient learning?” John explains. “As we explored this idea further, we realized that there was an opportunity to incorporate modern educational theory and practice with appealing media like computer graphics and video to make the learning experience more interactive, effective, and enjoyable.

With the help of some programmers, they mocked up a basic product framework, then got to work on their first procedure prototype: a laparoscopic appendectomy. As the lead subject expert, John had a starring role, performing and narrating the steps for the video portion.

The company gained support from an Auckland based business incubator and gradually attracted investors. To ensure commercial viability, the growing team branched out from surgical procedures into the wider healthcare market with a range of medical procedure simulations. Later they developed three suites of simulations for ultrasonography and radiography, and eventually more clinical procedures for medical assistants and entry-level nursing students. Dental Assisting modules are the latest addition to the catalog.

Cognitive learning is valuable and needs greater emphasis.

In developing the content, the SIMTICS team focused on the cognitive learning required for procedures, since this is a layer of knowledge that can be easily addressed by technology, outside of the clinical setting. It is also thought that cognitive knowledge represents up to 75% of the skills required for the safe performance of procedures. Cognitive knowledge doesn’t replace hands-on, psychomotor skills learning, but it is a critical part of the required learning that can be addressed separately, even while the learner is working alone, and without equipment.

The idea that cognitive learning is highly valuable and needs to be given greater emphasis originally came from the world of sport. Not only do high-performing athletes practice to achieve excellent physical performance, they also mentally rehearse their event or activity, running every single aspect through their minds beforehand. The movie, Rush, about Formula One drivers brings this to life with a scene where driver James Hunt lies on the floor with his eyes closed and ‘mentally’ drives his car around the course, steering and pressing pedals in his mind, before his next race.

The SIMTICS product also achieves Oosthuizen’s dream of having everything in one place for learning a medical procedure. It allows learners to read, watch, explore in 3D, practice, and test their skills, all from the same interface.

At the heart of SIMTICS is a virtual reality simulator. This is what allows the learner to do their mental rehearsal of each new skill or procedure. Each module covers one type of healthcare procedure, from lumbar puncture or administering an intradermal injection, to ultrasound assessment of the aorta or performing radiography of the chest. The simulations require the learner to cognitively learn and understand the steps of that procedure, then perform it online just as if they were doing it in real-life. For instance, in a SIMTICS simulation, the learner has to prepare, position the patient, select and move instruments and consumables, place them correctly, and in some cases operate a virtual machine. For people studying sonography or radiography, SIMTICS is a bit like having a real imaging machine at home or in the classroom – at a tiny fraction of the cost.

As well as interactive simulations, each SIMTICS module also contains a step-by-step video demonstration, a text description of the procedure, explorable 3D anatomy, and quizzes to test theoretical knowledge. The product does not dictate a pre-set ‘one-size-fits-all’ sequence of learning, so these components can be accessed in any order. “We home-schooled our five children,” says Professor Windsor, “and through that I came to appreciate the value of individualized learning, and providing choices in order to match learning opportunities with learning styles. And everyone gains by being able to experience and absorb the same information in different formats.”

The built-in SIMTICS logbook continually tracks your study hours, simulation completion times, and scores. It even records the errors made in the simulations, so you know what to work on next time. When SIMTICS is used in education institutions and work-teams, the logbook data can also be accessed by instructors and supervisors.

Making education available anywhere, anytime.

The desire to find the most cost-effective and accessible education solutions has been a strong driver for someone who grew up in one of the poorest parts of the world. “Coming from a missionary background in rural India, I know how important it is to find a generalizable and sustainable approach to education, that can be accessed regardless of geographical location. SIMTICS is one of my contributions to achieving that mission.”

SIMTICS currently has a catalogue of over 130 modules, covering ultrasound scanning protocols, radiographic positioning, dental assisting, medical assisting and common medical procedures.

Maximizing the teachable moments through flipped classroom and student performance analytics

By Angelique Praat
In any teaching environment, students come with a range of talents and challenges, and different learning velocities. Imagine if you could give every student a head start before they reached the classroom. This is the essence of the flipped classroom or blended learning model for healthcare professionals.
Web-based skills learning system, SIMTICS, offers medical and allied health instructors greater scope to prepare their students for class than simply asking them to read their textbooks and hoping some might comply. Through an integrated system of learning support, students can try procedures via online simulations before they come to class.
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