ICPR Junior College and SIMTICS: Improving students’ clinical skills through web-based simulations

By Dr. Mónica Cerejido Ruiz and Prof. Noris Colón Pagán

[This article is translated from the original Spanish]

ICPR Junior College is an educational institution on the Caribbean island of Puerto Rico with over 70 years’ history of preparing future professionals for the workforce. The institution has five (5) locations around the island with a range of academic offerings that include associate degrees, certificates and continued education in the fields of healthcare, business administration, gastronomy, education, information systems and criminal investigation among others. The healthcare department offers programs in nursing, clinical ultrasound, radiologic technology, and therapeutic massage.

The students of ICPR Junior College come from a wide variety of backgrounds. Youths and adults come from rural as well as urban areas looking for a short career program with good employment possibilities. Many of them are non-traditional students; they work while they study and often have families to look after.  They come from different social classes and many of them are first generation students with great aspirations for personal improvement despite social and economic difficulties.

Facing challenges in health care education

ICPR Junior College has encountered the typical challenges that most educational institutions that offer health courses are dealing with. Among these challenges is the emphasis that has emerged on the prevention of medical errors and the approach to patient safety, as well as other changes in the provision of health services. As a result, health centers, hospitals, clinics and medical offices have limited the opportunities for students to obtain an externship placement to practice the clinical skills that are necessary before they encounter real-life scenarios. For the college, this created the need to research and implement alternative strategies of learning, practice, and evaluation.

The other challenge that the college faced was the limited practice time available in our laboratories because of the number of students and the limited equipment available. This was a particularly acute problem in medical sonography where key objectives can only be met with repeated practice.  With the difficulty for students to practice with real patients, we determined that the required skills could potentially be obtained by simulation.

We therefore recognized that we needed changes in the traditional instructional methods that we were using in the medical area. The importance of competencies in clinical abilities has been emphasized which is considered part of an essential apprenticeship for students. New pedagogic support in health sciences is needed: before, teaching was centered on acquiring a wide volume of knowledge and now it’s centered on achieving the integration of clinical scenarios where learned skills can be put into practice and applied to different situations.

With our CIO advising us on advances in technology, we began looking for an affordable simulation-based education resource to enhance our allied health curriculum.

We knew, by experience and from the literature, that student satisfaction has a positive impact in their motivation and retention, giving positive attitudinal and cognitive results. Therefore we wanted to choose a clinical simulation product that would be both attractive and effective for the student.

We also knew that the ability to transfer knowledge or performance acquired with simulations into real scenarios, continues to be one of the biggest and most important challenges in education.

ICPR students working through a sonography simulation

Web simulations provide the solution

When we discovered SIMTICS we saw that the simulations would give us the capability to reproduce clinical scenarios, the opportunity of finding and responding to abnormal or critical findings in a standardized and secure environment, and the possibility of using individual performance metrics to track student progress and mentor them to success.

ICPR students in the computer lab

In ICPR Junior College the students take classes both on-site and in a blended format. We have successfully incorporated the use of SIMTICS simulations in our allied health courses in both formats. We have used SIMTICS as learning support in anatomy, protocols, processes and patient management, among others. For assessment, we have used it to measure performance and knowledge of important clinical skills through the simulations and quizzes incorporated in the modules, assignments, and investigation projects, individually and in group forms. These simulations have proven to be both attractive and effective for our students.

We have found that SIMTICS is a great tool. It was a wise decision for us to present it to the administrators of the institution not only as a solution to the challenges we were experiencing, but also to continue offering the highest quality in education.

Student views

In an action research study carried out in 2019, with 53 clinical sonography students of ICPR Junior College where simulations were used, including SIMTICS, some of the results obtained were:

  • 96% of students considered they achieved the course objectives;
  • 94% of students felt confident to apply their knowledge in other courses, in a job or in their everyday lives;
  • 83% perceived simulation as a useful method for learning;
  • 82% learned and improved scanning skills, machine operation and patient handling;

In addition, 86% of students agreed that the simulation scenarios presented were quite realistic and the same percentage also expressed that it was useful to observe errors, review them and fix them.

Also, the majority said they gained knowledge that went beyond the original objectives outlined in the course and they felt they improved their technical skills. In general, the students were really satisfied with the experience of the simulation.

We have been using SIMTICS in our medical imaging programs for about five years now. For us, as ultrasound professors, the structure of the SIMTICS modules with updated protocols and user-friendly interface have been of great value for both the professor and the student. Also, the opportunity that SIMTICS provides for students to use trial and error, and to repeat over and over until acquiring the required skill, are critical for successful learning. The new tests with selectable time limits make interesting challenges for the students and are closer to the license exam experience.  

We see in SIMTICS a valuable tool to reinforce clinical skills so the student can practice according to their own learning needs, at any time and any place. We are very satisfied and know that with the SIMTICS tools available to our students, ICPR Junior College finds itself to be a vanguard in health courses in Puerto Rico, which gives us a significant competitive advantage over other institutions. We recommend SIMTICS to other health and science education colleagues to improve professor performance and student learning.

The SimTutor team would like to thank Dr. Ruiz and Prof. Pagán at ICPR Junior College for contributing this article, and Nelson Mejias, the CIO, for facilitating it.

Right Now Nursing extends the reach and effectiveness of Limited Obstetric Nursing education with SIMTICS web-based simulations

Cindy Parke, owner of PEC

Cindy Parke, RNC, CNM, MSN leads a busy life. Certified nurse-midwife, educator and clinician, she took over management of Professional Education Center with her husband in 2010. Now called Right Now Nursing (RNNCEs), the company is devoted to continuing nursing and midwifery education specific to the field of Obstetrics, and since its inception has provided this type of education to over 1 million nurses.

Through RNNCEs, Cindy brings her years of clinical and lecturing experience in women’s health, pregnancy, fetal monitoring, and childbirth topics to nurses and other health professionals nationwide. An active member of the American College of Nurse-Midwives, Ohio Association of Advanced Practice Nurses, Sigma Theta Tau and the International Cesarean Awareness Network, her focus is on comprehensive maternal/fetal care throughout the labor and delivery process.

Cindy has a clear vision for her education business: the ultimate goal is to reduce maternal and infant mortality and morbidity.  She firmly believes that much rests on the skills of the nurse. 

RNNCE’s continuing education provides valuable knowledge that can be used daily in an OB practice. Their seminars have always been designed to be clinically focused, patient-centered, and result-oriented; from recognizing normal labor, ongoing assessment for risks, choosing appropriate interventions, and responding to both the normal and the critical clinical challenges.  And as you might expect, Continuing Education (CE) credits are available on completion of all their seminars and on-line educational products.

But, since they are working in a competitive market, Cindy wanted to offer more to meet the needs of their students.  In her team’s search to achieve that, early in 2014 one of Cindy’s OB ultrasound educators came across SIMTICS, an innovative education product that was just entering the US market at that time. Offering interactive web-based simulations for learning and practicing ultrasound scanning, including OB, SIMTICS seemed like it could be a perfect addition to their own seminar-based nurse education offerings.

After a thorough evaluation, Cindy decided to adopt the product into her programs and today SIMTICS is what she calls “an essential component” of their Limited Women’s and OB Ultrasound education. Now the company offers a variety of educational resources including Home Study Units, Webinars, Live Seminars, and on-line study utilizing SIMTICS web-based simulations, as part of RNNCEs “Ultimate Ultrasound Training Menu”.

Today SIMTICS is what Cindy calls “an essential component” of her Limited Women’s and OB Ultrasound education.

“From the beginning we used the SIMTICS modules as an adjunct for self-study. But then with assistance and permission, we began utilizing the graphics and ultrasound pictures within our lecture slides to further explain concepts. That has been very successful.”  Cindy and her instructors also utilize videos from the modules as a summary of sections of their lectures, and have added components of the modules, with acknowledgement, within their InPatient OB Review, Maternal Newborn Review, and EFM Review seminars as well.

“Finding excellent graphics for this type of education is difficult,” she explains.  “I go to SIMTICS first when looking for something to illustrate or explain a concept, and I’m amazed at the updates and additional details that I can utilize.”

RNNCE’s student audience for limited ultrasound is national and diverse, composed of nurses, midwives, and physicians.  Students typically attend live seminars, where they may have utilized a SIMTICS module as prep for the on-site seminar. During the seminar, an instructor utilizes relevant SIMTICS modules to demonstrate key concepts. RNNCE’s educators have also blended the use of SIMTICS modules with a webinar education series. This has been utilized without follow up, and also prior to check-offs of skills done by an instructor on site. 

“SIMTICS is modular which provides a great deal of flexibility and affordability,” says Cindy. “This is most important to the small hospital or midwifery group. They cannot manage for their staff to take time away for a conference, but they still need to refine the skills of limited OB ultrasound into practice.”

Trainees can study within their own time constraints, using relevant SIMTICS modules.  Ideally, then there is follow up by an educator including an onsite observation of a full exam to reinforce concepts. Cindy explains that this hybrid approach is very cost-effective for her customers, since a lot of pre-learning can be done by the students before any face-to-face instructional time.

Screenshot from SIMTICS showing scan of second trimester
Screenshot of a SIMTICS obstetric ultrasound simulation

Since adopting SIMTICS, Cindy has noticed significant positive change for her students, including the ability for them to demonstrate a level of competency through showing proficiency in the web-based simulations. “We had the request for hands on learning with our seminars for years, and SIMTICS provided the first opportunity to do this!”

We asked Cindy what made her feel comfortable to put such a reliance on SIMTICS in her business. “Obvious quality and the pricing were the first draw. Then the special attention in set-up that I received from the company was the crown on our initial decision to move to utilizing SIMTICS. That sense of personal attention has never changed as a customer, whoever at SimTutor is interacting with myself or my staff.  In addition, the continued quality improvements always make me proud to offer the product to my learners.”

Cindy was open about the initial learning curve required for some of her students utilizing this type of education technology. “Honestly, sometimes they are not patient with their computer and mouse, and have not read the instructions we provide! However, once they get that together, they just fly though the concepts.”

She points out that utilizing ultrasound in practice is a new skill and language for many of her students.  “SIMTICS, with the self-learning and anytime access, combined with the ease of repetition, is so very helpful to learners. They can take the time they need to become familiar with these new skills and terminology. I am confident to offer the use of SIMTICS to students for self-study, prior to my going to a clinical site to provide education.” 

“Do not hesitate! I consider my decision to utilize SIMTICS one of the best I have made as Director of RNNCEs!!” — Cindy Parke

We asked Cindy what advice she would give to anyone who is considering whether to adopt SIMTICS for their programs. Cindy was clear on the benefits. “For me, as an educator, SIMTICS makes my life so much easier and my teaching more effective. When students have used the SIMTICS simulations first, we move through concepts and the hand skills in the face-to-face sessions with much greater speed. This reduces the cost to the institution. And as a business owner, the quality of SIMTICS is a smart reflection on my company that we are able to offer this high quality learning resource.”

SimTutor would like to thank Cindy for her time in this interview, and most of all for being one of our long-term customers since 2014!

If you are interested in earning continuing education credits, up to 44 Board of Registered Nursing (BRN) Credits are available for SIMTICS obstetric & female ultrasound modules through RNNCEs. For further information, please visit the ultrasound training page on RNNCE’s website.