February 4, 2019 0 By FM

Lucina is in the labour room. Though admitted with normal pain, the doctors later notice signs of premature rupture of the membranes in the patient. Lucina also developed slight complications, including symptoms of preeclampsia and high blood pressure with protein in the urine. A medical team — doctors, para medics and a group of medical students, are keenly observing her fluctuating BP and other parameters. Although the doctors suspect abnormal position and presentation of the foetus, labour is in progress. Lucia moans and groans, and the baby’s head is about to be out. But there is a further complication with a suspected shoulder dystocia.
“The labour progressed slower than expected,” said the trainer and asked the team to do what is required as emergency.
Ah… the baby is finally out with a right 90-degree rotation of its head to the occipito-anterior position.
The team record every second of the labor progress meticulously. They keep monitoring the variation in BP and the CSE effect. Finally, the trainer takes the baby out, which makes its first cry, and puts it over the lactating nipples of Lucia.
Lucina is a high-fidelity female mannequin used in various obstetric & gynaecological workshops in Medical Simulation Laboratory at D Y Patil University, Navi Mumbai.
India’s first comprehensive medical simulation lab is now embarking on another pioneering project to make it the most unique medical simulation lab in the country. Established in 2013, medical simulation laboratory at DY Patil University is being expanded to the country’s largest and the first to have the most modern medical simulation modules such as augmented reality and Microsoft HoloLens platforms.



The Pioneer
The medical simulation laboratory at the Navi Mumbai campus of DY Patil University, which has at least half a dozen high fidelity mannequins to train medical students and doctors before they try their hands-on real patients, was billed as the only such facility in South East Asia when it was launched six years ago.
“This facility was started when none in this part of the world even thought of having such a comprehensive human patient simulation lab,” claims Dr N.Sippy, Associate Professor, DY Patil University.
A 5,000 sq ft lab is equipped with high-fidelity mannequins covering most of the medical specialities , a debriefing room and a conference room.
“We are now expanding this lab to a 15,000 sq. ft. facility with the latest technologies in simulator platforms, including augmented and mixed reality studios — again, for first time in India,” Sippy said.
As part of this innovation, it has already launched the Microsoft HoloLens module with CAE just two months ago. With this, it wants to enhance the training with the latest technologies that can interfere in medical simulation, especially in areas like ultrasound and gynec procedures among others.

The Beginning
“Since we didn’t have any models in India to follow, we took time to understand and analyse the requirement,” Dr Sippy quipped.
For this lab, mannequins were supplied by UK’s CAE, one of the best providers of high-fidelity mannequins for human patient simulation. Such mannequins are not available in India and are imported for the lab, as there are only three companies worldwide that have the expertise to manufacture them.CAE develops end to end spectrum of simulation solutions that includes patient ,interventional & imaging simulation.
“Though the Indian regulatory system typically mandates the very minimum modules or programmes, we wanted to introduce full- fledged simulation infrastructure and invested heavily on these high-end mannequins,” Dr Sippy added.
“We have so far trained at least 25,000 consultants from various hospitals from across India. This excludes our own UG and PG students,” says Dr Amit Nagpal, senior trainer at the Centre.
“India currently lags far behind in the utilisation of human patient simulation in medical education as the curriculum in the country is still based on trials on real patients,” he added.
Medical students, nurses and doctors are not allowed touch the real patients in developed countries before they complete a specific number of hours of training in a simulation lab, as human life is treated differently there.
The concept of simulation labs is still very nascent in India, though it is at least 20 years old in the Europe and US. Medical simulation in India was, till recently, focussed only on basic things such as a chest compression test. Even large government medical colleges, which do have simulation labs, use them suboptimally as their importance hasn’t been fully understood here.
The main reason for this was a lack of good trainers who can conduct effective workshops and the absence of regulation that makes it mandatory.
“In the advanced countries, there are large patient simulation labs. For instance, there are labs with much bigger infrastructure, very high-fidelity mannequins, simulator ambulances etc., to train the students, para medics and doctors on each and every aspect of the curriculum, including casualty, ICU and OT.”
“In a medical simulation lab, it is not the investment that is important, though it is highly capital intensive. The most critical aspect is the utilisation. Achieving the optimum level of utilisation by focusing on the efficiency of training modules and providing the best trainers are the most important factors,” says Dr Vijay Patil, President, DY Patil University.
The concept is also not fully established in India because there is no standardised way of training that has been stipulated as per the medical curriculum.
“There is no standardisation of training that has been introduced yet in the country as far as this branch of medical education is concerned. So, the student can easily go wrong in assessing the cause and treatment options or even get misguided in the way the procedures are done if he or she is not being trained the right way.”
“So, we have signed MoUs with at various universities from the West where there is a competent and very robust system in developing the standards for patient simulation training, for setting our standard of procedures,” Dr Patil added.
The world renowned HPS expert Guisappe Marraro, an Italian clinician with specialisation in anaesthesia, intensive care, neonatology and paediatrics, was instrumental in setting up the comprehensive human patient simulation lab at DY Patil University.
Currently Professor Emeritus at the University, Marraro is still involved in the development and improvement of training modules and the standard of procedures of the lab.
70-year-old Marraro had also contributed immensely in setting up medical simulator labs and development of training standards in several advanced countries, where this part of medical education is seriously pursued and adopted.
The DY Patil centre has also collaborated with several medical associations and pharmaceutical companies in India to conduct workshops for their members and consultants. The lab customises the modules as per the learners of the users while conducting the workshops.
“These customisations are with an aim to enhance the training programme for each set of students as we do not want to offer a one-fits-all course just for the sake of giving a certificate. This is also the reason for not opting for accreditations that often limit the possibilities of enhancement in the quality of workshops,” Dr Sippi added.
The other two medical colleges that run similar labs in the country are the Mangalore-based Father Muller Medical College and Yenepoya Medical College. But these labs were established much later.
According to Sippy, the lab at DY Patil University has been an inspiration for these later entrants and could also help them in many ways by sharing the experience and the learning.

This is part of a series that features India’s First & Most Unique institutions, facilities, technologies, products etc in the medical and healthcare space.