Management of the professional training process through the application of simulation methods in university medical education: Abstract of the Phd Thesis in medical sciences: 331.03 - Social medicine and management

Abstract

Relevance and significance of the topic. In the context of increasing demands for training, limited patient interaction, and the prioritization of patient safety, a new concept has emerged in medical education, integrating advanced technologies and innovative teaching methods. Simulation-based medical training is an educational process that utilizes simulators, clinical scenarios, and specialized technologies to replicate real medical situations. Its purpose is to develop and evaluate theoretical, practical, and communication skills in a controlled, safe, and ethical environment, without risks to patients. Simulation in medical education has immense potential for widespread application throughout the education system, from undergraduate to postgraduate levels and continuing medical education. Recent developments, such as the right to clinical practice during the residency stage, have increased the focus on professional medical training at the university level. The benefits of clinical simulation are increasingly reported in specialized literature, and its integration into curricula requires careful planning [1–3]. The implementation of simulation at the Nicolae Testemițanu State University of Medicine and Pharmacy began in 2003 with the use of standardized patient methodology in university training. The establishment of the University Center for Simulation in Medical Training (CUSIM) facilitated the enhancement and diversification of simulation-based medical training methods across all levels of professional education. Recent changes in licensing regulations and new responsibilities assigned to medical trainees have made it essential to increase the complexity and utility of developing practical competencies for students, particularly in the final years of their studies [30 – 35]. The complementarity of medical simulation must be justified and strategically applied to meet the requirements of the national healthcare system in alignment with policies for training specialized human resources. [4, 12, 24, 25]. The goal of medical education is to develop the skills of physicians capable of providing a high level of care in safe conditions for patients. Identifying the optimal methods and necessary elements to achieve educational objectives remains an ongoing challenge [5, 13, 14]. Over the past two decades, simulation has significantly enhanced the concept of traditional medical training, with its use increasing exponentially. Drawing on experiences from fields such as aviation and astronautics, efforts have been made to refine effective methods for utilizing simulation in medical education [6, 15, 16]. Description of the field situation and identification of the research problem. Simulation-Based Medical Education (SBME) has become fundamental in training healthcare professionals, providing a dynamic and interactive learning environment that mirrors clinical realities without compromising patient safety. It allows learners to practice procedures, make decisions, and manage patient interactions in a controlled setting, thereby enhancing their clinical skills, critical thinking, and confidence before practicing in real-world scenarios [1, 17, 18, 26, 27]. The significance of SBME lies in bridging the gap between theory and practice, providing an essential platform for experiential learning, and thereby preparing competent and efficient healthcare providers [7, 19, 22, 23]. The complexity of modern healthcare systems and the need for high-quality care demand innovative educational approaches that adequately prepare students for the challenges of clinical practice [8, 9, 20, 21]. Simulation-based approaches are essential, providing an effective means of teaching clinical skills, improving decision-making, and enhancing professional competencies in a safe environment [10, 11, 34]. The formulated research hypothesis asserts that simulation sessions, implemented based on a rigorous methodology, can have a significant impact on clinical skills, student satisfaction, and the standardization of the educational process in higher medical education. The research aims to identify optimal strategies for integrating simulation into national university programs by developing a procedural framework to implement simulation-based methods. The ultimate goal is to enhance the quality and effectiveness of medical education and to train graduates with transferable and generalizable professional competencies. Additionally, the research explores simulation techniques and methodologies, evaluating their merits and disadvantages while improving the understanding of simulation customization to meet specific needs based on available facilities and instructional objectives. Research aim: The development and validation of an efficient methodology for the application of simulation in university medical education, aimed at enhancing teaching quality and strengthening the management of the professional training process. General objectives of the thesis: 1. Development of the procedural framework by determining the need for and organizing simulation training at the university level. 2. Evaluation of students' acquisition of practical skills through the observational method, using checklists as an assessment tool. 3. Analysis of the impact of training on students' theoretical knowledge through the application of pre- and post-training testing procedures. 4. Determination of student satisfaction with the applied components of medical simulation training. 5. Development of recommendations for the comprehensive and efficient implementation of medical simulation training at the university level. Scientific research methodology. The research focused on evaluating the effectiveness of simulation-based training in university medical education at the University Center for Medical Simulation of the Nicolae Testemițanu State University of Medicine and Pharmacy. The study, analytical and experimental in nature, involved students divided into groups based on the practical skills being trained. Due to certain limitations, a quasi-experimental design was employed to assess the impact on theoretical and practical skills. Data were collected using written tests, checklists, and questionnaires, employing historical, mathematical, and sociological methods. The analysis was performed using specialized software, which facilitated the application of statistical tests and the validation of the research hypothesis. The scientific novelty and originality of the results obtained. The research conducted at Nicolae Testemițanu State University of Medicine and Pharmacy introduced an innovative methodology for implementing simulation-based training in university medical education. This approach incorporated diverse simulation methods, such as standardized patients and integrated clinical scenarios, which had not been previously applied in a structured educational setting. The originality of the research lies in a comprehensive pre- and post-intervention evaluation system that measured theoretical knowledge, clinical competencies, student satisfaction, and adaptability to unexpected situations. The results demonstrated a significant improvement in student performance, validating the effectiveness of simulation and proposing it as a standard for national medical education. The study highlighted the importance of integrating advanced technologies into the curriculum and opened new avenues for adapting the methodology. The important scientific problem addressed in the thesis. The research was initiated to address the need for improving the professional training of medical students in the context of increasing complexity in medical practice and heightened safety requirements. Traditional medical education, based on direct clinical experiences, was constrained by the availability of cases and posed risks to patients due to medical errors. Developing innovative training methods that enable the practice of clinical skills in a safe and controlled environment became essential. The problem solved in this study was the creation and validation of an efficient simulation-based training methodology that enhanced students' clinical competencies and satisfaction. This methodology demonstrated a positive impact on both theoretical and practical performance, providing a framework for its integration into the university curriculum. The implementation of simulation contributed to training in a safe environment, supported the accreditation process, and highlighted the potential of this approach to transform medical education. Theoretical significance. The research reveals a significant shift in the paradigm of medical education, highlighting the inadequacy of ad-hoc educational sessions in clinical settings for refining physicians' skills. In this context, the study emphasized the need for curriculum standardization and the adoption of a systematic approach that incorporates deliberate practices, structured exercises, and rigorous outcome evaluations grounded in continuous feedback. Practical applicability of the work. The effective implementation of the simulation component in various university-level study programs is essential. It aims to provide comprehensive and modern training for medical university students, facilitating their seamless integration into subsequent clinical activities during postgraduate residency. This is achieved by developing professional and communication skills, increasing self-confidence and decision-making abilities, and enhancing teamwork. Such an innovative methodology allows students to practice in controlled environments and receive constant feedback, significantly reducing medical errors. By applying this approach, graduates will be better prepared to face real clinical challenges, ultimately improving the quality of patient care. This will, in turn, enhance the overall quality of medical practice and increase patient safety, ensuring a higher educational standard and contributing to the general improvement of the healthcare system. Priority scientific results submitted for defense: 1. A procedural framework for identifying needs and efficiently organizing simulation-based training in medical university education was developed and validated. 2. A significant improvement in students' practical competencies was demonstrated through the use of checklists developed as standardized assessment tools. 3. The positive impact of simulation-based training on theoretical knowledge was highlighted, as confirmed by the comparative analysis of pre-test and post-test results. 4. A high level of student satisfaction with the relevance and effectiveness of simulation-based training in medical education was determined. 5. Recommendations were formulated for the integrated, comprehensive, and efficient implementation of simulation-based training in the medical university curriculum. Implementation of research results. As a result of the conducted research, the outcomes, including the procedural framework and developed evaluation tools, validated through innovation certificates, were applied within the University Center for Medical Simulation. These tools were utilized during the practical examination of the summer clinical internship, organized for 2nd- to 5th-year students from the Faculty of Medicine and Somatology, as well as for graduates of the Bachelor's program in General Nursing. The implementation of the Objective Structured Clinical Examination (OSCE), recommended by the World Federation for Medical Education and integrated into the University's Strategic Development Plan for 2021–2030, has strengthened the role of this evaluation method as a standard of excellence for assessing clinical competencies. Approval of scientific results. The results obtained during the research were presented and discussed at the following scientific forums: The Second Conference of Simulations Applied in Medicine (Târgu Mureș, Romania, 2017); Annual Scientific Conference - University Days (Chișinău, Republic of Moldova, 2019); International Scientific Conference: Health, Medicine, and Bioethics in Contemporary Society: Inter- and Multidisciplinary Studies (Chișinău, Republic of Moldova, 2019); Virtual Annual Meeting of the Society for Simulation in Europe (2021); Scientific-Practical Conference with International Participation "Medical Simulation - A Look into the Future" (implementation of innovative technologies in higher medical education in Ukraine), online (Chernivtsi, Ukraine, 2021); Annual Scientific Conference "Research in Biomedicine and Health: Quality, Excellence, and Performance" (Chișinău, Republic of Moldova, 2022); International Conference on Simulation and Virtual Reality in Medicine, MediSim III (Târgu Mureș, Romania, 2023); Annual Scientific Conference "Research in Biomedicine and Health: Quality, Excellence, and Performance" (Chișinău, Republic of Moldova, 2023); 5th Interdisciplinary PhD Forum with International Participation (Kyustendil, Bulgaria, 2024); 3rd Edition of the International Exhibition of Innovation and Technology Transfer EXCELLENT IDEA (Chișinău, Republic of Moldova, 2024). Publications related to the thesis. The thesis materials were reflected in 13 publications, including 2 single-author works, 2 articles in international journals, 2 articles in national journals, 2 articles in the proceedings of international scientific conferences, 6 theses in the proceedings of national and international scientific conferences, and 1 poster presented at an international scientific forum. Summary of the thesis sections. The paper is written on a total of 181 pages in electronic format, of which 130 pages represent the main text. The structure of the paper includes the introduction, four chapters, a synthesis of the obtained results, conclusions, practical recommendations, and 26 appendices. The iconographic material consists of 37 figures and 26 tables. The scientific foundation of the paper is based on 97 bibliographic sources. The study received favorable approval from the Research Ethics Committee of the Nicolae Testemițanu State University of Medicine and Pharmacy (no. 51, 12.04.2018).