A New Way of Learning and Teaching: CIME

by Ambreen Saleh

The Centre for Innovation in Medical Education is the Aga Khan University’s latest addition to its Stadium Road campus in Karachi, open to nursing, medical and allied health undergraduate and postgraduate students and healthcare practitioners.

A state-of-the-art education and training facility, Centre for Innovation in Medical Education is at the heart of AKU’s Faculty of Health Sciences efforts to remain at the forefront of technology and one of the leading academic medical centres in the region. Multi-purpose, multi-disciplinary and multi-professional, the Centre serves as a high fidelity simulation lab for students, faculty and practicing professionals in nursing, medicine, dental and allied health.

Almost entirely donor funded, CIME is the first facility in Pakistan built for the innovative use of robotic and virtual technology on this scale, in line with standards in the rapidly progressing global healthcare sector. The centre comprises of three donor-funded buildings spread across 80,000 feet: the Mariyam Bashir Dawood Building, the Ibn Sina Building and the Shiraz Boghani Building. The buildings are enclosed in a spacious courtyard that reflects the University Hospital’s signature attention to detail.

With its integrated digital infrastructure, CIME aims to transform clinical education, promote simulation-based innovation and research, bridge boundaries between professions, uphold ethics and safeguard patient safety. It is envisioned to be a resource for the nation and the region.


Mannequins and Simulators

Most medical students learn skills through on-the-art job training with real patients. Gaining experience in a busy hospital environment, where errors can cause harm, is daunting for trainee doctors who still need practice and detailed feedback. The innovative technology at CIME allows students to master everything from surgical procedures to complex new techniques through the use of state-of-art technology, before they practice on patients or in a hospital setting.

Technological progress over the past decade has seen the introduction of new teaching technology in the form of responsive high-fidelity patient mannequins and life-like simulations of surgeries. Keeping with latest technological trends, CIME houses an exciting range of mannequins and simulators which enable students to be trained in a safe, risk-free environment.

The high-fidelity patient mannequins can be controlled by the instructor to take on various conditions a trainee doctor will experience in their professional lives. The mannequins respond to mistakes that cause pain to patients, and display symptoms like sweating, heavy breathing, crying and changes in complexion. Instructors can use data from the simulator alongside their own experience of working on patients to give feedback on the trainee’s performance. Instructors can also test the ability of the student to treat a number of medical conditions and emergencies.

The ‘Harvey’, for example, is a cardiopulmonary patient simulator mannequin, which allows students to investigate a range of conditions from innocent to serious murmurs and grave heart conditions. The ‘SimBaby’ is a simulator mannequin of a six-month child and ‘SimMan 3G’ is an adult simulator mannequin.

The CIME also contains simulators that contain highly detailed images of the body’s organs and allow specialist to practice complex procedures in a life-like environment, without involving real patients. For example, ‘Mentice Vist-C’ area has been designed as a complete cardiac or heart catherisation laboratory with the ability to expose trainees to a wide range of patient scenarios. ‘EyeSi’ is an eye surgery simulator, ‘Voxel Man’ is an ENT surgical simulator and ‘LapSim’ is a laparoscopy surgery simulator.

Everyone learns at a different pace and medical procedures need to be repeated to be perfected. With simulation-based teaching, students can rehearse key skills in a realistic environment and incorporate feedback until they feel confident. Even seasoned physicians can practice on the simulators and train themselves to respond to a wider range of pre-programmable scenarios and emergencies than is possible in the hospital ward.


A Space to Learn

Mahatma Gandhi said “Freedom is not worth having if it does not include the freedom to make mistakes.”

CIME provides users an opportunity to make mistakes before touching a real patient, and to practice intricate and rare procedures before visiting the ward or the operation theatre.

Furthermore, CIME supports education, clinical practice and research, the three mandates of AKU. The conference space in CIME, equipped to provide international connectivity, has proved valuable for other departments at the Aga Khan University, such as Community Health Education and the Department for Continuing Professional Education. These departments have used the facility to conduct trainings on topics ranging from maternal and child health to basic life support skills, for external and internal participants.

In the long-term, CIME is envisioned to be a world class space for workshops and courses, which is open to national, regional and international institutions and collaborations. Earlier this year, two international events were hosted at the CIME – the Aga Khan University Annual Postgraduate Medical Education Conference 2016 and the University’s Surgical Innovations for the Developing World Conference 2016. Over 400 national and international teaching experts, specialists and young doctors were present at the three-day Postgraduate Medical Education Conference at the AKU campus in Karachi. Similarly, the two-day Surgical Innovations conference, attended by over 500 national and international surgeons, specialists and young doctors, saw experts from Germany, USA, UK, UAE and Switzerland conduct workshops in 11 major surgical areas.


The CIME complex has four sections. Each section is fully equipped with videoconferencing facilities. The buildings are enclosed within a picturesque courtyard.

Section I: Cognitive, Behavioural and Clinical Skills Learning and Assessment Circuit

This section has twelve multipurpose two-room units, each room can interchangeably be used as a clinic or a space for small group learning, with examiner observation facilities via one-way-glass. It is suitable for conducting the Objective Structured Clinical Examinations. This section includes a Standardized Patient Centre.


Section II: Four 5-bedded Wards for Skills Acquisition and Assessment

This section has four five-bedded wards (one of which can also be used for decontamination/isolation room training). It has an instruction-cum-debriefing room which can accommodate up to 40 persons.

A multipurpose educational hall with high interconnectivity joins section I to section II. The hall utilizes modern audio-visual and information technology that adds a new dimension to educational seminars, sessions and workshops, making them more effervescent, collaborative, connected and yet controlled.


Section III: The High Fidelity Simulation Centre

This high fidelity simulation center has a mock operating room, a phantom-head dental lab, a pediatric resuscitation room and a high-risk obstetrics room, dry lab, multi-disciplinary simulation lab with endoscopy, bronchoscopy, angiography, laparoscopic and other surgical and radiological simulators and debriefing rooms.


Section IV: e-Health Innovation Centre with Information Communication Technology (ICT)

CIME upholds the principles of quality and access by connecting the people in Afghanistan and Northern Pakistan to Aga Khan University’s faculty via tele-medicine clinics. It also has a e-Health/virtual ward, a digital library and a Virtual Research Simulation Unit.


A Surgeon’s Experience of using Simulations for Cataract Surgery and Funduscopy

In August 2016, 50 participants of the SAARC Ophthalmology Conference visited CIME and viewed the funduscopy procedure on the simulator. These teachers, students and residents from both within and outside Pakistan were also able to practice the procedure on the simulator.

“I am completely blown away by this technology,” said a resident ophthalmologist from Peshawar.

Dr Karim Damji teaches at the University of Alberta in Canada, and he was a lecturer at the   SAARC conference, along with Dr Irfan Jeeva, Service Line Chief of Opthalmology/ENT at AKUH.

Dr Damji said of his experience at the SAARC Ophthalmology Conference:  “As a visiting professor from the University of Alberta, it was a privilege to teach examination of the retina using a fantastic teaching lab and model at AKU’s world class simulation center. Students were able to take their time and practice using an ophthalmoscope to identify important disease patterns (such as diabetic eye disease) without the worry of shining a bright light in an actual patients’ eye for a lengthy period of time. The simulation experience will undoubtedly assist them in performing this skill with greater ease on actual patients. I am very impressed with the simulation center and hope that one day we can also have such a resource to teach our medical students in Edmonton!”

There are two types of simulations for eye care available at CIME: the cataract simulator and the funduscopy simulator. A cataract is a medical condition in which the lens of the eye becomes progressively opaque, resulting in blurred vision. The simulator allows ophthalmologists to practice the procedure to remove a cataract. The funduscopy is a test that allows a health professional to see inside the fundus or back of the eye and other structures. It is part of an eye examination and may be part of a routine physical examination for signs of diabetes, cancer and cataract. It is an essential skill for all medical students and doctors, and yet is considered one of the most difficult skills to learn.

“Traditionally, the only way to teach these procedures was on patients. Often these patients were already in some kind of eye pain or discomfort. Learning on a simulator means that the ophthalmologist is in a controlled environment, in which both teaching and learning can become effective, efficient and fun,” said Dr Irfan Jeeva.

The students also receive instantaneous feedback and a report that helps them to reflect on what they did and how they did it. It helps students, as well as health professionals who are training using this simulation technology, to reach a level of insight which is not possible in a more realistic environment.

Dr Jeeva also says that conducting a cataract surgery is a skill which is always being refined and there are situations which are challenging to every cataract surgeon.  The simulator simulates that kind of challenging situation. If a surgeon feels that they are going to encounter that challenge in an upcoming surgery, they can use the simulator to gain experience and dexterity. This allows the final procedure on the patient to be more effective, efficient and safe – the ultimate goal of every physician.

Student Experiences at the Simulator Dental Lab

Sharmeen Jawaid Hussain will be graduating from AKU’S newly established Diploma in Dental Hygiene (DDH) Programme in November 2016. She belongs to the first cohort of graduates of this two-year diploma programme. Sharmeen started using the simulation technology at the dental laboratory at CIME in January 2016, during her second year. It was an exciting experience for her.

“There are twenty mannequins in the dental lab and they can rotate 360 degrees like a real patient can. It felt like we were working on a real mouth. Only the mannequins did not get hurt or complain when we made mistakes!” she said.

Sharmeen felt she had more freedom to experiment and learn while working on the mannequins and this built her confidence and dexterity.

Her fellow student, Noorin Khan, also echoes her sentiments. Said Noorin: “Working in a sim lab is closer to reality and a danger-free practice. You don’t have the fear of hurting someone, which makes you more confident at your work. A person working on simulators will be more skillful and composed than one who has had direct exposure practicing on a person in his first clinic.”

Noorin said that she had the opportunity to use increasingly complex instruments while practicing at the dental lab and this was an experience she could not have had while practicing on a patient so early in her training.


For more information about CIME, please visit https://www.aku.edu/CIME, email  cime@aku.edu or contact us at +92 21 3486 3733-3705.


All the photos are copyright AKU and cannot be used again without permission

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