Skill Laboratory
Skill Laboratory (Skill Lab) - Shahroud University of Medical Sciences
Mission Statement
To provide a state-of-the-art, simulation-based learning environment that fosters the development of essential clinical and practical skills among medical and health sciences students, ensuring competency, confidence, and adherence to the highest standards of patient care prior to real-world clinical practice. This mission emphasizes a commitment to evidence-based practice, patient safety culture integration, and the cultivation of critical thinking skills necessary for autonomous decision-making in complex clinical environments. The Skill Lab serves as the crucial bridge between theoretical classroom knowledge and practical application.
Vision
To be a leading center for hands-on medical skills training in the region, recognized for innovative simulation techniques, high fidelity practice, and outstanding student preparedness. Our vision includes integrating virtual reality (VR) and augmented reality (AR) modules into the existing curriculum by the next academic cycle and achieving international accreditation for simulation methodologies within five years. We aim to foster a culture of continuous improvement and interdisciplinary collaboration in skills acquisition.
Core Functions and Objectives:
Skills Development: To facilitate structured training sessions covering foundational medical procedures, patient communication, and emergency response skills.
Foundational Procedural Competence: Ensuring students can independently and proficiently perform procedures such as aseptic technique, sterile gloving, venipuncture, urinary catheterization, and basic wound management according to institutional protocols.
Communication Proficiency: Integrating communication training, including breaking bad news, informed consent procedures, interprofessional handover (SBAR format), and active listening exercises.
Emergency Response Training: Dedicated modules for Cardiopulmonary Resuscitation (CPR), Automated External Defibrillator (AED) usage, basic airway management, and recognizing signs of critical deterioration (e.g., use of Early Warning Scores - EWS).
Specific Skills List (Placeholder for Insertion):
Specifics for Year 1 Clinical Skills: Basic history taking format, vital sign measurement precision.
Specifics for Year 3 Surgical Skills: Knot tying variations (simple, square, surgeon's throw), needle handling.
Specifics for Advanced Practice: Arterial blood gas sampling, lumbar puncture simulation.
Simulation Training: To utilize high-fidelity and low-fidelity manikins and simulation tools to create realistic clinical scenarios for experiential learning.
High-Fidelity Simulation (HFS): Use of programmable adult, pediatric, and infant manikins capable of physiological responses (e.g., breathing patterns, palpable pulses, measurable vital signs, pharmacological response simulation). Scenarios will incorporate audiovisual recording for post-session analysis.
Low-Fidelity Simulation (LFS): Extensive use of task trainers, task-specific models (e.g., intravenous arms, chest tubes torsos, abdominal pads), and standardized patients (SPs) for non-technical skills practice.
Scenario Fidelity Indexing: Developing a quantifiable metric to rate the fidelity of each scenario based on realism, complexity, and required student response, ensuring an appropriate challenge level is maintained.
Assessment & Feedback: To conduct objective, standardized evaluations of student performance in practical skills and provide constructive, immediate feedback.
Objective Structured Clinical Examinations (OSCEs): Implementing standardized checklists and rubrics for all graded assessments, ensuring inter-rater reliability (IRR) among evaluators. The pass standard for any critical skill is defined as achieving a minimum score of ( \frac{4}{5} ) on all mandatory steps, where ( M ) is the set of mandatory steps.
Immediate Constructive Feedback: Feedback sessions must occur within 10 minutes of task completion while the scenario remains fresh in the student's memory. Feedback structure will follow the "What Went Well, Even Better If" (WWBW, EBI) model.
Performance Tracking: Maintaining a secure digital portfolio for each student tracking performance across formative (practice) and summative (assessment) sessions. Average procedural time ( T_{avg} ) for a skill is tracked against the benchmark time ( T_{bench} ).
Curriculum Support: To align all training modules and practice sessions directly with the official curriculum requirements of all relevant university departments.
Mapping Matrix: Maintenance of a Skills Matrix correlating specific learning outcomes (LOs) from the undergraduate medical curriculum (e.g., KBMS 101, CLIN 305) directly to the Skill Lab modules and corresponding assessment methods.
Departmental Liaison: Regular quarterly meetings with representatives from Internal Medicine, Surgery, Obstetrics & Gynecology, and Allied Health Departments to review and update skill requirements based on evolving national standards.
Integration Frequency: Each core skill must be scheduled for practice a minimum of three distinct times during the academic year: Introduction, Intermediate Application, and Summative Rehearsal.
Resource Management: To maintain and manage all equipment, models, and consumables in excellent working order, ensuring continuous availability for scheduled sessions.
Preventative Maintenance Schedule (PMS): Implementation of a mandatory weekly inspection checklist for all high-fidelity manikins, focusing on battery life, fluid integrity, and software functionality. Complex repairs are outsourced within a defined Service Level Agreement (SLA) of 72 hours.
Inventory Control System (ICS): Utilization of barcode scanning for tracking high-value assets (manikins, monitors) and low-value consumables (sutures, gauze). Reorder points are set when stock level ( S ) drops below the Minimum Stock Threshold ( S_{min} = 1.5 \times (\text{Average Daily Usage Rate} \times \text{Lead Time}) ).
Sterilization Protocols: Strict adherence to centralized sterilization guidelines for all reusable instruments, including documented sterilization cycles and shelf-life monitoring for sterile supplies.
Prepared for: [Insert Department Name - E.g., Department of Clinical Skills and Simulation Education]
Date of Document Creation: October 19, 2025
Operational Guidelines and Protocols
A. Scheduling and Access Policy
Booking Procedure: All sessions (curricular or elective) must be booked via the centralized online scheduling portal a minimum of 7 working days in advance. Requests for HFS rooms require approval from the Faculty Coordinator.
Late Arrival/Cancellation: Sessions starting more than 15 minutes late without prior notification will be automatically cancelled. Cancellations must be made at least 24 hours in advance to allow rescheduling.
Student Capacity: Standard lab session sizes are capped at 12 students per instructor for practical skills and 8 students for HFS scenarios to maintain instructor-to-student ratio ( R \le 1:8 ).
B. Safety and Infection Control
Universal Precautions: Students must practice universal precautions at all times, including mandatory hand hygiene upon entry and exit, and appropriate use of Personal Protective Equipment (PPE) when handling simulated blood products or invasive devices.
Sharps Management: Used needles, scalpels, and broken glassware must be immediately disposed of in designated puncture-proof sharps containers. Under no circumstances should sharps be recapped.
Biohazard Disposal: Simulated biological waste (e.g., simulated blood, bodily fluids) must be segregated and disposed of according to institutional biohazard protocols, typically requiring double-bagging and labeling before removal by specialized waste management personnel.
C. Debriefing Methodology
The debriefing process is recognized as the most critical component of simulation training, facilitating the transition from performance to learning.
The Three-Phase Model: Debriefings will adhere strictly to a three-phase structure:
Phase 1: Description (What Happened?): Instructor prompts students to recall the sequence of events objectively, often using video playback. Focus remains on observable facts.
Phase 2: Analysis (Why Did It Happen?): Exploration of underlying factors, including cognitive processing, communication breakdowns, and technical execution. Use of the "Plus/Delta" system (what went well, what could be improved).
Phase 3: Application (What Now?): Forward-looking discussion focused on translating lessons learned into future practice. Students must formulate an action plan for improvement.
Cognitive Load Management: Debriefing discussions must ensure the cognitive load remains manageable, focusing on a maximum of three primary learning objectives per scenario.
Technical Specifications and Infrastructure Detail
A. Basic Skills Stations
These stations are designed for high-throughput, repetitive skill practice utilizing task trainers.
Quantity: 6 dedicated stations, expandable to 12 using mobile carts.
Suturing Bays: 4 stations equipped with dermatological models allowing practice of interrupted, running, and subcuticular sutures. Calculation of efficiency: Sutures per minute ( S_{pm} = \frac{\text{Number of successful knots}}{\text{Time in minutes}} ). Target ( S_{pm} \ge 2 ).
IV/Phlebotomy Arms: 4 high-durability silicone arms allowing multiple venipuncture attempts before model replacement is required. Pressure sensors integrated into two arms provide real-time feedback on needle angle relative to the vein wall.
B. High-Fidelity Simulation Room (HFS Room Alpha)
This area is optimized for complex, team-based scenario execution.
Manikin Suite: 2 Laerdal/Gaumard advanced adult manikins capable of simulating various cardiac rhythms (e.g., V-Fib, Asystole, SVT) and complex pulmonary ventilation mechanics.
Monitoring Equipment: Integration with standardized patient monitoring systems capable of displaying ECG waveforms, end-tidal CO2 (( EtCO_2 )), and invasive pressure readings, though simulated.
Scenario Control: A dedicated control booth separated by soundproof glass, equipped with simulation programming software (e.g., SimCenter Platform). The controller manages drug administration responses and physiological changes based on simulation scripts.
C. Debriefing/Observation Area
The cornerstone of reflective practice.
Capacity: Seating for 20 individuals (students and instructors).
Technology: Fully integrated audio-visual system capable of simultaneous recording from multiple internal cameras and the manikin control station. Playback software allows for frame-by-frame review and annotation overlay directly onto the video feed.
Communication Integration: Dedicated whiteboard space (2m x 4m) for mapping clinical pathways and flow charts during the application phase of debriefing.
D. Equipment Inventory (Major Unique Equipment)
Item IDDescriptionQuantityLast Calibration DateReplacement Cost (USD)HF-001Advanced Cardiac Manikin (Adult)22025-08-15$45,000LT-004Portable Ultrasound Trainer (POCUS)1N/A (Software Check 2025-10-01)$15,000AIR-011Advanced Airway Management Head (Difficult Intubation)3N/A$3,500SP-002Standardized Patient Training Modules (Software License)12024-12-01$2,000 (Annual)VASC-007Vascular Access Simulator (Arterial line capable)22025-05-20$8,000
Performance Metrics and Continuous Quality Improvement (CQI)
To ensure the Skill Lab meets its mandate, performance will be continuously monitored using quantitative metrics.
A. Utilization Rate
The percentage of available scheduled hours that are actively booked and utilized by students/faculty.
[ \text{Utilization Rate} (%)= \left( \frac{\text{Total Booked Hours}}{\text{Total Available Hours}} \right) \times 100 ] Target Utilization Rate: ( > 85% ) during peak academic periods (September–December, February–May).
B. Student Competency Achievement Rate (SCAR)
The percentage of students who pass all mandatory summative skill assessments on the first attempt.
[ \text{SCAR} (%)= \left( \frac{\text{Number of First-Attempt Passes}}{\text{Total Number of Students Assessed}} \right) \times 100 ] The SCAR must correlate positively with overall student performance in subsequent clinical rotations (correlation coefficient ( \rho > 0.6 )).
C. Instructor Feedback Score (IFS)
Average score derived from anonymous student evaluations regarding instructor clarity, preparedness, and feedback quality during simulation sessions.
Scale: 1 (Poor) to 5 (Excellent). Target IFS: ( \ge 4.5 ).
D. Equipment Downtime Percentage (EDP)
The proportion of scheduled hours where high-fidelity equipment is unavailable due to maintenance or malfunction.
Appendix A: Standardized Patient (SP) Protocols Summary
All SP interactions must follow strict, pre-approved case scripts to maintain standardized assessment conditions. SPs are trained specifically in portraying subtle physical cues (e.g., grimacing, guarding) relevant to the simulated pathology. Compensation for SPs is calculated based on contact time ( T_c ) and case complexity score ( C_s ):
[ \text{SP Compensation} = (\text{Base Rate} + (\text{T}_c \times \text{Rate per Minute})) \times (1 + 0.1 \times C_s) ]
Appendix B: Room Setup Checklists (Summary)
Pre-Scenario Setup: (Checked by Instructor): Airway equipment available, IV fluids opened, manikin programmed to baseline.
Post-Scenario Cleanup: (Checked by Students/Staff): All sharps cleared, patient models wiped down with hospital-grade disinfectant (e.g., 1:10 bleach solution), reusable equipment returned to designated storage, video recording terminated.
This comprehensive template serves as the foundational operating document for the Shahroud University of Medical Sciences Skill Laboratory, ensuring consistent, high-quality, and measurable clinical skills education.