The Clinical Simulation and Skills Unit was established in February 2013 to enhance training in the skills and competencies of undergraduate and postgraduate students in the Faculty of Health Sciences. People often ask me why simulation training is needed when we have many patients available for the training of students. It is true that simulation can and will never replace training on real patients, but there are three main drivers for using simulation as a teaching and learning tool.

The first driver is patient safety, where students can be exposed to adverse events and complication management. The ethical considerations of using patients for the training of students should never be ignored, with medico-legal disputes and possible litigation as drivers for using simulation in the training of students.

The second driver for the use of simulation includes educational imperatives such as skills training, deliberate practise, mastery of learning, rapid knowledge acquisition, and training in professional attributes.

Clinical placements play an important role in the decision to use simulation as teaching and learning tool, because the training platform reduces the demand for limited equipment and available resources. The change in case mix due to the HIV and TB epidemic, and now also the COVID-19 pandemic, also plays a role in the cases that we can expose our students to.

A good example where simulation can be used to train students and healthcare workers, was the preparations for the COVID-19 pandemic. Healthcare staff and students in the clinical years have been trained to correctly don and doff personal protective equipment (PPE). To facilitate this training, registrars in the Department of Anaesthesiology made videos to demonstrate the donning (putting on) and doffing (taking off) procedure for PPE.

The Clinical Simulation and Skills Unit’s facilities at the university were used to conduct this training; so, the participants could also physically practise putting on and taking off the PPE after watching the videos. More than 540 specialists, consultants, registrars, medical officers, interns, all ranks of nursing staff, clinical technologists, physiotherapists, dietitians, and household aids were trained during the lockdown. All students in the faculty who are doing clinical work and who are exposed to patients, also received the training.

It is important that all of these healthcare workers are taught about the different types of PPE in order to prevent contamination of the healthcare workers who are assisting the person in taking off their PPE – or even of the participants taking home the virus on their bodies and contaminating their family at home. Therefore, the healthcare workers had to be shown how to take off their PPE without contaminating themselves.

Volunteering doctors and nurses are also trained to work in ICUs with COVID-19 patients. The ICU department trained these volunteers in the use of ventilators, to assist with putting up drips and lines, intubation, and PPE. The goal is to train healthcare providers to assist in ICU when needed.

This training is essential to train and prepare healthcare workers when the patient numbers are increasing. The training is also essential to protect the healthcare workers against infection, because we need them to stay healthy in order to manage the patients.

Simulation is also used to standardise training by exposing students to the same conditions – for example, a heart murmur– to teach professional attributes such as clinical reasoning, teamwork, professionalism, communication, and leadership. Simulation is one of the best tools to train students these attributes in a safe and non-threatening environment.

The educational environment and the health-practice environment play a crucial role in the emerging trends in simulation. Clinical simulation has evolved from skills training on part-task trainers to high-technology and simulated patient simulations, for instance, practising communication skills on trained actors. Hybrid simulation is used where a simulated patient and a simulator is combined in the same scenario. Integrated simulations are used to train students interprofessional collaboration. Currently, we are moving towards virtual reality and augmented reality simulation. Simulation is an ever-evolving field with exciting new developments on the horizon, such as simulation training for robotic surgery and even mental simulation.

No healthcare student can receive a complete and rounded training without simulation as a training tool to augment clinical training on real patients.