The educational process involves teaching theoretical knowledge and practical skills to future medical professionals. Before it was possible to learn practical skills only at the patient’s bedside. However, this practice did not provide a safe environment for patients and students who were mastering practical skills. In healthcare facilities, the treatment process should be prioritised over the training of students. Thus, training at the simulation centre takes into account the binding principle of safety so students can practice the necessary skills until they fully master them. At the simulation centre, we can follow a simulation scenario, teach students, and not be dependent on the desires of patients, their relatives, or colleagues.

We did not have a simulation centre at our medical institute before. We only had classrooms with the necessary equipment to train future medical professionals. That’s why the establishment of a simulation centre became a new and interesting project for us, an opportunity that required additional effort.

From the moment of its establishment and during the first year of the centre’s work we had more challenges than we had expected. First of all, preparation for the establishment of the simulation centre was not easy: it started with the design of the premises, but not the organization of the educational process. We had to understand how to plan the space effectively to ensure its functionality. The ZhMI team together with the consultant of the Ukrainian-Swiss project “Medical Education Development” decided where to arrange a simulation room, operator’s room, and debriefing rooms, how to arrange audio and video equipment properly in these rooms. I not only enriched my experience with educational technologies but also with interior design knowledge (smiling. — Ed.). Our simulation centre is located on the fourth floor of the institute. We kept classrooms and created new clinical skill labs in its structure.

COVID-19 pandemic became the first serious challenge, as the education process went online and caused changes in work. Thanks to the participation of the instructors of the simulation centre in numerous educational events organized by the Ukrainian-Swiss Project “Medical Education Development”, which were held by experts from Ukraine, Lithuania, and Canada, together with our colleague clinicians we have introduced a new complex practical discipline “Simulation Course in Therapy, Surgery, Paediatrics, Resuscitation, Obstetrics and Gynaecology” into the curriculum. The knowledge received during the project trainings became the basis for the course, and students were able to practice clinical skills which they required for their future professional activity. The next trainings from the Project allowed improving our teaching skills, and abilities to create simulation scenarios and checklists.

The students particularly liked the thematic content and the possibility of teamwork in conditions close to real. They always asked teachers questions, improved their skills, and practised them using modern manikins. An obstetrical manikin made them especially excited (laughing. — Ed.). Before the COVID-19 pandemic, even doctor students couldn’t always learn how to take delivery during their studies. At our simulation centre, students practice monitoring pregnancy and actively participate in providing care during childbirth.

In December 2021, at the end of the simulation course, we held a test similar to the Objective Structured Clinical Examination (OSCE) — created separate stations for each discipline where students stopped for five minutes and showed their skill levels. Thanks to this interactive exam we were able to assess how effective the training was for the students. When the exam ended at 7 p.m., we understood that we did not only teach future professionals but also instilled in them a passion for continuing learning and development. In November 2022 we repeated the course.

During the COVID-19 pandemic, we arranged a two-week offline training for over 30 students at the centre, created new simulation scenarios, checklists which we tested on ourselves and adjusted in the process of working with students. During 2021, approximately 200 nursing students had a pre-diploma practical training at our simulation centre.

Another challenge, russia’s full-scale invasion of Ukraine, is much worse than the pandemic because invaders are violating our fundamental right to safety and life. At the beginning of the full-scale invasion, we did not work because we were in the zone of active hostilities and, therefore, had no possibility to practice skills at the simulation centre. Some students and colleagues left the country. After the studies had resumed, students had online classes. In June 2022 the situation in Zhytomyr oblast stabilized so willing groups of students of different specialities and educational programs took the training at the simulation centre. Now we have ensured the practical course similar to the simulation one we have for nursing students for the students of other specialities, i.e. paramedic and obstetric students, taking into account the specifics of their specialities.

Currently, the training at the simulation centre takes place offline with due safety measures for students who stay in Zhytomyr. During air-raid alerts, everyone goes to the shelter and the classes are resumed after it ends. The students who moved to the west of Ukraine or abroad due to the war and haven’t returned yet continue their studies on an individual schedule.

Today I’m proud that the centre is working. It has not become a museum after its opening where important persons go on excursions (smiling. — Ed.). Not only ZhMI’s students are trained at the simulation centre, but also nurses from the healthcare facilities of Zhytomyr as well as its residents. There is continuous movement and life at our centre. I am proud of my team of like-minded people who are working hard under martial law.

Our students are the primary target audience of our institute. We train nurses of three educational degrees: junior bachelor’s, bachelor’s and master’s in nursing. We also train emergency medicine personnel, physical therapists, and obstetricians. For them, the clinical skills labs are hubs for gaining professional competencies during their studies. The secondary target audience is nurses and postgraduate students.

Since the beginning of russia’s full-scale invasion of Ukraine civilians and representatives of territorial defence have become our active audience whom we train in pre-medical care. Over 2,500 residents of Zhytomyr and oblast have mastered their skills of providing pre-medical care at our centre. We continue training medical professionals of municipal and private healthcare facilities. We are currently also training about 20 teaching colleagues who haven’t worked at the centre before: teachers of clinical disciplines in internal medicine, surgery, paediatrics and fundamentals of nursing care who are gaining experience in writing scenarios and checklists.

We actively use the equipment provided by the Ukrainian-Swiss Project “Medical Education Development” in our trainings, especially related to basic life support, resuscitation measures, patient care, examination, and medical manipulations. The material and technical base of the centre should be occasionally updated: the more we use the manikin for venipuncture the less suitable it is for future manipulations. On the one hand, students seem to see where they should make a venipuncture, and on the other — they lose the feeling which should be at the initial procedure. That’s why we have replenished our stock of equipment with the manikins for CPR, patient care, venous access, and additional consumables.

Since its establishment and until now the simulation centre has been adding work for the management and teachers (laughing. — Ed.). But, to be serious, the introduction of simulation-based technologies is an integral part of an effective, modern and interesting educational process. Therefore, the centre allowed us to teach clinical skills to students effectively. I can confidently say that students like the training, they are highly motivated. From the first classes, we began receiving positive feedback. Now we see a sparkle in their eyes and desire to continue learning.

It is best to introduce the elements of simulation technologies of clinical disciplines into the educational process. That’s why we are now gradually implementing the trainings in CPR, haemostatic techniques, examination of patients, and injections.

After SESAM conference I understand that the simulation centre has to improve constantly. During the event, we saw innovative simulation technologies, possibilities for training, observed how SESAM SIM UNIVERSITY (competition of international university teams using simulation technologies. — Ed.) was held, and gained debriefing experience. I liked the program of free access to the conference activities. Even with a strong desire, we physically wouldn’t have been able to attend all the activities — about five-six sessions were held simultaneously. That’s why we (the delegation supported by the Project consisted of 10 representatives of KhNMU, BSMU, TNMU, LMA, and MOH. — Ed.) made our own schedule of attendance, and in the evening, we got together and shared our experience and impressions.

The simulation equipment presented at the conference really impressed me with its functionality and realism. For example, a geriatric manikin’s skin and hair had signs of age-related changes. The manikins of full-term and premature babies were like living babies and had the weight of real babies. When you look at this manikin and see veins on hands and heels that anatomically recreate the body of a newborn baby, you admire.

Also, we saw manikins of virtual reality, and it was something unbelievable! After the conference, we shared our ideas with the representatives of ZhMI administration and colleagues during the academic council meeting: told them about modern equipment and identified the need to add the one we saw at the conference to our centre. During the event, we took contacts of companies that develop and distribute simulation technologies, so we will plan further equipping of our center in the future.

Communication in health care, particularly in medical education, is still a big gap. I remember myself as a young intern when I graduated from the university. I had knowledge, and a desire to treat people, to help them. But effective communication with patients was a challenge, even when patients were non-conflict. It was difficult to explain in simple words, without medical terms, what were your recommendations, and why you suggested a patient this strategy. Communicating effectively with a sick person to discuss a treatment plan is important. When a patient for clear reasons is not open to positive discussion, it is difficult to work. We should learn how to communicate effectively. Unfortunately, we were not taught this.

From my experience, when students came to the hospital and had to perform some procedures, they were not too skillful at, then communication with patients was crucial. Due to communication, they could fully examine a patient without any objections. Students do not always want to work on this, they say that do not know how to do this. There are a lot of topics, that need specific communication. But even out of specific situations, it is necessary to be able to collect the family health history correctly, to build trust with patients.

Today we really need this in family medicine, and both physicians and nurses should have these skills. Further cooperation between medical professionals, patients and their families depends on communication. Now we have a family physician who can take care of us and all our problems: physical, psychological and mental issues, family things. Full cooperation can be reached only due to good talk.

As a teacher of nursing, I would love to say, that this specialty is prestigious. But frankly speaking, the situation is different. Graduates of medical schools not always can find a job place according to the professional competencies, they obtained at the medical school. In Ukrainian practical health care, there is no division between professionals with different levels of education. Sometimes a nurse with a specialist diploma can work in the intensive care unit. But abroad to work in such a department you need at least a bachelor’s or even master’s degree. We don’t have any differentiation based on professional competencies. Today junior bachelor’s degree professionals or even master’s degree professionals improve their clinical, management, and leadership skills mainly themselves.

The level of salary, no matter how trite it may sound, also affects it. It is nice to work and be satisfied with your work, but it is important to be fairly paid – to receive a sufficient salary not only to exist in society but to fully live, travel, and develop yourself. Unfortunately, we don’t have this now. After the reform at the primary healthcare level, and also already at the secondary care, we have more students who are willing to work at the reformed healthcare facilities with improved salaries and work conditions. I think that the prestige of the profession will raise, if practical healthcare will offer job places, qualification characteristics based on the level of education, and also will increase the salary.

European countries are welcoming lots of our graduates, and, unfortunately, this is our professional loss. I have graduates who continued to study in Europe and then got job places there. They enjoy their work conditions, and I am happy for them, but I understand that these great medical professionals could save many lives in Ukraine in other circumstances.

We are not just a community of like-minded people, we are a family. The Ukrainian-Swiss project “Medical Education Development” forms a powerful network. Meetings with other people within the framework of the project contribute to cooperation with other pilot HEIs of the project. For example, in October 2021, I and a colleague from the institute with a group of paramedic students, as well as together with colleagues from the Rivne Medical Academy (RMA), visited the ‘Simulation Training School’ at Ternopil National Medical University (TNMU). Now we actively cooperate with colleagues from TNMU and Bukovyna State Medical University (BSMU), learn from each other, and share experience.

I am inspired and motivated by the project team, and colleagues from the pilot HEIs. The project helped me to understand that it is worth moving in the direction of changes, improving the learning environment and the process of acquiring knowledge by our students, interest and motivate them to study.