Volume 11 - Issue 60
/ December 2022
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DOI: https://doi.org/10.34069/AI/2022.60.12.6
How to Cite:
Yuriy, R., Huzchenko, S., Lobach, N., Karbovanets, O., Bokova, S., & Isychko, L. (2022). Modern digital learning and simulation
technologies in higher medical education: definitions, innovative potential. Amazonia Investiga, 11(60), 53-61.
https://doi.org/10.34069/AI/2022.60.12.6
Modern digital learning and simulation technologies in higher medical
education: definitions, innovative potential
Aprendizaje digital moderno y tecnologías de simulación en la educación médica superior:
definiciones, potencial innovador
Received: December 5, 2022 Accepted: December 30, 2022
Written by:
Rayisa Yuriy25
https://orcid.org/0000-0002-5917-9370
Serhii Huzchenko26
https://orcid.org/0000-0002-3562-6172
Nataliia Lobach27
https://orcid.org/0000-0002-3795-7864
Olena Karbovanets28
https://orcid.org/0000-0003-4429-7371
Svitlana Bokova29
https://orcid.org/0000-0002-3426-9150
Liudmyla Isychko30
https://orcid.org/0000-0002-7269-5126
Abstract
Digital and simulative learning technologies
have become especially popular and are being
implemented in medicine. Consequently, this
article aims to investigate the main digital
learning and simulation technologies that are
used in higher medical education. For this
purpose, general scientific methods of research
were used: analysis and synthesis. Based on the
predictive method, the possible ways of solving
some problems in digital medical education were
demonstrated. Of separate importance was the
use of content analysis, based on which the basic
information materials concerning this problem
were investigated in detail. In the results
peculiarities of interpretation of digital and
simulative technologies were defined, the
problem of using digital technologies in modern
medical education was characterized, the
significance of simulative technologies in the
system of training of future medics was
25
Ph.D in Physical and Mathematical Sciences, Associate Professor, Department of Biophysics, Informatics and medical equipment,
National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
26
Candidate of Military Sciences, Head of the Department of Tactics and Foreign Disciplines Kharkiv National University of the
Defense Forces named after Ivan Kozhedub, Kharkiv, Ukraine.
27
PhD in Pedagogy, Associate Professor of Department of Physics, Poltava State Medical University, Poltava, Ukraine.
28
Candidate of Pedagogic Sciences (Ph.D.), Docent, Associate Professor, Department of microbiology,virology and epidemiology
with a course of infectious diseases, Faculty of Мedicine, Uzhhorod National University, Ukraine.
29
PhD, Assistant lecturer Department of family medicine with course of dermatovenerology, Sumy State University, Sumy, Ukraine.
30
PhD, lecturer Department of Medical Informatics, Medical and Biological Physics Poltava State Medical University, Ukraine.
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indicated, the main stages of simulative training
were investigated. It is noted that the key stage of
simulation training is debriefing, where the
analysis of basic errors takes place. In the
conclusion, it is noted that the combination of
digital and simulation technologies contributes to
the improvement of the educational process as a
whole.
Key words: higher medical education,
simulation technologies, digitalization of
education, analysis.
Introduction
Today, the rapid development of new
information and communication technologies
has changed the nature of knowledge acquisition.
Leading technologies have increased the ability
to respond quickly to new advances in medicine,
updated content and educational methods, and
greatly expanded access to higher education. The
use of digital innovations has also changed the
role of teachers, in particular expanding their
communicative role, making information more
accessible and understandable to use.
Current trends in educational technology involve
the use of digital elements of learning
(Oleksiienko et al., 2022). Mastery of these
techniques is an important part of the training of
today's medical students, while also making
extensive use of simulation devices. The
practices of application and combination of
traditional education and digitalization are
different, but the main directions of further
development are similar. It is true that the study
of regional specifics of digitalization and
automation of education in the medical industry
has not been fully established since many
elements still defy scientific classification and
verification. Consequently, the purpose of this
article is to analyze digital training and
simulation technologies that are used in higher
medical education. The main objectives, which
will contribute to revealing the main goal of the
article, are to define in more detail the definitions
used around the world to characterize the
proposed phenomena and to analyze the
possibilities of their innovative potential. The
emphasis, however, is also placed on the
Ukrainian context and the prospects for the use
of digital technologies in the training of medical
university students (Radziievska et al., 2022).
This will make it possible to demonstrate the
possibilities of the latest trained techniques based
on technological advances in the realities of a
country subjected to military aggression.
Theoretical Framework or Literature Review
Digital technologies in the medical education
environment
The spread of digital technologies and the large-
scale digitalization of society, the increase in
digital learning platforms and resources cause
changes in many areas of education, however,
also in medical (Wakhlu et al., 2021). Modern
trends in the labor market are related to the ability
of future doctors to receive and properly interpret
and use information (Jacob, 2020). Note that
informatization as a technological advancement
exposes users and future physicians to a variety
of ways of implementing and solving individual
information tasks or pressing needs (Rani et al.,
2022). Proper application of communication,
digital, information technologies contributes to
the solution of a number of significant societal
problems concerning the preservation of physical
and mental health. Therefore, the demand in the
labor market and the basic requirements for
medical professionals have transformed (Wakhlu
et al., 2021; Kushnir et al., 2019; Tsekhmister et
al., 2021; Safonov et al., 2022). Such educational
trends as “Lifelong learning”, continuous
education, STEM-education, etc. are a necessary
need in the environment of digital society
because during higher education students have to
acquire all the basic weighty necessary
competencies (Pereira & Pereira, 2015). It is in
the e-learning environment that these concepts
are fulfilled based on information digital
technologies and resources. In particular, in the
conditions of Covid-19 and then in the realities
of the Russian-Ukrainian war, teachers and
students in Ukraine use various features of digital
learning resources designed to support and
Yuriy, R., Huzchenko, S., Lobach, N., Karbovanets, O., Bokova, S., Isychko, L. / Volume 11 - Issue 60: 53-61 / December, 2022
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organize communication in educational
activities.
Note that the use of computer technology in
education (“E-learning”) entailed the emergence
of new educational digital technologies, which
influenced the quality of education, improving
the interaction of teachers and students with
computing technology, formed new means of
teaching and educational impact (Salvati, 2019).
Now, quite a debatable problem of interpretation
of the term “digital technology” because many
scientists interpret it differently. In particular
Rani et al., (2022) believe that this concept
should be understood as transferring and
processing information through the use of special
coding characters used in computer technology
(Rani et al., 2022, p. 123-124). On the other hand,
Kushnir et al. (2019) explain that digital
technologies are technologies that use different
digital signals to transmit information (p. 6-7).
For this reason, the term “digital learning
technologies” is understood as a type of
information technology, which involves working
with digital resources - objects contained in
electronic form and designed to achieve certain
learning objectives. Many modern scientists
agree with this definition (Tsekhmister et al.,
2021; Jena et al., 2021; Chen & Banerjee, 2021;
Nourzaie et al., 2018; Banić et al., 2020).
According to Salvati (2019), modern digital
technologies contribute to a 20-30% increase in
the effectiveness of classes (p. 236). The
introduction of computer technology in the field
of education has influenced the transformation of
traditional means and technologies of education
in the whole area (Salvati, 2019). Modern experts
prove that the introduction of e-learning tools
contributes to reducing the cost of organizing
education, because it does not require the cost of
renting facilities, travel to places of learning, etc.
In addition, it contributes to lecture and seminar
activities for a large number of individuals,
improving the quality of training through the use
of Internet resources, individual planning of time
and duration of preparation for classes, the
development of independence in students, the
formation of opportunities for interdisciplinary
discussion (See Table 1).
Table 1.
The main advantages of using digital technology in education
Benefits of using digital technology in education
Publicity, information from any location
Reduced costs for the organization of training
Widening of the target audience
Increased quality of education through a variety of interactive Internet resources
Wide range of educational platforms
Individual time planning
Development of significant competencies: digital, informational, and critical thinking
Formation of interdisciplinary discussion
High speed of information acquisition
Source: developed by the authors of the article
However, the application of educational digital
technologies in medical education is associated
with a number of weighty limitations: 1.
predominantly training the future doctor is in the
practical plane; 2. the need for computer
capabilities and the Internet on a clinical base; 3.
the need for higher education medical institutions
specialists in IT technology and a specialized
department for the implementation of IT
technology (Salvati, 2019).
In order to overcome the above-mentioned
negative points in the digital technology system,
we propose the following solutions:
• Formation of powerful web portals,
resources, platforms of medical educational
institutions in the systemic network of
medical institutions, medical institutions of
the region (or state) as a means of analysis,
processing of a large volume of educational
information and materials of practical work
of physicians (OECD, 2022).
• Formation of professional training of
doctors in the system of web-supplemented
learning (web-supplemented learning),
which allows to develop a number of aspects
of traditional training in a medical school
(Nourzaie et al., 2018).
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• Study some courses only online using virtual
simulation programs. This will contribute to
both theoretical and practical skills.
• Introduction of mobile learning technologies
(Andersone, 2020).
• Development of special medical training
applications that would be in the public
domain. Such apps should be aimed
primarily at forming practical skills for
future medical students. This stage also
includes the use of various mobile programs
for use in the professional training of
medical students to investigate those
problems that do not belong to the curricula;
• Application of VR platforms, virtual patients
in professional training with optimization
purpose.
• Use of special training platforms in order to
conduct mass public courses (Kryvoshein et
al., 2022).
• Formation of electronic libraries of medicine
on the portals of educational institutions.
• In the process of training, it is also possible
to use video recordings of medical
consultations, which can be placed in the e-
learning system.
• Combining fundamental learning with
interactive learning. This, in turn, will
involve role-playing activities (the student
can act as a doctor, perform certain actions,
make a diagnosis, analyze his or her own
decisions, and justify treatment algorithms.
• Development of information and
communication competence of applicants
for medical education, consisting of the
ability to properly use the media,
communication, and information resources
(Kryvoshein et al., 2022).
• Development of digital competence of
future doctors as an important integral part
of professional competence (Kryvoshein et
al., 2022).
Methodology
This research is non-empirical (involves
processing and applying the data of previous
researchers, working with systematic reviews),
fundamental (the article provides new results,
which in the future will be useful for a new
generation of researchers). So, the paper applies
theoretical pedagogical research methods. In
particular, based on the analysis the main subject
of the research is divided into smaller elements
(research on the state of use of digital
technologies in medical education, characteristic
of simulation technologies implementation,
analysis of the main stages of simulation
training). Through the use of synthesis, these
elements are combined to form their own
conclusions. Based on the axiological method, it
was possible to move from general statements to
their own advice. Based on the predictive method
of research, it was possible to characterize the
possible ways of solving some problems in
digital medical education.
Based on content analysis it was possible to
investigate in detail the main materials of written
and visual information posted on the Internet.
Using concretization, it was possible to highlight
the main stages of the situational exercise in
medical institutions. At the same time, the
method of abstraction was used to model and
describe some training simulation conditions
suitable for improving the learning process.
Results and Discussion
Simulation training in the system of modern
medical specialist training
Conditions for mastering and consolidation key
practical skills, as close as possible to the real
work of physicians, are created with the help of
technical simulation learning tools (Gosai, 2017).
In modern universities, simulation is understood
as an educational methodology, which aims to
“immerse” higher education applicants in
interactive work through the establishment of
real professional circumstances and challenges,
but without risking the life or health of patients
(Gosai, 2017).
Simulation training is based on the use of modern
simulation technologies. We believe that
simulation technologies are most optimally used
in emergency and urgent care training, i.e., when
practicing scenarios based on emergency medical
care. Directly in such cases, it is likely to
simulate the subject in a specific situation more
fully and realistically, obtain key theoretical and
practical skills, and practice the knowledge
obtained without harming the health of another
person (Han et al., 2022). The main areas of
simulation training should be cardiopulmonary
resuscitation, emergency medical care, mastering
of medical manipulations, sterilization work,
depending on the specialty - providing surgical,
pediatric, gynecological, therapeutic care (Gosai,
2017).
Based onthe simulation of cardiopulmonary
resuscitation there is organized a detailed
training of skills to ensure the patency of the
upper airways through the use of various modern
methods. Students can also practice skills in
mastering CPR techniques, testing basic
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resuscitation measures using an automatic
defibrillator, and so on.
Medical manipulations based on simulation
technology involve the organization of practical
training skills of intravenous, intramuscular,
intradermal, or subcutaneous injections (Han et
al., 2022). Such medical manipulations require
special simulation simulators by means of an
adult or child's hand with a venous network. Note
that the use of simulated blood in such simulators
also adds realism. Maternity simulators consist of
special functional mannequins that allow
learning weighty theoretical and practical
manipulations of their obstetrics. We are talking
about Leopold's techniques, manual separation
and removal of litter, external uterine massage
(applying obstetrical forceps, etc.).
Gynecological simulators consist of various
models for mastering gynecological examination
techniques (Gosai, 2017). This promotes the
acquisition of practical knowledge in general
diagnostic procedures by examining anatomical
structures, inserting dilators and mirrors, and
palpation.
Separately, there are special computerized
simulators that help to practice the skills of
examining the cardiovascular and respiratory
systems with the simulation of typical and
atypical situations in pediatrics. Such simulators
should consist of simulated mannequins with
different respiratory and cardiac pathologies.
Surgical simulation simulators consist of virtual
operating rooms, where a study of the main
qualities of the operating and preoperative rooms
is organized (Gosai, 2017). Traumatology
students must work with a variety of simulated
realistic human body bones with improvised
fracture options.
Of particular importance in simulation, education
are virtual simulation technologies that involve
training organized by an appropriate number of
computers in order to organize controls to
reinforce the material (Prokopenko, 2021). Such
virtual technologies influence the simulation
learning process through the use of a variety of
computer simulation programs (Ali, 2022).
Structure of a simulation session
Modern specialists distinguish several stages in
the structure of simulation training, each of
which is separate (Sherman et. al., 2021).
Consequently, at each stage students can
obtain certain competencies
Table 2.
The main advantages of using digital technology in education
The main stages of the simulation lesson
Stage name
Explanation
Pretest
An initial assessment of knowledge is carried out
Briefing
Conducting a briefing
simulatorsTraining to work on
Familiarization of students with simulators,
equipment, explanations
Simulation trainings
There is a detailed development of basic
This stage can manipulation skills on stimulators.
take place in groups or individually.
researchers are allocated to a Teamwork (not all
separate stage)
Staging
Debriefing
A thorough analysis of the results obtained
test -Post
Final testing
Final stage
Summing up the results, anonymous questioning of
students is possible
Source: developed by the authors of the article
The key stage of simulation education is the
practical practicing of skills. Consequently,
modern scientific literature considers debriefing
to be a particularly responsible stage of
simulation education. This term refers to a
meaningful discussion of all scenarios after the
completion of basic simulation activities (Li et
al., 2020). Often in medical education, the term
de-briefing also means a detailed analysis of the
educational process, however, and based on a
number of questions which are formed by the
teacher. The main goal of de-briefing is to make
students approach a constructive question from
different points of view, so it will form more
opportunities to choose different actions (Han et
al., 2022). This stage is shaped in such a way that
students focus on the main issues and determine
the cause-and-effect relationships of events.
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Problems and prospects for the use of
simulation training
Simulation training is a mandatory element of
professional training, based on the use of special
models of learning activities, allowing students
to engage in professional activities (or perform a
certain part of duties) in accordance with
professional standards, learned rules of medical
care (Pinheiro & Santos, 2022; Rak-Młynarska,
2022). As of today, several main classifications
of simulation training are used, according to
which they are categorized according to the
method of work: verbal (use of role-playing
games), standardized, work with simulators,
physical or virtual models, patients on the screen
(computer programs that allow training the
necessary skills), electronic patients (dummies
located in a simulated hospital environment) (Li
et al., 2020).
The introduction and use of simulation
technologies in the educational process has a
number of advantages. In particular, we are
talking about specific positives that Ukraine can
get as a state and a powerful employer in the
market of medical services:
− improvement of the quality of higher
medical education;
− a tendency to reduce medical errors in
Ukraine, respectively, an increase in the
quality of medical services in general;
− increase in life expectancy of people.
Specific stakeholders who will hire graduates of
medical universities will also have certain
advantages:
− decrease in the level of medical errors made
during work;
− the quality of services provided and trust in
medical staff;
− increase the credibility of the institution
among potential patients.
Probably the most obvious are the benefits for
students. The use of simulation training
technologies provides many advantages:
− the quality and relevance of the acquired
knowledge, skills, and abilities; increasing
the effectiveness of the education received;
− use of the personality-oriented approach in
teaching;
− flexibility of the educational system for
computer modeling of clinical scenarios,
which allows students to choose appropriate
topics independently. Flexibility is also
guaranteed by the absence of territorial
restrictions, quality access to the knowledge
base via the Internet, etc. (with the ability to
use different devices for individual work);
− tangible adaptability, since the use of
modern digital technologies in the
educational process, can be personalized to
the required level;
− stimulus for the active development of
cognitive work, improvement of analytical
abilities and logical thinking, improvement
of knowledge of evidence-based medicine,
independent systematization and evaluation
of information (acquisition of information
competence), increased motivation for
independent scientific research, use of
creative skills and abilities;
− reduction of barriers between theory and
practical use of acquired knowledge;
− the ability to control their own learning,
awareness of the strengths and weaknesses
of their training;
− the ability to study in asynchronous mode,
while maintaining the ability to work and
study at the same time;
− use of modern educational trends that exist
in the information field;
− an increase in students' motivation to study;
− reducing the stress level during the first
experience of working with medical
instruments;
− work with rare pathologies and complex
injuries (wounds, etc.) without threatening
the life and health of patients;
− an unlimited number of attempts to develop
the necessary skills.
Simulation technologies are also popular among
existing doctors who undergo additional training
and retraining at universities:
− prompt mastering of new work skills;
− opportunities for rapid development and
improvement of skills and abilities using
modern teaching methods;
− advanced training in accordance with the
requirements of potential employers and the
expectations of society;
Ease of use of simulation techniques is also
beneficial for university teachers, as the
availability of creating simulation scenarios
allows you to model a variety of situations. In
addition, everyday teaching work is greatly
facilitated:
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− accessibility for a mass audience (many
students will be able to perform practical
tasks at the same time)
− opportunities to use various pedagogical
techniques and methods, resources that will
help students in their work;
− easier control over the learning process,
monitoring the quality of the material
learned, opportunities for tracking the
success of student work;
− searching for incentives to improve the
cognitive work of higher education students,
doctors, improve their logical thinking,
ability to use analysis, generalization,
systematization, and other methods of
operational information processing
(Sherman et al., 2021).
At the same time, the effectiveness of simulation
training also lies in the creation of appropriate
conditions and compliance with the necessary
stages (Tsekhmister et al., 2022). Obviously,
without compliance with certain established
rules, without a special organization of the
educational process, the system of training
specialists will not work so successfully
(Tsekhmister et al., 2022). In particular, we are
talking about compliance with the following
requirements:
− for the effectiveness of the use of simulation
for educational purposes, it is more
expedient to use small groups of students,
where the number of the latter per teacher
will not exceed 10 people;
− appropriate theoretical training of students,
including the use of methods of observing
the work of experienced doctors;
− emphasis on independent work of higher
education students, and reducing the role of
the teacher to a consultant (Li et al., 2020);
− understanding by teachers of the process that
there is a right to make mistakes in learning,
so the reaction to the wrong work of higher
education students should be appropriate;
− changing the tasks and methods of work of
the teacher: the transition from strict
assessment to observation, understanding
the reasons why students made a mistake,
finding out the circumstances that led to it,
identifying the next actions of the student,
etc;
− creating conditions as close as possible to
the real situation. This will allow students to
gain the necessary experience, work
properly with instruments, feel the patient's
reaction to correct / incorrect actions and
their consequences, etc;
− emphasis on the use of necessary practical
skills in simulation conditions;
− active use of distance learning and
simulation training, management of
independent and group training of students
(Gosai, 2017);
− objectification of pedagogical control over
the educational process, zero tolerance for
bias, corruption, and manipulation;
− providing the necessary time for teachers
and students. Which they can use for
independent attendance of trainings and
seminars, advanced training courses, etc.
Conclusions
Consequently, the use of digital technologies and
simulation teaching methods is an obligatory part
of the modern educational process. At the same
time, the use of such tools requires both
compliances with certain pedagogical methods
and the creation of the necessary circumstances.
In particular, the use of digital technologies in the
training of future medics has several tangible
limitations associated with excessive theoretical
training, reduction of the practical component of
training, the need for permanent Internet access
at clinical bases, the need to involve IT and other
specialists in medical schools, which would
regulate and promote the use of digital
technologies. Keeping additional staff and
referring to this toolkit is generally quite
valuable, but effective when combined with
stimulation technologies. These technologies
have a number of tangible advantages in use,
which relate primarily to the acquisition of the
necessary practical skills of work, with the life
and health of patients remaining in complete
safety. At the same time, the competent use of
simulation technologies requires special
conditions related to both the theoretical training
of students and the correct organization of
educational work on the part of teachers. In
general, the list of requirements for the proper
use of simulation is not fully formed, so this topic
will require additional analysis in the future.
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