Maxime Segalen, Podiatrist and project leader, February 2021

The use of simulation during the training of caregivers has become a central topic in the medical field over the last ten years. Several studies recommend the use of simulation to improve the training of future chiropodists and the quality of the professionals trained.
Health simulation exists in all medical and paramedical professions with the use of augmented reality, 3D printing and artificial intelligence.
One profession is becoming increasingly interested in it and is beginning to put its “foot in it”: chiropodists.

Chiropodists are increasingly incorporating these technologies into their portfolio.

What is the aim on the inclusion of medical simulation in podiatry? What are the benefits for the profession? It’s clear that the integration of simulation into the pedagogical curriculum in podiatry is still limited, although specific solutions for the world of podiatry have emerged in recent years.
In this article, I propose to highlight the subject of simulation in podiatry, its benefits for the profession by discussing some case studies.

The emergence of simulation in healthcare in France?

“Never the first time on the patient!”

Who has never heard in recent years, the famous motto, which has become a “leitmotiv” of the health care sector?
In France, we discovered this notion in January 2012 in the mission report on simulation in health commissioned by the High Authority for Health. This report was accompanied by ten proposals which should allow, on the one hand, a structured development of simulation, and on the other hand, a concrete improvement in the quality and safety of care.
At the same time, many scientific studies show the increased interest of simulation in health.

Eight years after the submission of this report, what are the results of these proposals in the training course in podiatry in France and what advantages does simulation bring to initial training?

Simulation in podiatry in France, a contrasting situation

Where North American universities of podiatric medicine have completely integrated simulation into their curricula, in France, this integration is taking longer to implement.
The great freedom of dispensation of teaching units left by the adoption of the decree of July 2012 explains the two-speed development of simulation within the training institutes. Indeed, while some training centres are equipping themselves with teaching simulators for initiation into the handling of specific instruments and others are developing teaching programmes based on care scenarios with simulation centres, some still using vegetables or candles as training aids!

This gulf in the approach to teaching results in classes of young chiropodists graduating with different capabilities to face private practice, increasing the possibility for mistakes .

Podiatry simulation: real benefits for students ?

During initial training, the reception of a hyperalgesic patient presenting a pathology of which the student has only theoretical experience is often a source of stress and apprehension. The fear of provoking pain often pushes the student to make a mistake; either by provoking pain in the patient in, or by not treating the reason for the consultation.

Securing the beginning of the students’ learning process

With the help of the simulators, the student can train without risks to adopt the right gesture. They have the possibility of making a mistake without this having any impact on the patient’s well-being or health, or on their confidence in managing the pathology.

Better understanding of a pathology that is too rarely encountered

The aim is also to compensate for the lack of patients with this type of pathology in the institute in order to allow each student to train on the different forms that a pathology can take. Indeed, there are still too many inequalities in access to pathologies in training institutes, largely due to the lack of diversity of the populations attending these institutions.

Increasing students’ confidence in the management of pathologies

The simulators allow the student to take charge of a complex pathology without fear of slipping up. This will allow the student to understand the pathologies they are treating and hence understand better, once in practice. This increase in confidence will ultimately result in better management of the condition once they graduate.
Unlike teaching that brings the inexperienced student into premature contact with the patient, simulation is risk-free and even allows young chiropodists to “make mistakes”. The positive culture of error allows the student to learn from his or her failures and gain experience in order to be even more efficient once in contact with patients.

In short, the experience acquired through simulation favours the success of care and, in the same way, reduces the frequency of iatrogenic events for the patient.

We can only hope that French podiatry follows the same path as its international counterparts, other French medical and paramedical professions.

Overview of 3 existing simulation solutions
Simulation in health can take different forms. Both virtual and physical, multiple tools are avilable to improve the quality of training provided in podiatry, both in initial and continuing education.
Here is a non-exhaustive overview of the most frequently encountered innovations in health simulation that can be applied to podiatry

#1- Simulation by virtual reality & serious game

Virtual reality simulation, also known as VR, aims at learning protocols and care gestures in an immersive real or imaginary environment. This simulation mainly uses virtual reality headsets as tools. These tools were first developed for the video game industry but are now used as professional training tools in the same way as some Serious Games.

Although they have already demonstrated their pedagogical interest, they are still not very suitable for application in the field of podiatry. The exorbitant cost of these tailor-made tools, ranging from several tens of thousands of dollars to several million, is a considerable obstacle to an application in podiatry, not to mention the cost of additional equipment (VR headsets, high-performance PCs, etc.), which only adds costs to an already very expensive techology.

#2- Care scenarios and role plays

In its “Guide to good practice in healthcare simulation” of December 2012, the HAS describes healthcare simulation by role-playing as “[…] a teaching technique for learning interpersonal skills. It consists of simulating a plausible and partly unpredictable situation in a specific fictitious environment. People play a more or less determined fictional role, improvising the dialogue. It can be used to analyse the behaviour of the actors and to give feedback on one’s own behaviour.

The scenarios can be tailor-made to suit the medical or paramedical speciality concerned, but follow the same model, which concludes with an objective evaluation of the actors’ performance, particularly that of the health professional. This practice is already used in initial and continuing education and is the aspect of health simulation most used today in podiatry.

This type of simulation is of great interest in the analysis and research of a podiatric diagnosis, but has very little interest in the acquisition and improvement of care gestures and acts.

#3- Synthetic simulators

Synthetic simulation uses highly realistic physical models as a basis for training in the acquisition of technical gestures and is the perfect complement to role-playing simulation.

These physical models can take the form of training dummies, connected or not, of targeted anatomical elements or regions and allow to highlight a particular pathology or a precise care act.

Today, synthetic simulation is closely linked to another technology, 3D printing. This technology drastically reduces the acquisition costs of simulators by easily breaking them down into a support part that can be preserved in the long term and a destructible part that can be located at the region of interest.

Numerous 3D printed simulators are created each year, always more realistic in terms of texture and more precise in the representation of pathologies.
Podiatry is not left out and is also concerned by these innovations. Recently, nail care simulators, such as PodoTrain by Bone3D, are proposed and allow podiatry students to train on the acquisition of care gestures such as milling, nail cutting or hyperkeratosis removal, as well as in the fitting of small appliances or the performance of onychoplasty.

In the same way that medical practices and procedures evolve and improve over time, the same should apply to training tools. It is the responsibility of the national associations and learned societies to adapt the teaching of their professions to the latest medical and pedagogical technological advances, so that professional practices can best reflect the latest advances in their fields.

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