A conversation with Betty Alexandra Bravo Zúñiga, president of SOESIM, about her career in simulation, the challenges in Ecuador and her vision for the future of education and patient safety.
We have met with Betty Alexandra Bravo Zúñiga, doctor and PhD in Education Sciences, current president of the Ecuadorian Society of Clinical Simulation (SOESIM). With an outstanding career in medical education and simulation, Betty has led key initiatives for the integration of this methodology in healthcare training in Ecuador. In this talk, she shares her vision of the impact of simulation on patient safety, the challenges of its implementation and the need for standardization in the country. She also reflects on the future of simulation and SOESIM’s strategic projects to strengthen its adoption. This conversation is part of our commitment to give a voice to the presidents of international scientific societies, highlighting their work and vision for the advancement of education and health safety.
Alexandra Bravo Zúñiga
Betty Alexandra Bravo Zúñiga is a doctor with a PhD in Education Sciences and is the president of the Ecuadorian Society of Clinical Simulation. She is a member of SOMESICS and INACSL, with certifications in simulation. She has been the coordinator of the Simulation Center of the Catholic University of Santiago de Guayaquil, where she also works as a professor and instructor in educational innovation.
Hello Betty, thank you very much for accepting our invitation to have this chat.
Would you like to introduce yourself to our readers and tell us who you are and when you learned about simulation?
I am Betty Alexandra Bravo Zúñiga, 48 years old. My career began at undergraduate level and in the hospitals where I worked for many years; my goal was to master the profession, which is why I participated in altruistic medical brigades at the national level. However, my main purpose changed when I witnessed adverse effects in family and friends, which left a deep impression on me. My professional experience spans many years in critical areas of different health centers, where I always maintained a commitment to the patient and to training. In 2011 I dedicated myself to teaching, leaving hospital practice in 2015, and then focusing on undergraduate training and simulation education. My passion for simulation lies in its main purpose: to ensure patient safety and reduce the risk of adverse events.
What motivated you to become President of SOESIM, the national scientific society?
In 2017, I became the first simulation coordinator at the Universidad Católica de Santiago de Guayaquil (UCSG). I teamed up with an educator who is not a doctor, and as a result of conversations and reflections on teaching and simulation, we began to train educators in simulation. Starting with the formation of a team of Simulation Educators, we have trained several teachers from the Faculty, but I soon observed that the methodology was still unknown in other universities in the country; possibly due to various factors and internal contexts. This prompted me to look for strategies to standardize and disseminate the application of simulation in Ecuador. In 2022, we organized the First International Congress on Simulation Education at UCSG, which was attended by universities from all over the country, who unanimously decided that the Ecuadorian Society of Clinical Simulation (SOESIM) should preside over it.
How does the Brazilian Simulation Society collaborate with educational institutions and healthcare organizations to promote simulation in medical training?
Although the contexts of Latin American countries are different, they share similar challenges and realities regarding the dissemination of simulation in the healthcare field and in healthcare training. In Ecuador, we have faced obstacles in establishing and consolidating this methodology. However, I believe that we have made significant progress in integrating it into undergraduate training. Now, we aspire to see this practice adopted in the healthcare sector through public policies promoted by the Ministry of Public Health (MSP), which regulates the country’s hospitals, centers and clinics. The creation of the Ecuadorian Society of Clinical Simulation, collaboration with networks and the support of international societies, as well as the organization of international simulation conferences, seek to establish common frameworks and standards for its implementation. This promotes its adoption in educational and health institutions, focusing on the reduction of adverse effects and the improvement of patient safety.
What are the main challenges facing SOESIM in promoting simulation as an essential tool in medical education?
As a young society, we still lack a solid culture and awareness of the importance of the society, coupled with a profound lack of knowledge of its benefits for improving clinical skills and patient safety. In addition, the limited funding and resources of some educational institutions hinder its development, while the absence of public policies and government regulations causes inconsistencies in its integration into the curriculum, as well as in the implementation of in situ simulation and simulation areas in Health Centers. The resistance to change of some teachers and professionals, who prefer traditional methods, also represents an obstacle. To overcome these challenges, it is crucial to implement standards and foster collaborations between educational institutions and the Ministry of Health, in order to ensure the reduction of adverse effects, which represent more than 40% of cases worldwide and are caused by the human factor.
What role does SOESIM play in establishing national standards for healthcare simulation in Ecuador?
As a leader in simulation, SOESIM is dedicated to promoting and developing guidelines that ensure the quality and effectiveness of this valuable educational and professional tool for skills development. One of its most important projects is the creation of local guidelines based on international standards, but adapted to our context, in order to guarantee clinical training and patient safety. We are currently promoting the training of health professionals through online simulation programs and workshops, developed on a weekly basis and aligned with the international standards of INACLS and SSH. In addition, we promote the growth of simulation programs in universities that require it, providing advice on curriculum implementation, methodology and operations in simulation centers; in this way, we strengthen the culture of patient safety and contribute to the continuous improvement of the health system.
What is your view on the adoption of simulation as a mandatory requirement in medical training programs in Ecuador?
From a personal perspective, the adoption of simulation as a compulsory requirement in medical training programs in Ecuador improves the quality of education and patient safety, which should be mandatory in the country. In other words, simulation should not be just another strategy in the training of Health Careers, but rather its main methodology, which makes it clear that Patient Safety comes first. However, its implementation requires investment in infrastructure, teacher training and a regulatory framework to ensure its effective and sustainable integration into the education system.
Last November, the 2nd National SOESIM Congress was held. What would you say were the main achievements and conclusions of this event for the advancement of healthcare simulation in Ecuador?
I think the main achievements of the Congress were: 1. Strengthening through strategic alliances between universities and professional organizations, promoting the exchange of knowledge and resources for the implementation of clinical simulation; 2. Knowledge of international standards that can be implemented in their universities, adapted to the Ecuadorian context to guarantee quality in clinical training and patient safety; 3. Continuous training of health professionals through workshops focused on simulation, international standards and code of ethics; 4. Advice on the operations carried out in simulation centers, covering both methodological and operational aspects of the centers and; 5. The importance of a patient safety culture to improve the quality of healthcare.
What are SOESIM’s next steps after this conference to continue strengthening collaboration and knowledge exchange among the country’s simulation professionals?
Among the strategies that SOESIM will implement to strengthen collaboration and knowledge exchange are: the consolidation of agreements with prestigious simulation societies that have a common goal: patient safety; the creation of simulation networks and communities; the development of training and certification programs that guarantee quality and standardization in practices; in addition, collaboration with international organizations such as SESAM, INACSL, SSH, SOMESICS, among others; and the holding of simulation conferences and workshops, which will promote a significant improvement in the training of competent professionals and in the quality of healthcare. At the same time, incentives will be provided for research and publications in simulation, as well as advice to universities on the implementation of programs, with the aim of consolidating a culture of patient safety and minimizing the risks of adverse effects.
What recent technologies or innovations in simulation do you think will have the greatest impact on patient education and safety in your country in the coming years?
Advances in simulation technologies are accelerating, such as virtual simulation modalities (VR, AR, MR, haptic reality), the use of Artificial Intelligence (AI) and ultra-fidelity technological simulators; in innovation, from my perspective, the difficulty lies in the implementation of new or recent methodologies. However, I always question the acquisition of these technologies if the common problem lies in how we are going to use them to take advantage of the benefits that optimize resources in the educational and health fields. We should consider whether these technologies, which do not replace one modality or another in simulation, allow us to achieve the desired learning objective or result. On the other hand, the use of Big Data in simulation allows us to analyze volumes of generated data, extracting patterns and trends that optimize both the design of programs and real-time decision-making and developing more efficient protocols for the patient.
SOESIM was one of the contributors to the drafting of the Global Consensus Statement on Simulation-Based Practice in Healthcare. What do you think of this document?
SOESIM’s participation in the drafting of this statement reflects Ecuador’s commitment to improving the quality and safety of healthcare. Implementing the consensus recommendations can lead to more effective training of healthcare professionals, reducing medical errors and improving patient outcomes. In addition, this consensus facilitates international collaboration, enabling the exchange of experiences and best practices between countries. For Ecuador, this represents an opportunity to strengthen its simulation programs, aligning them with global standards and adapting them to local needs. Simulation helps to mitigate these inequalities, improving clinical outcomes, optimizing processes, strengthening the resilience of staff and preparing them to handle complexities, including unexpected emergencies. Simulation is key to optimizing health systems by improving patient care, safety and outcomes, and integrating into quality and safety initiatives.
Finally, what are SOESIM’s next objectives and projects to strengthen the use of simulation in healthcare in Ecuador?
Initiatives such as continuous training, conducting research on simulation and its impact on medical training and patient care, as well as collaborations with international societies, simulator suppliers, universities and national hospitals, can contribute significantly to establishing standards for the implementation of simulation programs and knowledge management. Our next objectives and projects are focused on continuing to grow as a Society, positioning simulation as the fundamental methodology in specialty training, continuing education and degree programs. In addition, to strengthen national and international collaborations so that simulation is recognized and adopted as an essential resource in the education of health professionals, promoting quality training that has a direct impact on the safety and effectiveness of patient care.
Thank you very much for this pleasant chat. And we wish you and the Society good luck.
LEGGI ANCHE
