The learning design of the virtual simulation application, partnered with a physical simulator, is a perfect conduit to evaluate a learner’s clinical competency. Our system divides learning into four hierarchical processes that mirror Miller's pyramid: knowledge, application of knowledge, clinical skills competency, and clinical performance. This instructional design methodology is echoed across all four modules and was chosen for its flexibility. Our theory utilizes a strong instructional design methodology, with adult learning theories that will yield a positive clinical competency output through ubiquitous learning. The creation of both virtual and physical simulators provides a lifelike example of a clinical encounter where a novice learner can make mistakes and learn from past experiences without endangering patients. Each module course begins with an MCQ section with a threshold of 80% for passing (knowledge), virtual simulation (application of knowledge), post-evaluations with self-directed feedback (clinical skills), and the final physical simulator (clinical performance).

Equipment

• x1 Wood board 50x20cm
• x1 Felt 50x20cm
• x2 Sponge/ panty shield 50x20cm
• 3cm diameter plastic Pipe x 50cm long
• Sand
• Vegetable oil
• x2 Screws
• Super glue
• Hole punch
• x10 pins or nails
• x10 elastic bands
• Drill & drill bit (1mm less than the Schanz pins)
• Ex fix kit

Step 1[edit | edit source]

Build the wooden base as per the Z-plasty and V-Y plasty modules. Use the wooden board, and x10 pins or nails for the sides (AmoSmile Physical Simulator)

Step 2[edit | edit source]

Make medulla

Cut x2 15-20cm of the pipe

Pack the pipe segments with a mix of sand and vegetable oil, ensuring that it is compacted as tightly as possible

Step 3[edit | edit source]

Place a 45cm x 10cm piece of sponge onto the wooden board

Step 4[edit | edit source]

Lay the x2 cut pipe lengths onto the sponge, which is on the wooden board. Ensure a 0.5cm gap is between the 2 pipes. These represent the bone ends with a fracture gap

Step 5[edit | edit source]

Secure the 2 bone end onto the wooden block with a 0.5cm gap between them

Use x1 screw on either lateral end of the pipes ensuring the screw is completely through the pipe and into the wooden board

Step 6[edit | edit source]

Lay a 45cm x 10cm sponge over the pipes and pipe gap. Glue if it raises on the edges

Step 7[edit | edit source]

Cut a 45 x 10cm piece of felt

Step 8[edit | edit source]

Punch x5 holes on both the long sides of the felt

Step 9[edit | edit source]

Lay the felt over the sponge, which is on top of the pipes

Step 10[edit | edit source]

Attach the felt onto the board using elastic bands looped through the punched holes

Reproducibility[edit | edit source]

We have developed a mobile app that guides learners through an entire curriculum, including step-by-step simulations and dynamic, customized training with competency tracking. Our physical simulator is low-cost, easily assembled, and entirely locally sourced, with the ability to simulate critical steps of the procedure in a self-directed, accessible, and clinically translatable manner. The application has been revamped several times to enhance UI/UX components and truly deliver a self-directed learning experience by adding 360 feedback to the assessment sections to direct the learner to areas needing more review. The build consists of wood, a felt material, a sponge, sand, vegetable oil, screws, drill bits, and a plastic pipe. All of these materials can be substituted for similar materials locally sourced.