A participant engages in practice simulation.
Dhulikhel Hospital, a teaching hospital affiliated with Kathmandu University School of Medical Sciences, has long been a leader in innovative medical education in Nepal. Among its recent transformative initiatives is LEAD Nepal, a program designed to strengthen simulation-based clinical education through a collaboration with Mount Sinai’s Simulation Teaching and Research (STAR) Center.
The Role of Simulation in Health Care Education
Traditional medical education relies heavily on lectures and bedside observation. Yet in critical situations—such as emergency response or trauma care—health care teams rarely have opportunities to practice real-time decision-making. Simulation-based learning fills this gap by recreating realistic clinical scenarios in a controlled environment, allowing teams to practice skills, test judgment, and learn without risk to patients.
LEAD Nepal—short for Leadership, Education, and Advanced Debriefing—enables participants to safely make clinical decisions, strengthen technical and communication skills, and reflect through structured debriefing sessions. The initiative was supported with pilot funding from the Arnhold Institute for Global Health at Mount Sinai to advance engagement with its AMPATH Nepal partnership.
Following a series of virtual preparatory sessions, a three-day intensive in-person workshop was held twice at Dhulikhel Hospital. Mount Sinai STAR faculty trained more than 40 clinicians and educators to design, implement, and evaluate simulation-based learning programs. Participants gained hands-on experience using technologically advanced mannequins, task trainers, and digital tools to enhance their teaching practices.
To support this work, the Arnhold Institute’s Education Program transported a full-sized simulation mannequin to Nepal for Dhulikhel Hospital’s simulation lab. The mannequin replicates vital signs such as breathing, pulse, and blood pressure, and can simulate conditions including cardiac arrest, shock, and stroke. Participants also used moulage—makeup and props—to recreate realistic scenarios such as snakebites and burns. Simulations ranged from childbirth complications to heart attacks and cardiac arrest, with faculty participating across disciplines including pediatrics, emergency medicine, critical care, dentistry, and physiotherapy.
From behind a two-way mirror, participants facilitate their self-designed simulation as colleagues carry out the scenario.
What Is LEAD Nepal?
LEAD Nepal is designed as more than a one-time training. It is a comprehensive educational initiative that strengthens simulation-based medical education while building leadership capacity among educators. The program aims to reshape how clinicians learn, teach, and lead through experiential, simulation-driven training.
The LEAD framework reflects the program’s core focus areas:
- Leadership—Empowering clinicians to guide teams in high-pressure environments and lead educational change.
- Education—Enhancing teaching through hands-on learning and training facilitators in best educational practices.
- Advanced Debriefing—Fostering reflective practice, emotional intelligence, and continuous improvement after simulations and in everyday clinical care.
Together, these pillars strengthen clinical skills while cultivating a culture of learning and educational leadership across Dhulikhel Hospital.
Building Leadership Through Reflection
A defining feature of LEAD Nepal is its emphasis on interdisciplinary teamwork and reflective learning. After each simulation, participants engaged in advanced debriefing sessions guided by trained facilitators. These discussions encouraged self-reflection and group dialogue to identify strengths, gaps, and opportunities for improvement. Faculty also received structured feedback on their debriefing techniques, strengthening their confidence as educators.
Participants are taught makeup and moulage techniques to add realism to their scenarios.
At the core of LEAD Nepal is the belief that technical excellence cannot be separated from leadership and communication. Debriefings incorporated evidence-based approaches such as “plus-delta analysis”—what went well and what could be improved—and “advocacy-inquiry,” a questioning method that promotes critical thinking. Conversations frequently extended beyond technical skills to explore teamwork, ethical dilemmas, decision-making under stress, and emotional resilience.
As one Dhulikhel Hospital faculty member shared, “Simulation helps us make mistakes safely, reflect honestly, and return to real patients with greater confidence and humility.”
Strengthening Local Capacity Through Global Partnership
LEAD Nepal builds on earlier simulation collaborations between Mount Sinai and Dhulikhel Hospital, including trainings in pediatric and adult critical care. Looking ahead, Dhulikhel Hospital is working toward accreditation from the Society for Simulation in Healthcare.
These collaborations bring world-class educational methodologies to Nepal while adapting them to local contexts and resource realities. The impact is significant: Hundreds of medical students, nurses, and clinicians will benefit from strengthened simulation-based education in the years ahead.
Transforming Health Care Education in Nepal
In a setting where resources are limited and emergency care systems continue to evolve, simulation offers a safe and scalable approach to training future health care leaders. By combining technology, teamwork, and reflection, LEAD Nepal represents a forward-looking model for medical education.
The program demonstrates that leadership is defined not by authority alone, but by communication, collaboration, and compassion under pressure. As LEAD Nepal continues to grow, Dhulikhel Hospital is shaping not only stronger clinicians, but also empathetic and adaptable educators prepared to serve Nepal’s diverse communities.
Jared Kutzin, PhD, DNP, MPH, RN, is Senior Director of the Simulation Teaching and Research (STAR) Center and a Professor of Emergency Medicine, and Medical Education at the Icahn School of Medicine at Mount Sinai.