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From The New York Times
Near the end of my surgical training, I spent three months as chief resident of a hospital trauma team. Two other doctors-in-training and I formed the first-line emergency room response, assessing and resuscitating patients who had been mangled, burned or otherwise injured. It was my first experience as a leader, but each of us was already fairly proficient and we all got along. I was confident that we would work well together.
I was wrong.
During our first week, one of the senior trauma surgeons played a video of one of our resuscitations, and I was reminded not of some slick made-for-television emergency room scene, but of the Three Stooges. In white coats.
One resident stood at the patient’s side, holding a rubber tube in one hand and a syringe in the other, unsure of which to use first. The other resident kept bumping into the nurses and the respiratory therapist as he paced alongside the patient. I watched myself standing at the head of the bed mumbling orders that no one could hear. The patient had sustained only minor injuries and ultimately survived; but his outcome had little to do with our team. Other than the one experienced nurse in the room and the senior surgeon who showed up 10 minutes into the resuscitation, no one seemed to know what to do or how to coordinate their actions with everyone else’s.
Although my team quickly gained the experience that would truly help us save patients, our growing competence came because we were submerging ourselves in trauma resuscitations day after day and night after night. We were learning as generations of doctors before us had — under the supervision of more experienced doctors, through trial and error, and on real patients.
Now it appears that this old paradigm of sinking or swimming with real patients is beginning to change, thanks to a growing field in medical education.
Medical simulation training, which is similar to that used in aviation and in the military, uses mannequins, computers, virtual reality or actors posing as patients to teach doctors, nurses and other clinicians. While simulation training has been used in medicine for nearly 40 years, it has until recently been limited primarily to teaching standard techniques like chest compressions in cardiopulmonary resuscitation or pelvic exams.
But over the last few years, as the technology and training techniques have advanced, experts in the field have begun to broaden the scope of training. No longer confined to isolated procedures, simulation can now recreate entire clinical situations, giving clinicians the opportunity to develop skills in what is often identified as one of the major causes of errors and quality issues in health care: poor teamwork and communication.
“Even if we are good individually, we are not always good at working collectively as a team,” said Dr. David M. Gaba, one of the earliest proponents of simulation in medical training and now associate dean for immersive and simulation-based learning at Stanford University School of Medicine. “Simulation can help develop decision-making, teamwork and team management skills.”
Anesthesia residents at Stanford, for example, must go through an extensive simulated situation in which the “patient,” a specialized mannequin, develops a severe, unexpected allergic reaction and then dies. During this training, the residents must provide and coordinate medical care with other members of the team and then conduct the difficult conversation with the patient’s “wife,” a live actor who has been trained to play the role of a shocked and then grieving widow.
“One of the beauties of simulation is you can let people practice those skills necessary in real-life medicine,” Dr. Gaba said. “You have to be able to handle more than just the cognitive or procedural skills; you have to be able to execute all those things while talking to the patient or the patient’s family.”
Not all doctors, however, are eager to train in a simulated environment, since even the most sophisticated simulations require suspending belief. The “patient” with low oxygen levels does not have bluish lips but a little blue light shining in her mouth. The grieving “spouse” is a well-versed but hired actor. And the dying trauma “victim” appears as flushed — and rubbery — as he was on arrival.
“It’s not the real thing, and doctors are often hesitant at first,” said Dr. Mark Smith, senior director of simulation and innovation at Banner Health, a nonprofit system that just opened a 55,000-square-foot simulation training center in Arizona, the largest of its kind in the United States. “But pretty quickly, doctors realize how nice it is to practice in an environment without consequences.”
The training can be quite challenging, too. Some of the simulated situations at the Banner Simulation Medical Center require as long as four hours to complete and take place in one of the center’s operating rooms, intensive care units or emergency department.
While research has shown that simulation training in specific procedures like the placement of catheters into a central vein can significantly decrease errors, it has been difficult to design and conduct studies that assess the effects of improved teamwork. Nonetheless, medical simulation experts believe that such training can only help clinicians.
“In sports, we would never have all the team members practice alone and then go off to perform,” said Dr. Haru Okuda, executive director of the New York City Health and Hospitals Corporation Institute of Medical Simulation and Advanced Learning. “It doesn’t make sense to have clinicians training alone either.”
The company will be opening a 10,000-square-foot training facility this fall at the Jacobi Medical Center in the Bronx, and Dr. Okuda plans to instruct some 14,000 clinicians over the next three years. “In the simulation world, you can practice to mastery,” he said. “In this way we can standardize the quality of care across our hospitals so that if, for example, a patient went to one hospital to deliver a baby, she would get the same level of care available at any other hospital in our system.”
The cost of these innovative training centers is high. The Banner Simulation Center cost $12 million to build, and the New York City Health and Hospitals Corporation Institute will require $10 million to complete. And unlike other investments, medical simulation training centers rarely generate revenue.
“Some people might ask, ‘Where’s my return on investment?’ ” Dr. Smith said. “But it’s really all about cost savings and patient care. We take such better care of our patients when we’ve got these skills. It’s no longer acceptable to learn on patients. It’s just not right.”
Which is true, though with one important caveat.
“Simulation allows you to do a lot of things safely and in a controlled fashion,” Dr. Gaba said. “But simulation will never completely replace practicing the craft of medicine under more experienced hands. People aren’t airplanes or machines. People are human beings, and we don’t come with instruction manuals.”
Or, as a friend who flies for a major international carrier told me recently: “You can get everything in a simulation except for the feeling, the real feeling, of the last 200 feet of landing.”
http://http://www.nytimes.com/2010/01/29/health/28chen.html?ref=health
Categories: Medical Simulation, Simulation Center | Tags: $10 million, $12 million, 000 clinicians, 000-square-foot simulation training center in Arizona, 000-square-foot training facility, 10, 14, 55, a growing field, a live actor, a nonprofit system, a patient, a severe, a shocked, a simulated environment, a simulation, a team, acceptable, actors posing as patients, advanced, airplanes, Anesthesia residents at Stanford, arrival, assess, assessing and resuscitating patients, associate dean, aviation, Banner Health, Banner Simulation Medical Center, blue light shining, bluish lips, build, burned, cardiopulmonary resuscitation, catheters, causes of errors, central vein, challenging, chest compressions, chief resident, clinical situations, clinicians, clinicians training, communication, complete, completely, computers, conduct studies, conduct the, confident, controlled fashion, coordinate medical care, cost savings, craft of medicine, decision-making, decrease errors, deliver a baby, design, develop, develop skills, develops, dies, difficult conversation, doctors, doctors-in-training, Dr. David M. Gaba, Dr. Gaba, Dr. Haru Okuda, Dr. Mark Smith, Dr. Okuda, Dr. Smith, dying trauma, eager to train, emergency department, emergency room scene, environment, everything, executive director, experience, experienced hands, experienced nurse, experts, extensive simulated situation, first-line emergency room response, flies, flushed, generate revenue, grieving widow., grieving “spouse”, health care, hesitant, high, hired actor, hospital, hospital trauma team, hospitals, Hospitals Corporation Institute, Hospitals Corporation Institute of Medical Simulation and Advanced Learning, human beings, immersive, important caveat, improved, innovative training centers, instruction manuals, intensive care units, investments, isolated procedures, Jacobi Medical Center in the Bronx, last 200 feet of landing, level of care, low oxygen levels, machines, made-for-television, major international carrier, mangled, medical education, medical simulation experts, Medical simulation training, medical simulation training centers, medical training, members of the team, minor injuries, mouth, my team, New York City Health, nurses, old paradigm, operating rooms, opportunity, other clinicians, otherwise injured, our patients, patient care, patients, patient’s family, pelvic exams, people, perform, placement, plans to instruct, play the role, practice to mastery, practicing, procedural skills, proficient, proponents of simulation, provide, quality issues, quality of care, rarely, real patients, real-life medicine, recently, recreate, replace, require, research, resident, respiratory therapist, resuscitations, return on investment, right, rubber tube, rubbery, safely, save patients, School of Medicine, senior director of simulation and innovation, senior surgeon, senior trauma surgeons, simulated situations, Simulation, Simulation allows, simulation training, simulation-based learning, sinking or swimming, skills, skills necessary, sophisticated simulations require, specialized mannequin, specific procedures, sports, standardize, Stanford University, submerging, surgical training, suspending belief, sustained, syringe, system, teach, teaching standard, team management skills, team members practice, teamwork, techniques, technology and training, The Banner Simulation Center, the center’s, the cognitive, The company, The cost, the effects, the experience, the feeling, the largest, the military, the nurses, the patient, the patient’s “wife”, the real feeling, the residents, the resuscitation, the simulation world, The training, things, to execute, to learn, to practice, trained, training, trauma resuscitations, true, ultimately survive, unexpected allergic reaction, United States, uses mannequins, video, virtual reality, well-versed, white coats, without consequences, “patient”, “victim” | No Comments »
From NurseWeek
A new $12 million simulation center will help better prepare both recent graduates and experienced Banner Health nurses for crucial situations.
Banner Simulation Medical Center, the largest simulation center in the U.S. devoted to medical training, opened in Mesa, Ariz. in October (2009) with a goal of reducing medical errors, and using simulation training as a model for nurse recruitment and retention.
The 55-bed “virtual hospital” boasts 72 computerized mannequins that can talk, breathe, bleed, and mimic several health issues. Nurses have the chance to perform a variety of tasks on the mannequins, including inserting IVs, treating heart attacks, and delivering breech births.
The simulation center is part of a $130 million project to remodel and repurpose the former Banner Mesa Medical Center.
Banner Health officials say the new facility has the capacity to train up to 1,875 nurses in 2009, tripling the number of nursing candidates previously trained via simulation at Banner annually.
Categories: Simulation Center | Tags: Arizona, Banner Health, Banner Simulation Medical Center, Largest Simulation Center in the U.S., Mesa, model, nurse recruitment, nurses, Simulation, training | No Comments »
By Michael Jones, Staff Writer, Gaylord Herald Times
Thursday, December 31, 2009 12:07 PM EST
LIVINGSTON TWP. — Otsego County EMS/Rescue first responders Troy Robertson and Becky Cobb had the opportunity last month to “respond” to a 9-1-1 report of an unresponsive child as part of a pediatric simulation exercise held for the county’s EMS paramedics.
“The training was done in real time,” Robertson said of the exercise which included responding to and assessing an unresponsive 6-month-old child — which in this event, was a high-tech anatomical model in which technicians could simulate breathing, body movements, crying and during Robertson and Cobb’s real-time response — a seizure.
“While we were examining the infant it went into a seizure,” Robertson said of the life-like simulation event. “We later determined there had been a head injury and then made the decision to transport.”
The simulation training took place in a self-contained mobile trailer which housed simulations of a room at the victim’s home, the inside of an ambulance and had a control room in which technicians controlled a bank of monitors and video equipment which recorded the event and allowed Robertson and Cobb to have their response critiqued during a debriefing held following the exercise.
The Pediatric Simulation Unit, parked inside the EMS garage on McLouth Road during the two-day training, was made possible through a three-year grant to the Michigan State University Kalamazoo Center for Medical Studies (MSU/KCMS).
Project coordinator Maria Byrwa said the purpose of the simulation training is to help first responders fine tune their response to high-risk, low-frequency pediatric emergencies — situations Byrwa said first responders are called upon far less often than the majority of emergency calls which involve adults.
“Most paramedics have a one in four chance that they will be called on to respond to an infant emergency,” Byrwa said. “This is a good way to prepare for such an event.”
County paramedics faced five different scenarios related to medical issues involving an infant. Byrwa said the simulated pediatric emergencies can simulate a variety of medical events including cardiac arrest, asthma and respiratory arrest and for Robertson and Cobb, a seizure.
Robertson said during his and Cobb’s evaluation of the infant they were able to cue in to an argument going on between child’s parents (played by Byrwa and a second technician), which led them to make a determination there had likely been some physical abuse which may have led to the child’s head injury, prompting their decision to transport the child to the hospital.
Once the simulations are concluded, Byrwa said she sits down with the paramedics and critiques their performance as they watch the video of their response to the emergency.
“We discuss what they did, ask what they were thinking and why they did what they did during the simulation. We may point out something they could have done differently or something they may have missed which could have helped them during their assessment of the situation,” added Byrwa.
“This really helped us to fine tune our response to the situation at hand. Whatever we can do to help us when we get that call to respond to a pediatric emergency is going to be beneficial,” Robertson said of the exercise. “Pediatric emergencies are tough because we don’t see a lot of them. We don’t get the hands-on experience that we do compared to adults. This is a good experience.”
Editor’s note: Since receiving the pediatric simulation training, EMS/Rescue Chief Jon Deming said as of Wednesday paramedics have responded to an unusual number of pediatric and child emergency issues including a home birth earlier this week and the transport/intercept of a critically ill 1-year-old child. “The training has been invaluable and has made our folks just that much better prepared to respond to pediatric issues,” he added.
Contact Michael Jones at 732-1111 or michael@gaylordheraldtimes.com
Categories: Pediatric Simulation | Tags: EMS paramedics, first responders, KCMS, Michigan State University Kalamazoo Center for Medical Studies, MSU, Pediatric Simulation, Pediatric Simulation Unit, training done in real time | 1 Comment »
CLEVELAND, Ohio, January 19 /PRNewswire/ — Simbionix, the world’s leading developer of medical simulation systems, introduces its new module for the ANGIO Mentor simulator, the Percutaneous Aortic Valve Replacement Module, which provides physicians with an opportunity to practice a revolutionary endovascular implantation of a bioprosthesis, without performing cardiac surgery.
Percutaneous aortic valve replacement is an innovative minimally invasive technique for heart valve implantation. This procedure, which takes place in a catheterization lab, is performed on a beating heart, so that there is no need for a cardiopulmonary bypass and its associated risks. In addition to having the potential to treat and heal many of the patients who are ineligible for traditional open-heart surgery, including elderly patients or patients suffering from additional conditions, this new technique is also less traumatic to the patient, and reduces healthcare costs and rehabilitation time.
The new training module provides surgeons with the opportunity to practice correct placement of the bioprosthesis during an Aortic Valve Replacement, which is critical for the success of the procedure. Surgeons can train on different virtual patients, and gain experience with complicated anatomies and various pathologies. At the end of the session the surgeon can assess and analyze the deployment process and learn how to work more safely with a bioprosthesis.
Mr. Gary Zamler, Simbionix CEO adds: “The medical device field is rapidly developing, with new technologies continuously being introduced to the market and new techniques being used every day. Based on the work of our exceptionally strong R&D team, we are able to assist clinicians in keeping up with these changes, while at the same time contributing to enhanced patient safety. Device manufactures share the same needs, and require advanced and efficient training tools. Simbionix solutions provide a wide scope of opportunities to attend to this positive trend in medical device developments, an example of which is demonstrated in this new application for percutaneous aortic valve replacement”.
About Simbionix USA Corporation
Simbionix is the world’s leading provider of simulation and training products for medical professionals and the healthcare industry. Founded in 1997, the company is committed to delivering high quality products, advancing clinical perfomrmance and optimizing procedural outcomes. Simbionix cooperates with physicians on a regular basis to produce the most reliable and effective training and supporting systems.
For more information on Simbionix, visit http://www.simbionix.com Rebecca Zitter Exhibition Manager Simbionix Tel : +1-216-229-2040 galia@simbionix.com
SOURCE Simbionix Ltd.
Categories: Medical Simulation | Tags: ANGIO Mentor simulator, cardiac surgery, Percutaneous Aortic Valve Replacement Module, physicians, Simbionix | No Comments »
By MONICA VON DOBENECK, The Patriot-News
Tavia Rhoden, left, a graduate nurse, is instructed by Dr. Thomas Verbeek in administering anesthesia in the operating room in the new simulation lab at the Penn State Hershey College of Medicine. JOE HERMITT, The Patriot-News
Norm the mannequin was feeling badly, probably because of an intestinal blockage, according to Thomas Verbeek, an anaestheologist at the Penn State Milton S. Hershey Medical Center.
So he showed graduate nurse Tavia Rhoden what to do – how to intubate Norm, watch his vital signs, make sure the anesthesia has taken effect, listen to his heartbeat and respirations.
Norm is one of several mannequins in the hospital’s new simulation lab, where students, doctors, nurses, emergency personnel and others can practice medical techniques risk-free on pretend people before it really matters.
Hershey Medical Center has had simulation labs for years, but the $6.6 million, 8,000 square foot one which opens today is more than twice as big and more sophisticated. It’s been in the planning for two decades, according to the lab’s medical director Elizabeth Sinz.
Some lab rooms feature body parts – arms for practicing IV’s, a spine for spinal taps, a torso for installing catheters, lungs for practicing ventilation.
In the virtual reality room, a face belonging to a virtual person who was having trouble swallowing was hooked to a computer while surgery resident Eric Pauli demonstrated an endoscopy, snaking an endoscope down the patient’s throat while watching her esophagus on the computer screen and taking a biopsy of a fungal infection. The patient gave a groan of discomfort and coughed when the endoscope bothered her.
Sometimes the sim labs use real actors to play patients. Patient rooms have one way glass so professors can watch the medical students at work. Cameras record the procedures, so students can watch themselves and learn.
According to Sinz, studies have shown that students do better in clinical work after practicing in the simulation labs.
The simulation labs will be open to the public for tours and demonstrations from 1 to 4 p.m. today on the second floor of the Penn State College of Medicine.
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Moulage University of a resource of news, information, and products in the field of injury, casulty, military, and medical simulation. Medical moulage is the art of applying mock injuries for the purpose of training Emergency Response Teams and other medical and military personnel.
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