1. Medical Simulation J. Peter Kincaid, Ph.D.
Institute for Simulation and Training
University of Central Florida

2. What are Medical Simulations?
Computer-based systems that support:
Interaction of the user with simulations of human anatomy and physiology using real or virtual medical devices.
Effective reproduction of medical procedures.
Training and performance assessment.

3. Questions about Medical Simulation
Is simulation an effective form of training?
Is it worth the cost?
Does it improve safety?
Should it replace some apprenticeship medical training?
Is simulation becoming an essential for medical training and education?
Can simulation be used for credentialing?

4. Why Simulation vs. Current Practice ?
Current Practice: Most common current teaching style for clinical health care education is apprenticeship model.
Limited exposure to unusual clinical conditions
Not very efficient
True of medical, nursing, and allied health students
A known quantity with known costs and effectiveness

5. Benefits and Costs
Simulation (vs. traditional training and educational techniques) can:
present more complex procedures
make better use of student learning time (reduce patient interaction time)
reduce medical errors
but. . .
is currently more expensive (costs are going down)
requires many different simulations and simulators for different procedures
does not cover all teaching requirements

6. Simulation and Patient Safety*
44,000 American die from medical error every year
Preventable adverse effects in US hospitals result in $ billion annually
Simulation is “a procedure to mitigate injury”
“Health care organizations and teaching institutions should participate in the development and use of simulation for training.”
* Institute of Medicine Report (2002)

7. Some Causes of Surgical Error
Operator
Fatigue
Stress
Poor training
Lacks experience
Low innate ability
Device
Faulty design
Wrong material
Wrong device
Poor fit
Broken
Non-sterile
Patient
Variable size
Variable pathology
Age
Anomalies
Movement

8. Benefits of Medical Simulation
Safe environment which forgives mistakes
Controlled proactive clinical exposure
Focus is on trainee
Hands-on: learning by experience
Rapid active feedback to trainee
Debriefing as a usual practice improves learning
Can improve public trust in medical profession

9. A Challenge: Skills Decay
CPR Skill Loss:
20% - 4 months
52% - 8 months
78% - 12 months
100%
50% 0%
Performance
Months 12

10. Intubation Manikin
Intubation (inserting a tube down the throat to restore normal breathing function) is a vital CPR medical skill for many types of medical practitioners. It is difficult and must be regularly practiced for the practitioner to maintain proficiency.

11. Medical Simulation Modalities
Low-tech
Simple 3-D organ models
Basic mannequin / Skill training models
Animal models / Human cadavers
Simulated / standardized patients
High Tech
PC-based simulators (software, web)
Realistic procedural simulators
Realistic interactive patient simulators
Virtual Reality / Surgical simulators

12. Early Example : Basic Mannequin (Low tech)
Rescue Anne (1960’s by Laerdal)

13. Hands-on Suture Simulator (Low tech)

14. IV Trainer to Augment HPS (Low tech)
Human Patient Simulator (HPS) does not support hands-on IV training. It is augmented with an inexpensive IV trainer for scenarios involving heavy bleeding.

15. Scenario Presented on PC (High tech)

16. Anesthesiology Simulator (High tech)

17. Human Patient Simulators (High tech)
Patient Simulators (Laerdal, METI)
Plastic manikin
Computerized sounds and physiology
Skill assessment
Anesthesiology training applications

18. Minimally Invasive Surgery Trainer (High tech)
Surgical Trainers Mentice, Xitact
Laparoscope as interface
Positioning, placing tasks
Skills assessment
Graphics computer

19. Bronchoscopy Simulator
Used to teach students the art of using a bronchoscope. System contains bronchoscope replica. The device is inserted into a mechanical interface simulating the patient. Encoders on both the bronchoscope and mechanical interface track the user's actions.. .
National Capital Area Medical Simulation Center

20. High Fidelity Surgical Suite
Teaches multiple tasks and advanced problem solving
National Capital Area Medical Simulation Center

21. Battlefield Trauma Using HPS
Leg Amputation from Landmine using Human Patient Simulator

22. Team Training Applications
Canadian Patient Safety Institute

23. Issues in Implementing Medical Simulation
Finance/Planning
Long-term business planning
Financial autonomy and institutional independence.
Institutional support
People/Culture
Recruiting qualified educators and simulation experts.
Developing a culture of patient safety that supports learning
Fostering multidisciplinary collaboration among stakeholders
Sending clear message that simulation contributes to patient safety
Canadian Patient Safety Institute

24. Issues in Implementing Medical Simulation (cont’d)
Finance/Planning
Long-term business planning
Financial autonomy and institutional independence.
Institutional support
People/Culture
Recruiting qualified educators and simulation experts.
Developing a culture of patient safety that supports learning
Fostering multidisciplinary collaboration among stakeholders
Sending clear message that simulation contributes to patient safety
Canadian Patient Safety Institute

25. Additional Resources Alverson, D., Scerbo, M., and Bowyer, M. (2005).
Emerging Trends in Medical Simulation: Identifying the Needs of the Medical Community and Methods to Address Them. PowerPoint Presentation.
Kincaid, J.P. Bala, J. et al. (2001), IST-TR Effectiveness of Traditional vs. Web-based Instruction for Teaching an Instructional Module for Medics. Orlando: Institute for Simulation and Training, University of Central Florida.
Ziv, Amitai, (2005). Simulation Based Medical Education – An Overview and the Israeli Experience. Canadian Patient Safety Institute (CPSI), Patient Simulation Symposium, Edmonton, Alberta, April 29, 2005.

26. Medical Simulation J. Peter Kincaid, Ph.D.
Institute for Simulation and Training
University of Central Florida