1. Advanced Initiatives in Medical Simulation Washington, DC May 10, 2004 Challenges Facing Simulation H ow a National Agenda Would Solve the Problem Richard M. Satava, MD FACS Professor of Surgery University of Washington School of Medicine and Program Manager, Advanced Biomedical Technologies Defense Advanced Research Projects Agency (DARPA) and Special Assistant, Advance Medical Technologies US Army Medical Research and Materiel Command and

2. Scientific Fidelity and realism No new ideas or breakthroughs Competition of experts for ‘low hanging fruit’ Standards Of hardware – for inter-operability Of software – for sharing programs Variety Few are different – no pathology (4 lap-sim) Validation Too few & too expensive to conduct trials Curriculum One simulator, one level (R-1), one procedure Challenges for Medical Simulation Medical Simulation : Doctors :: Flights Simulation : Pilots

3. Clinical use Pre-op planning, surgical rehearsal Performance assessment & Outcomes ROI Low hanging fruit to survive No overall direction on what to develop 80 work week No time with traditional training to fit in Funding Requires a Grand Challenge effort Small DoD, NIH, hidden in HHS Acceptance Medical community – will not implement Industry – will not develop Federal agencies – will not fund research Challenges for Medical Simulation Medical Simulation : Doctors :: Flights Simulation : Pilots

4. $8,000,000,000Annual TRADOC budget $3,000,000,000Annual simulation $ 800,000,000STRICOM budget FY03 $ 1,250,000,000New Naval Air Warfare system $ ~20,000Federal investment medical simulation DoD spending for simulation/training Medical Simulation : Doctors :: Flights Simulation : Pilots

5. Military Training Technology Vol 5, October, 2000 What is wrong with this picture? Survey of Federal Government Awards for medical simulation (FY04) Below is the list of award amounts by the federal government for medical simulaton for education listed by agency. Excluded are the Congressional Special Interest (CSI) programs through DoD or other agencies HHS$ NIH$.4 million DoD$ 1.2 million NSF$ DoC$ Endoscopic Sinus Surgery Simulator

6. Scientific Incentive for new ideas or breakthroughs Incentive for long-term projects Coordination of experts Standards Authority to hold consensus conferences Variety Develop a “digital library” of all diseases Validation Adequate “n” from multiple institutions Central ‘clearing house’ to coordinate studies Curriculum Recognition of need for comprehensive approach Why a National Agenda Medical Simulation : Doctors :: Flights Simulation : Pilots

7. Why a National Agenda? Clinical use Defines the need in clinical practice Provides legitimacy ROI Incentive for long-term investment No overall direction on what to develop 80 work week Assures incorporation into requirements Funding Provides coordination among agencies Incentive to post solicitations for simulation Acceptance Medical community – assured of value Industry – will commit to develop Federal agencies – will encourage funding Medical Simulation : Doctors :: Flights Simulation : Pilots

8. Calls to National attention: Simulation needs & opportunities Identifies simulation as National effort & priority Legitimizes simulation as science to be developed Empowers consensus conferences for standards Signal to federal agencies: Important area to conduct research Accelerates development of simulators Indicates to business a long-term commitment – they should invest Facilitate multi-institutional validation studies Results from a National Agenda Medical Simulation : Doctors :: Flights Simulation : Pilots

9. We need to do for Medical Simulation... What “To Err is Human” has done for Patient Safety Medical Simulation : Doctors :: Flights Simulation : Pilots Patients Passengers A Clear Need for a National Agenda