Medical simulation centres: now for FPs, too

From suturing to catastrophe training, the trend in Canada is
to simulate and stimulate

By Katherine Addleman

Virtual simulation labs have been around for several years. The first were adapted from airline industry simulations of in-flight crises that became a mandatory part of crew training. Dr David M Gaba, a professor of anesthesia at Stanford University School of Medicine in Palo Alto, CA, did the first medical adaptations using high-fidelity patient simulators in his own field of anesthesia. The idea caught on quickly. And now, with the availability of virtual patients from programs like SimMan and patient care task trainers, courses are popping up all over North America.

SIMULATION NATION
In Canada simulation centres linked with teaching hospitals are flourishing. The courses were traditionally aimed at trauma/emergency care, ICU, surgeons, anesthetist-related procedures and teaching medical students. But the courses are now branching out, becoming more available to community physicians as CME-type courses, as well as assessing foreign-trained doctors and nurses. This type of simulation program tends to be more low-tech and broad based. By all accounts, doctors are taking to them like fish to water.

A glimpse inside the simulation lab Dr Al Thumbs nearly offs his (virtual) patient Dr Al Thumbs* sat watching a video of himself carrying out a procedure he considered a 'no-brainer.' Suddenly, there he was, captured in living colour for posterity, making a life-threatening medical error. He had switched an acute care patient from an oxygen mask to a bag-type ventilator — without hooking up the oxygen tubing to the new mask. Luckily for Dr Thumbs and his patient, the whole event was virtual. Inexperienced doctors rely on more experienced MDs to step in when the going gets tough. "This is good for the patient but bad for the doctor," says Dr Randy Wax of the Mount Sinai Human Simulation Program in Toronto. "Using training simulators, doctors can learn by making mistakes safely." *Not his real name

Mount Sinai Hospital in Toronto is the leading centre for medical simulation. According to Dr Randy Wax, an intensivist and Medical Director of Mount Sinai's Human Simulation Program, there are two types of simulation programs on offer to physicians.

"The first type involves skills training, such as intubation, pelvic exams, resuscitations, new surgical skills — whatever that centre feels is relevant," he explains. "The second type focuses on the human factors involved in multidisciplinary teamwork: communication, decision-making, leadership — the global factors that keep a medical team at top efficiency." Both types of courses use simulators with trainers and mannequins that allow a case to be replayed and analysed.

US LAGS BEHIND
In the US, teaching hospitals aren't always associated with medical schools as they are in Canada, so medical simulation programs have been a little thin on the ground. That's all about to change. An enterprising group of docs from a small hospital in Columbus, OH recently decided to put together a primarily non-surgical medical simulation training centre that should be up and running this spring. Not intended for medical students, this physician-funded facility will target working MDs and residents exclusively.

Developed by Dr Edward Bope, director of the Family Practice Residency at Riverside Methodist Hospital in Columbus, and Pamela Boyers, PhD, Riverside's director of medical education, the Virtual Care Unit will be the first non-military medical simulation centre in the US to follow a patient from emergency through the OR to the ICU.

Dr Boyers put together a team of cardiologists, surgeons, family physicians and internists to design the program, with special input from primary care docs who encouraged them to keep their focus on care of the whole person. A Laboratory Skills Centre, where docs can practise suturing, removing 'bumps and lumps,' pelvic exams, joint care, neonatal resuscitation, intubation and general microvascular techniques, will be included in the facility. This lab allows clinicians and residents to practise critical skills that they may encounter relatively rarely or to learn new procedures.