What is Medical Simulation?

Medical simulation is a quickly growing field, attracting the media’s attention with its innovations and engaging nature. What is medical simulation? We spoke with Melissa Cappaert, Simulation Specialist and Manager of the Simulation Center at NewYork-Presbyterian, and Santos Cabreriza, Associate Research Scientist and Director of Surgical Simulation. Following is part one of our three-part series explaining medical simulation and the latest simulation initiatives at NewYork-Presbyterian/Columbia.

What is Medical Simulation? What are the goals of the Simulation Center and Surgical Simulation Lab?

Melissa Cappaert: Medical simulation is the creation of real-world situations so that healthcare providers can learn, practice, and assess their medical skills in a safe environment. Simulation can provide this learning opportunity using whole body manikins, devices called task trainers, actors who portray patients, or even simulated medical scenarios using virtual reality.

The primary goal of the Simulation Center is to improve quality and patient safety. We are trying to help reduce medical errors, build team communication, and improve skills around crisis resource management. The simulation center is very involved in mock code training around the hospital, and in training physicians, nurses, surgeons, and other practitioners across every medical and surgical specialty.

Santos Cabreriza: The primary goal of the Surgical Simulation Lab is to provide a controlled setting for simulation and further development of surgical skills and team training. Participants in this simulation include medical students, residents, nurses, physicians in practice/needing remediation, and other healthcare professionals. The Fundamentals of Laparoscopic Surgery (FLS) program, developed by the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), has become one of our core programs. FLS outlines a standard set of cognitive and psychomotor skills in basic laparoscopic surgery. This is achieved through the use of a computer based didactic component and a manual skills component. Specifically, the manual skills component measures technical skills and eye-hand coordination during basic laparoscopic surgical maneuvers. The learning and application of these fundamentals will help our participants provide a minimal standard of care for all patients undergoing laparoscopic surgery

What are the Simulation Center and the Surgical Simulation Lab? How do these two divisions work together?

MC: The Simulation Center is the centralized division at NYP that coordinates simulation education training throughout the hospital. There are pockets of simulation labs around the hospital, including the Surgical Simulation Lab with the Department of Surgery. In the Pediatric Intensive Care Unit, there is an adult size high fidelity manikin, more commonly referred to as a “SimMan” and a baby manikin. In the Neonatal Intensive Care Unit, there is a SimNewB®, a neonatal manikin.  In the Department of Obstetrics and Gynecology, we have Noelle® – a manikin with a compressor in her abdomen who can give birth. We partner with all of these labs. Because simulation is resource intensive, we are working towards developing a centralized center, where we can share resources around multiple departments and divisions.

Is simulation training part of education during medical school, residency, or part of continuing medical education for practicing physicians and surgeons?

SC: Simulation may and should be employed at all levels of medical education. In surgical education, it offers another dimension to Halsted’s traditional learning concept of “See one, do one, teach one.” It affords the learner to “See one, deliberately practice and perfect one in a safe environment, do one, and then teach one”.

Currently, medical students are using several types of task trainers to practice specific skills early in their education. These include suturing, IV insertion, intubation, and arterial blood gas collection. Experiences in the simulation lab offer our students the preparation needed to perform appropriately in patient care. For example, residents use instruments and technology found in the operating room to practice and perfect procedures commonly conducted in clinical cases.

Our lab follows the guidelines provided by the Association of Program Directors in Surgery. It provides a national forum for post-graduate surgical education and maintains a high standard of surgical residency training by improving graduate surgical education and patient care.

Can you describe examples of the different types of equipment used at the Simulation Center?

SC: The Simulation Center is a multipurpose suite in which residents and students learn and hone their surgical skills. Several types of task trainers are used to allow participants to practice specific skills. Task trainers are mannequins designed to physically replicate patients and provide students with the opportunity to learn the steps of clinical procedures. Learning with a task trainer familiarizes students with equipment and encourages the development of specific skills. These skills are applicable to real-life cases and can be appropriately applied to complex situations in a surgical environment. Skills training allow a participant to work at his/her own pace and master skills through deliberate practice. The Skills Lab also hosts a number of software based simulation programs and tutorials designed to enhance clinical decision making and guide skill development.  Mannequin-based simulation, task training, and virtual simulation in conjunction with the Standardized Patient Program available via the NYP Simulation Center, provide learners with a broad spectrum of resources to improve quality in patient care. Video recording scenarios are very effective learning tools that allow participants to watch simulated patient encounters and debrief each experience with the goal of improving future performance.

MC: The simulation center also commonly uses high-fidelity computerized manikins in their teaching programs, more commonly known as “simulation manikins.” They look like people and while they do not move on their own, the do have other human functions. They can breathe, their pupils react to light, they have pulses… they even have the ability to bleed, cry and sweat.

We also offer courses utilizing standardized patients. Standardized patients are actors carefully trained to portray patient roles. We have used them in courses on how to deliver difficult news in which family members are receiving news about a patient’s death or a difficult diagnosis, so the trainee has the chance to practice skills of empathy, educating the patient, and delivering painful news in a compassionate way.