Simulation and patient safety
Simulation in medical education dovetails with an increased nationwide focus on patient safety. Borrowing from the aviation industry's model, the American Society of Anesthesiologists (ASA) was the first physician specialty organization to embrace simulation in an effort to increase patient safety and reduce soaring malpractice insurance premiums in the mid-1980s.
As ASA leaders examined the outcomes in various perioperative scenarios, one of the things they identified was the enormous risk associated with a few extremely rare complications. For example, malignant hyperthermia is a rare but potentially fatal reaction that can develop quite suddenly in an anesthetized patient. "This condition occurs perhaps one or two times a year in a large medical center, and it requires an immediate and appropriate response — an intravenous injection of one particular drug," according to Richard Prielipp, M.D., head of the Department of Anesthesiology and holder of the J. J. Buckley Chair in Anesthesiology.
Medical school student Andrew Thompson uses a sophisticated patient simulator.
"There were no patient simulators when I was an anesthesia resident, and during my entire residency I never saw a patient who developed malignant hyperthermia," says Prielipp. "The only exposure I got was from monographs and lectures, and reading about a case like this in textbooks isn't adequate preparation. Now, with patient simu-lators, we can set up and practice algorithms to become proficient at all sorts of skills, such as the complex algorithm in a rare but critical anesthesia emergency like malignant hyperthermia. With simulation, we can give someone endless opportunities to practice this until there is demonstrated competency."
Many patient safety issues relate to not only the competence of the individual surgeon or anesthesiologist but also the teamwork required in any crisis situation. For example, how well do the surgeon, the nurse, and the anesthesiologist communicate in the surgery suite, especially when something goes wrong? During a code blue, which responder determines that a patient has had a cardiac arrest and has not just choked on a piece of food from the hospital tray? Simulation can be used to provide students and residents with a closer approximation of reality and give them the skills they will need in a team setting.
Simulation jump-starts students' skills
"Medical students come to the University wanting to do real work and offer real skills, and in the past they spent two years in the classroom before they could get out there and do anything," explains Kathleen Watson, M.D., senior associate dean for education at the Medical School. "What simulation does is jump-start their education by giving them experiences that will allow them to do straightforward tasks safely. I compare this to when I was unleashed on the perhaps-not-unsuspecting but tolerant public. I needed to do maybe 15 sticks in a patient's arm before I could draw blood."
Watson says that medical schools haven't changed their approach to teaching since the early 1900s. "We teach to what we expect, and we're always surprised when something different happens. Yet a good clinician needs to have the judgment to understand that there are hundreds of variations on every theme," she says.
"Simulation could help us get ahead on this. At least at a skill level, simulations can help us train better doctors. Simulation doesn't measure how good a doctor a person will be. It has its limitations. But it can teach and measure knowledge and skills, and it does that very well."