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University of Rochester
Center for Medical Simulation
(URCMS)
Evolution and Revolution
6th Annual International Meeting on Medical Simulation
January 14-17, 2006
Sheraton San Diego Hotel and Marina
San Diego, California
Simulation, which has become an integral component of training in the aviation
industry, is now recognized as a valuable tool for training medical
professionals and improving patient safety. Full-scale patient simulators help
a wide variety of practitioners and students learn the diagnosis and management
of clinical problems without risk to real patients. The University of
Rochester's Department of Anesthesiology was one of the pioneers in this
field, starting a medical simulation program in 1994. We hosted the first
International Conference on Simulators in Medical Education in 1995.
The Rochester Center for Medical Simulation is located near the Surgical Suite
at the University Medical Center, and officially opened in 1998. The core of
this specially constructed facility is a computer-controlled full-body patient
simulator that incorporates mathematical models of the cardiovascular and
respiratory systems as well as models of human responses to drugs. The patient
presents realistic vital signs and responds appropriately to clinical management.
Physiological parameters and disease processes can be pre-programmed, or
changed at any moment during the simulation by the operator.
The simulation room is flexible and can be configured as a fully functional and
realistic operating room, intensive-care unit, emergency department, or patient
room. Faculty members can control the simulator from the bedside for one-on-one
teaching. During full-scale team-based simulations, instructors can also operate
the simulator and video equipment from the control room, which is adjacent to the
simulator room and includes a one-way observation window. There is also an
adjacent debriefing room with an observation window and video monitors.
The simulator facility is used in undergraduate, graduate, and continuing
medical education. Medical students encounter the simulator early in their
curriculum and throughout their four-year course of study; the simulator program
has been further expanded to meet the needs of the Medical School's double-helix
curriculum. Residents from different departments participate in one-on-one
training sessions as well as realistic crisis management exercises. Medical
Center staff use the simulator to improve their skills in ventilator management,
ACLS, and conscious sedation. Multidisciplinary sessions allow participants to
improve their leadership, communication, and team resource management skills,
which are key components needed in managing medical crises.
Currently, the simulation center is owned and operated by the Department
of Anesthesiology, but its use has expanded far beyond one department.
Dr. David Stern,
an attending anesthesiologist, is the Director of the
Center and is responsible for the day-to-day operations of the facility.
Instructors who utilize the simulator in their teaching include faculty from
the departments of Anesthesiology, Emergency Medicine, Surgery, Medicine,
Pharmacology and Physiology, and the School of Nursing as well as staff from a
number of hospital services such as Respiratory Therapy.
During 2004, a multi-disciplinary Executive Advisory Board was formed to
assist the Simulation Center in developing enhanced internal and external
use of the Simulator Center and use financial profits from external use to
subsidize internal URMC academic and safety related programs. During the past
year alone, the Department of Anesthesiology contributed over $300,000 to
support programming, teaching, continued access to, and upgraded systems for,
the Simulation Center for URMC and the community.
Top
Medical Simulation - A Perspective
Simulation technology has already demonstrated its value in medical
education and in clinical and education research. It is now poised to fill a
key role in medical practitioner credentialing and patient safety initiatives.
Medical simulation offers educational advantages as an adjunct to
traditional teaching with patients. With simulation, there is no risk to
patients, realistic clinical scenarios can be reproduced reliably for different
trainees, and rare but serious types of medical crises can be duplicated for
instruction in crisis management, allowing participants to hone their teamwork,
leadership, and communication skills.
Although many institutions have acquired simulators over the past
few years, patient safety training is most effective at the few dedicated
centers (including the University of Rochester) that allow for videotaping
and debriefing of team skills and clinical performance in crisis situations.
Although software upgrades and equipment maintenance and updates
are major expenses, the faculty and skilled personnel who run the simulator
are the primary long term cost for utilization of the Simulation Center.
Top
History of Simulation in the Department
1994: Loral (METI) Human Patient Simulator was purchased
Original simulation group: Drs. Alice Basford, Ashwani Chhibber,
Lindsey Henson, Andrew Lee, David Stern, and Barry Zimmerman
1995, 1996: U of R Anesthesiology Dept. held the first International
Simulation conferences in Rochester (focus on anesthesiology at first, later
generalized to other medical fields)
1997: Simulator Engineer hired, partnership with Siemens
1998: Joint Simulation meeting with
Society for Technology in
Anesthesia; Opening of new
UR Center for Medical Simulation;
MCIC grant awarded
1999: Team-based Crisis Resource Management for Medical Resuscitation
("Blue 100") Teams;
Joint Simulator meeting with
Society for Education in Anesthesia;
Dougherty grant awarded
2000: Medical center-wide use of the simulator
2003: Based on programs developed with MCIC and Dougherty education
grants for Patient Safety Initiatives, Blue-100 Medical Resuscitation Team
training becomes formal part of Internal Medicine Resident curriculum, and OR
team training becomes formal part of Anesthesiology Resident Curriculum
2004: TeamBuilding exercises developed and tested with Simon School
and Warner School leadership groups, as part of an exploration of potential
corporate applications for medical simulation
2005: School of Medicine and Dentistry plans Surgical Simulation Center
to function cooperatively with the Rochester Center for Medical Simulation.
Revision of resident late shift schedule will allow resumption of weekly
simulation center cases.
Top
Current Usage of the Medical Simulation Center
"Blue 100" Team Crisis Training (Medicine and Anesthesiology Residents,
Nurses, and Respiratory Therapists). This group training for medical and
cardiopulmonary resuscitation (CPR) teams is now a standard part of the
educational curriculum for medical residents.
Operating Room crisis training (Anesthesiology and Surgery Residents,
Nurses, Technicians). Anesthesiology residents participate in at least one
intensive half-day course per year.
Advanced Cardiac Life Support (ACLS) using the full simulator
Conscious Sedation credentialing (Nurses and Physicians from
Gastroenterology, Radiology, Gynecology, and Reproductive Endocrinology)
Anesthesiology Department Uses:
- Management of complex and uncommon cases
- Difficult airway workshops
- Credentialing of first year residents for overnight call
- Physiology & Pharmacology demonstrations
- Anesthesia subspecialty case training (obstetrics, pediatrics)
- Supplementary training for residents from other specialties
(Dental and Surgical specialties, Emergency Medicine) taking anesthesia
rotations
- Sessions for medical students in the Anesthesiology Interest Group (AIG)
Users in Other Departments, URMC Groups, and the Community include:
Emergency Medicine resident training and research projects
Internal Medicine
Medical Students:
MS1: Human Structure and Function demonstrations
MS2: Integrated Systems, Comprehensive Assessment
MS3: Medicine/Surgery and Emergency Medicine Clerkships, Comprehensive Assessment
MS4: Seminar on Diagnosis and Treatment of Shock, Anesthesiology
Rotation (Introduction to Airway Management and General Anesthesia)
School of Nursing students
Hospital Staff: Respiratory Therapists, Registered Nurses (OR, PACU)
Industry: Training Sessions (Siemens, Arrow, pharmaceutical firms)
Public and Community Projects (Congressional Staffers, Friends of Strong,
Public School Students, College Students, Medical Center Board of Governors)
Recruitment of Medical Students and Residents
Legal Affairs - familiarization training in airway management
URMC Board of Trustees - familiarization with the benefits
associated with having the Simulation Center active and available for
improving patient care and safety
Top
Current Usage Summary (Historical Maximum Annual hours of actual simulator teaching time)
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Anesthesia Residents | 150 |
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Medical Students | 150 |
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Team Training (Blue 100, OR codes) | 100 |
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ED residents | 50 |
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Other staff | 50 |
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Industry, Public | 10 |
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TOTAL: | ~510 hrs/year |
Top
Limitations to Usage
Maximum Facility Availability: ~2,000 hrs/year
Actual Simulation Time is limited to ~1000 hrs/year due to extra time needed for:
Development and preparation of scenarios, patient charts, props, and supplies
Setup and breakdown of facility and associated equipment
Maintenance and repairs (downtime)
Faculty orientation and training
Scheduling efficiency: Staff and trainee availability
Faculty commitments to clinical service
Top
Increasing Utilization
Current utilization: 45%
Means to increase utilization
Industry applications and collaborations
Increased availability of faculty (dependent on clinical duties and
remunerative uses of the simulator that can support faculty academic time)
Increased availability of residents (dependent on work hours limits
and time left after other educational activities)
Administrative support (for scheduling, procurement, and reporting)
Increased simulator staff: programmer/technician (1.0 FTE), secretary
(.5 FTE), educator (1.0 FTE)
We maintain lists of Anesthesia Simulator
Users and Web Pages around
the world. Please notify
the Webmaster if you would like your program or web page added to
the list. Several new centers have been added in recent months!
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