In direct opposition to last week’s tongue in cheek poke at Medical Simulation of Olde, according to leadership and Director of MedStar SiTEL (and Human Factors Center at MedStar Institute for Innovation) Terry Fairbanks, MD, MS (@TerryFairbanks) “When the mission is patient first, you don’t try first on patients.”
One of the increasingly obvious missing links between patient safety and medical education is the opportunity for students to learn their skills in a safe and controlled environment–and that means safe for both patient and caregiver. Simulation offers that option, and is growing across the country, as well as at MedStar Health in the Washington DC and Baltimore areas, offering an affordable, interdisciplinary, safety-driven and effective training ground for care providers young and old.
In fact, Bill Sheahan, Managing Director of MedStar SiTEL recently announced that their team achieved a milestone, putting them among the elite in medical simulation training. The group was recently granted accreditation by the Society for Simulation in Healthcare (SSH) in the areas of Teaching/Education and Systems Integration: Facilitating Patient Safety Outcomes. Achievement of this milestone required both a comprehensive application and a full-day site visit by three experts in the simulation field who had the opportunity to tour MedStar SiTEL’s Clinical Simulation Center in DC, meet with program and institutional leadership, MedStar Health’s experts in systems integration and patient safety, subject matter experts who offer education and training sessions in the simulation setting, and learners who have attended sessions at one of MedStar SiTEL’s simulation centers. The application/site visit process also provided a wonderful opportunity for MedStar SiTEL to reflect on all they currently do daily to improve patient safety, as well as to learn from experts in the field.
To date there are just 41 centers who have received accreditation by SSH. MedStar Health has had a very robust OB/GYN simulation program, led by Tamika Auguste, MD, in place for some time. In fact, we have mentioned her MOST (MedStar Obstetrical Simulation Training) program here on ETY (see The Future of Medical Education...). With the success of rolling out the MOST program across all MedStar entities with OB/GYN services, the SiTEL team is now in the process of implementing simulation education for additional disciplines across the health system, such as pediatric and cardiac critical care.
While most envision simulation training to include the lifelike, talking mannequins pictured above, some of the most critical training that occurs in healthcare simulation revolves around teamwork and communication. Because communication has repeatedly been shown to be the largest contributing factor to medical harm, the rehearsal of these skills could not be more pivotal. The debriefing that occurs after a simulation at MedStar SiTEL is key, and participants engage in the follow up discussion as though it had been an actual event. Having observed a number of simulation training exercises at MedStar SiTEL firsthand, the professionalism of the leadership team pre-event was equally as impressive as the commitment of the learners to participate as though the event was occurring in real-time. For more information on MedStar SiTEL services, click here.
Stay tuned for Stories of Simulation to come!
…unfortunately, we barbers are not Gods. You know, medicine is not an exact science, but we’re learning all the time. Why just 50 years ago we would’ve thought your daughter’s illness was caused by demonic possession or witchcraft. But now a days, we know that Isabelle is suffering from an imbalance of bodily humors. Perhaps caused by a toad or a small dwarf living in her stomach…
…Perhaps I’ve been wrong to blindly follow the traditions and superstitions of the past centuries. Maybe we barbers should test those assumptions analytically. To experimentation and scientific method. Perhaps this scientific method could be extended to other fields of learning. Like natural sciences, art, architecture, navigation, perhaps I could lead the way to a new age. An age of rebirth. A Renaissance!
Whether or not these talented, SNL comedy sketch writers of the 70s knew how close to medical training they might be hitting, we would all like to trust that our own medieval barber of today has a few more practice rounds under his/her belt before taking one’s skills to the streets. Thanks to medical simulation training of today, an increasing number of resident physicians, medical and nursing students have already perfected their skills on life-like practice mannequins that talk and bleed with unsettling realism before practicing on patients–a practice all too common not very long ago. Not surprising that medical education would eventually catch up to the bar being set by the special effects capabilities of Hollywood action films, trainees who experience modern-day medical simulation will tell you how real some of these manufactured medical crises feel.
Stay tuned for stories from the frontlines of care on how medical simulation training can positively influence both patient and caregiver safety.
If you want to succeed, double your failure rate.
Thomas Watson, Founder–IBM
John Seely Brown, often referred to as JSB and former Chief Scientist at Xerox and Director of the Palo Alto Research Center (PARC), co-authored A New Culture of Learning: Cultivating the Imagination for a World of Constant Change. In the book, JSB and Douglas Thomas, associate professor at the Annenberg School for Communication at the University of Southern California, discuss the need for learning in this century and beyond to be collaborative, welcoming questions, and challenging what we “know” to be answers. From the book:
…in the new culture of learning the point is to embrace what we don’t know, come up with better questions about it, and continue asking those questions in order to learn more and more, both incrementally and exponentially. The goal is for each of us to take the world in and make it part of ourselves. In doing so, it turns out, we can re-create it.
The authors also talk about the need to embrace change, “looking forward to what comes next and viewing the future as a new set of possibilities, rather than something that forces us to adjust.” We don’t have to look very far to see the world changing much more quickly around us. The technology being developed is so intuitive, kids 5- and under can easily pick up an iPad or smart phone and navigate their way through the latest version of Angry Birds. JSB and Thomas provide examples of the 70 years it took from the discovery of a color TV signal in 1929 by Bell Labs to color TVs becoming ubiquitous in American homes, versus the exponentially faster adoption of internet technology (18% of households with internet access in 1997 to 73% in 2008). The tools we use in all business sectors, especially healthcare, are now more capable of harnessing large amounts of data that can drive solutions to questions that years ago may have seemed ridiculous, too “far out”, or even crazy.
So how does this all fit in medicine and medical education? The quote that led this post–“If you want to succeed, double your failure rate,” has no place at the bedside. But now, more than ever before, healthcare has a real need to solve the problems that are burying the industry with new thinking that comes from new learning. Simulation training and redesign of curriculum are two ways to address the needs not currently being met in medical education. But it goes deeper than that–as so many have said, the culture of medicine needs to shift. Medical students and residents have not only been bullied in their training by know-it-all mentors creating a learning environment that not only kills creativity, but the spirit as well. With all the discovery yet to be made in the sciences, how could one person think they “know” all the answers–wouldn’t it be best to view what is known as a starting place, and use it as a springboard to invite other intelligent, knowledgeable people into the conversation to take that baseline knowledge further?
In my maybe not-so-humble opinion, learning should embrace the not-knowing as well as the knowing. How we accomplish that in healthcare will take a shift–not only in thinking but in long-held beliefs as well. We don’t have the luxury of waiting for those afraid of change to leave medicine, and we don’t want to continue a stilted learning process that has proven to limit options. This change needs to be embraced today, and John Seely Brown’s book is both a lifeline and a roadmap. Please take a look at his keynote at Indiana University below, or pick up the book–I barely scratched the surface of the wealth of content contained within.
In a previous ETY post, Medical Education and Classrooms of the Future, I briefly touched on the value of simulation in training healthcare professionals. Academic medical centers across the country continue to funnel resources toward high-tech simulation centers that put providers–young and old–in learning environments that spare the patient as test subject and encourage skill mastery through practice. Others are complementing high-tech learning with team-based drills, allowing multidisciplinary teams to practice emergency procedures long before they are faced with a similar real-time event. One such center, SiTEL, is one of many entities within the MedStar Health system in the Washington DC and Maryland area that is helping redefine the science of safety through translational research, education and innovation.
Dr. Tamika Auguste, an OB/GYN physician, is one of several innovators within the health system. Auguste is training residents and fellows at the MedStar Washington Hospital Center and Georgetown University Medical Center, as well as OB/GYN providers throughout MedStar, using technological and team-based simulation of obstetric and gynecologic procedures and emergencies. Skill development is only part of the equation, as the ability to anticipate next steps and effectively communicate with patients, and as a team, is what elevates care to new levels.
What is truly amazing is not so much the current technology being utilized, as Auguste will tell you that low-tech solutions sometimes create a more realistic feel of being “inside the body”, but rather the results from her MOST (MedStar Obstetrical Simulation Training) program, and the related reduction in adverse events for Moms and babies. Tamika, amiable and happy to relate her efforts even post-call when we spoke, shared that the MOST program focuses on teams who need to complete a set of tasks in rapid order to save the life of a Mom or baby. Her energy and enthusiasm is infectious in and of itself, but the results showing a reduction in the number of shoulder dystocia events at her hospitals are worth smiling about–whether a provider or patient in a MedStar hospital for OB/GYN care.
A simple definition of shoulder dystocia, a sometimes unavoidable complication during childbirth, is a delay in labor due to the baby’s shoulder becoming lodged behind Mom’s pelvis. According to Auguste, the way a team responds to this occurrence is what can change outcomes for all involved. MOST training at all MedStar hospitals completed in 2012, and both brachial plexus injuries and clavicle fractures have been reduced overall. The Infant Mortality Rate (IMR=infant deaths/1000 births) in Washington DC has also declined from 13.1 in 2007 to 8.0 according to 2010 data. And while Auguste won’t take credit for the drop, the fact remains that in 2010 over half of all babies born in Washington DC came into the world at two of her hospitals (Washington Hospital Center and Georgetown University Medical Center).
MedStar programs to create simulation and training of obstetric procedures and emergencies reach deeper than just the training of healthcare providers and the care of Moms and babies within their own health system. In addition to MOST, the following programs Auguste oversees also reach into the local community, as well as the OB/GYN community across the US:
- Resident, Fellow and Midwife Simulation Labs
- Society of Maternal and Fetal Medicine Postgraduate Course Development
- ACOG Simulation Consortium Member
Community Outreach Partnership – Unity Healthcare
Special Moms/Special Babies (SMSB)
Teen Alliance for Prepared Parenting (TAPP)
MedStar Georgetown University Hospital – Girl Talk 2 Program
For more information on residency programs or OB/GYN simulation training, contact Dr. Tamika Auguste at MedStar Washington Hospital Center. Meanwhile, stayed tuned for future examples of medical education simulation and training–both high-tech and low-tech–and please share what you have found along the way.