The Smart Magazine About Medical Technology Innovations

#34 - Next Generation Training

Learning the Sim Way


Medical simulation centers are the classrooms of the 21st century. (Courtesy of Robert Benson)

Healthcare training is becoming increasingly high-tech and medical simulation centers are the classrooms of the 21st century.


Cutting-edge technology is not only leading to ground-breaking advances in medical research and treatment, it is also improving training techniques. High-fidelity, computerized “manikins” allow trainee doctors and nurses as well as working medical professionals to “practice on plastic” and hone their skills within scenarios that mirror real-life emergency situations. Google Glass cameras offer live links into operating theaters while virtual reality (VR) brings expertise from the gaming industry so learners can practice within a digital world.

According to the experts, simulation is the way forward. It decreases learning curves, improves patient safety and allows trainees to ask questions and learn from mistakes.

Lynne Farrow, simulation educator at the US $6.8 million Johns Hopkins Medicine Simulation Center, which opened in Baltimore last year, explained: “We are caring for patients and their families, and having opportunities to practice in a safe environment can improve skills and bedside care.

GAPS Simulation Center (Courtesy of GAPS)

“Healthcare professionals can better prepare for low frequency, high-risk events, such as cardiac arrests or cricothyrotomy, and having a space to ask questions and get hands-on time with medical equipment is beneficial.”

High-Fidelity Manikins

Like other sim centers, Johns Hopkins has manikins that breathe with sounds, have heart tones and palpable pulses. They are fitted with monitors that display electrocardiograms, pulse oximeters, blood pressure, arterial waveforms, pulmonary artery waveforms and anesthetic gases. Procedures such as bag-mask ventilation, intubation, defibrillation and chest tube placement can be performed.

“Our staff come into a simulated clinical room and care for their patient in the bed,” Farrow said. “They are expected to respond to vital signs on a simulated patient monitor and provide medical treatment based on these changes. We are observing the scenario to see if they respond in an appropriate manner. If they fail to respond accordingly, we then debrief the event and provide feedback.”

High-fidelity manikins at GAPS simulation center (Courtesy of GAPS)

Many sim centers also heighten the level of realism by connecting speakers in the manikins to microphones in adjoining rooms. These may be staffed by actors who can answer questions, offer patient histories and mimic pain and panic.

Johns Hopkins has manikins that breathe with sounds, have heart tones and palpable pulses.

Founder and Head of St George’s Advanced Patient Simulation & Skills Centre (GAPS) in London, Nicholas Gosling, explained that their high-fidelity manikins connect to all hospital equipment to enable medical device training. And they don’t even need to be in the GAPS center itself: “We have created an army of mobile simulators that can be taken out into the clinical environment,” he said. The benefit here is that staff can practice within the exact setting they will be in when required to use their skills.

The mobile simulators have been taken to medical centers in Greece and China, and have been used in the training of fire crews. GAPS is firmly focused on developing its use of technology in training, Gosling emphasized: “We do live link surgery where people can watch from the lecture theater and even talk to the surgical team.”

“We have a 360-degree camera connected, but the next stage will be to have the surgeon wearing Google Glasses so everyone can watch the operation from his or her perspective.”

Valuable Lessons

The medical world is learning the value of simulation in training from industries such as aviation and oil and gas, said Dr. Jack Pottle, medical director at Oxford Medical Simulation. A practicing doctor in acute medicine, and a medical trainer, he launched the company in 2016 to focus on VR for healthcare training. His team has developed software that works via Oculus Rift headsets, to immerse learners in virtual scenarios with fully interactive “patients.”

Abdominal exam at Oxford Medical Simulation (Courtesy of Oxford Medical Simulation)

It is already being used for training by Oxford University and discussions with institutions in the US are underway. “This is professional gaming which allows us to recreate any medical scenario in high definition,” he said.

“This is professional gaming which allows us to recreate any medical scenario in high definition.”

“The learner can interact with the patient, perform investigations, instigate treatment and work with an interdisciplinary team. We believe it has advantages over manikins in the amount of physical space required, the time it takes to get people through the scenarios and the cost.”

“Once the hardware and license have been bought, it costs about US $10 compared to US $400 for one person to complete a scenario.”

Oxford Medical Simulation will soon launch a multi-player version, where trainees can take on different roles and interact with each other. The company also eventually hopes to integrate voice recognition technology. “At the moment, it is just not good enough and can therefore cause an interruption or delay within the medical scenario,” said Pottle.”But the technology will come up to speed—and when it does the VR characters will be able to respond to the player’s voice and then the ability to train this way will become even better.”

About the Author

Abigail Saltmarsh is a freelance journalist with 25 years’ experience for national magazines (The New York Times, International Herald Tribune).

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