By ROSANNE SPECTOR

This notion, offered by associate professor of surgery Sherry Wren, MD, at a workshop last week on simulators in medical education, crystallized the technology’s potential to revolutionize the medical school experience.

The "baby" has stopped breathing in a simulation at the Center for Advanced Pediatric Education. To keep their patient alive, William Rhine, MD, (from left), nurse Kristen Braccia and nurse practitioner Kristi Boyle, place an airway in the mannequin’s trachea. The role of simulation in learning was explored in a roundtable last week. Photo: Steve Fisch

Parvati Dev, PhD, associate dean for learning technologies and director of the SUMMIT lab; LeRoy Heinrichs, MD, emeritus professor of gynecology and obstetrics, now at SUMMIT; and Maggie Saunders, education program and project planner, organized the roundtable event to stimulate thinking on simulators, also known as immersive learning tools. Several such tools are planned for Stanford’s new medical knowledge center, or SMILE. The event was the second in a series of symposia on the use of technology in education.

The plans for SMILE dedicate one full floor to immersive learning facilities. While the completion of the 120,000 square-foot building isn’t expected until 2008, program planning should start now, said Dev.

Traditional medical training takes students straight from their lectures and books into the clinic. But in recent years, medical simulations have moved into the training sequence.

Many schools allow medical students to practice examination skills on an actor who presents with problems they would expect to see in a real patient. Stanford students also practice gynecologic pelvic exams on "ePelvis," a model with realistic internal organs equipped with sensors that give students feedback on whether they’ve touched the right part. And two full-fledged simulation centers provide select students and residents the chance to practice crisis management skills — an adult patient simulator at the VA Palo Alto Health Care System directed by anesthesiology professor David Gaba, MD, and a pediatric simulation center in the Stanford Barn directed by associate professor of pediatrics Lou Halamek, MD.

Simulators are poised to play an even larger role in medical training, said the six roundtable panelists, all leaders in simulator use. They gathered at the Clark Center before an audience of about 45 students and faculty to discuss the future of simulators. Among the points raised during the roundtable:

• You could almost imagine a training sequence in which students don’t even go into the hospital, said Wren. "Should we be aiming for that? Now we use simulation as a tool. Should we make it our platform for our students?"

• Tactics used by the computer-gaming industry to snare players could work to hook students on simulator learning. Social pressure and comparisons with other players are key, said panelist Laura Kusumoto, a producer at the online gaming company There Inc. "One interesting thing to think about in education is how this might level the playing field for teachers and students," she said.

• "In the future, a medical education will not be a fixed period of time. It should be criterion based," said panelist Richard Satava, MD, medical simulation pioneer and professor of surgery at University of Washington School of Medicine. Once the criteria are established, said Satava, simulators will allow teachers to test the students in a standardized manner.

• "In addition to evaluating students, it’s important to evaluate simulators. Immersion is a powerful tool. You want to make sure it’s training the right thing," said panelist Mike Van Lent, PhD, a simulation developer at the University of Southern California.

• "So far, we’ve been focused on teaching skills. But surgery is much more than that. It’s decision making, coping with the flow of information, identifying potential problems," said surgeon Anders Hyltander, MD, president of Surgical Science AB, a simulator developer based in Sweden. "The technology is now so immature. But I expect in a year or two you will see material on decision making in simulators."

In the breakout sessions, faculty explored the possibilities and challenges for simulators in various educational realms: preclinical and graduate, clinical, house staff, postgraduate and allied health-care provider education.

The group addressing issues of preclinical and graduate education viewed faculty unfamiliarity with new technology as one of the biggest challenges, said Neil Gesundheit, MD, associate dean of medical education, who served as that group’s facilitator. "To convert the faculty, the new technology must work flawlessly, be intuitive and must provide clear advantages over the way we teach."

And despite the use of technology, the classroom needs to maintain a human connection, said Gesundheit. Among his group’s conclusions: "Ideally, technology will be used by faculty to bring the material to life much more so than in many of today’s sterile classrooms."

New center innovates teaching through simulation (11/13/02)

E-Pelvis builds student skills in
difficult-to-learn procedure (3/6/02)

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