Download Wikipedia Article on Medical Simulation

Wikipedia Article on Medical Simulation- Examples from
IDS5717 and IDS6147 Classes
The main purpose of medical simulation is to properly educate students in various fields through
the use of high technology simulators. According to the Institute of Medicine, 44,000 to 98,000
deaths annually are recorded due primarily to medical mistakes during treatment.[4] Other
statistics include:
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225,000 deaths annually from medical error including 106,000 deaths due to "nonerror
adverse events of medications" [5]
7,391 deaths resulted from medication errors
If 44,000 to 98,000 deaths are the direct result of medical mistakes, and the CDC reported in
1999 that roughly 2.4 million people died in the United States, the medical mistakes estimate
represents 1.8% to 4.0% of all deaths, respectively.[6]
A near 5% representation of deaths primarily related to medical mistakes is simply unacceptable
in the world of medicine. Anything that can assist in bringing this number down is highly
recommended and medical simulation has proven to be the key assistant.
Examples
The following is a list of examples of common medical simulators used for training.[7]
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Advanced Cardiac Life Support simulators[8]
Partial Human Patient Simulator (Low tech)
Human Patient Simulator (High tech)
Hands-on Suture Simulator (Low tech)
IV Trainer to Augment Human Patient Simulator (Low tech)
Pure Software Simulation (High tech)
Anesthesiology Simulator (High tech)
Minimally Invasive Surgery Trainer (High tech)
Bronchoscopy Simulator
Battlefield Trauma to Augment Human Patient Simulator
Team Training Suite
“Harvey” mannequin[9] (Low tech)
Much of the content contained in this excerpt from the Wikipedia article on Medical Simulation came
from students in the introductory courses of the Modeling and Simulation Graduate Program at the
University of Central Florida from 2007-2012.
Advantages
Studies have shown that students perform better and have higher retention rates than colleagues
under strict traditional methods of medical training. The table below shows the results of tests
given to 20 students using highly advanced medical simulation training materials and others
given traditional paper based tests. It was found that high technology learning students
outperformed traditional students significantly.[10]
E-Learning vs. Textbook Learning[10]
Mode of Learning
Mean Test Score on Multiple Choice
Test
Time to Complete
Module
E-Learning (N=20)
4.03 / 5 (80.6%) "B"
28–30 minutes
Traditional Paper
Based
3.05 / 5 (61%) "D"
28–30 minutes
Significant Difference
Yes (p < .001)
N/A
In addition to overall better scores for medical students, several other distinct advantages exist
not specifically related to training.
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Less costly
Time efficient
Less personnel required
Many automated processes
Ability to store performance history
Track global statistics for many linked medical simulators
Less medical related accidents
Military and emergency response
One of the single largest proponents behind simulators has always been the United States
government. Billions (and perhaps trillions, at this point) of dollars have been spent in the name
of advancing simulators for space exploration, computer advancements, medical and military
training, and other projects funded for research by the government. The Department of Defense
(including the military ser4vices) is one of the largest fund producers for simulation research,
training, and support. As such, most simulators tend to be created for military purposes including
soldier, tank, and flight training in combat situations. In terms of medical simulation, military
applications have played a large part in its success and funding. Some examples of scenarios
useful for medical applications include casualty assessment, war trauma response, emergency
evacuations, training for communications between teams, team/individual after action
assessment, and scenario recreation from recorded data.
Combat trauma patient simulator
Full Process of Casualty Assessment in Combat Simulation[11]
Electronic Casualty Combat Trauma Patient Human Patient
Patient Simulator
Card
Simulator
Simulator
Software
Combat Trauma Patient
Simulator (CTPS):
"Casualties" that
Human Patient
This network based
Integrates the training &
occur during military
Simulators (HPS)
application, which is
analysis of medical
force-on-force
are fullscale, fully physiologically similar
personnel in treatment
training are initiated
interactive
to the HPS, models and
processes with military
on MILES II/SAWE
simulators used to queues casualties to be
force-on-force exercises,
Electronic Casualty
train healthcare
treated when an HPS is
creating a realistic and
Cards (ECC)
practitioners
available
complete battlefield
environment
The Combat Trauma Patient Simulation Program is perhaps the most vast in terms of processes
and people involved at one or sequential times. According to Kincaid, Donovan, and Pettitt, the
CTPS program has been created in order to assess and analyze the feasibility of simulation in a
battlefield environment.[12] Combat casualties, massively destructive outbreaks, chemical spills,
gas leaks, and other forms of large scale negative events can be accurately simulated in a safe,
inexpensive, and relatively small environment.[13]
One of the rather large advantages to such a massive simulation of intertwining processes is the
fact that people ranging from the field medics all the way up to the hospitals located in key
military bases receive proper training for potential casualty prevention. The process of
simulation begins with the Point of Injury and leads into Casualty Collection Points, Ground
Medical Evacuations, Medical Aid Stations, and finally Hospitals.[12] Another advantage is that
all casualties can be monitored through high-tech computer software and GPS receivers located
in medical vehicles and in key medical clothing. By monitoring such data, leaders can be aware
of which areas in the flow needs to be sped up, slowed down, moved to a different format, or
removed completely. The flow between the Point of Injury and Hospital is required to be
uninterrupted if a successful goal is to be met.
Live field exercises are another benefit of the CTPS program. By allowing many individuals to
engage in a “live fire” simulation, people can become acquainted with the processes involved in
transferring duties among team mates in order to keep the flow moving between locations. While
there is the chance of these simulations not inspiring true dedication into the actions of some
participants because it is not necessarily a real disaster, the truly dedicated individuals will shine
in their ability to remedy the destruction. Leaders can spot weaknesses and strengths in the
participants of the simulation without worrying about every single piece of the simulation. In a
real disaster, leaders would need to concentrate on individual success, team success, and overall
progression. Alternatively, in a simulation of exactly the same event, the leaders could ignore
certain areas in order to concentrate on the individuals involved in order to analyze weaknesses.
Overall, the CTPS program is beneficial to everyone involved due to cost savings, risk reduction,
personnel safety, enhanced effectiveness, and reduction of the learning curves.
CTPS contains many different technologies and smaller simulations within the rather gigantic
“mother” simulation. Because the smaller simulations are potentially developed by separate
companies (at times even competing companies), the interfaces have the high chance of being
non-communicative or are simply incompatible without some sort of translation between the
competing interfaces. All of this integration is made possible through a highly researched and
deeply developed High Level Architecture containing interface modules to link up incompatible
parts of the complete CTPS process.[14]
The simulation federates (subsystems) of the CTPS involves the Lockheed Martin MILES
system, the Operational Requirements-based Casualty Assessment system (ORCA), the Jackson
Medical Simulation library (JMSL), and the Human Patient Simulator (HPS).[12] By combining
these systems together, trainees can be contained to their respective areas of study while also
studying the possible hindrances between stages of transition.
Beginning the military casualty treatment simulation is the MILES engagement simulator, which
accurately simulates gunfire and other combat engagements.[15][16] When trainees under the
simulated engagement system fire upon each other and register virtual hits, the simulated
casualties are moved to the next stage.[15][16] At first glance, this system may seem similar to
entertainment driven laser tag centers found within urban cities of the United States. But after a
deeper look, the overall training that a user would go through involves much more than pointing,
shooting, and laughing at the outcome. Proper combat procedures can be taught to single users,
team based squads, or larger squads. Obvious advantages to this approach include reductions in
physical harm to trainees, increase in physical realism by tagging individuals as “dead,” and
providing immediate feedback to users who score a hit. While the MILES training system is not
necessarily a medically based simulation; however, it is completely necessary to begin the
process into medical procedures. Without proper combat engagement, realistic casualties and
injuries cannot be simulated and cannot be transferred into the beginning medical stages in a
manner that would provide meaning to a medical trainee.[14][15][16]
The next stage involves casualty assessment based on results driven by simulated engagements
under the MILES system. Any and all casualties are transferred to the ORCA stage, given initial
wound assessments, put into an initial medical state (severe, critical, dead), and finally passed on
to the JMSL. Under the JMSL, all casualties generated by MILES and assessed initially by
ORCA are sent through transition phases in order to accurately simulate a casualty progressing to
a more and more deadly state while awaiting treatment under average circumstances.[14]
After casualties have been generated, processed, and sent through various stages, actual training
under a medic or doctor can be attained through the HPS. By using a physiologically realistic test
dummy, users can treat a patient and receive immediate, accurate feedback regarding the results.
Using this approach, users can engage in proper medical training as if a live patient was being
used without subjecting the patient to physical harm in the case of accidents. From a financial
standpoint, the entire system offers a cheaper alternative to throwing untrained medics into a
potentially hazardous and live situation. On the job training simply does not cut it when it comes
to lives and equipment on the line.[14]
1. ^ a b c d e f Chakravarthy, Bharath. Academic Resident. Medical Simulation in EM Training and
Beyond
2. ^ Ahmed K, Jawad M, Abboudi M, Gavazzi A, Darzi A, Athanasiou T, Vale J, Khan MS, Dasgupta P.
Effectiveness of Procedural Simulation in Urology: A Systematic Review. J Urol. 2011 May 13.
PMID 21571338
3. ^ Milburn J, Khera G, Hornby ST, Malone P, Fitzgerald JEF. Introduction, Availability and Role of
Simulation in Surgical Education and Training: Review of current evidence and
recommendations from the Association of Surgeons in Training. International Journal of Surgery
(2012), doi:10.1016/j.ijsu.2012.05.005
4. ^ Institute of Medicine (IOM), "To Err Is Human: Building a Safer Health System", 2000,
http://www.nap.edu/books/0309068371/html/.
5. ^ Barbara Starfield, MD, MPH, Is US Health Really the Best in the World?, JAMA, Volume 284,
No. 4, July 26, 2000, http://jama.ama-assn.org/issues/v284n4/ffull/jco00061.html
6. ^ How Common Are Medical Mistakes? (2008). Retrieved November 30, 2008, from
http://www.wrongdiagnosis.com/mistakes/common.htm
7. ^ Kincaid, J.P. & Khaled, A. (2008). Presentation on Medical Simulation. Institute for Simulation
and Training, University of Central Florida.
8. ^ Simcode ACLS - web-based simulator and certfication tool for ACLS training
http://www.simcodeacls.com
9. ^ Cooper Jeffery B, Taqueti VR (2008-12). "A brief history of the development of mannequin
simulators for clinical education and training". Postgrad Med J. 84 (997): 563–570.
doi:10.1136/qshc.2004.009886. PMID 19103813. Retrieved 2011-05-24.
10. ^ a b Kincaid, Bala, et al. (2001), IST-TR-01-06. Effectiveness of Traditional vs. Web-based
Instruction for Teaching an Instructional Module for Medics.
11. ^ Combat Trauma Patient Simulator. (2008). US ARMY PEO STRI. Retrieved November 30, 2008,
from http://www.peostri.army.mil/PRODUCTS/CTPS/
12. ^ a b c Kincaid, J.P., Donovan, J., & Pettitt, B. (2003). Simulation Techniques for Training
Emergency Response. International Journal of Emergency Management.
13. ^ Jaganathan, B., Kincaid, J.P., & Kimrey, S. (2002). Interoperable Surgical Simulation: Hands-on
Medic Training for Common Battlefield Scenarios.
14. ^ a b c d Petty, M. D., Windyga, P. S. (1999). A High Level Architecture-based Medical Simulation
System. SIMULATION, 73, 281-287.
15. ^ a b c Miles Shootback Device (MSD). (2008). Retrieved November 30, 2008, from
http://www.lockheedmartin.com/products/MILESShootbackDevice/index.html
16. ^ a b c Multiple Integrated Laser Engagement System (MILES XXI). (2008). Retrieved November
30, 2008, from
http://www.lockheedmartin.com/products/MultipleIntegratedLaserEngagement/index.html
17. ^ Ziv, A., Ben-David, S., & Ziv, M. (2005). Simulation Based Medical Education: an opportunity to
learn from errors. Medical Teacher, 27, 193-199.
Further reading
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http://www.rightdiagnosis.com/mistakes/common.htm
http://www.nap.edu/openbook.php?isbn=0309068371
http://www.saem.org/sites/default/files/Medical%20Simulation%20in%20EM%20Training%20a
nd%20Beyond.pdf