Medical Simulation-Based Training: The Future of Health Care

Health care is always evolving, which means the various modes for training future health care professionals are ever-changing as well.

Over the last 15 years, clinical simulation as a training modality and performance-improvement tool within health care has taken off. While older, more traditional learning mechanisms, like lectures, apprenticeships and practice-based learning, continue to provide students with the foundational knowledge required for future success, simulation-based training has truly revolutionized medical education.

"Michigan Medicine was one of the first academic health centers to launch an interdepartmental simulation center," says James M. Cooke, M.D., executive director of the University of Michigan's Clinical Simulation Center (CSC). "And its rapid growth and evolution has been both disruptive and transformative for the institution's educational programs."

The history

Launched in 2004, the CSC began as a 1,500 square-foot renovated classroom with two team-training bays and a handful of surgical and procedural simulators, including laparoscopy and endoscopy. It only served a few hundred learners per year and provided simulation-based education to graduate medical education students across the institution.

"Unlike centers at most other institutions, the CSC was developed as a unique collaborative with hopes of maximizing our investment in emerging technologies," says Cooke. "This included leveraging the integration of high-fidelity procedural and patient simulators within the center."

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Soon after the center's launch, a total of 11 clinical departments, including anesthesiology, emergency medicine, family medicine, internal medicine, neurosurgery, obstetrics & gynecology, orthopedic surgery, otolaryngology, pediatrics, surgery and urology, adopted integrated tools within the CSC to help students attain skills in bedside task-training, surgical procedures, and respiratory and anesthetic-related emergencies.

The CSC's administrative home is in the Department of Learning Health Sciences, and its six core faculty members support a robust portfolio of simulation-based research, education and service. Both faculty and staff from the CSC are frequent visitors at the center's two locations, as their visits provide them with opportunities to engage in team training, code drills and skill-based activities.    

"When we first started assessing the impact of the CSC on our students, it became increasingly clear that they were showing rapid improvement levels in some very critical areas," says Cooke. "This, coupled with generally positive feedback from our learners and measurable improvements in patient outcomes (when observed in hospital-wide simulation intervention studies), helped fuel a rapid interest in expanding the center, itself."

A notable year

This year marks the CSC's 15-year anniversary, which has grown dramatically over time. It now provides training for over 12,000 visitors every year, while employing a wide range of procedural simulators within its over 13,500 square feet of dedicated simulated learning space.

"We're so proud of how this center has grown," says Cooke. "It now spans two locations and has nine simulated clinical rooms, which closely match those across Michigan Medicine."

In February of 2018, the CSC expanded into Medical Science Building II of U-M's medical school and now includes five purpose-built inpatient rooms. Each room is designed to house audio and visual capabilities, as well as electronic medical record (EMR) access to provide students with fully immersive EMR-enabled training opportunities.

October marked the grand opening of the 3D & Innovations (3DI) Lab at the Medical Science Building II location. This venture, led by Deborah M. Rooney, Ph.D., director of education and research in medical simulation at the CSC, is staffed by a small team of biomedical engineering students.

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"The 3DI Lab works with collaborators from across Michigan Medicine to design, prototype, test and refine novel simulation teaching tools," says Cooke. "It's a really innovative enterprise."  

In addition, the CSC now offers high-fidelity clinical simulators that cover a broad range of procedural skills, including laparoscopy, endoscopy, bronchoscopy, robotic surgery, intravascular procedures (i.e. endovascular aortic repair and trans-catheter aortic valve replacement), cardiac catheterization and many others.

"We also make sure that the CSC is accessible to students 24 hours a day, seven days a week," says Cooke. "This is in an effort to provide our learners with the maximum value of the center's resources."

Lasting effects

While U-M researchers continue to study the residual impact of clinical simulation-based training on undergraduate, graduate and continuing education programs, it's important to note that medical simulation has widely become accepted as an effective form of education for both applied knowledge and complex task and procedural skills-based training.

And beyond educational outcomes, U-M researchers have also evaluated the direct benefits of simulated team training for Michigan Medicine's patients.

"One specific example of sustained improvement among our patients includes an improved pediatric cardiac arrest survival rate at C.S. Mott Children's Hospital," says Cooke. "Research revealed that when simulated mock arrests were conducted at the beginning of each month over the course of three years, there was a significant improvement in survival rates, which far exceeded the national survival rate for in-hospital pediatric cardiac arrests."