From simulation to practice for doctors

For Ashlee Holman, M.D., innovation in education begins with a simple but powerful question: how do you prepare clinicians to do something well before they ever have to do it under pressure in clinical practice?

As an Associate Professor of Anesthesiology at Michigan Medicine, Holman has spent years advancing the use of awake spinal anesthesia for infants and young children.

This technique can reduce perioperative risk, shorten recovery time, and improve outcomes for some of the youngest surgical patients.

But as she helped establish this clinical practice, she began to see another challenge emerge–while the technique was effective, opportunities to learn it were limited.

“Awake pediatric spinal anesthesia is not something most residents encounter during standard training,” Holman said.

“At some institutions, even pediatric anesthesia fellows may graduate without ever seeing one performed, let alone gain enough experience to feel comfortable enough to do the procedure themselves independently.”

That gap in training became the catalyst for a new kind of innovation, one centered not on the operating room itself, but on how clinicians learn before they ever step into it.

Using an Innovations Research Grant from the University of Michigan Medical School’s Graduate Medical Education Office, Holman designed a structured training pathway that pairs formal instruction with hands-on simulation and progressive clinical exposure.

The program focuses on teaching the full pediatric spinal anesthesia process, from patient positioning and anatomical recognition to needle handling, medication delivery, and team-based stabilization techniques that are rarely covered in standard residency training.

Building confidence before the first case

The training program is designed to introduce pediatric spinal anesthesia through a deliberate, stepwise learning process.

Rather than relying on first attempts at pediatric spinal anesthesia in a stressful operating room, trainees begin by learning positioning, anatomy, and technique in a calm simulation environment, where they can practice repeatedly, receive feedback and refine their approach before transitioning to supervised clinical cases.

“In adult anesthesia, you can talk a patient through what you are doing. You can ask them to stay still. With infants, that is not an option," said Holman.

"They are moving, they are crying, and the margin for error is much smaller. Simulation gives learners a chance to build muscle memory and confidence before they perform the procedure on an actual patient.”

Bringing the training to a national scale

What began as a local educational effort has grown into a model with both institutional and international reach.

Within Michigan Medicine, pediatric spinal anesthesia has expanded from a single urologist to include multiple surgeons in urology, as well as pediatric surgery, plastic surgery, and orthopedic surgery.

The program has also been extended to Sparrow Hospital in Lansing, allowing children there to benefit from the technique.

“One of the most rewarding parts of this journey has been watching people take this back to their own institutions and build something new,” said Holman.

“I’ve mentored faculty starting spinal programs at institutions such as St. Vincent in Toledo, Henry Ford Hospital and Corewell Health in Metro Detroit, University of Utah, Pennsylvania State University, Medical University of South Carolina, AIC Kijabe Hospital in Kenya, and others. Seeing them adapt it to their teams and patients in ways we hadn’t imagined makes the work feel bigger and more impactful than anything we could do on our own.”

Learning that changes practice

That confidence, built through structured training and deliberate practice, is a critical part of patient safety.

“When clinicians feel prepared, they are more focused, more precise, and better able to respond to what is happening in front of them,” Holman said. “That is good for learners, and it is even better for patients.”

“At its core, this work is about access to knowledge, to training, and ultimately to safer care,” said Holman.

“If we can help more clinicians feel confident and prepared, then we are doing something meaningful.”

Learn more about innovation in medical education at the University of Michigan.