In the second in a series of articles on medical simulation centers, Group Editor Marty Kauchak explores developments in the technologies used by these facilities’ learners.

One End User’s Insights

The burgeoning number of medical simulation centers around the world supports nothing less than a transformation in the healthcare community’s learning programs. These facilities allow individuals and teams to learn and rehearse their skills in a simulated environment until they achieve prescribed levels of proficiency or certification.

One foundation of healthcare providers’ training experiences at these facilities is a blend of learning devices and systems. This community, much like its counterparts at training centers for different military occupational specialties, civil aviation aircrews and other high risk occupations, learns skills and procedures through a “crawl-walk-run” process, with different technologies guiding learning at the next level.

The Palmetto Health – University of South Carolina School of Medicine Simulation Center is one representative facility that integrates learning technology into its curricula. The luster on the center’s brand increased last September, when the Columbia-based facility was granted a 3-year accreditation by the Society for Simulation in Healthcare. This accreditation was a significant accomplishment and a testament to the quality education at the center. The simulation center was the 22nd program in the world to achieve the society’s accreditation.

Eric A. Brown, MD, FACEP, pointed out that there is a blend of products at the simulation center, with devices providing instruction for disparate patient cohorts, from premie babies, to neonates, to adolescents and adult models.

Brown, who is dual-hatted as the director of the center and a faculty member in the Department of Emergency Medicine, further told MEdSim that his facility is “brand neutral”, in that it selects the best model for each particular educational endeavor with standardization as a secondary concern. “Towards that end we have a blend of Laerdal, CAE-METI and Gaumard products. Similarly our task trainers include a number of vendors’ products from Blue Phantom, to Limbs & Things to Laerdal,” he said.

The Palmetto Health – University of South Carolina (USC) School of Medicine Simulation Center has a deliberate strategy to match its requirements with fielded products. Brown said his colleagues decide what the goals and objectives are for each project or course offering they are supporting and then find the best simulation technology to meet that need. “We avoid getting into the trap of building curriculum around a simulator's capabilities. As our older equipment becomes obsolete we do scan the marketplace for the latest technologies, but we will only justify that purchase if our customer demands or special initiatives call for the model in question.”

Similar to other facilities around the globe, the Palmetto Health – USC center plans to add more simulators this year to support expanded operations. The center’s mobile simulation platform will be operational by mid-year. “Additionally, we have a third hospital opening at the end of 2013 which we will also need to support with additional simulation equipment and personnel,” Brown pointed out.

Blend of Technologies

Learning devices at the Palmetto center and other community venues provide a range of capabilities. On the low-end side, an observer may find SimScreen, which MEdSim learned about in early 2012 on the exhibition floor of a community conference. Joseph Burns, the president of Appleton Inc., SimScreen’s manufacturer, said the idea for the product and its design were generated by his wife Holly, who teaches Nursing and Nursing Simulation at Cecil College in Maryland. “She observed that simulation works best if you can create a realistic environment for the student nurse. Most students were always more concerned with her and what she was doing to operate the mannequin.” So not wanting the students to constantly be “cueing” on her actions she came up with the SimScreen concept.

Burns said SimScreen is a commercial, mobile panel with a two-way mirror that one could use throughout the simulation lab and, when finished, put away

Some new developments that Appleton Inc. is working on include a sound panel which can help in noise reduction when used with the SimScreen.

Innovation is occurring in other spaces within this sector.

CAE Healthcare (CAE) is reported to have the widest breadth of healthcare simulation products in the industry, and has sold 7,000 surgical, imaging and patient simulators around the globe, according to Kim Cartlidge, the company’s marketing communications manager. Cartlidge recalled CAE’s “HPS (Human Patient Simulator) was one of the first commercial simulators on the market 16 years ago,” and said it is still considered “the gold standard today.” The HPS can breathe in oxygen and breathe out CO2, interface with real clinical monitors and be used with real anesthetic gases to train anesthesiologists.

Cartlidge also noted how CAE’s products are tailored to the end users’ requirements. In the case of the HPS, the simulator is “helping medical schools meet American College of Graduate Medical Education requirements for simulation practice. Practicing anesthesiologists meet part of their Maintenance of Certification in Anesthesia requirements through high-fidelity patient simulation training, often with the HPS.”

The industry is also responding to the requirement to deliver devices for team training.

CAE’s iStan and METIman wireless simulators, for instance, remain very popular in simulation centers in colleges that are training interdisciplinary teams (such as paramedics, nurses and health sciences students) in one scenario, and hospitals that are practicing code responses or testing new procedures or facilities.

Systems Level Insights

Another evolving commonality between medical simulation centers and similar venues in other high risk industries, is their embrace of technology solutions at the systems level – which permit integration of individual and other level devices.

It should come as little surprise that CAE’s fastest growing product is not one of the previously discussed devices, but rather a simulation center management system called LearningSpace, which allows centers to capture simulation on video for debriefing. “LearningSpace helps center managers schedule and assess learners and store data from one room, up to 25 different rooms at once, or among multiple simulation centers in different locations (such as on different college campuses within the same system),” Cartlidge explained.

In this same product space, B-Line Medical’s product line of digital solutions, which capture, and allow debriefing and assessment of medical training and events, also continues to evolve.

One of many products which may be found in service around the globe is B-Line’s SimCapture®, which combines up to four channels of synchronized video, native resolution video capture of medical devices, simulator physiological trending and powerful annotation / assessment tools into a single 100 percent, web-based solution. Sandy Yin, a marketing strategist at the company, pointed out such an all-encompassing recording of an encounter enables more accurate, objective review and debriefing of scenarios. “We think this type of recording, bundled with powerful administrative functions such as assessment and report-generators and organization of participant portfolios means measurable improvements in learner outcomes,” she added.

SimBridge® is what the company calls the “backbone” of the simulation and clinical skills center. SimBridge® centralizes all SimCapture® activity and allows for the addition of powerful software modules such as the Central Control Module (CCM), assessment, courses, scheduling, and Lightweight Directory Access Protocol integration. “SimBridge® increases accessibility and integration resulting in significant return on investment and allows users to more easily coordinate a large center, and increase ease of use for a larger number of learners and administrators,” Yin said.

Since 2011, B-Line Medical® has released several product updates, resulting from a need to unify its Clinical Skills® and SimCapture® platforms.

As B-Line wanted to make it easier for these programs to team up, and make it easier for hybrid centers to operate, the company released the aforementioned CCM in January 2012. Yin told MEdSim the module allows clear, complete administration of simulation programs, standardized patient programs, or a fusion of both. “With CCM, administrators can control large centers with a single user interface, automate workflows and recordings, and even communicate with each room using an integrated messaging function.”

B-Line used the SimCapture platform as a building block for other products when it saw a need to provide a solution that was more flexible, portable, and affordable while still fully capable of capturing a wide variety of simulation activities. “That’s why we came up with SimCapture® Ultraportable. SimCapture® Ultraportable is fully compatible with B-Line Medical’s existing product line and is built on the exact same recording platform that has made SimCapture® the choice of more top-tier medical institutions than any other solution,” Yin added.

The company has pursued other enhancements to fielded products as well as new capabilities. “One simple thing our clients also got really excited about was the addition of expanded color choices for color coding rooms in our control interface’s facility view,” Yin recalled, and continued, “We popped that little upgrade in when we created CCM, and we were delighted to find an outpouring of positive feedback. We’ve also introduced our MED360 data integration, which means we can integrate with any medical device, giving our users even more flexibility and choices for inputs.”

Also on the high end of the technology spectrum, the University of Toledo College of Medicine has installed Barco's I-Space and CADWall as the cornerstone of its virtual immersive reality center, which is chartered to educate its health care providers. Housed within the University of Toledo's Interprofessional Immersive Simulation Center (UT-IISC), the simulation solutions, the two 3-D stereoscopic immersive CADWalls and an I-Space system are fully operational in the virtual immersive spaces of the Center, allowing educators, researchers and students alike to explore the human body in a new way.

The four-sided I-Space “virtual room” portrays 3-D computer images of skeletons, organs, arteries and medical conditions, allowing participants to “walk through” parts of the body for a truly immersive learning and training experience. 3-D visualization of anatomy is projected to show normal and abnormal pathology as well as CT scan reading. The Barco I-Space is used to simulate entire environments such as operating suites.

Hernan Rodriguez, the company’s director of Channel Management for Control Rooms & Simulation for North America, said while Barco continues to increase resolution and image performance, the company is focusing on key customer concerns, specifically the real estate required by these systems and the cost of maintaining and operating them. “We are leveraging technology developed in our R&D department, which together with our existing products and technology, will enable Barco to deliver to its channel partners, best-in-class solutions that will provide space-saving, solid performance and lower maintenance and operating costs,” he added.

The University of Toledo College of Medicine has installed Barco's I-Space and CADWall as the cornerstone of its virtual immersive reality center. Image Credit: Barco
The University of Toledo College of Medicine has installed Barco's I-Space and CADWall as the cornerstone of its virtual immersive reality center.Image Credit: Barco

Services Provider

CAE has also established a beachhead in the simulation center management sector.

For its part, the company manages the University of Montreal simulation center, which is accredited by the Royal College of Physicians and Surgeons of Canada for simulation training. Cartlidge pointed out an interesting, symbiotic aspect of the agreement. “That center is our laboratory for development and delivery of simulation that meets today’s end-user needs and requirements,” she added.

What’s New

CAE’s product portfolio is rapidly expanding.

The trauma simulator, Caesar, was built to withstand extreme temperatures, rain, dirt and dust and body impact. While Caesar was developed for the military, it is also reported to be generating enthusiasm among disaster response centers that simulate man-made or natural disasters on a large scale.

The company’s new VIMEDIX Women’s Health ultrasound simulator for the ob-gyn market simulates the 20-week fetal ultrasound exam. Cartlidge added, “The VIMEDIX ultrasound simulator uses both a mannequin and virtual reality technology to train residents and physicians in bedside ultrasound in medical schools and hospital simulation centers.”

CAE’s EndoVR and LapVR surgical simulators are training medical residents to get a feel for bronchial and gastrointestinal assessment and laparoscopic surgery.

The company has also upgraded its HPS simulator with a new Müse operating system and scenarios for anesthesia, emergency medicine and obstetrics.

Barco is in the midst of critical development of its I-Space and CADWalls product line, but is not ready to make an announcement yet. “We look forward to bringing this new technology to our partners first as they represent the commercial force behind our product line,” Rodriguez said, and continued, “At the appropriate time, we will make an announcement. We look forward to 2013 with the release of our new technologies.”

Another company, Smooth-On, has platinum-based silicone materials often used by mannequin manufacturers to build their training devices. Similar platinum silicone materials provided in Smooth-On’s Ultimate Wound Kit, are also used to modify the training devices throughout their life cycle in addition to being utilized to create separate moulage for on-skin wounds.

Smooth-On's Brad Frikkers noted the silicone materials are used when the medical

simulation center staff “doesn’t want to permanently modify the mannequin, for example, when the it wants to build a moulage application directly on the device itself. Or the material can be used to pre-make moulage dressings and put in place anywhere of the mannequin in a short period of time – for many standard applications.”

Additionally, these silicone materials may be used to quickly manufacture suture pads and injection pads.

Frikkers also freely discussed the price point on his product and its high return on investment. “We’re suggesting that you can make the moulage or mannequin patch yourself – and if you spend roughly $60 on two different products you can make eight of these pads. So the cost to you becomes $7-$8 worth of material for items every first year medical student and others will use – the suture and injection pads,” he said.