Focus on Innovation, Training and Patient Safety

Editors Judith Riess and Marty Kauchak share highlights from the show floor and this year’s IMSH conference program.

Editor in Chief Judith Riess and Group Editor Marty Kauchak filed this report from the 2015 IMSH in New Orleans.

Program Highlights

The Society for Simulation in Healthcare hosted its 15th Annual International Meeting on Simulation in Healthcare (IMSH 2015) in New Orleans, Louisiana January 10-14, 2015. The theme ‘Simulation Celebration’ was carried throughout the conference, enjoyed by 2,300 attendees from fifty-six countries.

SSIH presented its Pioneer in Simulation Award to Dr. Michael Gordon, the inventor of the lifesaving Harvey™ cardiovascular patient simulator. An inspirational video highlighting his lifelong contributions to healthcare education brought the audience to its feet.

Dr. Gordon accepted his award with a heartfelt speech of encouragement and appreciation that left many in the audience equally emotional with gratitude for his enduring legacy and ongoing support. The video tribute to Dr. Gordon is on the SSH website.

The Lou Oberndorf Lecture on Innovation in Healthcare Simulation was presented by Marco Tempest. Lou’s support made it possible to invite Marco who encouraged participants to translate technologies from industries such as entertainment (magic in this case) to education.

He is a cyber illusionist who combines magic and technology to create astonishing illusions. His interest in computer generated imagery led him to incorporate video and digital technology into his work and the development of a new form of contemporary illusion that could easily be translated to simulation and other means of clinical education.

The Michael S. Gordon Center Lecture on Medical Education was presented by Suzan Kardong-Edgren, who talked about the importance of simulation as competency validation and improved assessment spreads across academia. She discussed how simulation is becoming a major educational pedagogy. She believes emerging ideas around the use of technology in education will transform education as we know it, allowing new emerging models to fast track health provider education.

For the third year, the SSH Public Affairs and Government Relations Committee provided a Government Agency R&D Demonstration Corral. This provides an opportunity for civilian healthcare training simulation professionals to see and provide feedback on medical training system research prototypes being development through federally funded projects. Although funded to address military gaps, it is the explicit intent of the Congressionally-funded SBIR programs that the products, once developed, are of general broad commercial value thereby directly supporting civilian healthcare.

Trends from the Conference Floor

One of the interesting trends in our sector is for some S&T companies to remain focused on specific customer needs, and not diversify their portfolios. To that end, Gaumard’s business model specifically supports its mannequin and related simulation equipment products. “That’s all we do on a daily basis is worry about our customers’ simulation needs,” Jonathan Cabral, the company’s vice president for sales and marketing in the US and Canada, explained and added, “we’re dedicated to providing what the customer needs to conduct the highest level of simulation. And as such we’re focused.”

One Gaumard mannequin on display was the Victoria®obstetric simulator and its’ complementary gynecologic pack. The training package is one outcome of more than 67 technological enhancements to the baseline Victoria simulator.

Cabral noted Victoria supports the company’s quest to achieve fidelity and realism for healthcare students and professionals. Cabral pointed out “Victoria is the first mannequin in the history of the industry that has a smooth and supple skin. It’s completely wireless and tetherless – which is huge.” The new gynecologic pack supports the company’s efforts to support individual skills, team skills, and care in motion.

Victoria is being marketed and developed to be used with regular hospital equipment. That allows a simulation center to use its own monitoring equipment, a fetal heart monitor for instance, with the mannequin. “With Victoria you are able to use whatever you have. We are accommodating ourselves to you,” the Miami, Florida-based executive emphasized.

Tony Rubin, Surgical Science’s vice president for the Americas, noted his company’s 2015 LapSim virtual reality system is available for immediate shipping. Hundreds of copies of the latest update to the LapSim platform were shipped at the start of this year. Beyond the more than 50 new courses in the 2015 version’s default library, the Gothenburg, Sweden-based company is also emphasizing enhanced metrics applications. “A lot of the LapSim metrics also allow you the opportunity to evaluate your performance. And now we have made it easier to also establish benchmarks for those metrics so you can start to compare yourself to either your own program directives at your own institution or metrics that we provide based on other training programs or validated curriculum.”

Surgical Science remains true to the medical S&T sector’s focus on enhancing team training and education in the healthcare community while it significantly increases the learning audience in its latest product rollout, TeamSim® the inter-professional education simulator. “TeamSim fits our education objectives while encompassing the operating room team, surgeons, a surgical tech, surgical nurses and others circulating with surgeons, nurses and others – the whole team – not just individualized technical training but now incorporating non-technical team training skills as well,” Rubin said.

B-Line Medical is bringing first-person, point-of-view video recording to healthcare simulation training with its new Google Glass application. When MEdSim spoke with Hartley Thompson, the president of B-Line Medical, the application was in its production release version. The application records high definition, first-person point-of-view videos of simulated and mobile healthcare scenarios and delivers them via wi-fi directly to SimCapture, B-Line Medical's simulation management platform.

B-Line Medical's integration of Google Glass was introduced at IMSH. The B-Line Medical team demonstrated how the new recording device provides a new perspective by simulating a surgery with Surgical Sam - an infant manikin provided by the Chamberlain Group - with its chest cavity exposed. The "surgeon" wore the Google Glass and display monitors, demonstrated SimCapture with live video feeds, one via Google Glass, as well as several other fixed cameras capturing various angles and patient monitor data.

This January 15, Google announced that it would stop producing the Google Glass prototype. However, the company remained committed to the development of the product. The “smart glass” phenomenon continues to make inroads in training programs for high risk industries. Halldale’s CAT magazine ( www.halldale.com/cat) follows the inclusion of these devices in the civil aviation community and similarly, MS&T (www.halldale.com/mst) for the military market. MEdSim is also seeing the emergence in healthcare learning strategies, i.e. Ray, Sudikoff series of articles.

Konsiderate has created a web site, http://konsiderate.com, to furnish healthcare learning technology users and industry suppliers with an opportunity to comment on simulation and training products and services.

One Gaumard mannequin on display was the Victoria obstetric simulator with its complementary gynecologic pack. (Photo: Gaumard)

The company’s business model allows access to the web through a free “subscription” for validated members of the global healthcare community. Jacqueline Morck, co-founder and the current chief executive officer, added, “We take reviews from those who purchase and/or use these simulation products and services including clinical educators, administrators and technicians."

This new startup already has the largest database of online product reviews in the medical simulation space. The web site’s revenue source; four levels of paid subscriptions from simulation and training sector industry members, a ‘flat model’ for each level so there is no favoritism, she added.

In a demonstration, Morck accessed the web page of one company product – Laerdal’s SimMan 3G – and pointed out some of the content specific for the user review that included aggregate scores for quality, value and customer service. “The users are connected by their LinkedIn account so you can see who wrote the review. Users can rate others reviews as ‘helpful’ or ‘not helpful’ with most helpful placed at the top of the page,” she said.

Any user can add a product and write a review. “Konsiderate is an unbiased platform. Abusive or unconstructive reviews can be flagged by users or vendors, and reviews cannot be altered or removed by vendors in any way,” Morck observed.

Simtabs is creating realistic, interactive simulations following a specific instructional design – a short format simulation, with each sim duration ranging from 5-10 minutes “This is a big change,” Parvati Dev, PhD, Simtabs’ chief executive officer, emphasized.

The Simtab product viewed at the company booth was Rapid Virtual Simulation, a five episode simulation suite for the recognition of Sepsis. The interactive scenario provided feedback to allow the user to advance through a series of steps with his or her patient.

The company’s customized healthcare simulations allow instructors/trainers to rapidly author patients and scenarios, customized to their spec, on a simple Google Doc. The Simtabs team then converts these cases/scenarios - using virtual - and augmented reality technologies to enable the learner to hone critical thinking skills as well as respond to complex situations.

“This is available right now,” Dev remarked, and continued, “We would like to invite people to submit material to us so we can customize solutions for them. It’s a platform on which you can create scenarios very quickly.”

We had the opportunity to view 3D Systems' 3-D printer at the company’s booth, which also featured the latest innovations from its Simbionix product line. Susan Vetrone‎, the company’s global director of marketing, noted there are many uses for printed models which meet training needs, provide a solid platform for device bench testing by the industry and comprehensive procedure planning. Vetrone added, “Many institutions need an ongoing supply for patient specific cases that show the patient’s anatomy for patient preparation or to build a variety of anatomical models for training requirements. Many institutions present a need for better procedure preparation for the experienced and inexperienced physician. Part of the preparation relies on better understanding of patient's anatomy and the allowance of repetitive practice without putting the patient at risk.”

Asked to cite some of the efficiencies gained from 3-D printing, Vetrone, responded, “These products and services replace and complement traditional methods with improved results and increased patient safety. These solutions are used to rapidly design, create, communicate, plan, guide, prototype or produce functional parts, devices and assemblies, empowering customers to manufacture the future.”

Putting 3-D printing theory into practice, 3D Systems has proved patient-specific models can be printed from segmentation files that were created by PROcedure Rehearsal Studio software. “These files can be used for analysis, review and hands-on practice on the ANGIO Mentor or you can print a physical model for complementary procedure insights,” Vetrone said.

She emphasized 3-D printing is part of her products’ life cycle. “3D Systems provides the most advanced and comprehensive 3-D design-to-manufacturing capabilities. Personalized medicine digital thread allow for a smooth and comprehensive integration of Simbionix product line with patient data streaming through 3-D analysis, planning and printing.”

Developments at One Simulation Center

Ben Stobbe, the administrative director at The University of Toldeo’s new Interprofessional Immersive Simulation Center (UT-IISC), provided one business case for expanding a simulation center. The UT-IISC’s original facility was constructed to allow university faculty and staff to better understand how they could incorporate simulation into their curriculum. Stobbe explained that the fully integrated UT-IISC offers a comprehensive and unique range of simulation experiences: 3D/Virtual Immersive Reality (VIR), patient simulation, task trainers, standardized patients, and surgical skills – both simulation based and human cadaveric specimens. “We had small components of each within the original center and have significantly expanded within the new center. As we provided training, built our clientele base and managed the smaller, original area, we designed and built the new center, taking us from 12,000 sq. ft. to 65,000 sq. ft.”

Created to meet The University of Toledo mission – to improve the human condition – the expanded UT-IISC opened for training in April 2014 and currently has an average of 2,000 learners per month.

Based on a Tri-Center Concept, the UT-IISC, provides interactive and experiential environments for training, education, and research, and features the Virtual Immersive Realty Center; the Advanced Clinical Simulation Center; and the Progressive Anatomy & Surgical Skills Center.

“The UT-IISC was created with both an academic and a business mission. Our business mission is to create collaborative relationships with industry that have a like-minded culture" Stobbe said. “We work closely with our collaborators to develop and nurture mutually beneficial, innovative opportunities in product beta tests, research, and clinical and surgical workshops”.

The academic mission supports training opportunities for all of UT with the greatest emphasis on health care training and interprofessional education. Other UT colleges, engineering, communication and the arts, and natural sciences and mathematics work with UT-IISC staff to incorporate simulation into their disciplines. UT-IISC has an excellent relationship with The University of Toledo Medical Center. Stobbe added, “We work closely with staff development and clinical quality to provide skills and team training, as well as annual competency assessments that help positively impact patient safety and improve the quality of clinical care”.