Medical Training Magazine's take on the state of the healthcare education and simulation industry

by Medical Training Magazine Publisher Andy Smith

Medical Training Magazine exhibited at our 7th IMSH event in Los Angeles two weeks ago and our team can now give our considered view of the event and state of our industry.

With 250 booths and 108 exhibitors listed, 2541 attendees and more than 250 papers, the event was certainly the largest we’ve seen, with heavy sim industry participation. This reflects the increase in industry and user interest in the field that we’ve watched in the development of our readership databases and online traffic across 2017.

Although this was reported as a record year for attendance it was certainly recognized as a quiet show by the exhibitors.

It is less easy to draw conclusions as to the state of the sector. Perhaps one of the advantages of an annual meeting is the snapshot it gives of the assembled group, although moving it across the country every year brings a different audience. There are pluses and minuses to hosting at different locations, but the event venues are likely booked for at least the next 3 years.

By the end of day one, our team felt that we were speaking to a mature group of users and suppliers, as evidenced by comparing the day’s conversations with those of previous events. In general, the excitement and wow factor of a few years ago has decreased while the number of the ‘right’ questions being asked has increased; an example would be not what is the best ‘x’ available, but what can I look at that best fits my training/educational needs. How much fidelity do I need and how much is it to add ‘x’ to my mannequin?

Loss of that excitement is a challenge for us all, not least SSH in hosting the industry event, but it is a net positive (to an extent) as we are past the stage of having to convince users that simulation for skills and team improvement is the way to go. Certainly, there was a lot on the tradeshow floor to excite, however, more time in the program to view the industry advances would be good for all.

As a colleague commented, we don’t know the people we don’t know, i.e. who else ought to be here? This is the biggest issue we have as an industry:  we are not seeing the adoption of the technology and best training practices by more of the community, particularly not in enough hospitals. When I raised the need for concerted industry outreach at a Summer 2017 meeting, I was stunned at the general response, which was ‘that is going to be hard’. Anything worthwhile usually is, but we do need action.

In the words of one industry leader, Doug Beighle of Simulab during the very good 2-day modeling and simulation pre-con meeting, “the industry is stalled”. Doug went on to state that what we are doing and saying now does not appeal to the hospital leadership and the message that ‘you should be doing simulation’ simply does not cut it.

The conclusion from the modeling and simulation meeting, and Doug, is that we need to move from a sole focus on skills to a broader look at process and system improvement if we are to access the huge potential growth available via hospital sector C Suites. We couldn’t agree more!

Another big, positive and challenging move forward was the unveiling of the Advanced Modular Mannequin (AMM) by Dr. Rob Sweet of University of Washington and his team. This project is funded by the Defense Research Agency and supported by the ACS etc. The goal is to provide a common platform for the development of future mannequins with open source software available to all developers free of charge. This represents a maturation of the sector as all users want their devices to ‘talk to each other’, and this again mirrors the development of the equipment to common standards in other S&T industries. More information is available at    http://www.advancedmodularmanikin.com/.

Major and small companies may find this a reasonably easy transition but those in the mid-range may find it more difficult, having sunk so much into the development of an existing suite of devices. It may be a stretch to compare it to the Dreadnought effect of 1906 when the British Navy rendered all fleets, including its own, second tier by building the first ‘all big gun battleship’, but some in the healthcare S&T industry might view the AMM in the same light.  They should not as the current suite of devices are excellent but AMM represents a move to the next iteration of the industry and there is time! The launch date is available via http://www.advancedmodularmanikin.com/.

Another big, but in the background, piece of news was the ‘black box.’ This device or system of devices can be used, with all participants de-identified, to record multiple procedures over time and then analyze them for weak spots. Retraining can then be applied to correct and improve general faults. This implies a look at the ‘system’ mentioned above and not at the individual, mirroring the airline process of (assuming all approved procedures have been followed faithfully), then error must be the result of a weakness in the system that is then addressed by training improvements, globally in the airline industry. It seems via a quick google search that this was originally mooted in 2014; as healthcare standards go, they have moved at great speed.

Continuing to look at what must be done to move us ahead, we, parts of industry and groups like GNSH have tried to tie the results of skills-based simulation to improved outcomes, and while there are loads of examples we can all quote, very few practitioners will allow transmission into print because of the implied liability for past ‘shortcomings’.

Healthcare has a particular problem here because it can never be as open about improvements, near misses or errors as it needs to be to inform and lift the entire sector as for example, the airlines can. As a result, healthcare cannot collectively learn from errors and correct them; all is local. That must change and we need the bigger not-for-profit organizations to change it.

We also need to determine how to effectively engage practitioners and hospitals who do not see the need for individual, team and system training improvement so they become part of the change.

Take heart, though, as the other two main simulation user groups, Defence and the Airlines, with whom our company has 30 years of experience, were also slow to accept moving their training from the real to the simulated world. Even when ordered to do so, resistance lasted a generation – but they have both fully made the transition and, more importantly, even with resistance to change, system-wide improvements were felt immediately.

Another change underway is the realization from certain of the equipment suppliers that they can use simulation-based standard curricula to help improve their sales. Allowing practitioners to develop their techniques and confidence by providing better than usual training is a major differentiator. This again mirrors the development of major aerospace and defense companies whose S&T departments 30 years ago were nearly impossible to locate, but rapidly became operating divisions, and in many cases, they are the independent companies that form today’s industry. This is likely to happen again in healthcare because the mix of skills needed to run a training business is quite alien to most manufacturing businesses.

It is clearly time for massive change in the way healthcare is delivered and that requires a mindset change on behalf of industry and healthcare leadership to address the need. 2018 promises to be interesting; let us hope that most of the 108 exhibitors this year are still with us to consider exhibiting again in 2019!