A call to the industry by Andy Smith, Medical Training Magazine publisher

The National Training & Simulation Association (NTSA) organized this year’s annual NMSC meeting at UNMC’s Interprofessional Experiential Center for Enduring Learning (iEXCEL) in Omaha, with Rick Severinghaus, Chair of the NMSC Policy Committee as conference organizer and Chair.

Focused on healthcare the meeting provided an opportunity for those with critical skills and experiences of value to healthcare to join with healthcare professionals in looking at ways in which both might contribute to a healthcare system fit for the future with patients, outcomes and safety at its core.

For the full conference program click here.

2018 NMSC event sponsors were; Karl Storz, CAE Healthcare, EON Reality, MultiTaction, AVI-SPL and RAVE Computer.


A key take away from the event was that healthcare should adopt a ‘safety culture’ as the core of its operational philosophy which leaders assert is the way to both deliver the care and outcomes that patients deserve while also delivering a sustainable successful business model for healthcare businesses.

Reference was made to the need for behavioral change within healthcare, similar to that made in other high risk industries which operate a safety culture to deliver safe and viable businesses.

For full information on the IEXCEL center click here 

And see these features in Medical Training Magazine

iEXCEL: The Transformation of Health Professions Education

Building a Future Model for Health Professions Education

Funding and Purpose of iEXCEL

Just prior to the conference Medical Training Magazine and Healthy Sim, the two media representatives supporting NMSC, were invited to meet with UNMC Chancellor Dr. Jeffrey P. Gold and State Senator Robert Hilkemann to review the launch of the iEXCEL initiative, its purposes, as well as the astonishing support of the state of Nebraska and the philanthropic community of Omaha. The meeting took place at the Fred & Pamela Buffet Cancer Center itself a subject of the discussion as well as the venue for the pre-event reception.

The iEXCEL center has been the beneficiary of cross community support and a public, private and academic partnership with initial state funding, quickly endorsed by Hilkemann’s senate colleagues, being supplemented by local private donors to stand up the new center in record time. This highly complex and capable center of learning is already well advanced in construction and is scheduled for completion Summer 2019.

Aside from utilizing and demonstrating the huge potential of simulation to enhance healthcare education through the experiential learning model, both the Senator and Dr. Gold went to great lengths to point out the benefits of this same method to general education, especially as we grapple with the new generations of digital natives who understandably expect the use of the latest media and platforms in their education.

Additionally, as a rural state, Nebraska requires the best practices in education and training exemplified by iEXCEL to be made available to healthcare entities statewide. Already a statewide network has been set up networking our UNMC sites statewide (representing our CON, COD, CAHP) with iEXCEL, supplemented by four sim truck labs to enable local hands on experience.

Nationally too iEXCEL has a high profile role in ensuring that natural and man made health disasters of the future can be contained and treated through its work with the National Strategic Research Institute (NSRI) led by Gen Bob Hinson and supported by STRATCOM. An entire floor of the Davis Global Center is dedicated to health security and biopreparedness.

A key element of the funding is an annual grant from the State to provide ongoing operating funding for the center. An element of the teaching business that many healthcare simulation centers have overlooked; to their cost.

Aviation a model for healthcare

In his presentation Dr. Gold showed a harrowing video of the 1977 collision of two 747 jets at Tenerife airport resulting in the loss of all 538 passengers aboard. It was, he said, a seminal moment for the airline industry involving two pilots who were recognized by their community as amongst the ‘best in the world.’

As publishers of Civil Aviation Training magazine for over thirty years, as well as Medical Training (and Military Simulation & Training) we certainly endorse that statement and have been witness to the incredible technology changes that the airline industry demanded, as well as the behavioral changes they instituted, the safety culture that endures to this day and the use of simulation to train, retrain and test pilot, cabin crew, and maintenance engineer competencies.

Dr. Gold showed two slides from CAE that demonstrate the ‘hardening of the aviation system’ to deliver vastly more flights whilst ‘increasing safety from one death per million miles in 1977 to one death per billion miles in 2015’. In that period reported avoidable patient deaths have rocketed to the third leading cause of death in the USA at possibly as many as 440,000 per year.

"When it's your child or your parent in the operating room, you don't really care whether the system or the individual insures a successful procedure," he said. "You want to be sure that the quality and safety of that interaction is as high as possible.

"Experiential learning can enhance both systems, he said, enabling health care professionals to go beyond rote lectures and the age-old "see one, do one, teach one" philosophy. Instead, trainees will have greater opportunities to engage, interact and master knowledge, skills and procedures long before seeing, and caring for, patients.

Studies show that actively involving students in their education yields a 75 percent to 90 percent retention rate, well beyond traditional lecture models that garner a 5 percent retention rate, Dr. Gold said.

In closing Dr. Gold challenged the healthcare sector with a quote from Teddy Roosevelt to ‘dare to do mighty things’ stating that incremental changes are inadequate and that now is the time for fundamental change.

The CAE View

Dr Robert Amyot, President of CAE Healthcare, continued this theme using the immense experience gained by CAE as a whole in working with high reliability industries like the military and the airlines.

In reviewing the current position within US healthcare Dr. Amyot also emphasized government action in applying the financial pressure that the poorest performing 25% of hospitals will be under, losing $38bn of government funding or 6% by the end of 2019. This he stated was already driving change

In advocating for a close look at what the airlines do he suggested attention be paid to the use of data. Within the airlines, Flight Operations data is collected on every flight, globally and closely compared to Simulation Operations data to ensure that reality is aligned with practice or vice versa to ensure FOQA and SOQA (Flight Operations Quality Assurance and Simulator Operational Quality Assurance).

With all the training tools available to us including gamification, AR and VR, distance learning and increasingly powerful simulators, plus more and data available from hospitals and insurers to enable identification of the biggest areas of threat Dr. Amyot argued that now is the time for healthcare to start this journey to high reliability, finishing with a powerful statement ‘and we can do it’.

For a view of AR as a training tool click here for LucinaAR

An expert view of Big Data and Artificial Intelligence

Though presented last in our review this was the focus of the keynote for the entire event presented by Daniel Serfaty Founder and CEO Of Aptima entitled “The Future of Work: Engineering Human Performance in the Age of AI”.

Given the extreme reliance being placed by healthcare leaders on emerging technologies to solve their problems in the coming years this was a welcome and very reassuring tour de force on AI and the use of ‘big data,’ to support both human and institutional performance improvement.

It is accepted that staff shortages within healthcare that are already evident will worsen considerably over the next years as demand accelerates through an ageing population and yet more treatments become available. More and more data is now being collected in healthcare and suitably redacted can be used to drive outcomes with fact.

The potential for AI and deep learning to revolutionize the way in which healthcare works was outlined and the progress of both were outlined using the defeat of chess grand master Gary Kasparov by IBM’s Deep Blue 15 years ago as a base point.

With purportedly 8000 healthcare papers written globally each day the potential for machine processing to distill the content and potentially to weed out very rapidly the 30% plus that will be incorrect would be a massive advance on today’s system of reliance on peer review and CME’s to provide ongoing education to healthcare staff.

Diagnosis was highlighted as another area where improvements could be made today using these tools.

For Mr Serfaty’s presentation, visit The NM&SC website


The presentations made at NMSC 2018 were powerful and timely. As NTSA leader Admiral James Robb stated in his summing up, now is the time for action.

It is hoped that NMSC and NTSA continue to focus the event on improving healthcare; aside from the ethical consideration of preventing avoidable deaths and harm to millions of patients in the US (and globally) the IHI has set out in its Triple Aim a laudable set of goals. We would agree with many who would add a 4th aim, the health and safety of the healthcare workforce to that list.

One major issue is that too many caring healthcare staff are unaware of the error rates and, or do not perceive they have a role at their institution in bringing that error rate down.

A key outcome of the meeting was that the adoption of a safety culture by all within healthcare was urgently required. That would shape the way they all work as individuals and teams and is the way ahead, just as it was for aviation.

As many speakers commented ‘we can do it and it is time for it to happen’.

US healthcare concerns

  • Studies indicate that over 250,000, possibly as many as 440,000, avoidable deaths a year happen year on year within the US healthcare sector and many millions suffer harm, from mild to severe.
  • Healthcare costs are a strategic national concern, currently accounting for 18% of the national economy.
  • 25% of that expenditure is wasted on unnecessary or incorrect care.
  • Healthcare is the largest cause of personal bankruptcy, accounting for 62% of all bankruptcies declared.
  • The US has the lowest life expectancy and highest childhood mortality rates of the 11 most developed economies.
  • Its nearest rival in terms of healthcare expenditure spends half the US total per head of population.
  • The spiraling cost of healthcare and its impact on society, families and individuals is unacceptable and is a danger to the nation.