Simulation has come so far! Today, almost every industry including sports and flying uses simulation, where athletes and pilots train in the necessary skills and become proficient so as to execute skill, reduce error, and better understand optimal body position and aerodynamics for critical decision-making during competition and flights. Over the last 2-3 decades, the medical system has also seen a rapid and exponential adoption of simulation. The COVID pandemic certainly challenged the medical field where, as a profession, we were under-prepared partly due to a lack of training, pre-set protocols, and manpower. It is obviously tough to plan for natural disasters such as hurricanes and earthquakes as well as mass casualties/shootings, it is nonetheless critical to have an insight about the progression of events that can follow and have pre-set protocols and preparedness guidelines set in place that are periodically simulated.
When training medical students and nursing, mannequins and models are routinely used to teach both anatomy and physiology of the human body. Mass medical teaching via online modules, simulation labs, monitors, and applications where students are able to manually enter data to study and analyze potential aftermaths as a result. Such impactful training has allowed us to translate this concept of simulation to EMS training, ATLS, and ACLS/BLS courses. The implementation of virtual reality platforms to better understand cardiac remodeling, valvular pathology, and vascular stress are also widely in practice now. The utility of 3D bio-printed models both for educational and operational purposes is also widely apparent, especially when used for complex resections involving multiple teams or when planning reconstructive surgery, or when understanding congenital heart defects and/or it’s pathology and physiology. Orthopedics and plastic surgery have also successfully integrated 3D models into their practice for designing of bioprosthetic and orthopedic implants. Fortunately, with the implementation of wet and dry labs, general surgery has been able to adopt simulation into its practice by training residents and medical students various suturing skills, endoscopies, enhanced laparoscopic skills, and now robotic surgery. Indeed, new graduates are pretty much expected to be proficient in robotic surgery. And now with other novel robotic platforms and tools on the uprise, it is becoming extremely critical that mass trainings be performed, albeit with the aid of simulation. With the uptick of litigation and scrutiny of surgeons in the OR by hospital staff for efficiency and for complications make them less likely to allow trainees to operate. It then becomes more and more necessary that residents and fellows have access to simulation labs, animal models that mimic true tissue anatomy/texture, and are graded on proficiency and safety that can allow them to reduce error as well as make mistakes, rescue themselves out, and learn from them. While there are pros to simulation, the cons must be outweighed. The cost of simulation, time away from clinical space, self-learning, and lack of real-time feedback, must be outweighed with time-saving (one can learn on their own time), cost-saving, and bulk teaching. There are phases of simulation and in order to plan for a stronger, brighter generation of surgeons, it is critical for Surgical Educators to build a training platform that promises trainees a robust and effective training despite limited ‘hands-on’ skills.
Another arena where simulation is becoming popular in healthcare is in the training of leaders and engaging clinicians who may want to mature into C-suite holders one day. Corporates like Google, Apple, and Amazon routinely engage their prospective leaders in simulated training where online modules and in-person simulated scenarios are presented and discussed to allow attendees to learn skills to seamlessly integrate into new system processes of leadership. The simulation mechanisms or techniques that are used are merely to amplify real experiences with guided ones. The simulated training sessions, therefore, must truly be immersive in nature and must replicate real issues that leaders face in an interactive fashion. The advantage of such simulation is that employees have a better understanding of uncommon events that they may face as a leader (which they may otherwise will not), learn how to react and resolve such real life issues, and gain an understanding on how to deliberately practice with appropriate feedback on how they would have otherwise reacted. It is truly an opportunity for the learners with complete absence of risks to patients and colleagues. Several executive leadership training programs across the nation are now promoting such simulated-training of healthcare leaders and even MBA programs have incorporated this teaching methodology into their curriculum.
Puja G. Khaitan, MD, FACS
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