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The Network of Excellence in Simulation for Clinical Teaching and Learning: Rocket Fuel for our Academic Activities in Simulation

Richard Reznick
Richard Reznick
In the past year, the Faculty of Medicine, in conjunction with the Michener Institute, the Faculty of Nursing, and other Ontario partners have petitioned the Ministry of Health for assistance in the development of a Network of Simulation for Clinical Teaching and Learning. The result has been the receipt of a $4,900,000 grant to make this network a reality. This is a great boost for the University of Toronto and its network of partners as we move forward to capitalize on the significant potential of simulation and position our institution in the forefront of scholarship in this area.


I am confident that if one were to pick one dominant trend that will have a profound effect on learning in the next decade, it would be what lies ahead in the field of simulation. Simulation is a constellation of techniques that range from very basic activities, such as a young medical student learning how to do a history and physical examination through engagement with a standardized patient to more sophisticated learning, such as a surgical resident learning a complex procedure through practice in a virtual reality environment that mimics the real world. What characterizes the most important strategic advantage of simulation technology is the provision of opportunities for deliberate practice. Anders Erikkson is likely the most influential motor psychologist of the last 30 years. He has pointed to deliberate practice, the effortful activities designed to optimize performance as the essential route to expertise. Deliberate practice implies repetition of a task, coupled with feedback from an expert coach. What distinguishes these activities from most types of surgical practice, is the ability to make mistakes, analyze these mistakes, and then, with guidance, develop a program of continuous improvement measured against established benchmarks.(1)

There is a breadth of simulation activities going on in our Department. In our Surgical Skills Centre at Mt. Sinai Hospital we have augmented our focus on surgical simulation. Over the last five years we have purchased an increasing number of sophisticated virtual reality simulators and are shifting our focus from activities that used to be centred on "low-level" simulation to one that now embraces the ever-increasing sophistication of modern day simulators.


In truth, we are really in the embryonic stages of simulation technology developing into a vital part of our daily teaching enterprise. As computing power augments exponentially, as web-enabled technologies reach an entire generation and as the cost of technology diminishes, we can expect dramatic changes in the way we train and of the role of technology in training. Current estimates suggest simulation will be a 4B industry by 2013. Frost & Sullivan's study suggests a 6 month return on investment for medical simulation. As well, current estimates are that time spent on a simulator is 20% as effective as time spent in the O.R. This compares with a current figure of 80% for the airline industry. The implication is that there is great room for growth as investment capital fuels further development.


Dale Dauphinée, a respected Canadian academic, has spent the last 8 months in Toronto as the Interim Director of the Network, putting the pieces of our future operation into play. Part of Dale's work is to analyze the extent of activities going on at the University of Toronto as the base from which to grow our network. In addition to our Skills Centre, we have a sophisticated Standardized Patient Program that has, for over a decade, been involved in teaching, assessment and research at an international level. Our Nursing Faculty boasts a state of the art simulation laboratory aimed at teaching novice nurses skills needed for procedures, resuscitattion, and a broad range of other technical and cognitive skills. For decades our anaesthetic colleagues have pioneered research in the use of simulation to both train anaesthetists and promote a focus on the safety agenda of anaesthetic care. We are actively practicing telesimulation. Our colleagues at St. Michael's Hospital are developing an institute in which simulation will play a vital role. We have a heightened involvement in patient safety initiatives enabled by simulation. Our surgical group is involved with the National Research Council of Canada which recently received a large grant from Industry Canada to promote technological innovation in simulation. We now have a natural alliance with engineers, mathematicians and computer scientists, all aimed at developing medical simulations as a practical, cost effective and progressive tool. And progressive it will be. We are just around the corner from a very new paradigm. Just picture a PGY-3 surgical resident who has already spent hundreds of hours in a technical skills laboratory, who has become accustomed to the team culture in the operating room through moulage activities, who has achieved many technical benchmarks through simulators and is now preparing for tomorrow's operation. Instead of reading a technical manual, he or she will now prepare for the operation by downloading patient specific data into a simulator and practicing the conduct of the case repeatedly, with the team. The simulator will have haptic feedback-- it will provide a realistic sense of touch during palpation of tissues and it will bleed when incised.


Our academic focus on simulation has provided us with the opportunity to apply for, and receive, substantial funding to further our agenda. It is now our responsibility to capture the moment and put this money to good use. We are currently putting together a business plan and a governance structure for the Network. We anticipate, because of our past successes and current talent, that Surgery will factor prominently in the Network. In my opinion, the most strategic element for success will be a coordinated effort to break out of our silos and bring the richness of talent to the table. This includes our hospitals, our health science faculties, our industry partners, our Departments in the Faculty, and our educational institutes.

(1) Ericsson KA, Krampe RT, Tesch-Romer C. The Role of Deliberate Practice in the Acquisition of Expert Performance. Psychological Review: 100: 363-406: 1993

Richard K. Reznick
R.S. McLaughlin Professor and Chair

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