The Network of Excellence in Simulation for Clinical Teaching and Learning: Rocket
Fuel for our Academic Activities in Simulation
Richard Reznick
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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.
SIMULATION: AN AMAZING FUTURE
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.
THE MARKET PLACE MAY END UP BEING THE STRONGEST BOOST TO SIMULATION
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.
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A STRONG BASE TO BUILD ON
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.
CAPTURE THE MOMENT
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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