RD302 - The Virginia Modeling and Simulation Initiative (VIMSIM) Report on the Building of Research Capacity in Medical Modeling and Simulation for the Fiscal Year Ending June 30, 2007


Executive Summary:
Several studies have revealed that the U.S. health care system is not as safe as it should be. For instance, in a study of Medicare data collected from over 5,000 hospitals across all 50 states from 2002-2005, the HealthGrades organization (2007) found that 284,798 patients had died from safety incidents (e.g., failure to rescue, foreign bodies left during a procedure, infections due to medical care, etc.) with an estimated cost of $8.6 billion. Further, more than 85% of those deaths were potentially preventable. Research has shown that equipment and instruments, the ergonomic design of equipment, individual performance, team and group behavior, organizational practices, legal and regulatory constraints, and societal and cultural pressures all contribute to errors in the health care system (Bogner, 1994). Further, the American Medical Association's Accreditation Council for Graduate Medical Education, the organization that accredits graduate medical education programs in the U.S., recently set restrictions on the working hours of medical residents. These restrictions have raised new concerns about how to provide adequate training opportunities for residents.

In many high-risk occupations (e.g., aviation, military operations, nuclear power plant operations, etc.), computer-based simulators have been an historical and fundamental component of training. Not only do simulators provide a safe environment for trainees to acquire skills, but they also facilitate our understanding of human performance in those contexts.

By contrast, computer-based simulator systems for training healthcare providers have only become commercially viable within the last 10 years. However, the number and variety of medical simulator systems are increasing rapidly. These simulator-based training systems promise many advantages. They enable trainees to learn fundamental procedures without putting patients at risk. They allow greater opportunities for training to be matched to individual needs and can expose trainees to rare or unusual conditions. They also reduce the need for cadavers and animal models. Moreover, evidence is beginning to show that clinicians who train with this technology are more skillful when they perform procedures on genuine patients. Consequently, a growing number of residency review committees are now considering how to use this technology for assessment and certification.

Unfortunately, simulation technology has not yet had the impact on medical curricula that one might hope. There are a number of issues that continue to impede its acceptance. First, there are few studies demonstrating training effectiveness that are grounded in fundamental principles of skill acquisition or learning. Thus, many systems are not designed to take full advantage of an individual's potential for learning. Similarly, training regimens do not include current methods for validating skills and expertise. Second there are large gaps between those systems that are currently available and the needs of medical educators. For instance, most current commercial systems address the psychomotor skills needed to perform individual procedures. There are few systems, however, that target the problem-solving and decision-making skills of more advanced trainees. Third, there are also gaps between current commercial systems and the needs across all medical specialties. The vast majority of systems available today target anesthesiology, airway management, and laparoscopic surgery. Few systems exist for training in specialties such as family medicine or obstetrics and gynecology.
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Bogner, M.S. (1994). Human error in medicine. Hillsdale, NJ: Erlbaum.
HealthGrades, Inc. (2007). HealthGrades quality study: Fourth annual patient safety in American hospitals. Lakewood, CO: Author.