DIEGO — Look at Victoria long enough and she’ll
blink. Nearby, her buddy HAL, who lost his legs due to
some unspecified accident, takes a deep breath.
Hall D at the downtown San Diego Convention Center last
month, these little actions brought slightly unnerved
smiles to people unaccustomed to the latest level of
realism in medical simulation.
the International Meeting on Simulation in Healthcare,
visitors could browse simulated skins stratified from
newborn to senior, use an ultrasound machine to guide a
needle into a disembodied knee or practice suturing with
a surgical robot.
stopped to check out Victoria, a state-of-the-art
mannequin made by Gaumard Scientific Company that’s
capable of simulating birth and other gynecological
issues with no wires or other tethers necessary. Over
and over again she delivered, simulating complicated
scenarios from breech presentation — when the baby’s
feet come out first — to obstructed labor, when a
shoulder gets wedged against the mother’s pelvis as
the child passes through the birth canal.
pulse thumped. She cried out that the baby was coming.
Her pupils dilated. Her abdomen contracted, depending on
the stage of labor.
was enough to get the attention of Anthony Moore and
Travis Hoberecht, two local emergency medical
technicians who attended the show to perform
demonstrations for Southwestern College and CAE
who recently had to deliver a baby unexpectedly at Petco
Park, home of San Diego’s Padres, said he knows very
well the value of using a simulator. He had just
performed a simulated delivery before having to use
those skills in the real world.
was able to remember some of the little things, like
creating a sterile field, the way that you wipe the
child when it’s born. We have references for all of
that stuff, but it was nice to have it fresh in my
mind," Moore said.
and Hoberecht said the simulation products’ level of
realism keeps getting ever closer to how things look
when they roll out to an actual emergency. While many
visitors at the conference were impressed by the
lifelike skin tones or sounds that the latest crop of
simulators made, they were more struck by the sheer
range of medical situations represented.
not just labor. Now they can create scenarios where they
can simulate something like an allergic reaction where
the airway’s super constricted and you have to
overcome that to do an intubation. Some of them respond
and react to the treatments as you’re giving
them," Moore said.
added: "Now some of them sweat. You get pupil
changes, their tongues constrict, their jaws bite down
… it’s getting closer and closer to the real
it was actual people, not sophisticated mannequins, who
were the simulation subjects.
one section of the convention hall’s display floor, a
young woman reclined as a technician passed an
ultrasound wand over metal targets stuck all over her
body. As the wand glided over her abdomen, the
ultrasound showed twins. As it passed over her chest,
the machine displayed pericardial effusion —
potentially deadly fluid build-up around her heart.
and young, the model was clearly neither pregnant nor
suffering advanced heart disease. But those little
targets on her skin told the ultrasound to make it look
like she was, at least on the simulation screen anyway.
technology is being incorporated into mannequins made by
Laerdal Medical that are commonly used to hone doctors’
diagnosis skills, said Dr. Eric Savitsky, founder of
SonoSim, manufacturer of the device.
ultrasound machines are filled with mechanical
structures, they have long been a destination beyond the
reach of even the best medical simulators. But the
SonoSim targets get around that problem by mapping
specific body surface locations to pre-recorded
allows for more in-depth ultrasound training than has
ever been possible, Savitsky said. It also can enable
more sophisticated simulations where the mannequin is
programmed to exhibit subtle symptoms that could lead to
a broad range of other diagnoses.
lot of conditions that doctors have to diagnose the
symptoms are what we call protean, which means that the
way symptoms present themselves are very vague and could
mean several different things. Now we can have
simulations where the doctor can choose to move to
ultrasound in these situations, and when they do, they
have an opportunity to clarify their diagnosis by
looking inside the body," Savitsky said.
he made his pitch, others in booth after booth at the
convention center were doing likewise.
so many products and with health care costs continually
on the rise, it is more important than ever that medical
schools, hospitals and first responders invest in
technologies that truly deliver a discernible benefit
over less sophisticated but cheaper alternatives.
medical schools in the United States have made
simulation a large part of their curriculum. The
University of California at San Diego and the University
of San Diego, for example, have invested millions of
dollars in simulation centers using many of the
technologies that were put through their paces at the
increased utilization has provided room for research on
whether simulation improves health-care outcomes, said
Dr. Dimitrios Stefanidis, a bariatric surgeon from South
Carolina. He was part of a research team that examined
the available evidence on simulation and published a
review on the topic last year.
said there are multiple studies that have shown clinical
skills do increase among medical professionals who use
simulators as part of their training. The evidence
indicates that allowing repeated practice of skills in
low-pressure surroundings, and having detailed
debriefings with instructors afterward, builds
competency more effectively than more traditional
said there have also been a few studies that show some
patients fare better when they receive care from a
simulator-trained doctor. The strongest evidence of
positive outcomes, he said, involves simulating
insertion of central line catheters — typically a
significant source of infection and injury for patients.
is less clear how much incremental benefit is added by
increasing the realism of simulations. Here, the
evidence is thinner and there is debate over whether
making a simulated procedure feel more authentic results
in better learning, Stefanidis said.
situations where simulation is simply being used to
learn the right sequence of steps for a given procedure,
there may be less benefit.
on the other hand, you’re teaching something where
precision is a lot more important, having it look real,
in my opinion, is more important," Stefanidis said.
The San Diego Union-Tribune