Healthcare simulation is a series of methodologies and technologies that allow educators to re-create a medical environment for the purpose of teaching a new skill or refreshing an existing skill. The purpose of healthcare simulation is to provide a safe environment for all healthcare workers to practice their skills and subsequently improve the safety and effectiveness of care delivered to actual patients.
The current methodologies used to simulate healthcare environments are:
1. Simulated or standardized human patients;
2. Full body computerized mannequins;
3. Procedure task trainers; and
4. Screen based simulation.
Each of these methodologies has been influenced by advances in technology that allow educators to craft simulations that are more realistic and can achieve the desired learning objectives.
"The world of healthcare simulation continues to expand its reach beyond professional schools and hospitals and into the everyday practice of healthcare professionals"
Let’s examine some of the newer technologies that are transforming healthcare simulation and its delivery.
Simulated or standardized patients are humans who are recruited to portray the role of patients to learners. They can be used to teach or assess skills such as patient interviewing, physical examination and counseling. Until recently, the physical examination was limited to whatever findings an individual patient actor portrayed, which were usually normal findings. In order to increase the range of abnormal physical findings in normal actors, several companies have invented “smart” stethoscopes or wearable RF tags that can reproduce abnormal heart lung and abdominal sounds when a learner examines the correct location on the patient. This enhances the ability of the learner to recognize abnormal findings in an otherwise normal patient actor. Future work in the area includes developing better location software so that abnormal findings can be localized to any body part examined.
Full body mannequins are computerized machines that replicate human physiology. They have detectable pulses and heart, lung, and abdominal sounds. They have openings in the nose and mouth into which an airway tube can be inserted and they have arms and legs into which catheters and tourniquets can be applied. They can be used with defibrillators to “shock” a patient out of a fatal heart rhythm as seen in a cardiac arrest situation. Some mannequins have chest and abdominal compartments that contain artificial organs that can be cut on as if in surgery. Many of these mannequins can talk using pre-programmed phrases or by having the instructor talk for the patient through hidden speakers. New developments in this area include developing better speech recognition and artificial intelligence (AI) software so as to have a natural conversation with the patient and better algorithms that allow the patient to adapt their responses to the person asking questions of the mannequin. Further developments of speech recognition and AI software could allow mannequins to be controlled by the instructor through simple voice commands rather than having commands typed or keyed into a computer.
Screen based simulation is a method in which a computer program creates the reality sensed by the learner in the simulation. This type of method employs 2-D and 3-D renderings in virtual and augmented reality scenarios to enhance realism. Virtual patients have traditionally been 2-D rendering of patients on a computer screen with limited ability to interact with the learner. Using technologies from the gaming world, these patients can now have facial expressions, move about on the screen and respond back to the learner in conversation using AI software algorithms. Future developments will see the ability to do an examination of these patients and have them learn the personality of the learner with whom they are interacting.
Screen based simulation also includes head mounted and immersive virtual reality technologies that create an interactive environment for the learner to practice their skills. Early attempts at cave automatic virtual environment (CAVEs) put learners into a virtual reality (VR) environment with limited ability to interact with the patient or the equipment. Recent advances in computer hardware and software have allowed learners using headsets or specialized glasses to be interact in several ways: in a room interviewing a patient, in an operating theater with the surgical team, in an emergency room, in an intensive care unit or out in the field with a first responder without the need for the physical presence of equipment or people. These VR platforms are evolving rapidly and the cost of headsets is decreasing. This will allow more simulation programs to employ these VR resources and reduce the need for maintaining large physical spaces and expensive medical equipment on site.
Augmented reality (AR) technologies are advancing rapidly and are making it possible to look under the skin of actual people or mannequins to see the underlying anatomy or to perform procedures. Wearable headsets that combine the physical world augmented by screen based simulation will allow simulations to occur in the physical healthcare environment that has been modified by the computer generated reality. Further developments of AR technology should allow direct tutoring of a learner through a procedure or operation under the guidance of an expert who can “see” what the learner sees and guide them through the procedure safely.
The world of healthcare simulation continues to expand its reach beyond professional schools and hospitals and into the everyday practice of healthcare professionals. The specialty of healthcare simulation has established principles and practices, a research base of scholarship, a dictionary of terms, a system of certifications/accreditations and a code of ethics. There are several professional societies, such as the Society for Simulation in Healthcare, that advocate for the expanded use of simulation to improve the care and safety of patients in many different settings. The partnership of healthcare professionals with technologists to improve the realism and learning value of simulation is evident from the brief survey presented here. This is an exciting time to engage with this field of healthcare.
Disclosure: These are the personal opinions of Dr. Lopreiato and do not reflect the official views of the Society for Simulation Healthcare or its Board of Directors.