Gourley, Scott R., Army
One rapidly growing aspect of Army medical care involves the use of medical simulation (MedSim) in the training of medical personnel at all levels - from initial combat lifesaving skills through multiple levels of hospital care, and in the development and maintenance of specialized medical proficiencies.
"There is really a growing body of evidence supporting the effectiveness of clinical medical simulation/' says LTC Wilson Ariza, U.S. Army program manager for medical simulation. "That's because it not only improves proficiency but it also improves the performance of the health-care provider and improves patient safety. I think that's the key in telling this story."
Organized under the Program Executive Office for Simulation, Training and Instrumentation (PEO STRI), Ariza's team is at the forefront of emerging medical simulation technologies.
"Simulation improves the competence of the provider/' he explained. "And it improves competence by providing a safe environment in which providers can practice as many times as they want. They can master those skills. They can practice different protocols, they can apply critical decision-making skills, and they can even develop communication and interpersonal skills."
According to Ariza, the current model in medicine involves a process that is commonly called See one, Do one and Teach one.
"Whether you are a medical student or a new provider you will first observe a medical procedure from a staff member," he says. "That's the 'See one.' Then you will most likely practice that procedure on a cadaver being supervised by a staff member once. That's it. That qualifies that provider to perform that procedure later on a patient, but that also means that a doctor who graduated from school today might not do the first one until 10 years down the road." Recognition of that fact has been an important factor in the rapidly expanding adoption of simulation in the medical field.
MEDICAL SIMULATION TRAINING CENTERS
One critical early element of the U.S. Army's medical simulation program was the fielding of medical simulation training centers (MSTC). (See "Soldier Armed/' ARMY, August 2006.) Today there are 23 MSTCs located worldwide, including six in Iraq and Afghanistan.
"That first one went into continuous operation in 2005 to support Operation Iraqi Freedom," Ariza recalled. "The medical simulation training center is a facility of about 10,000 square feet in which we have provided the sustainment training for all the EMTs [emergency medical technicians] - we call them combat medics - in the U.S. Army as well as the EMTs of any other service who were deploying to support Iraq and later on Afghanistan."
He added that the systems are also being used to educate medics, doctors, nurses and nonmedical personnel throughout the entire U.S. Army and the sister services.
In the case of nonmedical personnel, he said, "Let's say you have infantrymen deploying to Iraq or Afghanistan. They could be sent to the medical simulation training center where they will learn basic combat lifesaving skills. That's where MedSim has supported the tactical enterprise. Now we have a truly integrated training platform that deploys a very comprehensive training and education medical system using simulation."
LTC Ariza estimates that 40 percent of the current MSTC training mission involves combat lifesaver training.
"The emerging [MedSim] technologies provide training in what I call a low risk, supportive environment, where I can really recreate the nuances of patient care, whether in a hospital or a combat environment," he explained. "I can really identify and re-create it, and they can practice as many times as they feel they need to practice. Then later on I can do the training and I can even test to see if they've learned those levels of competency needed to save a life."
The wide array of simulation methods includes mannequins, human patient simulators and body-part task trainers. …