Editor's Note: Attendees at this year's Oliver Wyman Health Innovation Summit in Dallas will be touring UT Southwestern Medical Center's new 50,000 square foot simulation facility to experience their virtual reality medical training program firsthand. To learn more, we interviewed Dr. Daniel Scott, a surgery professor and UT Southwestern's Director and Assistant Dean of Simulation and Student Integration.
Oliver Wyman Health (OWH): What are some approaches to medical training and virtual reality today that weren’t possible, say, five years ago?
Dr. Daniel Scott (DS): Virtual reality has been the Holy Grail of simulation to provide high fidelity replications of actual patient care, whether that’s task training, team training, or standardized patients.
There’s an interesting partnership with UT Dallas, for example, where some investigators are working on virtual reality to standardize or create patient encounters. This type of simulation teaches medical students how to interview patients. It’s almost as if you have an Avatar with machine learning behind it, and you could even say early steps toward artificial intelligence, where you can ask the virtual patient a series of questions. When you ask questions, the virtual patient responds and the student is expected to create a differential diagnosis and start refining their acumen to select diagnostic tests, confirm their diagnosis, and render appropriate treatment. That was not possible five years ago. Even now, it’s more of a research and development tool.
What’s also changed dramatically compared to five years ago is the notion of transferability. There’s a whole science behind translational research, and there’s now application of that framework to simulation.
OWH: How has UT Southwestern’s work with medical simulation, such as practicing procedures on lifelike mannequins, evolved over time?
DS: The whole field of simulation has advanced dramatically over the last two decades. We’ve been studying simulation-based training’s effectiveness for decades. In 2000, I was part of one of the first studies that showed skill transferability from box trainers for laparoscopic surgery. Residents practiced on models to learn laparoscopic skills. When we observed them in the operating room, we detected a measurable difference in their operative performance. But what’s exciting is we’re now seeing simulation being linked to patient outcomes. There have been several recent studies documenting that simulation-based training improves patient outcomes, which is a whole other level of transferability.
Here at UT Southwestern, we are very excited about our new campus-wide simulation center. The start up cost for this effort is nearly $40 million. We’re very fortunate resources came together through a variety of means, including some state funding, that allowed our campus to embark on this journey and build a nearly 50,000 square foot simulation center.
Right now, we have a project regarding central line insertion. Our simulation group has very carefully created a standardization according to best practices and built the simulation curriculum around it this year. Our next step is to partner with our healthcare system to look at clinical outcomes related to that training. We hope to document fewer complications – specifically line infections, pneumothoraxes, or other adverse events. We expect to show a return on investment and that simulation-based training actually pays off in the clinical arena.
If we can shave off even half a day in length of stay, that’s a substantial savings. If you get a line infection, that’s a nearly $30,000 cost to the healthcare system each time.
"If we can shave off even half a day in length of stay, that’s a substantial savings. If you get a line infection, that’s a nearly $30,000 cost to the healthcare system each time."
OWH: What are the challenges of simulation-driven medical training?
DS: We’ve have had success in training medical students, residents, fellows, and even practicing physicians, over 20 years. But we’ve never had an integrated campus-wide simulation program.
Our new center integrates our efforts across all departments, different schools, and diverse levels of learners – from the novice, first-year medical student to the sophisticated training modalities for practicing physicians. But, we are about two and a half years into planning the opening of our new center in September.
It’s quite a challenge to get everybody on the same page, standardize the processes, streamline our evaluation expectations, and create a supportive infrastructure. These new concepts have been a challenge for us.
But, results are evident, like that team training and practicing resuscitation drills are lowering the mortality rate in hospital systems related to rapid response conditions, or central line training is making a significant difference on patient outcomes and length of stay in the ICU.
OWH: As a modern-day mechanism, how does simulation ensure physicians – both the novices and the experts – are kept up-to-date? How will technology continue to impact care?
DS: Simulation gives you a safe environment to measure performance and remediate as needed to teach additional skills to folks that need to brush up on various things.
Our simulation is not just part training for medicine or training for residents, but part of our fabric as a whole educational infrastructure. It can be, and probably should be, used to verify the levels of performance that patients expect.
If, for example, you look at the aviation paradigm, where a pilot has to get checked out on any specific aircraft they’re going to fly, they arguably have about a half a century head start on medical simulation because flight simulation really started around World War II, with a simulator called the “Link Trainer”. And very quickly they diminished crashes on landings. But aviation also has an incredible amount of resources. Their simulators routinely cost several million dollars.
Medicine is not quite there yet, but if I had my crystal ball, I’d say in the future every physician who graduates medical school, and every physician matriculating through the more advanced training levels will also likely have verification that they have requisite competency to do what’s required in their practice.