Patient Simulator in Anesthesia at Icahn School of Medicine at Mount Sinai Miguel Yaport Simulator-based education, developed by the aviation industry in 1909, was initially designed to help pilots fly the Antoinette monoplane. Simulation programs aim to recreate real-life situations. Given this goal, a simulation’s biggest challenge is achieving fidelity: does the simulation facilitate learning that translates into real-life settings? Simulation programs that do adequately portray their depicted scenarios provide many benefits. Programs are inexpensive in the long term, as they can be mass-produced and reused once constructed. For medical schools, simulationbased education provides important opportunities for students to experience rare cases and safely learn from incorrect actions or diagnoses. A simulator program in medical education may re-create patient encounters or feature critical care situations. As a specific example, throughout training medical students are told a crescendo-decrescendo murmur that is loudest at the upper right sternal border, is louder on expiration, and radiates to the carotids is a physical finding of aortic stenosis. Despite constant repetition, this statement is often not truly understood until experienced in person, but unfortunately, this particular pathology is relatively uncommon. Today, educational simulations (in this case, recordings of the heart sound) make it possible for every medical student to become familiar with an otherwise rare finding. During simulated patient encounters with a mannequin – a second example of simulation-based education medical students make decisions for their mock patients under the watchful eye of an attending doctor. These sessions allow students to learn how to make rapid, important decisions, and to experience the consequences of these choices without ever putting their patient in real danger. The attending physician’s main role is not to step in to intervene; failure is always an option. In many real-life instances, these errors would lead to negative outcomes or death, results which highlight the powerful role of simulators as teaching tools. Although simulator-based experiences are now commonly used in medical education, Mount Sinai’s Anesthesiology Program is known throughout the world
for its simulator center, known as The Mount Sinai HELPS Center, or simply the Sim Center. The Sim Center is open not only to anesthesiology residents but also to Icahn School of Medicine medical students as well as several other groups of providers from Sinai and other institutions. It was in the Sim Center that Dr. Adam Levine, Dr. Samuel Demaria Jr, and Dr. Jason Epstein first developed a computerized preoperative patient interview simulation. According to Dr. DeMaria Jr, the idea evolved from the desire to augment “our high-stakes simulation-based assessment for attending anesthesiologists”. Mount Sinai’s Anesthesiology Department now employs this Sim Center as part of its re-certification program for
residents was examined in a randomized study. Residents were assigned to interview either the avatar or a standardized patient. The study found that simulatorbased training and assessment were statistically comparable to training and assessment using a standardized patient. Interestingly, residents were more likely to perform a physical exam and check vitals on the avatar than on the standardized patient. The avatar, says Dr. DeMaria Jr., has the potential to teach medical students both history and physical exam skills, as well as to help with practice for Step 2 CS. Similar to the online exams that medical students take at home, this avatar program can be accessed online. Additionally, Dr. DeMaria Jr. says the machine “can reliably
Avatar Patient Interview Interface
Anesthesiology attendings as well as for individual assessments for medico-legal reasons. As a first step towards creation of this simulator for high-stakes assessment, Dr. DeMaria Jr, Director of Research of the Mount Sinai HELPS Center, partnered with LogicJunction, Inc to develop a screen-based virtual human simulator (known as an avatar) to train and evaluate Anesthesiology residents. This simulator was the first of its kind in anesthesiology. It can be set to mimic the preoperative environment, and its design allows “the full range of human emotions, facial expressions [and] body language…”. It is so realistic that Dr. DeMaria Jr believes it can even be used to “train physicians to interview difficult patients or patients with psychiatric disorders”. Recently, the avatar’s ability to train and assess the performance of 11
reproduce patients and pathophysiology” in contrast to standardized patient actors, who cannot reproduce medical phenomena such as heart murmurs. However, Dr. DeMaria Jr does have a few words of warning. “When it comes to a mannequin simulated patient, human standardized patient or avatar, the primary goal is not care of the patient; it’s sometimes training to the test.” In other words, although simulated patient encounters offer tremendous value as an adjunct to medical education, they cannot replace treating and caring for real patients. These simulator programs are gradually but powerfully transforming medical education. The Mount Sinai HELPS Center has long been at the forefront of simulation technology and has become an important training tool. As Dr. DeMaria Jr. makes clear, however, its full potential is only just being realized.