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The University of Washington is changing the way medicine is taught by incorporating simulated training of surgery and other medical techniques into medical education. The UW’s Institute for Surgical and Interventional Simulation (ISIS) is a pioneer in the use of simulation technologies to improve the quality of healthcare education and to improve patient safety and outcomes.

New technologies advance training
Medicine has long followed the “see one, do one, teach one” apprenticeship method for training its practitioners. Students or interns observe and emulate a more senior physician making a diagnosis and treating a patient. After mastery, the trainee is encouraged to take charge, under supervision, the next time a similar case occurs. The University of Washington has determined that there is an additional way to train doctors, especially in surgical techniques. Just as the airline industry requires pilots to practice on flight simulators to ensure safety, the UW recognizes the effectiveness of simulation training to benefit both practitioners and their patients. Paul G. Ramsey, dean of the School of Medicine and UW vice president for Medical Affairs, has made increasing medical simulation training a priority at UW Medicine.

Students and residents in the UW School of Medicine practice surgical techniques on a human patient simulator, a smart “dummy” that can metabolize drugs and has a heartbeat and lungs, as well as eyes that dilate and blink. This is perhaps the best-known type of medical simulation, but many others are available at ISIS. For example, UW Medicine students and interns practice laparoscopic gallbladder surgery using instruments that allow them to mimic the motion and intricacy of real surgery. They practice on a simulated gallbladder that is displayed on a video monitor in front of them. At the end of the simulated procedure, the program provides feedback about accuracy and the length of time taken to complete the procedure. This kind of objective feedback helps students and interns set and attain improvement goals.

“They do a procedure a few times and they get very skilled at it. And they’re not trying it on patients for the first time,” says Dr. Brian Ross, director of ISIS. Ross, an anesthesiologist, has developed an anesthesiology curriculum that demonstrates a full range of medical situations, providing students and residents with vital hands-on experience. The advantage of simulation, Ross says, is that residents know how to do these procedures before they go into the operating room. Simulation is now part of many curricula within UW medical training. Internal medicine, orthopaedics, obstetrics/gynecology, anesthesiology, surgery, and nursing are all using simulation capabilities.

In addition to learning procedures, students and interns learn teamwork. Working with colleagues within their specialty and across disciplines on simulated patients in a simulated operating room, trainees learn key aspects of communication and interacting in a team setting.

Studies show advantage of simulation
Studies by UW researchers highlight the importance of simulation as part of medical training. Dr. Richard Satava, professor of surgery at the UW and senior executive advisor for ISIS, conducted early national research on simulation. In 2000, Satava, then a surgeon at Yale Medical School , conducted a study with several colleagues to determine whether doctors who had practiced on surgical simulators performed better in the operating room than doctors who had learned their skills under an apprenticeship system. He and his colleagues enlisted 16 surgical residents who were randomly assigned to either simulation training or conventional training in laparoscopic gallbladder removal. The residents then performed the surgery on patients under the supervision of attending surgeons.

The results were remarkable. The residents displayed similar psychomotor skills, but those who had trained on the simulator completed the operation, 29 percent faster, on average, than those who had not. The residents who had received standard surgical training were nine times more likely to hesitate during the operation, five times more likely to injure the gallbladder or burn surrounding tissues, and six times more likely to make other errors.

The future of simulation
ISIS has a number of long-term and short-term plans and goals. In the short-term, ISIS will move to the UW Medical Center Surgery Pavilion and occupy a new simulation skills center. Five years from now, ISIS may be part of a UW simulated hospital, where trainees will follow a simulated patient from admission through discharge. Teams that could include doctors, nurses, social workers and others would work together to learn effective skills for treating patients in an array of scenarios, from a routine surgical admission to a biohazard contamination.

Community physicians also will be able to take advantage of the simulation center. As the pace of medical discoveries quickens, new and better techniques and procedures are developed. ISIS will provide a setting for physicians at all levels to master these techniques before using them on patients.

The Division of Education of the American College of Surgeons has taken steps to support surgeons’ efforts in acquiring skills in new procedures and technologies. A major area of focus is verifying the knowledge and skills of surgeons at the completion of experiential courses. The division is developing a model to establish a network of ACS-Accredited Education Centers. The University of Washington hopes to be one of the first centers in the country.

Along with being a leader in simulated medical training, UW Medicine has been ranked consistently among the top academic medical centers, and UW School of Medicine has been ranked #1 in training primary-care physicians for the last 13 consecutive years by U.S. News & World Report.

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