Seeking a Balance
Written by Marty Kauchak
DATA POINTS
The services have diverse requirements for medical learning technology. The Naval School of Health Sciences (NSHS) has three simulators—a Trauma Man Simulator, an Emergency Care Simulator and a Human Patient Simulator. “The first two can be used to simulate a variety of emergency scenarios and are great for teaching triage principles and emergency care management,” Lieutenant Commander Dennis Spence, Seeking a Balance spokesperson for NSHS, told MMT. Spence, a member of the service’s nurse corps, also pointed out that both are wireless and can be used in the field. The Human Patient Simulator is a high-fidelity simulator, which is ideal for training anesthesia providers.
All three simulators allow for intubation, chest-tube placement and other task simulation. While the NSHS nurse anesthesia training program uses oral boards to evaluate critical thinking, simulators also allow the staff to evaluate learners’ critical thinking and real-time management of a patient during a crisis. “Simulators are ideal because they take all the risk out of clinical training,” Spence remarked.
For its part, the Army uses simulation for training combat lifesavers and combat medics at the point of wounding, through the Medical Simulation Training Center Program (MSTC). The program delivers state-of- the-art medical simulation and training with mannequins. These devices have the ability to provide realistic responses to actions taken or not taken, and either improve or deteriorate based on what takes place.
CSC was awarded the MSTC contract in 2005 and currently has 19 operational sites, with three more slated to become operational later this year.
The MSTC program is “the Army’s first and currently its only medical simulation program,” explained Lieutenant Colonel David Thompson, assistant project manager, Medical Simulation, PEO STRI. He added, “Our goal for tactical combat casualty care is the ability to create a training capability that responds to a casualty producing event, such as a gun shot or an IED blast. Allow the soldier that is applying the medical care to encounter the casualty in an immersive and realistic battlefield environment, interact with an irrational and potentially combative casualty or set of casualties, and allow failure.” After the failure, the Army wants the learner to be able to hit the “reset” button and try it again, as many times as needed to learn how to succeed in saving lives on the battlefield. This requirement is ideally filled by simulators.
BLENDED LEARNING
Virtual simulation is an emerging tool for teaching critical thinking skills and other competencies. Differing from its older technology siblings—mannequin-like simulators and other training devices—this capability immerses a person in a virtual environment.
The applications of virtual simulation available to the community are expanding and include serious gaming, haptic feedback, blended reality and immersive environments. The astounding progress in the fidelity and utility of one virtual application for medical learning—serious games—was evident at the 2008 I/ITSEC in Orlando. The winner of both the conference’s Overall Best Serious Game and Best Small Business Game was Burn Center, developed by 360Ed.
Burn Center is a fast-paced, medically accurate simulation of a mass-casualty disaster involving multiple-burn victims. The product was developed to electronically recreate established medical procedures and tactics, and follows patients over the course of 36 hours of treatment in an intensive care unit.
Another industry partner, ECS, is also pushing the virtual envelope. The company developed the Tactical Combat Casualty Care Simulation for the U.S. Army RDECOMSTTC in cooperation with the Army Medical Department’s Center & School, Department of Combat Medic Training. “During development, ECS spent considerable effort in marrying high fidelity 3-D character models with high performance, real-time physiology systems to realistically depict the most common injuries encountered on the battlefield. There are a number of systems that must interact when trying to simulate a casualty on the battlefield,” Brent Smith, chief technology officer, engineering and computer simulations (ECS), told MMT.
The company’s product portfolio builds upon the successes of US-Nexus—a National Guard-sponsored program that provides a secure persistent virtual world capability for training and collaboration.
Reflecting on the broader state of virtual simulation, Smith noted that while the state of the art allows curriculum designers to merge the virtual environment with training devices and simulators, “the most common use of this technology revolves around teaching when to provide a specific medical intervention within the continuum of combat.” And one of the biggest benefits of virtual simulations is the ability to provide context to a teaching point. “These simulations will immerse students into scenario-driven events to teach procedures relating to the initial point of injury, casualty assessment, scene security, triage, initial treatment and evacuation of a casualty,” Smith pointed out. “Each scenario is typically designed as a short, goal-oriented training exercise that provides the means to train within the context of a mission. It is this contextual experience of knowledge acquisition in an authentic environment that facilitates the learner to transfer this knowledge to new unfamiliar situations,” he said.
Virtual simulation is also touted to overcome instructional obstacles, including the difficulty to teach young medics the signs and symptoms for different types of casualties like when a chest wound advances into tension pneumothorax or when a casualty begins to go into shock. “Virtual simulations have the potential to expose young soldiers to these signs and symptoms on a more regular basis so that they are not seeing them for the first time on the battlefield and are more prepared to deal with them when they do encounter such injuries,” Smith said.
STRIKING A BALANCE
Course sponsors and designers are working to achieve a balance for using training devices, simulators and virtual simulation— and are discovering some impediments along the way.
“The mix of the different simulation capabilities depends on the focus area,” Thompson said. The PEO STRI Med Sim office has three primary focus areas:
• medical simulation for medical units/ activities (for training and treatment);
• medical simulation for non-medical units/ activities (training);
• non-medical simulation for medical units/ activities (for training and treatment).
The correct mix of simulation depends what community is being addressed. “There is a large difference between what is needed in a potential brigade medical training set, which could be located at installation training support centers, for use by infantry or armor brigades to conduct combat lifesaver training, versus what might be needed to address extremely complex surgical simulation inside of a hospital or predeployment team training for an intensive care unit team prior to deployment into a combat support hospital. None of this is currently defined although the urgent need to address it is recognized,” he concluded.
The Navy’s Spence said there should be a balance between virtual and simulated, though the number or use of each should be dependent on the number of personnel anticipated to use the simulator equipment. He emphasized, “The most important issue with high-fidelity simulators—it is important to have enough support personnel to run the simulator and to teach the scenario. Ideally you need at least two personnel at a minimum to run a high-fidelity simulation. Also, the simulator should be easily accessible to staff and personnel; ideally in a central location. If it is not convenient to use, personnel will not use it.”
From an industry perspective, ECS’s Smith observed that the government customer’s requirements for virtual simulations and simulator devices are constantly changing. “The use of simulation technologies for the medical domain is still very much in its infancy,” he said. “As new technologies are developed, these quickly have the potential to become new requirements. For this reason, in the future, devices and simulations will need to work together within a blended program of instruction.” ♦