Simulation centre will teach new skills and latest surgery techniques

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St. Michael’s Hospital opened the most advanced simulation centre in Canada this fall – and has already added new equipment, a simulator for practicing 3-D surgery.

The Allan Waters Family Simulation Centre will allow students and health care workers from a wide range of disciplines to learn and practice new procedures and conduct research using computers and mannequins.

“The use of a simulation facility allows us to practise skills and learn new ones in a safe environment so that we can deliver better quality and safer patient care,” says Dr. Patricia Houston, the hospital’s vice-president for education.

The 5,800-square-foot simulation centre includes a full-size, state-of-the-art operating room — where trainees are put through real-life medical scenarios or crises to learn how to respond quickly and as a team – and a skills lab where they learn and practice the newest surgical and diagnostic procedures.

The OR can be transformed into an emergency trauma suite, intensive care unit, patient ward—or even a mock rave party for training EMS workers. Every effort is made to ensure training participants feel the same sense of stress and urgency as they would during a real-life experience.

For added effect, scenarios may include role players such as a surgeon, circulating nurse or respiratory therapist. Instructors can also throw in artificial vomit and spray the scent of stool in the room. By the end of the simulation session, participants will have gained hands-on training with no risk to patients.

The star player in these scenarios is the Laerdal SimMan 3G — a life-size, anatomically correct mannequin that has a pulse, heart beat and breath sounds and responds to interventions such as the administration of oxygen, fluids and chest compressions. This is the most advanced mannequin available. He or she – it can become either – can cry, froth at the mouth and sweat through pores in its forehead.

Its pupils dilate in response to the injection of certain drugs; it can turn cyanotic; and instructors operating a computer in a control room on the other side of a one-way mirror can make fluid ooze from its ears, nose and mouth. It recognizes and responds to more than 100 prescription medications. In addition, the hospital has two infant mannequins.

St. Michael’s was a pioneer in simulation, opening only Canada’s second simulation centre in 1996. The centre has focused on training health care workers how to respond to crises and on training interdisciplinary teams. This new $4 million centre brings all the hospital’s simulation activities into one centre on the bottom floor of the hospital’s new Li Ka Shing International Healthcare Education Centre and greatly expands into surgical simulation.

“I see this as a turning point in the history of simulation at St. Michael’s,” says Dr. Houston. “Today, with the opening of this beautiful new simulation centre, we are moving forward to becoming a world-class centre for surgical simulation.”

The skills lab focuses on minimally invasive procedures, for which St. Michael’s is a leader. It has equipment to practice virtual laparoscopies and has the most up-to-date endoscopy equipment, with miniature microscopes that may reduce the need for more invasive biopsies.

Studies have shown that only 5 per cent of medical students are naturals at the fine motor skills involved with surgery.

“Surgeons who have simulation training perform faster, are more accurate and make fewer errors,” says Dr. Teodor Grantcharov, medical director of the simulation centre. “For patients, this means fewer complications and less time on anesthesia.”

Dr. Grantcharov said about 50,000 patients die every year in the United States due to medical errors. About half those deaths occur in ORs and about half of them are preventable by better education.

Recently, the hospital acquired a new simulator made by the Swedish company Surgical Sciences on which students and physicians can practice 3-D surgery.

On Dec. 1, Dr. Grantcharov performed the first 3D surgery in Canada, a gastric bypass, using prototype equipment supplied by Karl Storz Endoscopy Canada Ltd.

The simulation centre is also set up for telesimulation, where trainees practice treating patients at a distance over a secure network. The latest in audiovisual equipment will allow procedures, real or simulated, to be broadcast to anywhere in the world.

In addition to the Waters family, Karl Storz was a major contributor of equipment for the operating room and six training stations and the equipment for tele-mentoring. Johnson & Johnson Medical Companies gave funding for education, teaching and curriculum development, including a lectureship series.