Major Conference Showcases Health Care Modeling and Simulation at ODU

Old Dominion University's growing research emphasis on health care modeling and simulation, and the university's successful collaborations in this field with Eastern Virginia Medical School, were evident at the 12th International Meeting on Simulation in Healthcare last month in San Diego.

Human factors psychologist Mark Scerbo led an ODU delegation to the conference, delivered a plenary presentation and was part of two project teams that won research awards.

Scerbo's plenary address, "Human Factors and Simulation: Limiting Iatrogenic Harm," underscores a major emphasis of health care modeling and simulation, which is to use simulations to train physicians and others in the health care field. "Iatrogenic" defines harm that is done by a health care provider, for example, by a young physician who learns by administering to real humans in an actual hospital environment.

The traditional "see one, do one, teach one" apprentice training of physicians does not expose residents to a standard set of medical conditions and procedures, or to standard performance measures, Scerbo said. Furthermore, limitations by the Accreditation Council for Graduate Medical Education on the work week for residents represents a cutback in apprentice training hours for the typical resident, he said.

Scerbo believes the time is ripe for simulation-based medical training. "Simulation offers the opportunity to study the practice of medicine from a more scientific perspective," he said. "It will never replace the apprentice system, but it can make the system much better."

At the conference in San Diego, a research team led by Scerbo won a second place award in Outstanding Technology and Program Innovation for "Teaching Communication Skills Using Standardized Patients in a Team Scenario: A G Theory Analysis." Others on the team are Robert Turner, an ODU doctoral student in psychology; Miguel Padilla, ODU assistant professor of psychology; and two representatives of the Sentara Center for Simulation and Immersive Training at EVMS, Gayle Gliva-McConvey, director of professional skills teaching and assessment, and Patrick Walker, media production manager.

This communication skills project was designed to test the work of standardized patients (SPs) involved in an operating room training scenario. (SPs are "actors" who typically are trained to act as patients with specific symptoms of illness and to evaluate their examination by a medical trainee.) For this research project, however, four SPs were asked to portray members of a surgical team who are working in an operating room with one medical profession trainee. The surgical team was directed to follow a prescribed script called "Describe, Express, Specify and Consequences (DESC)" that helps any member of such a team speak up - firmly but constructively - if he or she believes the surgery patient's safety is threatened.

After the procedure, the four SPs evaluated how well the trainee used the DESC protocol. Then, Scerbo and the research team sought to examine the reliability of the SPs' ratings using generalizability (G) theory. What they found was that SPs did give valuable feedback.

The results show, among other things, "that the role of the traditional SP can be extended beyond patients to cases in which they portray other health care professionals," the researchers wrote. But "perhaps most important, the findings indicate that simulated scenarios using a team of SPs can provide an effective means for teaching individuals how to communicate in difficult situations."

Scerbo and ODU psychology graduate student Rebecca Kennedy also won fourth place in the Outstanding Research Abstract category for "Initial Laparoscopic Performance: Impoverished Visual-Spatial Cues Compromise Movements in the Depth Plane."

In this project, the researchers recruited 26 undergraduate students with no laparoscopic or medical experience to attempt a task using the laparoscope-equipped tools that a surgeon would use in minimally invasive surgery. (In laparoscopic surgery, the surgeon performs a procedure while following his or her work on a television monitor.)

The undergraduates were asked to perform a "needle threading" task using two laparoscopic graspers. The eyelets that the needle was to pass through could be moved to various planes within the laparoscopic box simulator. Proficiency was measured by threading time, number of needle drops and number of successful attempts to pass the needle through the eyelets.

Kennedy and Scerbo knew in setting up the experiment that the two-dimensional representations surgeons see of three-dimensional space include distortions not found under natural viewing conditions. Their goal was to assess the magnitude of initial difficulties encountered in performing laparoscopic movements in the depth plane as compared to the horizontal and vertical planes.

Their findings suggest that laparoscopic training programs for novices may need to place additional emphasis on tasks that require movements in the depth plane over lateral and vertical movements.

ODU and its Virginia Modeling, Analysis and Simulation Center (VMASC) and EVMS have worked together on a virtual operating room in ODU's Cave Automated Virtual Environment (CAVE). In the room, real medical professionals and trainees can work in simulations involving virtual surgeons and patient.

The virtual operating room can simulate more than a surgeon's core duties. It can expose trainees to real-world team-building challenges and pitfalls brought about by cultural, gender and age differences. It also can be a test lab to study task sequencing and other aspects of how people learn in a stressful environment.