The future of simulation is to be found in Tel Hashomer

Simulation centers have been popping up in hospitals across the world.  These are useful, but for the most part their function is to provide technical training in surgical and other interventional techniques, as well as to practice resucitation and the like. Sometimes, too, they are used to study teams in stressful situations to provide lessons in team dynamics.

Amitai Ziv has a broader view of the purpose of simulation. His goal is nothing less than to use this tool to help in the transformation towards a safe, humane, ethical, and patient-centered medical culture.  As the director of MSR, the Israel Center for Medical Simulation at Sheba Medical Center on the outskirts of Tel Aviv, he is pursuing this goal with passion and energy and the support of his home base, philanthropists, and medical professionals throughout the country.

When an adverse event occurs in hospitals, we sometimes say that "the holes in the swiss cheese lined up" to permit a series of small problems to cascade into a big medical error.  Amitai draws on that imagery to describe "the educational Swiss cheese model."

He sees flaws in several key components that comprise the continuum of education and practice for physicians and other health professionals. He suggests that targeted use of simulation can help address the holes in the continuum, and he and his colleagues are out to test that proposition.

MSR is designed as a virtual hospital, offering a wide spectrum of medical simulation technologies. These include computer-driven physiological mannequins, advanced task trainers for manual skills and live simulated patients played by role-playing actors.  MSR combines these different technologies in "high-risk" scenarios to develop and build crucial clinical and communication skills and enable team training in risk-free environments.  Customized audiovisual equipment and one-way glass facilitates real-time observation and allows effective debriefing and constructive feedback to trainees.

Beyond technical training, MSR:

Enhances communication skills through programs dedicated to teaching challenging tasks, such as delivering bad news, obtaining consent and the detection of domestic abuse.

MSR training in a variety of technical and interpersonal competencies is now required of all medical students in Israel before they start their internships.  Interestingly, the center is also working in collaboration with the Tel Aviv University Sackler Faculty of Medicine to provide simulation-based personality screening of medical school candidates.  The aim is to improve the humanistic quality of medical school candidates by assessing their personal and interpersonal characteristics.

MSR conducts hands-on experiential simulation training in a wide variety of clinical domains such as Anesthesia, Cardiology, OB-GYN, Trauma, Chemical & Biological Warfare Management, and more. MSR is an integral part of the accreditation and licensure process of several of Israel's healthcare professional bodies.  These include competence-based board exams for Anesthesiology Residents and for Paramedics. 

The center also conducts a faculty development program for those interested in developing simulation programs in their home institutions.

In short, this is not a view of simulation as an adjunct to the medical education system.  It is a conception of simulation as being deeply integrated into many of the phases of a physician's career--starting before medical school, leading through that school and residency, and then staying with the person throughout his or her career. This larger vision welcomes the use of simulation by regulators and professional societies, as well as risk management organizations. Beyond a focus on safety, there is an attempt to influence the practice of medicine in many dimensions, consistent with the underlying values of clinicians and the roles expected of them by patients and families.

As someone who has been involved in several aspects of simulations, I will tell you that the MSR vision is expansive beyond anything I have seen.  The future of simulation is to be found in Tel Hashomer.  If I were running a center anywhere else in the world, I would be doing my best to learn from Amitai and his colleagues lest my own center fall behind and fail to meet its potential value to society.