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Prof. Dr. Doris Østergaard, immediate past president of SESAM, and Prof. Dr. Wolfgang Heinrichs, AQAI simulation centre Mayence (Photograph: MR)

SESAM Medical Simulation Conference in Germany

Increased awareness around patient safety, a shortage in resources, and pressure for continuing education are key drivers which put simulation on the agenda of caregivers. Today, the call for this approach reaches well beyond the education of specialists at university level. – Last June, a conference brought together experts, users, and the industry.

The Society in Europe for Simulation Applied to Medicine (SESAM) – founded 15 years ago by a small group of anaesthetists – held its 15th annual meeting in Mayence, Germany. “Physicians are trained to work as individuals, not as team members”, explained immediate past president of the society, Prof. Dr. Doris Østergaard. Issues in organizing workflows and in communication between healthcare workers involved in a patient case contribute significantly to problems. “Things do go wrong inside and outside hospitals, and education and training are required to achieve improvements. Simulation helps in optimizing the distribution of tasks, in communicating, and interacting within teams”, Prof. Østergaard went on to say. Procedures in cardiac arrest are a case in point: first, staff from various medical disciplines and nursing needs to acquire know-how; second, training has to take place – e.g. on a skill simulator; third, these skills have to brought together in a simulation scenario, where team skills are trained.

“Focus Is On Processes”

Prof. Østergaard is the Director of the Danish Institute for Medical Simulation and Associate Professor at Copenhagen University. In addition to the university, her institute today serves caregivers in the capital region in Denmark, with simulation campaigns such as this: “A 55-year old goes jogging at five in the morning, falls, and the ambulance is calle. and takes the patient to the hospital. The team arrives in the emergency unit and proceeds to handle the case. Actions are video recorded, and in a post mortem, are discussed in detail to identify necessary improvements.” The manikin used for resuscitation training, and the ancillary IT which evaluates the effect staff action would have on a real human being, are only part of the “big picture” – the focus is on processes and interaction. The teacher, or facilitator, in these scenarios is challenged in several ways: interdisciplinary know-how is required from him/her, and there is a difficult borderline between letting project members act “as if in real life” and stepping in to curb serious errors. Participants value these scenarios because they receive immediate feedback.

Prof. Dr. Wolfgang Heinrichs is the co-founder of the AQAI simulation centre in Mayence which is one of a few organizations serving healthcare providers in Germany: “We help hospitals of all sizes in improving medical/nursing and social skills for their staff. The private group Helios, for example, uses our organization to train incident management in anaesthetics”.

Optimizing Safety and Cost

Patient safety statistics show clearly that there is significant room for improvement in care. Cost reductions are another benefit to be reaped from optimized education and training. How, according to the expert from Denmark, should specialist and team training be organized? “I think you have to have regional centres plus local simulation activities; and you should collaborate to produce overall comprehensive learning.” The benefit of the use of manikins from Meti, Laerdal, Gaumard, and further vendors is obvious: they allow for a lifelike training of novices which is more suitable than the use of animals. Healthcare workers receive a higher level of qualification before they start working on humans, which helps avoid harm being afflicted to patients.

“In the field of medicine, simulation-based cross-disciplinary training will be required which orients itself to clinical pathways”, predicted Prof. Heinrichs at the conference; “simulation needs to be a requirement in curricula, and an integral part of existing training programmes”, stated Prof. Østergaard; “in future, patients will demand this type of training from their caregivers.”

Genetics and biomarkers are at the top of the agenda; simulation may appear to be a less attractive topic, but it is key to necessary improvements in care. “Many European countries see the need to establish a national society to be linked to SESAM; this is the right path”, “underlined the Danish expert, towards advancing the simulation approach in Europe”.

Pioneering Example – Investment in Simulation

According to a statement from Dr. Ian Curran, Associate Dean and Lead for the Simulation and Technology-enhanced Learning Initiative at London Deanery last April, “The London Deanery’s pioneering advances in simulation and medical education are providing our doctors and clinical teams with unique opportunities to develop their individual and team-based skills in a patient safe way. Over the last 18 months, with the support of NHS London, we have invested over £11 mn. equipping every one of the 32 acute trusts in London with state of the art educational equipment. Therefore, we are confident that as simulation training is adopted more widely, it will support the provision of higher quality and safer patient care for London both today and in the future.”

SESAM’s Mission

… is to “…encourage and support the use of simulation in medicine for the purpose of education and research.” Members are physicians, nurses and other health care professionals, also technicians, engineers, psychologists, physicists, and biologists: www.sesam-web.org.