The techniques, feedback and team building will be real, but the patients won’t be alive or even organic - construction of the Goodman Simulation Center (GSC) is well under way and on schedule for opening in November, announced Thomas Krummel, Emile Holman Professor and Chair, Department of Surgery.

The GSC will be located on SHC’s 3rd floor, adjacent to the operating room suites and close to the ICUs. The surgical resident curriculum has already begun to use the immersive and simulation-based tools, which will soon be available in the new center to a wide variety of clinicians, including attending physicians, nurses, allied health professionals and others at SUMC and Lucile Packard Children’s Hospital (LPCH), Krummel said.

The Goodman Simulation Center is part of the Stanford University School of Medicine’s overall simulation strategy under the aegis of the Center for Immersive and Simulation-based Learning (CISL), headed by Associate Dean David Gaba, professor of anesthesia, whose team has led development of a Stanford-affiliated multispecialty simulation center at the VA Palo Alto Health Care System since 1986.

The new center, operated by the Department of Surgery, “expands our hands-on training capabilities significantly and provides a fully equipped center available to a wider group of Stanford participants at SHC,” Krummel said.

The Goodman Simulation Center curriculum is led by Krummel; Ralph Greco, Johnson and Johnson Professor of Surgery and professor, by courtesy, of mechanical engineering; Myriam Curet, associate professor of general surgery; Jason Lee, assistant professor of surgery (vascular); and Sanjeev Dutta, assistant professor of surgery (pediatric).

Sandi Feaster, a registered nurse with an MBA, is program director of the center.

“We’ve never had this type of training before, but even the most experienced surgeon, anesthesiologist and nurse can benefit from practice on those rare but potentially high risk surgeries that we don’t practice continually,” Gaba explained. “In addition, simulators allow everyone to practice new procedures and to finetune our teamwork skills.”

Gaba was quick to add that “there is no substitute for the ‘real thing’. No one is suggesting that healthcare can do without lots of experience with real patients. But, for many situations, the ‘real thing’ is not encountered very often, so when it does occur we need to feel comfortable. Simulation practice allows us to become systematic about our initial and recurrent experiences while we tackle real surgeries that present in a wide range of difficulty and variation,” Gaba explained.

Immersive and simulation-based tools that will be used in the Goodman Simulation Center include:

The Standardized Patient. Actors play patients to improve history taking and physical examination.

Part-task and Procedural Simulation. Three dimensional anatomical models simulate the feel (haptics) of tissue being pulled, cut, and manipulated. Additionally, these trainers can assist in skills training for manipulating laparoscopic and endovascular instrumentation.

Patient Simulation for Individuals and Teams. These provide mannequin-based simulation drills to assess decision-making, team collaboration skills and to enhance training, teamwork and skills involving complex surgical cases, ICU patient care and trauma resuscitation.

Gaba explained that the Center will be a place for residents to practice core surgical skills such as suturing, knot tying, and incision biopsies. Trainees can also practice placing central and arterial lines, as well as perform laparoscopic cholecystectomies - all before performing these procedures on patients. “Augmenting surgical training with simulation allows the maneuvers to be practiced over and over until mastered,” he said.

The Center is expected soon to incorporate simulation-based techniques to select, train, credential and retrain physicians and other healthcare professionals

Surgical teams will have the ability to rehearse an operation on a patient-specific palpable hologram, and later, deliver the data set of that operation with robotic assistance.

“Simulation is about techniques, not technologies, but many of the technologies have advanced to the point that many things can be learned using simulation that are hard to learn otherwise,” Gaba said. “As new clinical techniques emerge, all of us are likely to be ‘early learners’ for some things.”

“For example, in the past vascular surgery was largely practiced as open surgery. Now, however, up to 50 percent of a vascular surgeon’s practice may be in percutaneous endovascular techniques.

“Even highly experienced surgeons are having to learn such techniques from the ground up, and Dr. Lee, recently recruited to the faculty, will inaugurate an endovascular simulation program,” Gaba added.

“No longer will medical and surgical education be by random opportunity,” Krummel said. “The Goodman Simulation Center will lead the way towards improved patient safety and quality of care by providing the best and most comprehensive learning available.”

For more information, please contact Krummel at phone: 650-498-4292; email: tkrummel@stanford.edu; website: http://surgery.stanford.edu.