Thursday, October 10, 2013
By Jennifer Parraga

An actor, an anesthetist and an engineer along with a cast of renowned physicians, and educators are setting the stage for expansion in simulation education and research at the Schulich School of Medicine & Dentistry. Together they are writing a new script for more diversified and integrated simulation training in the School’s education portfolios. As leaders in their fields, they are also supporting the establishment of an international, leading centre in simulation.

Their efforts are being directed by Dr. John Denstedt, MD ’82, special advisor to the dean on globalization, internationalization and simulation.

Dr. Denstedt sees the expansion, diversification and integration of simulation education as a need critical to the future of the School. “Numerous departments across the School, including anesthesia, psychiatry, surgery and emergency medicine—just to name a few, are actively utilizing simulation as a learning technique. More and more, simulation is integrating itself into all aspects of training in medicine and dentistry. There’s no time like the present to harness all this knowledge and expertise and create a stronger and more cohesive program,” said Dr. Denstedt.

At the heart of simulation training is the patient experience and continuous improvement in patient safety. That is the catalyst for the planned expansion as well. 

Also driving this expansion is the incredible rate of development of new technology and new surgical procedures. “As a medical school, it is our responsibility to provide education programs, courses, teaching techniques and learning environments to keep our students at the forefront of medical care delivery,” said Dr. Denstedt. Accrediting bodies for medical schools are also now demanding that simulation training is in place.  

“The value of simulation training is unmatched as it allows students to experience scenarios that mirror real-life situations they will encounter in the clinic, operating room, or waiting area,” said Dr. Bertha Garcia, vice-dean, Education. With simulation, students practise the same skill over and over again, increasing their proficiency, competence and confidence. Students also refine their communication skills and enhance their approach to teamwork. Meanwhile, simulation provides faculty theopportunity to effectively assess students while creating scenarios and unanticipated events to challenge students.

With a background in the theatre and advanced training as a simulated patient trainer, Justin Quesnelle is now the Manager of the Clinical Skills Program (CSP). He is responsible for overseeing a wide range of nearly 100 annual projects ranging from Enhancing Communication Skills for Dentistry Students to Teaching Physical Exam Skills Specific to Respiratory Examinations. Programs are offered to medical, dental, and nursing students, as well as resident trainees at Western University. Practising physicians and a host of other health care students and professionals access workshops, courses and structured assessments through CSP. This is all supported by a small administrative staff and nearly 400 simulated and volunteer patients who undergo hours of training.

Schulich Medicine & Dentistry is a leader in the field of clinical skills training. “We have one of the most mature and diverse programs in the country,” said Quesnelle. “Each year the program is growing. Last year alone, more than 100 standardized patients were hired just to meet this demand.” That growth, undoubtedly stems from the incredible value simulation training brings to the students.

Quesnelle believes this is an exciting time for simulation learning. “During the past couple of decades a strong foundation for simulation training has been laid,” said Quesnelle. “Now, it’s time to build upon that foundation by bringing together the different types of simulation environments.” Quesnelle is looking forward to developing new aspects for existing programs where they can integrate standardized patients into operating room scenarios, and challenge students to practise their surgical techniques along with their communication skills when working with patients’ families.

Dr. Rich Cherry echos Quesnelle’s sentiments. Dr. Cherry is an Associate Professor in the Department of Anesthesia & Perioperative Medicine, and Director of Anesthesia and Critical Care Teaching Through Simulation (ACCTTS). He is passionate about the power and possibilities of simulation training, and believes the current programs can be taken to the next level, further developing their teaching effectiveness and increasing the capabilities of students.

Dr. Cherry works with learners at all levels from undergraduate medical students to physicians pursuing continued medical education. His classroom is a simulated operating room located at London Health Sciences Centre in the world-renowned and fully accredited Canadian Surgical Technologies & Advanced Robotics (CSTAR). His patients are highly realistic mannequins who can be programmed to present any number of reactions or conditions. These high fidelity scenarios provide trainees an exceptional learning experience. As with clinical skills practise, trainees debrief with their professors following each procedure. They review their technical skills, their communication skills, their teamwork, and coping mechanisms.

Understanding how physicians adapt when they face complex situations in the operating room has become the focus of a critical research program being led by Sayra Cristancho, PhD. Cristancho is an Assistant Professor with the Department of Surgery, and a scientist with the Centre for Education Research & Innovation (CERI).

An electrical engineer with a life-long interest in medicine, Cristancho completed her doctoral work at UBC and her postdoctoral work at SickKids Hospital. Cristancho’s research, which is funded by grants from the Canadian Institutes of Health Research and the Royal College of Physicians and Surgeons, will seek to answer questions such as: What allows surgeons to be effective in making good decisions in the operating room? How does surgical judgment manifest during challenging surgical situations? And how can simulation be better designed to enhance decision making during complex situations?

“The patient isn’t the only human in the operating room,” said Cristancho, as sheexplained the details of her research. “We often don’t think about how many external factors play a role in the operating room. We also don’t consider how the social negotiations play out or the importance of non-verbal actions.” These all can add to the complexity of the situation. The student or trainee needs to begin to learn the elements of each situation and how it may impact them, their decisions, and their own actions as they provide care.

Cristancho’s findings will help to build more sophisticated and specialized training programs that push students and expose them to scenarios to further develop their skills. Her research will develop a theoretical framework of the process through which experienced surgeons use their interactions with the surgical environment and adjust their decision-making process during challenging situations. 

Further to Cristancho’s work, CERI will play a larger role in determining the overall effectiveness of simulation training in a variety of different medical specialties. It is essential to develop an understanding of the most effective forms of simulation training and determine if the investment in this area of training is making a difference.

As the School looks to expand and integrate its training programs, it is also working to create a world-class Simulation Education Centre. Although early in the planning stages, Dr. Denstedt has a clear vision of this new Centre, incorporating operating suites, clinic-style treatment rooms, and a teaching auditorium. It is here where interdisciplinary and team training for medical and dental students, residents and health care professionals from across the region and around the world will take place.

Taking leadership of the Centre and the new integrated simulation program will be a new Chair in Simulation and Technology Development. The Chair and Simulation Education Centre are key projects within Western University’s Be Extraordinary fundraising campaign. To date, more than $700,000 in private support has been received in support of the Chair.

Schulich Medicine & Dentistry’s simulation education and research program is on the verge of great change. It’s Dr. Denstedt’s goal that it will very soon become a “pinnacle of excellence” in the School. There’s no question in anyone’s mind, with the people, knowledge and innovative spirit at the School, this vision will become reality and worthy of a standing ovation.

Simulation education and training takes place in several medical disciplines across Schulich Medicine, supported by an outstanding team of physicians.

Dr. Robert Arntfeld
Dr. Lois Champion
Dr. Rich Cherry
Dr. John Denstedt
Dr. Ken Faber
Dr. Kevin Fung
Dr. Jeffrey Fuss
Dr. Jeff Granton
Dr. Marie-Eve Lebel 
Dr. Deric Morrison
Dr. William Moote
Dr. Michael Ott
Dr. Robert Stein
Dr. Mithu Sen
Dr. Alice Tsui