Friday, April 29, 2005
The New Yorker's Annals of Medicine column this week contains an interesting overview on the use of the simluator to help medical school students and practicing physicians refine their skills.
At most schools, medicine is still taught largely as it has been for centuries, with students and young doctors serving as apprentices to veteran physicians. Training begins with textbook descriptions of cases and is followed, in the second or third year of medical school, by instruction at the patient’s bedside, an approach known as “See One, Do One, Teach One”: the student or intern observes the diagnosis and treatment of a particular disorder and is encouraged to take charge the next time a similar case occurs. . . .
However, the apprenticeship model is becoming increasingly difficult to sustain. As insurers reduce reimbursements to hospitals, senior doctors are under pressure to focus on revenue-generating work—treating sick people and conducting procedures—rather than on teaching. Moreover, in order to cut costs, operations and therapies that once took place over several days are now performed in a few hours, or in outpatient settings. As a result, students are spending less time with individual patients and have fewer opportunities to observe a case from diagnosis to resolution. Some life-threatening conditions, such as anaphylactic shock or a ruptured aortic aneurysm, occur infrequently enough that a trainee may become a licensed physician without encountering such disorders or mastering the skills to treat them. Health care may be unique among high-risk fields in that learning takes place largely on human beings.
Dr. David Gaba, an anesthesiologist who directs a simulation center at the Veterans Affairs Palo Alto Health Care System, and who teaches at the Stanford University School of Medicine, created one of the first patient simulators nearly twenty years ago, in an effort to change the way physicians are taught. Gaba estimates that fewer than half of the medical schools in the United States routinely use the devices today. (meti, a Florida company that is one of this country’s principal manufacturers of high-tech medical simulators, says that it has sold more than sixty to schools in the past eight years.) “You wouldn’t get on an airplane unless the pilot had been trained in a flight simulator and certified to use the new instruments on a jet,” Gaba told me. “Why would you place yourself in the hands of a doctor who hadn’t proven his competency and been certified on a simulator?”
These dummy patients are quite realistic and it makes sense that doctors should be practicing techniques and learning how to treat a variety of ailments on them rather than experimenting on the rest of us. Unfortunately as the article points out, the fake patients are very expensive. Perhaps medical malpractice insurance companies can be persuaded to purchase some of these simulators for medical schools to help increase quality of care and prevent malpractice. [bm]