Medical Simulation Training

Simulation Training a Strong Focus of Innovative MASTRI Center

On any given day, the site is staged as an operating room, with a drape set over the stainless steel operating table, boom lighting and surgical tools at the ready. Another day, it morphs into a patient room with a hospital bed, end table, suction equipment and a nearby crash cart. But it’s not a movie set: The setting is the Maryland Advanced Simulation, Training, Research and Innovation (MASTRI) Center, the 3,600-square-foot surgical/medical simulation training center that primarily serves the University of Maryland Medical Center and the School of Medicine.

Opened in December 2006, the MASTRI Center is one of only 78 facilities of its type nationally or internationally that has earned accreditation by the American College of Surgeons. Beyond that, it’s the one place where a wide array of learners — including surgeons, residents, medical students, nurses, emergency medical technicians and other health professionals — can master new technologies and leadership skills in a safe, supportive clinical environment before they’re put to the test among real patients.

Originating from collaborative efforts by the UMMC Department of General and Oncologic Surgery and the U.S. Air Force, more than $1 million was initially spent to adapt the MASTRI Center from a wing of the medical center that was formerly used as operating rooms. In addition to four simulation rooms, the facility also includes a conference room and office space, hosting an average of 600 courses a year and training 3,200 people over the past three years alone.

“Our space has the ability to be configured in multiple ways and we want the environment to be as close as possible to a live experience,” says Sheree Carter Chase, R.N., MSN/MBA, interim operations director of the MASTRI Center. “It’s important because you want to suspend disbelief.” The MASTRI Center provides learners with exposure to clinical situations in a safe environment where mistakes can be corrected and patients aren’t compromised. “Sometimes it’s just testing out something they haven’t done before and want to increase their skills and level of comfort before they have to perform on an actual live patient,” she adds.

Impressive Array of Technology

The goals of the MASTRI Center are many: To lead the development of effective medical curricula; pursue the testing and validation of emerging simulation technologies; and improve patient safety by training the next generations of healthcare providers and facilitating efforts to ensure excellence in future medical practices. The Center’s location, housed within the medical center itself, also makes it stand out among similar facilities elsewhere and is a true asset, Chase says.

“A lot of places that have these wonderful spaces off-campus don’t get used,” she explains. “When people have to go three or four blocks to get to it or take a shuttle, it doesn’t get utilized the same way it does with us directly within the institution.”

“The MASTRI Center remains committed to training a wide variety of health care professionals, including minimally invasive surgeons, so it houses an impressive array of state-of-the-art technology." This ranges from high-fidelity mannequins dubbed “SimMan,” “SimBaby” and “Noelle the Birthing Mom” to virtual reality equipment to practice procedures as diverse as PALS to ATLS.

In designing the space, a deliberate choice was made to preserve the structure and atmosphere of operating and critical care delivery rooms, with new technologies taking their place among the built-in paraphernalia left in place.

“Noelle, our birthing mom, is a mannequin that gives birth to another mannequin who is sometimes in distress,” Chase says. “There’s a lot of preparation for these courses,” she adds. “For every hour of simulation, there’s typically more than twice that amount of time for prep that goes into the front end. But it’s vital because none of us works in a vacuum.”

Simulation-Based Learning

For medical professionals to optimize the use of technology in patient care, communication and leadership skills are key, Chase notes. That’s why a vital component of simulation training focuses on honing these abilities, which are especially important when patients’ lives hang in the balance.

“You really see in critical incidents, like a mock code blue, that these learners don’t necessarily consistently work together even though they are talented in their respective fields,” Chase explains. “The primary thing people often lose sight of is communication. If you ask for a crash cart or a drug, who are you asking? We’re training advocates for closed-loop communication. It’s a way to ensure all parties involved are aware of what’s happening so the ball doesn’t drop somewhere.”

We acknowledge our learners for things they do well in the MASTRI Center, as well as provide constructive criticism, which Chase describes as “a non-threatening, non-punitive environment.

“It’s a whole different ballgame making a mistake on a mannequin. Simulation-based training allows room for growth even with error,” she says. “Or it allows learners to move on to a new skill or anticipate something coming down the road — like a budding laparoscopic surgeon practicing sutures using his left hand, or using a defibrillator on a mannequin so if they shock someone in real life they’ll know how to do more than turn the machine on.

“This way, it’s repetition — it’s not brand-new in a real-life, stressful situation,” Chase adds.

Research, Expansion on Horizon

“As we expand and grow, we’re looking to collaborate with external institutions on a national level — to share our expertise and have others bring their own expertise,” Chase says. There have been several grant proposals submitted to provide support for research and training. For instance, there is a desire to continue research into the ergonomics of minimally invasive surgery.

“Laparoscopic surgeons are often in a static position for a long period and to move instruments at the angles they need requires awkward rotations of the wrist and hand,” Chase explains. “A lot of them are getting carpal tunnel syndrome, back pain or neck strain. We’d like to find a way so they would be able to do surgery for extended periods and not suffer from these injuries.”