The Future of ISL at SUMC
Stanford University Medical Center (SUMC) encompasses the School of Medicine along with the key teaching hospitals Stanford Hospital and Clinics and the Lucille Packard Childrens Hospital. While ISL has made great inroads into the conduct of education, training, and patient care at SUMC (and at the affiliated VA Palo Alto Health Care System) there is much more to be done.
The goal of CISL is to improve the quality and safety of patient care both in the present and for the future. Not only will ISL become an increasingly key component of the training of future clinicians, it will become indispensable as a tool for ensuring the competency and preparedness of experienced personnel and health care systems. We will continue to develop, test, and deploy ISL techniques for students, interns and residents, and experienced personnel both as individuals and teams. In the future, nearly all SUMC clinical staff will undergo repeated simulation training and practice for the entirety of their careers.
We hope to use ISL to keep SUMC at the top of the world in healthcare delivery, but we also hope to be a beacon for all other centers to emulate, to the benefit of their patients as well.
Among the future developments we plan are:
Better ISL Technologies
Simulators will in many ways become more “life-like”, providing better representations of patients. Some of this progress will come from enhanced mannequins and other “hardware”, but most of the progress is likely to come from new innovations in virtual reality. Virtual worlds will be created in which one – or many – participants can work together in a computer-generated game space. Creating the virtual patient in such worlds will be important, because there are significant limitations to making “fake patients” using mannequins. At the current time, rudimentary virtual patients can be seen on the computer screen (or in 3D) but there is limited provision for touch, smell, or physical manipulation or examination of the patient. Future virtual patients will allow completely natural interactions as with real patients or standardized patient actors. Another important future milestone will be the creation of completely interactive virtual co-workers. This will allow fully realistic team exercises without the need to assemble a complete team for the session. Such developments will challenge computer science and artificial intelligence. The ultimate expression of these developments will be something like the Star Trek Holodeck – the creation of virtual experiences that are indistinguishable from real life.
ISL-based Performance Assessment of Individual Clinicians and Teams
Today there are many limitations to our ability to assess the performance ability of clinicians. Every patient and every case they see is different. If we observe clinicians at work and see them performing in ways that are sub-optimal, we must intervene to protect the patient; yet, this prevents us from really determining if the mistake would have been caught by the clinician before causing any harm. ISL techniques allow the presentation of standardized situations to different clinicians allowing the validation of appropriate measures of performance. Already, good measures of the technical performance for some surgical procedures have been developed, allowing tests that can differentiate the expert surgeon from those still learning the skill. In the future, robust metrics will be developed for all sorts of clinical performance, including interacting with patients and families, decision-making and teamwork. These measures and tests will be used for “formative assessment” to help learners see what they need to practice further, and they will eventually be used for “summative assessment” of ability at key milestones and gates of training. An example of Simulation will in the future be used for “high stakes” testing for readiness for graduation from professional (e.g. medical or nursing) school, for on-the-job competency testing, and for specialty board certification and re-certification.
