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Veterans Health Administration

“Simulation Training” Prepares Medical Staff for Real Thing

Doctors performing a surgery in an operating room

 

VA Doctor

Dr. Haru Okuda

There is one word that connects what Dr. Haru Okuda does and what Captain Chesley “Sully” Sullenberger did to set his crippled Airbus down on the Hudson River in a flawlessly executed emergency landing in January, 2009.

Practice.

Like every commercial airline captain, Sullenberger spent the better part of two full days every six months at the controls of a flight simulator while midair disasters happened all around him.

Dr. Okuda’s job is to give every VA doctor and nurse a chance to “practice” before they treat a Veteran. He likes the comparison between Captain Sully and the goal of his new job.

He is the National Medical Director for the Veterans Health Administration Simulation Learning Education and Research Network program. It’s called SimLEARN.

Dr. Okuda notes that airline pilots would never fly a passenger jet for the first time without hundreds of hours of training in an aircraft simulator. But generally, within a medical community, the first time a physician draws blood or inserts a breathing tube, it is often on a sick patient.

It’s not generally known outside of the medical profession, but it is one of the most important ways the VA is improving the quality of health care for America’s Veterans. It’s called medical simulation training, and it provides learning conditions that imitate real-life situations without putting patients at risk, and lets VA medical staff develop sharper diagnostic, team training, and surgical skills.

“In the next five years, this will be the standard of care for most hospitals and academic centers.”

— Dr. Haru Okuda, SimLEARN National Medical Director

You’ve heard of nurses using an orange to practice giving shots. That’s simulation at its most basic. Compare the Wright Brothers’ biplane to a 747 and you have an idea of how far we have come from that orange.

Dr. Okuda has believed in simulation training for his entire medical career.

“It began with my frustrations with the traditional method of training to become a physician. The model of training was see one, do one, teach one. It just didn’t feel right, especially coming from my background.

“I have 20 years of training in music, playing the violin. And my knowledge of becoming a professional at something was really about practicing. You practice before you perform and that’s what I grew up learning.”

Dr. Okuda came to the United States with his family when he was four. His personal passion for caring for Veterans comes from a colonel his family knew who was always kind to his family.

“My hope is that our operation will be ten times better than the private sector.”

Prior to joining the Department of Veterans Affairs, Dr. Okuda served as the Director and Assistant Vice President of the Institute for Medical Simulation and Advanced Learning for the New York City Health and Hospitals Corporation, the largest municipal health care system in the United States.

With numerous publications in the areas of simulation, patient safety and education, Dr. Okuda recently published the textbook “Emergency Medicine Oral Boards Review Illustrated.”

To be based in Orlando

The new SimLEARN National Center will be located on the campus of the new Orlando VA Medical Center which is part of the exciting new "Medical City" campus at Lake Nona. The center is scheduled to open in 2013.

VA uses simulation training to make medical education authentic and focused, using a broad spectrum of technology and staged interaction to provide a controlled and safe learning environment for both students and practitioners.

That means work with high-tech mannequins which breathe and speak — complete with mock veins and intricate sensors and mock-ups of emergency rooms where teams of medical experts can hone their skills.

In the coming years, the staff hopes to expand that to include laparoscopic surgery simulators, intensive care simulators, mock-ups for emergency room crisis training, and a host of other medical education programs.

Training Unique to Women Veterans

As an example of the necessity of simulation learning, Dr. Okuda points out that, “Ten years ago, if a woman walked into a VA clinic requiring a pelvic or breast exam, the staff would probably have said, ‘Well, I haven’t done that in quite some time.’

“We’ve had a doubling of the number of women Veterans using the VA in the past ten years. It’s important that we help develop training for primary care and emergency care providers to refresh certain skills and diagnoses unique to women Veterans.

“In the future, we will be doing training for things like spinal cord injury and traumatic brain injury. We will be able to focus on rarely seen or high-risk processes in a very effective way.”

One effort already underway was developed by Dr. Laure Veet, Director of Women’s Health Education, and her team at VHA’s Women Veterans Health Strategic Health Care Group (WVHSHG). The Mini-Residency Program on Primary Health Care for Women Veterans is furthering VA’s goal of implementing comprehensive primary care for eligible women at all VA sites.

A recent Mini-Residency event for nearly 300 providers incorporated pelvic and breast exam instruction using several types of simulation, including simulation training equipment and gynecological training associates. More than 1,200 VHA providers have received training through this program.

Simulation training increases confidence and elevates competence by providing a safer and more supportive environment for learning skills and using critical decision-making skills. SimLEARN serves as a valuable resource to VHA health care providers and educators on the operational strategies, simulation technologies and training methods needed to address local training priorities. The SimLEARN program staff is developing curricula to address national clinical priorities, including women Veteran’s health and surgical team training.

Dr. Okuda believes that, “In the next five years, this will be the standard of care for most hospitals and academic centers. And it’s important to emphasize the team work of the entire approach. Nurses and other health professionals are crucial to the success of the training process.”

The center will use train-the-trainer approaches utilizing the most suitable types of simulation, including mannequin-based simulation, procedural skills trainers, virtual patients, standardized patients and virtual environments.

VA will put a new emphasis on medical simulators, in an effort to provide more comprehensive training for all physicians and better care for patients.

“Dr. Okuda is a recognized leader in clinical simulation,” said Dr. Robert A. Petzel, VA’s Under Secretary for Health. “He brings a drive and energy to SimLEARN that will help advance the program’s vision of unparalleled excellence.”

“I’d expect, in coming years, that every physician in the country will have had some contact with simulators before they treat patients,” Petzel said. “Our expectation is that we’ll use our national program to spread simulation techniques throughout our system, and then beyond.”