The future of medical training is already here

A patient is in trouble.
Residents move quickly. CPR is underway. Vital signs are changing. Every intervention matters because, every intervention matters when lives are at stake.
But this patient isn't real.
The scene is unfolding inside Carl R. Darnall Army Medical Center's Simulation Center, where residents and providers can practice treating patients in an environment designed to feel as real as possible.
“The more realistic we can make a simulation, the better the training,” said Capt. Demetria Miller, an emergency medicine senior resident.
That realism is at the heart of CRDAMC's expanded simulation capabilities. The center now has more than 17 simulators, including neonatal, pediatric, adult male, adult female, and birthing manikins, along with numerous procedural task trainers.
The Simulation Center also recently expanded its footprint within the main hospital, giving teams immediate access to the experts who train them. The center now includes two simulation pods within the Emergency Department and additional space in the Medical Surgical Pediatrics Unit.
For residents, the difference can be felt in the details.
“In the SimLab we are watching the vital signs change in real time. We are seeing the full cause and effect of what we are doing,” Miller said. “Interventions such as EKG's, IV placement, and ultrasounds are actually performed.”
The technology goes even further with one simulator that uses artificial intelligence to generate conversational responses. Once programmed with a detailed patient history, the simulator can respond to a learner's questions in real time, allowing the provider to focus on the patient instead of relying on an instructor to play the patient's role.
For Capt. Collin Bezely, an emergency medicine physician assistant resident, the ability to practice procedures repeatedly is one of the biggest advantages of simulation.
“Getting the prep, sets, and reps on invasive procedures on sims is a big help that we don't always get on live patients,” he said.
Bezely said the opportunity to practice, receive feedback, and try again helps build confidence before treating a real patient.
“After having a good session with the simulator, it does help inspire confidence that we are doing and reinforcing the right things so when the live patient comes, we are prepared to the best of our abilities to respond,” he said.
While the technology is impressive, Richard Silvia, administrator of the CRDAMC Medical Simulation Center, said the real value of simulation is what it allows providers to do: practice.
Simulation gives learners the opportunity to work through low-frequency, high-risk procedures, including cardiac defibrillation and pacing, central venous access, rapid sequence intubation, cricothyrotomy, and emergency deliveries, without putting a real patient at risk.
It also gives them permission to make mistakes.
“Simulation is where we get to make mistakes and learn without anybody getting hurt,” Miller said. “We make mistakes in SimLab so that we can give better care to our patients.”
For Bezely, being able to reset and try again is part of what makes the training valuable.
“It feels good to be able to practice, reset, then reattempt,” he said.
The goal also extends beyond the hospital. CRDAMC trains its residents not only to provide emergency medicine but also to operate in military environments where resources may be limited and multiple casualties may arrive at once.
“We can place them in stressful environments, building the mental and muscle memory needed to perform in those environments,” Silvia said.
For the patient who will eventually need that training, the purpose is simple.
“It mitigates the risk to patients, providing a safe outcome and overall higher quality of care,” Silvia said.
The technology may represent the future of medical training, but the reason for it remains very human: When the patient is real, CRDAMC's providers need to be ready.

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