Fright Simulator

Health care professionals at the Israel Center for Medical Simulation work on high-risk scenarios. Here, one performs surgery, top, and another an intubation.

Health care professionals at the Israel Center for Medical Simulation work on high-risk scenarios. Here, one performs surgery, top, and another an intubation.

by Michele Chabin
Israel Correspondent

Tel Aviv — Israel is at war and you, a pediatrician by profession, have been called up for combat duty. Suddenly, two soldiers in your unit are severely wounded and could die at any moment.

The soldiers’ moans and cries are barely audible amid the sounds of gunshots and helicopter blades. It is difficult to see for all the smoke.

Your goal, to keep the soldier alive until he can be safely evacuated, seems almost unobtainable. You start him on an intravenous, open an airway and staunch the bleeding, only to have his blood pressure drop dangerously low. Then, the reinforcements sent to take the soldier to safety come under fire and the evacuation is delayed indefinitely.

Fortunately for you and the wounded soldier, this is only a simulation, just one of the many that take place every month at the Israel Center for Medical Simulation (MSR), a state-of-the-art facility at the Sheba Medical Center in Tel Aviv.

To date, more than 36,000 health care professionals, many of them from outside Israel, have received experiential simulation training at MSR, whose “command centers” create sophisticated high-risk scenarios that, when applied in real life, save many lives.

MSR utilizes several modalities to provide nurses, physicians, medical students, army medics, paramedics, pharmacists, social workers and others involved in the health field the opportunity to hone their skills without causing potential harm to a patient or client.

The training is tailor-made for the participants, whose simulations may include virtual reality, mannequins and role-playing with actors, or a combination of all three.

The goal, says Amitai Ziv, the physician who created MSR, is to reduce human error through experience and feedback by the instructors and fellow students.

Every year, Ziv says, thousands of deaths could be prevented if medical personnel were able to brush up on old skills and to safely practice new ones.

Ziv says several studies have shown that doctors who undergo MSR training “are adhering to guidelines more than those who do not. For example, those who undergo domestic violence training are more aware of and sensitive to the issue. They report more cases.”

Simply reinforcing a protocol requiring professionals to cross-check the names of patients before handing them medication or checking to see which leg needs surgery could save a lot of misery, Ziv says.

Unlike other medical simulators, MSR “is multidisciplinary,” Ziv says, explaining that all health professionals are welcome.

“Typically, in the U.S., only the cardiology department will have a simulator. Here, an anesthesiologist can be in one simulator and in the next room a mental health professional may be training how to offer spiritual guidance to a terminally-ill patient,” Ziv says.

Much of the inspiration for the center came from Ziv’s years as a fighter pilot, during which he simulated every maneuver — from starting the plane to ditching it in an emergency — countless times.

“I assumed that medical training would be similar, but in reality it was culture shock,” says Ziv, who also instructed pilots. “Ultimately, I wanted to apply some of the pilot training concepts to medicine.”
One measure of the center’s success is the high number of foreigners who choose to train here. The center has trained groups of Ethiopian health professionals in HIV management — in Amharic — utilizing the skills of Ethiopian Israelis. Senegalese surgeons have been taught how to perform circumcisions as a way to lower the risk of HIV infection.

On this summer day a group of surgeons from Serbia, Nigeria and a dozen other countries have come to MSR (courtesy of their governments, the EU and a health organization) to engage in some of the 60 medical scenarios being offered on machines stationed throughout the large room.

Still, the majority of visitors are local Israelis.

Just a few yards away from the foreign surgeons, several social workers employed by various municipalities sat in a booth on the other side of a one-way mirror. With earphones on their heads, they were glued to a scenario in which two of their fellow social workers tried to persuade a dysfunctional mother (a highly convincing actress) to seek the help she desperately needs.

Later, teams of social workers participated in lengthy debriefings that included not only oral feedback but also a videotape that they and others could examine for educational purposes.

“It was hard work but the experience was invaluable,” said one of the social workers. “I wish we could use the simulator more often.”

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