Everything But the Risk

In a busy operating room, monitors beep and hum, pagers go off, the surgical team holds several conversations at once, the telephone rings, staff members walk in and out. In short, it's not an ideal environment for thoughtful concentration. But, that's exactly what's asked of surgeons in many operating room situations. How can new surgeons develop the poise required of them? According to David Farley, M.D., a Mayo Clinic surgeon and vice chair for education in Mayo's Department of Surgery in Rochester, Minn., the answer is practice, practice and more practice.

"We want our students to have training in the operating room, so they understand what's happening around them and are familiar with all the sights and sounds in there," says Dr. Farley. "Surgeons are asked to make crucial decisions in this environment, and it's not an easy one to work in. People have to learn to think on their feet."

From hands-on guidance, to active role-playing in the operating suite, every scenario within the Simulation Center is recorded. Together, students and physicians review these and use as learning opportunities.

Instead of just putting surgical residents in an operating room and allowing them to watch what's going on or participate in a limited way, through its Multidisciplinary Simulation Center, Mayo Clinic can immerse students in the operating room environment, allowing them to learn firsthand.

In the simulation center, students have a unique opportunity to practice and master their skills in a setting that mimics almost every aspect of real patient care, except for one crucial feature. In the simulation center, students can make mistakes and learn from them risk-free. Here, the only damage from errors is perhaps a bruised ego.

A powerful teacher

When you walk into the Mayo Clinic Multidisciplinary Simulation Center on the first floor of the Stabile Building at Mayo Clinic's campus in Rochester, the setting looks like most other clinical areas. It has a reception desk, signs that point you in the right direction, and several patient exam rooms. But, what happens there is far from ordinary.

From hands-on guidance, to active role-playing in the operating suite, every scenario within the Simulation Center is recorded. Together, students and physicians review these and use as learning opportunities.

In this exceptional learning environment, instructors can simulate almost any medical situation. In addition to the reception area and the patient exam rooms, the simulation center has four suites, each equipped as a different medical area: an operating room, emergency room, intensive care unit, and an endovascular lab.

Within these spaces, Mayo educators use several types of simulation training. Life-size, technologically advanced mannequins are programmed to show complex findings and react just as a patient would to treatment decisions. Students learn surgical or endoscopic procedures, such as cardiac catheterization or colonoscopy, using the center's task trainers. These trainers allow students to experience the look and feel of performing a procedure.

Honing interpersonal skills that are key to good patient care is also part of the simulation center. Actors play the roles of patients and family members so that students can enhance their communication proficiency in difficult situations, such as delivering bad news.

"The concept of simulation use in medicine is that experience is a powerful teacher," says William Dunn, M.D., a Mayo Clinic Pulmonary and Critical Care physician and the simulation center director. "Technology can now produce incredibly real, simulated environments that provide memorable learning experiences."

An ideal learning atmosphere

According to Dr. Farley, the simulation center is an ideal place to give Mayo Clinic's surgery residents a chance to problem-solve in uncommon but critical circumstances that require not only surgical skill, but communication and teamwork, as well.

"When residents are working in the hospital, there's no guarantee they will be involved in a variety of cases," he says. "The simulation center allows us to concoct educational experiences, so our students are ready to handle rare situations that they may not see otherwise."

For example, dealing with a lab report from a pathologist during surgery can be a challenge for new surgeons. At Mayo, every surgical resident gets a chance to face that scenario in the simulation center.

In one simulated situation, students surgically remove a pancreatic tumor and send the specimen to the lab for evaluation to determine if they extracted all the cancer. They wait in the operating room for a call from the pathologist. If the report indicates cancer at the edges of the tissue that was removed, the students must make a decision.

"At that point, an astute surgeon — assisted by an astute pathologist — would assess if he or she should keep going to ensure all the cancer is out," says Dr. Farley. "Usually, if there's cancer at the edge, you have to take out a little more. But, with that decision come other considerations. The more of the pancreas you take, the more likely a patient is to become diabetic. There are times where it's not black and white. We like to explore those gray zones in the simulation center and test the residents' ability to think on their feet in the midst of a stressful situation."

"The really impressive part is that after our students leave the center, the experiences stay with them."
David Farley, M.D.

A safe place for mistakes

After students finish in the simulation center, a debriefing session follows in which students and instructors analyze what happened. Audiovisual equipment in each room records the simulation, so participants can review exactly what they said and did. The debriefing is the most important part of the experience because students learn ways to improve, and instructors can raise students' awareness about what they may have overlooked or forgotten in the heat of the moment.

"In this setting, it's okay to make a mistake. In fact, sometimes it's great because it gives us a perfect opportunity to teach," says Dr. Farley. "The really impressive part is that after our students leave the center, the experiences stay with them. Adults learn better by being involved in a process like this. Although the simulation center is only one part of the students' education, it's a crucial one. The realistic situations in the center engage them in a way that makes a lasting impression and enhances their ability to use mature judgment — a critical skill they need as surgeons."

By using the Multidisciplinary Simulation Center to teach students ways to respond appropriately in difficult situations — before they actually have to face those situations involving real patients — Mayo Clinic is not only enhancing medical education, it's improving patient safety and patient care quality.

"Simulation is transforming the way we are educating health care providers," says Dr. Dunn. "We expect this to have serious impact on improving patient safety and outcomes, and we are committed to being a world leader in this area."