Simulations do more than teach medical professionals how to perform specific procedures, according to Charles Pozner, M.D., executive director of the Neil & Elise Wallace STRATUS Center for Medical Simulation. Done properly, simulations bring together teams of professionals to work on essential, effective communication to give better care in crisis situations.
“It’s about seeing how people respond to adverse conditions,” Dr. Pozner said. And when something inevitably goes wrong in the simulation, “We try to figure out what it was that brought them to that decision. It’s never that’s there’s not enough people in the room. It’s how do people work together, communicate together to get the job done. At the end of the day, we all have to work together.”
Pozner was the last talk of the fall semester in the Bridge to Excellence lecture series, sponsored by the Imoigele P. Aisiku, M.D., ’92 STEM Center. The series brings physicians from Brigham & Women’s Hospital to campus to offer guidance to students interested in pursuing careers in medicine.
Pozner, associate professor of emergency medicine at Harvard Medical School, is passionate about medical simulation, saying “It’s what makes me tick.” But his route to medical school was not direct. He spent nine years as a firefighter/paramedic in New York City before entering Tufts Medical School, but that experience gave him a unique perspective on emergency medicine. It also showed him that he liked to take care of people.
“If anyone thinks life is straight forward in all cases, it isn’t. You have to take the twists and turns and to finally find out what your dream is,” he told students. “If I can give you any bit of advice, always keep dreaming.”
Back in 2000 when he was chair of the Beth Israel Hospital’s resuscitation committee, he recognized a problem with how medical teams were responding in crisis situations.
“When someone has a cardiac arrest, they call everyone, and people show up and it was usually utter chaos. I was trying to fix that and no one was listening. So ultimately, I had to do something bold,” he said.
Working with the rudimentary simulation equipment he had at the time, he used a conference room to create one of the first emergency simulations. “I hired the A.V. folks, put [the simulator] into the board room of the hospital, put it into cardiac arrest, and told them to roll the tape and call for help. Exactly as I predicted, it was a zoo. It took 16 minutes to zap the ‘patient,’ and I had it all on tape.”
He took the video tape to the president of the hospital and said, “We have to get people to understand there needs to be better care provided in these low frequency, high acuity situations. So, we started a simulation center,” he recalled. The STRATUS Center opened in 2002 and now boasts 23,000 user hours per year.
In addition to training students, simulation centers are important for all medical professionals to practice crisis situations in a “psychologically safe” way. “The last thing we want to do is make someone feel dumb. Before we do a simulation, we say to them, you are going to make a mistake; this is the best place to make mistakes. We’re only human. We need to accept our humanity,” he said.
Pozner talked about a research project, detailed in the first and only paper involving simulators ever published in the New England Journal of Medicine, that tested the worth of checklists in emergency rooms.
While check lists for routine procedures were common in operating rooms, checklists for emergency scenarios were not.
The project involved 20 O.R. teams going through six cases in the simulation center. Half the teams used a checklist and half did not. The results showed that the teams using the checklists did 75 percent better than those who did not.
“In medicine, we use our brains. We think that we can remember everything because we’re so smart,” said Pozner. “Even if you’re smart, there will be gaps in our knowledge.”
Two more talks in the Bridge to Excellence series are planned for the spring semester.