AUSTIN, Texas — Is the use of simulation devices the best method for surgical training to reduce patient errors and raise the competency level of clinicians?

Or, as Gail Morrison, MD, put it: “Is simulation an answer to our prayers.”

Not quite, and not yet, were her responses.

Morrison, MD, vice dean of education and director of programs at Pennsylvania State University (Happy Valley), said the research on medical simulation for complex procedures hasn’t provided a clear answer yet but is a step in the right direction.

In her keynote address, Morrison greeted a packed room full of attendees at the 22nd annual meeting of the NorthAmerican Spine Society (NASS; Burr Ridge, Illinois) gathered yesterday in Austin, Texas, at the Austin Convention Center. It was standing-room-only in the conference room, bearing witness to the high level of interest regarding the future of medical technology and its role in patient safety.

“We are now pressured to make sure that patient safety comes first,” Morrison said. “Healthcare is a decade behind other high-risk industries in its attention to basic safety.” And she called on the surgeon attendees to act as “agents for change” in this area.

Morrison in particular addressed the use of devices such as test mannequins and simulated environments which are being developed with the goal of increasing physician competency in spinal procedures.

“This gives you a safe, controlled environment and allows someone to do a procedure with repetition with guidance,” she said.

The presenting need for improving procedural techniques is the plethora of mishaps that have occurred at an alarming rate within the last three years. And Morrison cited cases, most of them involving interns in training, who did more harm than good to patients. The harm ranged from the simple, but dangerous, inability to draw blood correctly, to examples of pierced bowels.

She cited the oft-referenced study by the Institute of Medicine which has estimated between 45,000 and 98,000 Americans dying each year as the result of medical errors. She noted that even if the lower figure is used as an estimate, deaths in hospitals resulting from medical errors are the eighth leading cause of mortality in the U.S. — a figure also more and more frequently being aggressively cited by malpractice attorneys.

She also discussed a study by Applied Nursing Research, in which nearly 119 nurses (30%) surveyed reported making at least one error, and 127 nurses (33%) reported at least one “near error,” and an overall total of 199 errors and 213 near errors, in the 28-day data period that the survey was taken.

Morrison described some of the available simulations available, billing them as “cradle-to-the-grave techniques.” Though this term is usually related to the patient, she was using it in reference to techniques usable by the surgeon from the very first steps in training to highly sophisticated techniques being learned by highly experienced practitioners.

But she also noted that, despite the data concerning patient injuries and fatalities and the availability of new simulation systems, the field is replete with key issues and significant barriers.

“There isn’t any conclusive data to suggest that simulations are improving safety outcomes in patients,” she said. “But we hope this is the beginning of a process that would handle those goals.”

Among the barriers for adopting simulations and using simulation training are cost and time, and Morrison emphasized the necessary commitment to pursuing these techniques with consistency and care.

“This isn’t something you can just review with a class on the weekends. This needs to be implemented every week and made a vital part of the program,” she said.

“A major problem comes from the sheer amount of the cost in maintaining these systems,” she added.

Such costs come on top of prices running up to $2 million for some of the mannequins or test dummies currently being used, and close to $1 million to provide the infrastructure and clinical setting for this type of training.

And so with no hard-hitting data demonstrating the improvement in patient outcomes with these devices, clinical centers have opted not to fully immerse themselves in this kind of technology and training.

Morrison noted, however, that more and more agencies and stakeholders in healthcare are beginning to utilize these models, driven in part by regulatory requirements.

She cited the example of the FDA requiring simulation training for any physician wanting to deploy a specific carotid stint.

And she referred to a new study being developed at the cost of $5 million to pursue advanced methods for using medical simulations.

So the effort to adopt these devices is gaining momentum. “It’s starting to catch on,” she said.

And “the ‘see one, do one, teach one’ method is out in a lot of places,” with increasing emphasis on simulation as an important form of adjunctive training.

The NASS annual meeting ends Friday.

The organization says that its members include a broad range of those in medicine “with an abiding interest in the spine.” authorities in spine care, representing a multidisciplinary community that includes: orthopedic surgeons, neurosurgeons, radiologists, physiatrists, rheumatologists, pain management specialists, anesthesiologists, osteopathic physicians, psychologists, chiropractors, physician assistants, nurse practitioners, nurses, physical therapists, researchers, administrators and all other healthcare professionals.