Providing physicians, nurses and technologists with state-of-the-art training in invasive and interventional cardiovascular techniques and promoting patient safety — these are the primary goals of the SimSuite™ Center at Geisinger. Opened in October 2002, the SimSuite Center marries the look and feel of a cardiac catheterization lab with computerized simulation equipment to provide hands-on medical training. Modeled after the aviation industry’s ground-based flight trainers, SimSuite is unique in its field, providing complete case management training.

       Through an orientation given via a computer terminal in the Suite’s pre-cath training area, a student receives a simulated case as if it were coming directly from a hospital emergency room. A doctor appears on the screen and shares vital case information with the student. Pertinent patient history, vital signs and important physical findings, medications received, ECG, chest x-ray and blood lab studies are reviewed on screen. Based on this information, the student decides on a clinical approach which may or may not involve an invasive procedure. Then he selects appropriate medication and instrumentation.

Bill Jakubowski – SimSuite Site Manager on left. Michael Wolfe – Student in School of Cardiovascular Technology

       When the student moves the case into the cath lab, the first thing encountered is a patient by the name of “Simantha” positioned on the cath lab table with a catheter placed in the right groin. Monitors one and two display “real time” images of coronary anatomy and “road maps” to be used for interventional procedures. A third monitor displays the patient’s ECG, blood pressure and arterial blood oxygen saturation data. As the student reacts to the data, he may position the X-ray equipment, advance the catheter to engage either coronary orifice, “inject” contrast material and take “cine runs” to document anatomy. Computer haptics (the sense of touch) provide the feel of actual catheter advancement.
       If an obstruction is found in the infarct-related vessel, the student can maneuver a support wire with a PTCA balloon across the lesion. When the balloon is in position, it can be inflated and an angioplasty is performed. If it is appropriate, a stent can also be placed at the lesion site. The procedure can be done and redone in a practice mode. The student is tested by a variety of complications during the procedure such as cardiac arrhythmias, drops in blood pressure and even perforation of a coronary artery. The response time of the operator and the cath lab team is measured along with the appropriateness of therapy for each such complication.
       Attention to reality makes this learning experience a very vivid one. Simantha complains of chest pain during inflation of an angioplasty balloon, and she notes the easing of pain as the balloon is deflated. In some cases, Simantha speaks Spanish!
       When the cath lab portion of the procedure is complete, the student moves to a post-cath area to address follow-up management. Finally, a preceptor reviews with the student each step of the pre-cath, cath and post-cath decision-making process, along with actions taken. The student can then receive a performance-based grade.
       This technology spans the gap between academic learning and learning in the cardiac cath lab with live patients. Students are quick to mention how it helps them avoid errors and manage complications that may result in patient discomfort, injury or even death.
       “This is as close to the real thing as you can get!” comments third-year cardiology fellow Dr. Kirk Gavlick. He adds, “The SimSuite Center allows me to concentrate on learning with a comfort level that is not possible when dealing with a live patient who may experience unexpected emergencies.“
       “Patient safety trumps learning,” Gavlick says, “I wish I had this as my first cath lab experience. It shortens learning time and should get first-year fellows up to a high level in the playing field before they start with a live patient in the real cath lab.”

Dr. Tom Haldis on left, Dr. Chris Palma on right. Both are second year Cardiology Fellows at Geisinger.

       For Michael Wolfe, a student at Geisinger’s School of Cardiovascular Technology, SimSuite eases the stress associated with the transition from classroom to cath lab. According to Wolfe, “SimSuite gives me a feeling for the physician’s role in the procedure and helps me better understand my cath team responsibilities.”
       Developed by Medical Simulations Corporation of Englewood, Colorado, SimSuite brings to life scenarios — anticipated and unanticipated — that occur in cardiovascular labs. These scenarios are authored by doctors in the field who draw on actual patient cases and situations. AHA and ACC guidelines were utilized in choosing appropriate steps for case management. Currently, the SimSuite Center library offers the following case variety. There are several cases in each category:

       • Acute Myocardial Infarction

       • Right Heart Catheterization: Jugular and Femoral approaches

       • Peripheral: Renal and Iliac.

       • Diagnostic Coronary (sometime in Q1 ’03 release)

       • Diagnostic Carotid (demo phase ready by March ‘03)

       • Broadskills

       Medical Simulations Corporation is committed to expanding the teaching library and its applications for diagnosis and treatment within cardiology and in other areas such as peripheral vascular disease.
       How does this new learning technology stack up against approaches that are more traditional? An AHRQ* grant-funded study is looking at the efficacy of simulation-based training followed by preceptor training in the cath lab compared to traditional patient-based preceptor training. Geisinger cardiology fellows, along with students in Geisinger’s School of Cardiovascular Technology, will be participating in the study.


*Agency for Healthcare Research and Quality – Dept. of Health and Human Services