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THE CENTER, SIMULATION, AND ToL
The fundamental philosophy of the Center – fostering collaborative leadership in health care based on the implementation of the ToL methodology - allows expansion of simulation into a territory that still fails to attract the attention of the medical simulation community, i.e. comprehensive healthcare simulation and modelling based on federated systems, rather than stand-alone task simulators now widely used in medical education and training. The development of a new approach is greatly facilitated by the Center’s affiliation with the recognized pioneers of globally-distributed healthcare simulation and modelling, whose original work can now be expanded and strengthened by rooting it in the transboundary environment of ToL. For the first time, this combination allows simultaneous training of all professionals relevant to healthcare operations conducted in environments as simple as that of a rural hospital’s emergency room to one as complex as a healthcare catastrophe unleashed by a major natural disaster.
NEW REALITIES OF NATIONAL AND INTERNATIONAL HEALTH CARE
The past 50 years has witnessed the most explosive rate of growth of clinical knowledge in history. New discoveries in pharmacology, molecular biology, neuroscience, and reproductive biology to mention just a few disciplines, were accompanied by a similarly dynamic development in clinical practice, new diagnostic instrumentation, new surgical techniques, and treatment modalities. Improved understanding of the process of disease combined with a revitalized interest in preventive medicine resulted in new, often international, treatment guidelines, while the emergence of new threats imposed further changes on the manner in which administration and delivery of health care are executed. Increasing recognition of potential healthcare catastrophes such as pandemics or acts of bioterrorism emphasizes the rapidly growing need for executive personnel capable of equal proficiency in dealing with the complexities of the daily challenges of rapidly changing healthcare delivery and in responding to catastrophic events of unprecedented, potentially global magnitude.
SIMULATION: THE NEW FORM OF HEALTHCARE EXECUTIVE PREPARATION
Classical methods of education and training prove to be increasingly inadequate to provide sufficiently flexible platforms: the tenets of Boyd’s OODA Loop (Observe-Orient-Determine-Act) cannot be satisfactorily practiced or realistically implemented in the largely monolayered classroom setting. While education/training curricula need to be both reproducible and based on best practices, they must be also be sufficiently flexible to incorporate unpredictable events, and incorporate challenges, honing readiness rather than preparedness alone. In view of the transboundary nature of modern healthcare operations, such programs must also emphazize cooperation and collaboration of all participants, and their ability to develop rapidly a focusing unity of purpose in every operation. At the moment, simulation, particularly distributed simulation , offers the only environment in which all attributes required of a modern healthcare professional and/or executive can be developed, honed, and sustained. Simulation allows effective “just-in-time” preparation for events of a particularly challenging nature, e.g., participation in humanitarian operations or disaster relief. When conducted in a distributed and interactive setting, simulation allows simultaneous training of a large number of participants, while allowing real-time involvement of a wide range of intellectual and technical resources necessary for action in the transboundary environment of a simulated scenario.
SIMULATION IN HEALTH CARE
Contrary to the military, where distributed simulation has reached a very high level of sophistication, and where highly complex scenarios involving large number of often globally dispersed and professionally diverse personnel are routinely practiced, healthcare simulation lags significantly behind. It continues to focus on clinical skills training based on a variety of platforms ranging from ultra-sophisticated, multifunction, computer-driven, human patient simulators to relatively simple, single task training devices. Despite the vast potential for increasing and expanding operational complexity by fusing outputs of several human patient simulators with information/knowledge streams provided by supporting disciplines, the devices are persistently used as stand alone rather than federated devices. Consequently, while simulators have been finally accepted as devices of pre-eminent utility in medical education, training, and skills refreshment, their use in complex scenarios involving the entirety of healthcare delivery and adminstration in both routine and crisis/catastrophe situations is virtually nil.
DISTRIBUTED INTERACTIVE SIMULATION AND ToL
The Center bases its approaches to simulation on standards for Distributed Interactive Simulation (DIS) originally developed by the military establishments of the US and NATO, and on platforms currently used by the US and NATO military communities (e.g., VBS2). Such a philosophy allows interoperability of platforms used by the Center with those favoured by a number of civilian, home defense, and military entities in several countries. The concept of platform and environment federation constitutes the essential foundation of the Center’s approach to simulation since it allows true fusion of all relevant resources needed to simulate complex and challenging healthcare scenarios relevant for regional, national, and international level training. In that sense, the approach to simulation practiced by the Center differs dramatically from everything that is currently offered in health care: the Center does not use simulation solely to train performance of specific tasks, but in the execution of complex, system-wide functions performed often under significant mental and physical stress. The distributed nature of such simulations supports the rapid development of shared Skills, Knowledge, and Attitudes that are critical for the generation of High Performing Leader Teams. The transboundary nature of teams involved in each simulation promotes the generation of ToL environment in which collaborative activities of all actors are based on mutually shared actionable understanding and directed by the unity of purpose.
Even in its simplest form simulation can be challenging (link to a simple simulation game (http://www.stopdisastersgame.org/en/home.html ). The approach selected by the Center is vastly more complex. It is unique, and, as previous work of scientists affiliated within the center has already demonstrated, the collaborative skills developed in the simulation environment translate readily into skills utilized in real life settings.
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