A new sim center and a virtual medical center change the face of medical education and health care delivery at the Dayton VA
When the Dayton Veterans Affairs Medical Center (VAMC) held the grand opening of its $3.3 million state-of-the-art simulation learning center in June, it was the culmination of a vision for patient safety that began more than seven years ago with a Boonshoft School of Medicine professor.
In 2008, Rosalyn Scott, M.D., MSHA, professor of surgery, attended a leadership retreat at the Dayton VA to help determine how some available dollars might best be used within the VA. Scott, who also directs the Veterans Health Administration (VHA) Veterans Integrated Service Networks (VISN) 10 Simulation Consortium and serves as medical advisor to the deputy chief learning officer of VHA’s Employee Education System (EES), proposed promoting patient safety and requested funding for a simulator and other related equipment.
Her proposal resulted in generous support from the VA regionally and locally. This support led to the purchase of simulation training equipment for multiple disciplines and the only mobile simulation center in the VA system. Ultimately, funding was provided for the remodeling of the first floor of Building 315 at the Dayton VA Medical Center into the most advanced simulation center of any kind in the region. The building had been used for medical education by Wright State during the medical school’s beginning years. But in 2004, it was transferred back to the VA. Today, the 17,000-square-foot facility uses simulation technology to enhance the skillsets of the entire health care team.
The center features life-sized computer-activated mannequins with heart rates, blood pressures, breath sounds, and other bodily functions, which are regulated in a control room by medical staff. The center features six simulation rooms, three task-training rooms, and five debriefing rooms. State-of-the-art audio/visual systems allow recording and playback of simulated events to enhance the learning experience. It also includes a nurse’s station, a medication and code cart room, and an auditorium with 125 seats. It is the largest simulation center in the region.
“The simulation center is a way for caregivers to learn how to handle real, life-threatening scenarios on simulated patients in order to minimize error and risks when caring for human patients,” said Scott, who is the first African-American woman to be trained in thoracic surgery and to be offered membership in the Society of University Surgeons. “It challenges learners and teaches them what to expect in a critical event.”
Scott is a member of the board of directors of the MedBiquitous Consortium, a Johns Hopkins Medicine-founded organization, developing XML and web services standards that serve as a technology blueprint for health care education and quality improvement. Scott sees simulation as a key component of health care education.
“This 21st century rebirth of Building 315 will be an unparalleled platform for health education,” said Dean Margaret Dunn, “Through that education, we will continue to improve the care of veterans, and undoubtedly many other patients as well.”
Medical student training
Medical students from the Boonshoft School of Medicine will benefit from the Dayton VA Simulation Center. Already, students in the Prematriculation Program, a four-week summer program for incoming medical students, and residents from the medical school have utilized the new facility. In addition, students from the medical school’s Horizons in Medicine Program, a unique program designed to give disadvantaged high school students a sense of the career possibilities in health care, have visited the simulation center.
Scott foresees other departments bringing medical students to the simulation center for training or working with the VA to help educate providers. The Department of Obstetrics and Gynecology has been working with Scott to develop programs that help the VA advance excellence in women’s health care.
“Traditionally, the VA has taken care of male patients,” Scott said. “However, there are an increasing number of women veterans.”
She explained that the VA is promoting women’s health and is using simulation training with virtual patients as well as mannequins and task trainers to help providers enhance their skills in women’s health.
VA Virtual Medical Center
In addition to the Dayton VA Simulation Center, the new VA Virtual Medical Center (VMC) was debuted at the June grand opening event. Developed by the EES, the VMC is designed to enhance clinical outcomes, promote collaborative health care, provide care in virtual clinics, and employ tele-health technologies.
The Veterans Health Administration is the largest integrated health system in the world, serving veterans in both urban and rural environments, said Scott, who has been instrumental in the development of the VMC, collaborating with faculty in the College of Engineering and Computer Science and the Boonshoft School of Medicine at Wright State University and across the nation.
The VMC has the potential to improve the condition of veteran health care by eliminating barriers to access, increasing veterans’ health literacy, and cultivating patient engagement. Scott said that this virtual technology promotes veteran participation from the convenience of veterans’ home computers. It also affords opportunities for increased patient-provider interactions.
“Our newest generation of veterans is very tech savvy and embraces virtual world technologies,” said Scott, who is leading the development of several virtual reality projects, including a serious medical game for training tele-ICU teams. “The VMC will allow geographically separated staff and patients to interact in a rich avatar-based environment.”
The VMC was launched as a collaborative care and learning environment available to veterans and their health care teams anytime and anywhere.
To better understand the challenges with activation of the VMC, five pilot projects are being developed focusing on key conditions diagnosed among veterans. Those clinical areas include diabetes, congestive heart failure management, obesity, palliative care and sleep medicine. Several of the members of the multidisciplinary team are part of Wright State University.
Diabetes project increases access
The diabetes project is being conducted at the Dayton VAMC to help increase access and participation in diabetes education, group classes, and shared medical appointments, especially for the rural, underserved, disabled, and elderly veterans. Veterans will be able to access diabetes materials from the convenience of their home computer. A serious medical game is in development to enhance the skills of health care providers.
Brian V. Burke, M.D., chief of the diabetes service and lead physician in the heart failure clinic at the Dayton VAMC and an assistant professor of internal medicine and endocrinology, is part of Scott’s collaborative team. Scott explained that veterans often feel overwhelmed by the sheer volume of information presented in diabetes education sessions. “This can result in lengthy questioning during clinic appointments or unnecessary trips to the emergency room,” she said.
The Palliative Care Project is one that is shared by VISN 10, the VA Healthcare System of Ohio, and the Miami VA Healthcare System. Scott said that 2.5 million veterans will need end-of-life care in the next five years. The project seeks to enhance basic palliative care competence of non-palliative care specialists, such as primary care team members, caring for veterans with serious medical illnesses.
“Primary care team members rarely have in-depth education in palliative care during their training. The VA is dedicated to caring for veterans throughout their lives, and palliative care is an important component of the care provided,” Scott said. “We want our primary care team members to be able to support veterans, their caregivers, and families to achieve the best quality of life during the end of their lives.”
Battlefield to classroom
Virtual environments help returning veterans adjust to student life
The Dayton VA has been working with Wright State University for many years to support the academic success of its returning veteran students with an array of strategies and programs.
“Many veteran students experience emotional and cognitive impairments that interfere with their ability to study, concentrate, and perform academically, while interpersonal problems affect social functioning,” Scott said. “These issues, when coupled with the challenges related to returning to general civilian life, place returning veteran students at a significantly higher risk of dropping out.”
In collaboration with the Wright State University College of Engineering and Computer Science, the School of Professional Psychology, and the Office of the Vice President for Enrollment, Scott and her interdisciplinary team are developing a virtual environment, replicating areas of the WSU campus to help students learn to cope with triggers in the civilian environment that can psychologically return them to combat and distract them from their educational goals.
The Battlefield to Classroom project helps returning veterans face a unique set of challenges and stresses, including symptoms associated with post-traumatic stress disorder (PTSD), post blast injuries, including traumatic brain injury, chronic pain, substance use problems, and partner relationship problems.
“For returning veterans, campus life can be full of potential triggers, including loud noises, arguments, unattended backpacks, rooms that have not been cleared, and classroom discussions or assignments, which many contain content directly related to current military conflicts,” Scott said. “We have recreated these experiences in a virtual environment and are working with the students to help them with coping skills.”
Scott’s collaborative team includes several people from Wright State. Jennie Gallimore, Ph.D., is the associate dean for research and graduate studies of the College of Engineering and Computer Science, professor of industrial and human factors engineering, and professor of surgery in the Boonshoft School of Medicine, on virtual reality projects. Jeff Cowgill, M.B.A., is the manager of multimedia and technology in the WSU College of Science and Mathematics. The team also includes two VA simulation fellows, Cathy D. Graham, M.S., Ph.D., and Terry L. Oroszi, M.S., a research instructor in the Department of Pharmacology & Toxicology at the Boonshoft School of Medicine.